Frontiers of Psychotherapist Development

At the Bleeding Edge of Development, Reaping Benefit for Our Clients.

Tag: feedback

How Do You Get Better At Eliciting Feedback?

 

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…But what questions should we ask?

In the previous post, we addressed the issue of how to receive feedback.

In this post, we take a step back and address how we can elicit feedback.

But before we dive right in, ask yourself:

Do you really want to know? I used to find myself hesitant to ask for feedback when I know someone was amiss in the session. I’ve learned from my colleagues that this is common. What I learned is to point it out anyway, “You know Tim, I noticed that I might have missed something essential to you today. Am I mistaken? Can you help me figure out what that is, or what we could have explored further on?”

How we convey a sense of openness to the other person’s point of view will determine the type of feedback we get.

When we ask, ”Is everything ok today?” will skew towards a vocal-tic response, “Yeah. All good.”

Where we point the lens, it becomes the foreground. Discuss in advance what you are looking out for. While it may sound counterintuitive at first, take some time to process the following:

High session ratings of engagement by your client is not predictive of good outcomes (e.g., Owen, Miller, Seidel, Chow, 2016). In contrast, highly effective therapists seem to be able to elicit low engagement scores in early sessions. High alliance scores in the first session tells us nothing. The client could be truly happy with the session, or she might not feel safe to tell you how badly you missed her point today.

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Do you know the average alliance formation trajectory among your clients? Which of the above fits your pattern?

We’ve also found in our initial Supershrinks study (Chow, 2014; Chow et al 2015. Stay tuned. We are on to some replication studies. More on that next time) that as compared to the average cohort, highly effective therapists are more likely to report being surprised by client feedback. That is, the top performers are more likely to report being surprised by client’s feedback that their counterparts. It does seem to suggest that the highly effective therapists are more willing to be corrected. They have a sense of openness to receive and consider client’s viewpoints, even if it may be contradictory to the therapist existing expectations.

Janet Metcalfe and colleagues suggest that individuals are more likely to correct errors made with initial high confidence than those made with low-confidence, so long as the corrective feedback is given (Barbie & Metcalfe, 2012; Butterfield & Metcalfe, 2001; Butterfield & Metcalfe, 2006; Metcalfe & Finn, 2011). Although it may seem intuitive that deeply held beliefs are more entrenched and are the hardest to change, experimental studies have indicated that individuals are more likely to overwrite their responses and correct their beliefs (Butterfield & Metcalfe, 2001; Butterfield & Metcalfe, 2006), and are more likely to retain the correct answer compared to knowing the correct answer at the outset (Barbie & Metcalfe, 2012).

What? That’s a mouthful. Put it this way. Stand tall, and stand corrected.

Here’s some key points to remember when trying to elicit feedback from your clients at the end of a session:

1. Prime the Recall:

Give a good rationale WHY your client’s feedback about the session is crucial to you;

2. State What This is Not:

For example, “This is not an evaluation tool…You know how we are asked to do feedback surveys at restaurants? This is exactly what it’s not! Simply because those types of feedback, do not effect a change that will impact you. Your meal isn’t going to change because of your feedback. Here in the session, your feedback is important to me as it can help me tailor to fit you specifically…”

3. Juxtapose Open and Close Ended Questions:

Conventional wisdom argue to use open ended question. “What was the session for you?” Most of the time, this is too vague for clients. Instead, ask the specifics. “As you recall out what we talked about, and the exercise we did before we wrapped up, What was helpful to you?” After they share with you a response, follow it up with, “What was not helpful to you?” “…I know it’s tough to give feedback… we don’t normally tell others what we think, but your point of view is very important to me. I won’t take it personally, but I will take it very seriously…. cos’ sometimes, I just can’t see what I can’t see.”

4. Be Specific:

If you want specific feedback, be specific with your questions. “You know Kelvin, I got a feeling that I’ve pushed you too far today, especially when we were attending the issue about your fears. Am i mistaken?”

“What should I do more of?”

And

“What should I do less of?”

5.  The Small of Things:

Say this, “You know as it’s hard to give someone feedback, I just want you to know that even if you think it’s a small or minor issue, please, I would love to hear about it.”

Cite examples: “You know, I once had a client who told me that I was too careful with her, and she wanted me to just be blatant with her. Do you feel that way too?”

As a form of closure, you can ask, “If there’s just one thing, what stands out for you today that you’d like to remember from our session?” Write that down, and begin to form ideas to bridge this into the next session.

Don’t forget to take a gamble on your own to make a prediction of how your client rates the session, before you see their ratings on the alliance measure. (see an older post that I talked about this practice, called Rate & Predict exercise)

All systems balances itself with a feedback loop. It’s up to us to elicit the specifics, and then follow through be an open and warm receiver. It’s abit like receiving presents during this Christmas. Be thankful.

At the time of this writing, I wish each of you a happy new year.

Best,

Daryl Chow, PhD

30th of Dec 2016

 

How Do You Get Better at Receiving Feedback?

 

waitress-funny-service-with-a-smile

“How was your meal sir?”

“Fine, thanks.” I lied.

Five minutes into the meal, the waitress comes back to me. She’s wondering why I haven’t touched my pasta one bit since she last enquired.

“Erm, your meal going ok?”

“Yes, it’s fine.” I feel for the leading question. I smiled, and returned to my conversation with my two friends.

The truth is, the pasta was so salty that I couldn’t continue without numbing my mouth. But I couldn’t be bothered. I was planning to wash it down with a cup of coffee later, and continue my conversation.

This time, she’s bold. She stepped into the fire and asked me again, “Sir, is everything ok?”

I thought to myself, man, she’s persistent. I gotta hand it to her. Maybe I should just tell her.

“Actually, since you asked me for the third time. I have to say,  Frankly, I don’t think I’m a fussy eater, but the pasta is so salty I can’t eat anymore of it.”

In a million years, I couldn’t have guessed her reply. She came up with a one-liner. In fact, it was just two letters.

“Oh,” she said.

Bypassing the awkward silence, she stepped one foot back, and inched away. We couldn’t believe what just happened. I’m a hopeful guy. I waited to see if she might return with  a replacement, indulge me in a tiramisu  cake to sweeten my tooth from the numbing sensation in my mouth, or maybe even waive the cost of that half eaten dish.

None of that happened.

If you ask for feedback, you got to learn to receive it. Period.

Another time, at a phone centre in Singapore, this customer service personnel blatantly said to me, “Bro, everything’s good (with the service) right?”

“Erm,” I said.

“Hey, don’t mind, please give me a good feedback rating here (pointing to the form) please.”

For once I manned up, and said no. It just doesn’t make sense. He was asking for my help, not my feedback. He wasn’t very please with me thereafter.

~~~

Feedback is tough. In the process of writing their book Difficult Conversations: How to Discuss What Matters Most, authors Doug Stone and Bruce Patton realised that most people found it the most difficult giving and receiving critical feedback.

We expect our clients to give us just their honest feedback about the session, and we expect ourselves to enter into potential landmines with open arms. What we really need to learn is the fundamentals of being a good feedback elicitor and receiver, with all the good, the bad and the ugly that comes with it.

Look at your personal library.  Do you own a book that teaches you to be a good receiver of feedback?  I recommend you check out Stone and Patton’s 2014 book “Thanks for the Feedback: The Science and Art of Receiving Feedback Well” It’s not a psychotherapy book. In fact, I think therapists should do their best to read outside of the jargon-laden therapy world to widen your lens and speak a common language.

I once heard a therapist say to a client who was mad at her for making her feeling interrogated with a barrage of questions, “Thank you so much for your feedback. It must take so much courage to say what you said.” On the surface, it sounds ok to say that. It’s polite. It’s what we are taught to say.

Lets face it. Is it easy to take negative feedback from you client? No. Is is pleasant? Hell no. Then I think we should be honest and simple say that. “You know, I must admit, this is hard to take in. I’m trying to digest what you are saying… because this is important… What you are saying is that I’ve interrogated you, bombing you with questions after questions. It’s hard for me to admit… but you are right. Instead of helping you,  I’ve made you feel like a criminal, when you have don’t nothing wrong…. I’m sorry. I’ve let you down today. Again, it’s tough to hear this, but thanks for telling me.”

Supervisors can also highly benefit from digging deep into learning about how to elicit and receive feedback. It’s easy to take for granted the collegial bond, and expect supervisees to vocalise their concerns when the need arises. I argue, that because of the relationship, it can be even harder in a supervisory context than in a therapy.

The authors of Thanks for the Feedback points out three key triggers that can set us off when we receive critical feedback:

  1. Truth Triggers: When something we deny or disagree with. It makes us feel indignant;
  2. Relationship Triggers: Think about how your dad can say something that makes you explode, but when your trusted coach say the exact same thing you take it as good advice. Who matters more than the What, and
  3. Identity Triggers: This gets personal. It shakes the core of you. “We feel overwhelmed, threatened, ashamed, or off balance” by the feedback. (Has that happened to you before? I’m no stranger to this. It hurts.)

Stone and Patton offers some suggestions of dealing with such triggers. For truth triggers, they suggest learning to separate appreciation, coaching, and learning to see your blindspots. For Relationship triggers, they suggest separating the We from What. Finally, for identity trigger, they suggest learning to challenge our pre-existing assumptions and cultivating a growth (vs. fixed) mindset (ala Carol Dweck’s philosophy). (See their book for further elaboration)

That’s all well and good. I think what matters most is not just having these content knowledge, but we need to learn how to explicitly receive and respond to critical feedback.

To whet your appetite, check out Doug Stone’s interview about the book on The Art of Manliness podcast (Ladies, I assure you that you’d find is not an exclusive gender bias podcast). Around the last 10mins of the interview with Brett Mckay, listen to an example Doug gives about men’s lack of attention to women.)

Doug rightly points out,

“One of the most difficult conversations people have is to give and receive negative feedback “

Maybe someone should have taught the waitress on how to follow-through after asking for feedback. She missed a huge opportunity. I don’t blame her. She had the courage but not the skills yet.

Ask, and be ready to receive.

Stay tuned for the next post on the why the difference between performance feedback and learning feedback matters to your development.

Best,

Daryl Chow, Ph.D.

Guess who’s the king of feedback?

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