Develop Your Own Gift of Therapy
We are more likely to be persuaded by our own ideas, if we capture them.
FIT: Feed-Back to Feed-Forward
There is an important foundation you can develop in your clinical practice.
And this is the one of the four critical steps many practitioners skip.
That is, to become feedback-informed in your work.
What is FIT?
Feedback informed treatment (FIT) is a pantheoretical approach for evaluating and improving the quality and effectiveness of behavioral health services (e.g., Miller, Hubble, Seidel, Chow, Bargmann, 2014). It involves routinely and formally soliciting feedback from consumers regarding the therapeutic alliance and outcome of care and using the resulting information to inform and tailor service delivery.
FIT is not an evaluative tool.
It is a conversational instrument.
FIT is not just about looking evidence to support your approach.
It is a way to let your dataset change your mindset.
What is the main reason to measure outcomes and engagement in therapy?
To be adaptive.
I don’t think many therapists will disagree with the idea of being adaptive.
But first, let’s make a distinction between being Reactive, Predictive, and Adaptive:
1. Reactive:
Without the use of measures, we can still be doing good work. This could also maybe explain why untrained persons can do a good job helping someone some of the time, albeit unreliably. We are just reactive to whatever presents our way.
2. Predictive:
Our work can’t be entirely outsourced to predictive algorithms or manualised treatments (or AIs, though some might disagree. See a related essay, Can ChatGPT Replace Psychotherapy?). We live in an uncertain environment, or somethings referred to as a “wicked” environment, and thus, we are not able to 100% predict the best approach to a situation beforehand.
3. Adaptive:
Adaptability is the sweet spot between being reactive and predictive, where we calibrate and adjust according to the demands of a situation, but while holding an inherent ability to respond efficiently to a wide range of challenges, not just to those known or anticipated.
The key is this: Are we willing to let the dataset change your mindset?
Each time we receive a new set of information via a client’s indication on their wellbeing and their engagement levels of the session, we must marry this with what we know.
For instance, if a client’s outcomes score is higher than previous session, we must tap into that. This is where strengths-based approaches shine.
However, if a client’s outcome score is lower than the previous session, we must not be tone-deaf and not ask the question, “What has been better?” in this instance. Instead, questions like “What has been difficult?” makes more sense.
A Big Decision to Avoid Small Decisions
In 2004, one of the biggest decisions that I made when I moved from being a youth worker to a psychologist was to measure outcomes and alliance at every session.
I was inspired by the book Heroic Client.
Plus, I was plagued with a nagging worry that didn’t go away.
“What if I suck?”
That one big decision I made more than 2 decades ago made a big difference.
I not only tracked the impact of our sessions, one client at a time, I also started to see, on aggregate, how effective I am, and where were times I was not effective.
One mistake I made early on: I was too obsessed on the numbers.
I was asking the wrong question. “Am I effective?”
This performance mindset was fear-based.
Only after 5-6 years on, it dawned on me that I was coming from a place of fear.
I needed to shift from a performance mindset to a learning mindset.
A learning mindset asks different questions.
Not “Am I effective?” but “What areas am I effective in?” “What areas am I not effective in?” and “What can I learn about the way I conduct sessions?” “What is one area that I can improve on?”
To be clear, do not outsource decision making to measures alone.
It is the use of measures, combined with clinical intuition that enhances our clinical decision-making.
Simple Suggestion: Measure Outcomes and Alliance at every session.
Outcome ratings at the start, alliance ratings at the end.
What measures to use? There are many. Outcomes: OQ-45, CORE-OM, ORS, etc
Alliance: WAI, HAQ, SRS, etc.
The ones that I’ve been consistently using are the Outcome Rating Scale (ORS) and Session Rating Scale (SRS).
Why? Because they are brief and easy to use.
Here are some articles on FIT to get you going.
Related Articles
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