But the reality is, in clinical practice, you know how hard it is to elicit useful feedback.
Asking a client what can be improved, often draws a blank. (Or your client might say, “You’re the expert. You tell me.”)
Photo by Oscar SĂ¶derlund
Further, without the use of some formal alliance measure, it is doubly difficult. When we ask for feedback without a clear ritual and routine based on a measure, our questions will often unintentionally skew towards a confirmation bias; asking for the feedback goes nowhere.
Here’s another subtlety that dawned on me recently:
Instead of trying to elicit positive or negative feedback, try to get comparative feedback. By comparative I mean, contrast your client’s experience of the current session with the previous. The contrast helps to make the conversation richer, more nuanced and individualised.
Higher Alliance Ratings
If a client scorers higher in the alliance measure in the current session, ask what makes the difference in this session compared to the last. Take verbatim notes of what your client says. Listen carefully to the choice of words and metaphors. (Note: While your client scores the alliance measure, make sure you have the previous scores available at hand to contrast. If you are using the Session Rating Scale (SRS), pay close attention to subtle shifts in the scores.)
Lower Alliance Ratings
If a client scores lower in the alliance measure in this current session, offer some speculations. Taking the first move to openly hypothesise helps them to be less guarded with what’s unspoken. “Now that I think about it, maybe we were too unfocused today,” or “You know, I’m not sure what it is, but the approach I took today didn’t quite fit, isn’t it?” The idea here is not for your be accurate with the assessment of the situation. The intention is to spark a dialogue. Seek to be corrected, not confirmed.
Use feedback to feed-forward.
Feed what your client tells you when you are making comparative feedback into future sessions. This is where the individual’s feedback becomes highly valuable.