{"id":2267,"date":"2019-02-21T23:01:59","date_gmt":"2019-02-21T15:01:59","guid":{"rendered":"http:\/\/darylchow.com\/frontiers\/?p=2267"},"modified":"2019-02-24T22:05:58","modified_gmt":"2019-02-24T14:05:58","slug":"payoff","status":"publish","type":"post","link":"https:\/\/darylchow.com\/frontiers\/payoff\/","title":{"rendered":"Here&#8217;s the Payoff"},"content":{"rendered":"<p><span style=\"font-family: 'Book Antiqua', Palatino;\">It all begins with an investment of faith. Organisations, supervisees, and practitioners whom I consult with know that, for the most part, they wouldn&#8217;t see immediate results. It&#8217;s a calculated gamble.<\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">I recently began to see significant payoffs. By comparing these inspiring teams and individual outcomes from their previous years\/half-years, these handful of therapists whom I was coaching with are now reaping the rewards. Their dedication and focus in designing and implementing a\u00a0tailored plan for deliberate practice.<\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">By first using their baseline data to determine where they are at before &#8220;<span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"http:\/\/darylchow.com\/frontiers\/2017\/12\/30\/figure-out-where-you-are\/\" target=\"_blank\" rel=\"noopener\">where they need to go<\/a><\/span>,&#8221; and then spending the time to identify and work on the stuff that has leverage on moving the needle on their performance, they now see the fruits of their labor:<\/span><\/p>\n<ul>\n<li><span style=\"font-family: 'Book Antiqua', Palatino;\">An improvement in overall effectiveness, <\/span><\/li>\n<li><span style=\"font-family: 'Book Antiqua', Palatino;\">Reduction of dropout rates, <\/span><\/li>\n<li><span style=\"font-family: 'Book Antiqua', Palatino;\">An increase in the percentage of clients achieving reliable improvement and even <\/span><\/li>\n<li><span style=\"font-family: 'Book Antiqua', Palatino;\">A more efficient rate of change.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">It is indeed possible to improve our outcomes, one at a time.<\/span><\/p>\n<p style=\"text-align: center;\">~~~<\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">One therapist found out that her overall initial high alliance rating was actually something to work on (i.e., highly effective therapists tend to be able to elicit lower alliance scores at the initial engagement). Her sustained efforts on\u00a0<a href=\"http:\/\/darylchow.com\/frontiers\/2016\/12\/30\/how-do-you-get-better-at-eliciting-feedback\/\" target=\"_blank\" rel=\"noopener\"><span style=\"color: #3366ff;\">eliciting more critical feedback<\/span>\u00a0<\/a>from the get-go had led to an improvement of engagement and consequentially, outcomes. <\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">Another therapist, after picking herself up from a slump when she discovered that a large percentage of clients did not return for therapy after the first visit, she began working at <span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"http:\/\/darylchow.com\/frontiers\/2018\/06\/27\/undoing-the-intake-model-in-psychotherapy\/\">undoing the intake model<\/a><\/span> of clinical assessment and instead, began to zoom in on what her clients are <strong><em>receiving<\/em><\/strong> in the initial session. Much to her surprise, this had a domino effect of improving her effectiveness and efficiency of change in not just her retention rates, but also her overall outcomes!<\/span><!--more--><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">Another therapist, during the early phase of our consults, was so beaten down by the fact that his efforts to improve (money spent at workshops; reading all that he could on various treatment approaches while maintaining a practice&#8230; and balancing a family life with young kids), not only did not translate to better results, but actually led to a dip in his aggregated performance. \u00a0You can imagine how vexing this must be. <\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">We went back to the drawing board. We began to relook at the <strong><span style=\"color: #3366ff;\"><a style=\"color: #3366ff;\" href=\"http:\/\/darylchow.com\/frontiers\/2017\/02\/15\/mastery-learning-for-therapists-figure-out-the-what-before-the-how\/\">taxonomy of deliberate practice<\/a><\/span> (TDPA) worksheets<\/strong>, combined with his outcome data, and began to ask ourselves some hard questions. What does his data say? Anything glaring? Any patterns that we can detect from the data and his session recordings? What is ONE thing he can work on that is <em>influenceable<\/em> and <em>predictive<\/em> of better results? We identified one key area that he should keep his eyes on (in his case, it was about establishing a consensual and effective focus on what client&#8217;s wanted to work on). More importantly, given the opportunity cost, we had to make the decision for him to <strong>subtract<\/strong>\u00a0other aspects that he was working on that took alot of his time (not that these didn&#8217;t matter), but yielded little returns in improving client outcomes at this stage of his development. \u00a0<\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">Some months later, we began to see the payoff. Once he had enough cases to make a new comparison, he saw a change of tide in his stats. . But still, he wasn&#8217;t satisfied, because he wasn&#8217;t achieving <span style=\"color: #3366ff;\">&#8220;<a style=\"color: #3366ff;\" href=\"https:\/\/www.academia.edu\/9686106\/The_role_of_deliberate_practice_in_the_development_of_highly_effective_psychotherapists_Chow_Miller_Seidel_Kane_Thornton_Andrews_2015_\" target=\"_blank\" rel=\"noopener\">super shrink<\/a><\/span>&#8221; [1] results just yet.\u00a0<\/span><\/p>\n<blockquote>\n<p style=\"text-align: center;\"><span style=\"font-size: 18pt; font-family: 'Book Antiqua', Palatino;\"><strong>&#8220;There is nothing so useless as doing efficiently <\/strong><\/span><\/p>\n<p style=\"text-align: center;\"><span style=\"font-size: 18pt; font-family: 'Book Antiqua', Palatino;\"><strong>that which should not be done at all.&#8221;<\/strong><\/span><\/p>\n<p style=\"text-align: right;\"><span style=\"font-family: 'Times New Roman', Times;\"><strong>~ Peter Drucker<\/strong><\/span><\/p>\n<\/blockquote>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">Here&#8217;s what I suggested for this highly motivated therapist to think about, &#8220;Direction over speed.&#8221; He needed to take stock that he had made some course-correction, and now his intentions and efforts are aligned. Being in the right direction trumps being efficient. A small degree change in direction at the onset can literally mean either hitting the moon or missing it completely. I stressed that this was a ripe time for him to extrapolate <strong>principles<\/strong> he discovered through the process that led to good outcomes<\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\"><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter size-medium wp-image-2268\" src=\"http:\/\/darylchow.com\/frontiers\/wp-content\/uploads\/2019\/02\/direction-over-speed-Feb-20-2019-291x300.png\" alt=\"\" width=\"291\" height=\"300\" \/><\/span><br \/>\n<span style=\"font-family: 'Book Antiqua', Palatino;\">For me, this is hugely rewarding. This renews my faith in what we do. But, we need to start to see the practice of psychotherapy less or an <em>individual sport<\/em>, and more of a <em><strong>team sport<\/strong><\/em> (see this blog post on<a href=\"http:\/\/darylchow.com\/frontiers\/2016\/10\/22\/scenius-vs-genius\/\" target=\"_blank\" rel=\"noopener\">\u00a0<span style=\"color: #3366ff;\">scenius vs. genius<\/span><\/a>). \u00a0We can also begin to challenge our business-as-usual ways of<span style=\"color: #3366ff;\">\u00a0<a style=\"color: #3366ff;\" href=\"http:\/\/darylchow.com\/frontiers\/2015\/03\/05\/the-scandal-of-clinical-supervision-heres-the-shocker-part-1-of-2\/\" target=\"_blank\" rel=\"noopener\">clinical supervision<\/a><\/span>, which has not consistently demonstrated actual improvement in outcomes.[2] I&#8217;m guilty of this too. Working with someone in clinical supervision, and continuing to do so, despite the lack of improvement, or conflating therapist&#8217;s feeling of benefit from supervision with actual client improvement.<\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">All of this is not possible in the examples above, had we not begin to systematically obtain client feedback using measures on a routine basis, <strong>BEFORE<\/strong> investing our efforts in &#8220;deliberate practice.&#8221; (Again, take the time to figure out where you are before where you need to go. We are all prone to work on stuff that has little to no leverage on improving our outcomes.)<\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">&#8220;Any clinical tool or technology is only as good as the therapist who uses it.&#8221; [3].\u00a0<\/span><span style=\"font-family: 'Book Antiqua', Palatino;\">It&#8217;s not about the measures nor\u00a0the numbers. A top athlete wouldn&#8217;t say that it&#8217;s the stopwatch that helped her run faster [4]. Ultimately, in order to achieve better performance, measurement <em><strong>precedes<\/strong><\/em> professional development. <\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino;\">We need to invest in improving individual therapists, and less on improving therapies.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong><span style=\"font-family: 'Book Antiqua', Palatino;\">Notes:<\/span><\/strong><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino; font-size: 10pt;\">[1]\u00a0Chow, D., Miller, S. D., Seidel, J. A., Kane, R. T., Thornton, J., &amp; Andrews, W. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. <i>Psychotherapy, 52<\/i>(3), 337-345. <a href=\"doi:http:\/\/dx.doi.org\/10.1037\/pst0000015\">doi:http:\/\/dx.doi.org\/10.1037\/pst0000015<\/a><\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino; font-size: 10pt;\">[2] Rousmaniere, T. G., Swift, J. K., Babins-Wagner, R., Whipple, J. L., &amp; Berzins, S. (2016). Supervisor variance in psychotherapy outcome in routine practice. Psychotherapy Research, 26(2), 1-10. doi:10.1080\/10503307.2014.963730<\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino; font-size: 10pt;\">[3] see p. 449 of Miller, S. D., Hubble, M. A., Chow, D. L., &amp; Seidel, J. A. (2015). Beyond measures and monitoring: Realizing the potential of feedback-informed treatment. Psychotherapy, 52(4), 449-457. doi:http:\/\/dx.doi.org\/10.1037\/pst0000031<\/span><\/p>\n<p><span style=\"font-family: 'Book Antiqua', Palatino; font-size: 10pt;\">[4]\u00a0Birgit Villa, personal communication, 9th of August 2015.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>It all begins with an investment of faith. Organisations, supervisees, and practitioners whom I consult with know that, for the most part, they wouldn&#8217;t see immediate results. It&#8217;s a calculated gamble. I recently began&#46;&#46;&#46;<\/p>\n","protected":false},"author":1,"featured_media":2271,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[116,111,115,114,113],"tags":[121,120,16,18,63,25,32,45,48],"class_list":["post-2267","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clinical-supervision","category-deliberate-practice","category-fit","category-principles","category-learning","tag-better-outcomes","tag-better-results","tag-deliberate-practice","tag-development","tag-feedback-informed-treatment","tag-first-principles","tag-learning","tag-professional-development","tag-routine-outcome-monitoring"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Here&#039;s the Payoff - Frontiers of Psychotherapist Development<\/title>\n<meta name=\"description\" content=\"It all begins with an investment of faith. Organisations, agencies, supervisees, and practitioners whom I consult with know that, for the most part, they wouldn&#039;t see immediate results. It&#039;s a calculated gamble.I recently began to see significant payoffs. By comparing these inspiring teams and individual outcomes of those I was coaching from previous years\/half-years, these handful of therapists are now reaping the rewards of their dedication and focus in designing and implementing a\u00a0tailored plan for deliberate practice. By first using their baseline data to determine where they are at before &quot;where they need to go,&quot; and then spending the time to identify and work on the stuff that has leverage on moving the needle on their performance, they now see the fruits of their labor: An improvement in overall effectiveness, Reduction of dropout rates, An increase in the percentage of clients achieving reliable improvement and even A more efficient rate of change.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/darylchow.com\/frontiers\/payoff\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Here&#039;s the Payoff - Frontiers of Psychotherapist Development\" \/>\n<meta property=\"og:description\" content=\"It all begins with an investment of faith. Organisations, agencies, supervisees, and practitioners whom I consult with know that, for the most part, they wouldn&#039;t see immediate results. It&#039;s a calculated gamble.I recently began to see significant payoffs. By comparing these inspiring teams and individual outcomes of those I was coaching from previous years\/half-years, these handful of therapists are now reaping the rewards of their dedication and focus in designing and implementing a\u00a0tailored plan for deliberate practice. By first using their baseline data to determine where they are at before &quot;where they need to go,&quot; and then spending the time to identify and work on the stuff that has leverage on moving the needle on their performance, they now see the fruits of their labor: An improvement in overall effectiveness, Reduction of dropout rates, An increase in the percentage of clients achieving reliable improvement and even A more efficient rate of change.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/darylchow.com\/frontiers\/payoff\/\" \/>\n<meta property=\"og:site_name\" content=\"Frontiers of Psychotherapist Development\" \/>\n<meta property=\"article:published_time\" content=\"2019-02-21T15:01:59+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-02-24T14:05:58+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/darylchow.com\/frontiers\/wp-content\/uploads\/2019\/02\/Heres-the-Payoff.png\" \/>\n\t<meta property=\"og:image:width\" content=\"560\" \/>\n\t<meta property=\"og:image:height\" content=\"315\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"Daryl Chow, MA, PhD\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Daryl Chow, MA, PhD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/darylchow.com\/frontiers\/payoff\/\",\"url\":\"https:\/\/darylchow.com\/frontiers\/payoff\/\",\"name\":\"Here's the Payoff - Frontiers of Psychotherapist Development\",\"isPartOf\":{\"@id\":\"https:\/\/darylchow.com\/frontiers\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/darylchow.com\/frontiers\/payoff\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/darylchow.com\/frontiers\/payoff\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/darylchow.com\/frontiers\/wp-content\/uploads\/2019\/02\/Heres-the-Payoff.png\",\"datePublished\":\"2019-02-21T15:01:59+00:00\",\"dateModified\":\"2019-02-24T14:05:58+00:00\",\"author\":{\"@id\":\"https:\/\/darylchow.com\/frontiers\/#\/schema\/person\/29803547b9b29324d78e46bfcd1eb08a\"},\"description\":\"It all begins with an investment of faith. 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By first using their baseline data to determine where they are at before \"where they need to go,\" and then spending the time to identify and work on the stuff that has leverage on moving the needle on their performance, they now see the fruits of their labor: An improvement in overall effectiveness, Reduction of dropout rates, An increase in the percentage of clients achieving reliable improvement and even A more efficient rate of change.","og_url":"https:\/\/darylchow.com\/frontiers\/payoff\/","og_site_name":"Frontiers of Psychotherapist Development","article_published_time":"2019-02-21T15:01:59+00:00","article_modified_time":"2019-02-24T14:05:58+00:00","og_image":[{"width":560,"height":315,"url":"https:\/\/darylchow.com\/frontiers\/wp-content\/uploads\/2019\/02\/Heres-the-Payoff.png","type":"image\/png"}],"author":"Daryl Chow, MA, PhD","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Daryl Chow, MA, PhD","Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/darylchow.com\/frontiers\/payoff\/","url":"https:\/\/darylchow.com\/frontiers\/payoff\/","name":"Here's the Payoff - Frontiers of Psychotherapist Development","isPartOf":{"@id":"https:\/\/darylchow.com\/frontiers\/#website"},"primaryImageOfPage":{"@id":"https:\/\/darylchow.com\/frontiers\/payoff\/#primaryimage"},"image":{"@id":"https:\/\/darylchow.com\/frontiers\/payoff\/#primaryimage"},"thumbnailUrl":"https:\/\/darylchow.com\/frontiers\/wp-content\/uploads\/2019\/02\/Heres-the-Payoff.png","datePublished":"2019-02-21T15:01:59+00:00","dateModified":"2019-02-24T14:05:58+00:00","author":{"@id":"https:\/\/darylchow.com\/frontiers\/#\/schema\/person\/29803547b9b29324d78e46bfcd1eb08a"},"description":"It all begins with an investment of faith. 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By first using their baseline data to determine where they are at before \"where they need to go,\" and then spending the time to identify and work on the stuff that has leverage on moving the needle on their performance, they now see the fruits of their labor: An improvement in overall effectiveness, Reduction of dropout rates, An increase in the percentage of clients achieving reliable improvement and even A more efficient rate of change.","breadcrumb":{"@id":"https:\/\/darylchow.com\/frontiers\/payoff\/#breadcrumb"},"inLanguage":"en-AU","potentialAction":[{"@type":"ReadAction","target":["https:\/\/darylchow.com\/frontiers\/payoff\/"]}]},{"@type":"ImageObject","inLanguage":"en-AU","@id":"https:\/\/darylchow.com\/frontiers\/payoff\/#primaryimage","url":"https:\/\/darylchow.com\/frontiers\/wp-content\/uploads\/2019\/02\/Heres-the-Payoff.png","contentUrl":"https:\/\/darylchow.com\/frontiers\/wp-content\/uploads\/2019\/02\/Heres-the-Payoff.png","width":560,"height":315},{"@type":"BreadcrumbList","@id":"https:\/\/darylchow.com\/frontiers\/payoff\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/darylchow.com\/frontiers\/"},{"@type":"ListItem","position":2,"name":"Here&#8217;s the Payoff"}]},{"@type":"WebSite","@id":"https:\/\/darylchow.com\/frontiers\/#website","url":"https:\/\/darylchow.com\/frontiers\/","name":"Frontiers of Psychotherapist Development","description":"At the Bleeding Edge of Development, Reaping Benefit for Our Clients.","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/darylchow.com\/frontiers\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-AU"},{"@type":"Person","@id":"https:\/\/darylchow.com\/frontiers\/#\/schema\/person\/29803547b9b29324d78e46bfcd1eb08a","name":"Daryl Chow, MA, PhD","image":{"@type":"ImageObject","inLanguage":"en-AU","@id":"https:\/\/darylchow.com\/frontiers\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/d5708a17fa4fa97aad72d7dd31b9f64e02813a7c21334c650618fedb402df4f2?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/d5708a17fa4fa97aad72d7dd31b9f64e02813a7c21334c650618fedb402df4f2?s=96&d=mm&r=g","caption":"Daryl Chow, MA, PhD"},"sameAs":["http:\/\/darylchow.com"],"url":"https:\/\/darylchow.com\/frontiers\/author\/darylcho\/"}]}},"_links":{"self":[{"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/posts\/2267","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/comments?post=2267"}],"version-history":[{"count":9,"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/posts\/2267\/revisions"}],"predecessor-version":[{"id":2279,"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/posts\/2267\/revisions\/2279"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/media\/2271"}],"wp:attachment":[{"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/media?parent=2267"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/categories?post=2267"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/darylchow.com\/frontiers\/wp-json\/wp\/v2\/tags?post=2267"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}