Why do I measure my effectiveness?
If I ask you for simple feedback about how therapy is going and how you feel, I will be more effective in helping you get the change you want. Research strongly supports this. Some therapists are now being trained in "evidence-based treatments" whose effectiveness is based on the performance of a few highly partisan, highly trained therapists in strictly controlled studies. There is so much variability in quality among therapists that the results of such studies tell us nothing about how effective a therapist is who happens to train in one of these methods. Direct evidence of an individual therapist's actual outcomes is much more valid and meaningful to potential clients. Also, by providing referrers (such as physicians) with data about my overall effectiveness, I can be accountable to them without compromising my clients’ privacy.
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Why don’t other therapists measure effectiveness?
Only 3% of independent psychotherapists collect any kind of effectiveness (“outcome”) data. Extremely few therapists in private practice (perhaps 1 in 10,000) systematically track the outcome of treatment with valid measures.
Why is this?
- New technology. Effective therapy doesn’t require any technology, but quickly identifying ineffective therapy does. A recently developed method of tracking effectiveness (which I use in my practice) is called the PCOMS, and it takes us only about 2 minutes to complete in the session. Clients usually find it very helpful to see their changes over time, and I can know much more quickly if there’s a problem in how the therapy is progressing for you. Despite a lot of clear research in this area, many therapists are unaware of it, and it is not yet taught in most training programs.
- Fear of being judged as ineffective. While most therapists are effective (significantly better than no treatment), there is a lot of variation between therapists in how effective they are. It is in a client or referrer’s interest to know this, but many therapists decline to find out where they fall on the “bell curve” of effectiveness.
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How does measuring effectiveness help you as a client?
Everyone is unique. Labeling you with diagnoses or scores on tests can’t fully capture how you feel or who you are. Yet, as long as a measurement of change is valid (actually measures what it claims to measure), and is used sensibly and with respect for your individuality, it can help us have a clearer sense of whether therapy is going in the right direction. In fact, some research shows that giving this kind of simple feedback to me (about how well the sessions are going, and how you are feeling in your life from session to session) can be enormously helpful in making therapy more effective.
The Outcome Rating Scale (“ORS”; Miller et al., 2003) is one of very few measures for clinical practice that is very brief, easy to use, validated with a “gold standard” (the OQ-45), and reflects your point-of-view about things. You, the client, are the most accurate judge of how things are going in your life and in therapy. The ORS is a “guardrail” to keep us on track and alert us to ineffective therapy and a lack of change.
It is a huge step in a new direction for psychotherapy to be accountable to clients and referrers (and without sacrificing our clients’ privacy or labeling them through unreliable and harmful diagnoses). More than a measure of “satisfaction” with therapy, the ORS is a measure of real change outside of therapy.
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Effectiveness Statistics for Jason A. Seidel, Psy.D. P.C.
My 5-Year Accountability Report is a technical blueprint for therapy effectiveness. It concisely displays several well-established indicators of therapist outcomes. It shows my results since I began tracking my clients’ well-being since June 2004. I have aimed to fulfill the following core principles for presenting effectiveness data:
Since I began measuring outcomes in my practice over five years ago, my clients have experienced significantly more change (about 2x more, based on Effect Size) than they would in typical psychotherapy or with medicationincluding the type of treatment they would receive in a well-controlled clinical study.
A brief bibliography on psychotherapy effectiveness and outcome research
Asay, T.P., Lambert, M.J., Gregersen, A.T., & Goates, M.K. (2002). Using patient-focused research in evaluating treatment outcome in private practice. Journal of Clinical Psychology, 58(10), 1213-1225.
Anker, M.G., Duncan, B.L., & Sparks, J.A. (2009). Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77(4), 693-704.
Barkham, M., Margison, F., Leach, C., Lucock, M., Mellor-Clark, J., Evans, C., Benson, L., Connell, J., & Audin, K. (2001). Service profiling and outcomes benchmarking using the CORE-OM: Toward practice-based evidence in the psychological therapies. Journal of Consulting and Clinical Psychology, 69(2), 184-196.
Brown, G.S., Lambert, M.J., Jones, E.R., & Minami, T. (2005). Identifying highly effective psychotherapists in a managed care environment. American Journal of Managed Care, 11(8), 513-520.
Duncan, B.L., Miller, S.D., & Sparks, J.A. (2004). The heroic client: A revolutionary way to improve effectiveness through client-directed, outcome-informed therapy. San Francisco: Jossey-Bass.
Gawande, A. (2004, December 6). The bell curve: What happens when patients find out how good their doctors really are? The New Yorker Online. Available through http://www.ihi.org
Hansen, N.B., Lambert, M.J., & Forman, E.M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice, 9(3), 329-343.
Harmon, S.C., Lambert, M.J., Smart, D.M., Hawkins, E., Nielsen, S.L., Slade, K., & Lutz, W. (2007). Enhancing outcome for potential treatment failures: Therapist-client feedback and clinical support tools. Psychotherapy Research, 17(4), 379-392.
Hawkins, E.J., Lambert, M.J., Vermeersch, D.A., Slade, K.L., & Tuttle, K.C. (2004). The therapeutic effects of providing patient progress information to therapists and patients. Psychotherapy Research, 14(3), 308-327.
Hubble, M.A, Duncan, B.L. & Miller, S.D. (1999). The heart and soul of change: What works in therapy. Washington, D.C.: American Psychological Association.
Lambert, M.J. (2004). Bergin and Garfield’s handbook of psychotherapy and behavior change, 5th Ed. New York: Wiley.
Miller, S.D., Duncan, B.L., Brown, J., Sparks, J.A., & Claud, D.A. (2003). The Outcome Rating Scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2(2), 91-100.
Miller, S.D., Duncan, B.L., & Hubble, M.A. (2004). Beyond integration: The triumph of outcome over process in clinical practice. Psychotherapy in Australia, 10(2), 2-19.
Wampold, B.E. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, N.J.: Lawrence Erlbaum.
Also, see The International Center for Clinical Excellence for more information and resources.
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