Using measures

By John Mcleod

A theme that often comes up in conversations with pluralistic is the challenge of using feedback tools (CORE, ORS, etc) in therapy sessions. I would like to suggest three points here, for further consideration and possible discussion.

First, it is helpful to look at what is happening for you during the administration of a feedback tool, and the subsequent conversation with the client, perhaps through a brief segment of a session that could be audio recorded. I view a feedback tool as a prop within the overall performance of therapy, that I needed to learn how to accommodate. This is a good area for deliberate practice.

Second, across the field of therapy as a whole, there is a massive amount of research and clinical innovation going on around how best to use feedback measures. If you think that CORE is too clunky, then you are not alone. If you think that CORE is really useful, you are not alone either. We are probably at least 5 years away from really understanding how to make the most effective use of this kind of prop/tool.

Third – the research evidence is pretty convincing. Clients hold back on sharing their disagreements with their therapist, or their disappointment. Clients lie about how good their therapy is. Clients general appreciate the structure and formality of completing a questionnaire. Clients respond better to therapists who are open to feedback, and poorly when they think that completing the form is just an empty bureaucratic exercise. Feedback informed therapy is, on the whole, associated with better outcomes. This point is worth emphasising: a brief activity, carried out by therapists who may lack training in its use or feel ambivalent about it, actually has a bigger impact than any other planned intervention that has ever been studied. The implication of this third point, I believe, is that it touches directly on the claim of being research-informed. How can any therapist who is research-informed not use feedback tools?  

Finally, it is useful to keep talking to colleagues about what works for them. For instance, I know that some pluralistic therapists have had really positive experiences of using the Session Bridging Form, developed by Mavis Tsai (in my view, one of the most interesting contemporary writers on therapy) and her colleagues in the Functional Analytic Therapy network.