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.

4 thoughts on “Using measures”

  1. This reminds me of some discussions I’ve had in different places I’ve worked in. I’ve always found using some sort of measure helpful, and they’ve varied dependent on what the organisation uses. I’ve discussed handing someone anything and saying it just needs completed ‘just to tick a box for reporting’ etc. isn’t going to motivate anyone to do something, but importantly the value of what the measure can bring to the therapy is lost due to the therapist communication. Some have found it difficult to do certain ones, but mostly, people can find it helpful to see in front of them in a tangible way any changes rather than just hearing this feedback from others (the therapist).

    1. Lisa – thanks for your comment, which sums up the issue really well. I’d be interested in the experiences of other people in the network, around the use of feedback tools. John

  2. I love the SRS (Scott Miller). I use it with many clients. I’ve tried others (& sometimes offer others in a choice approach) but I keep coming back to this one if the client declines a choice but Is happy to try out a form.

    A few clients are too self conscious to fully utilise, or ‘just don’t like forms’ … but a discussion around their preferences, I think, empowers them to take an active role so really no-ones yet had any sticky problems!

    Thank you for mentioning the bridging form. I hadn’t seen it & can think of one client just now who I will offer it to next time they attend.

    Core-om 34 I find is a better discussion tool than outcome measure for most of the clients I see!

  3. Whilst I accept that forms can be useful for some clients some of the time my own experience has been of clients from the NHS etc relieved not to have that kind of monitoring as part of our sessions.

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