Some Thoughts on being an Outcome Informed Counsellor and Doing More of What Works

In our quest to apply our skills effectively and make a difference to the clients we want to help, it is necessary to ask ourselves “Is the therapy I am doing helpful to the client?” and “Is the client achieving a change in outcomes?”

We cannot assume that having a counselling qualification and becoming a practitioner will magically make us effective and competent practitioners. Somehow in our practice and engagement we need to find a fit between the kind of therapy we do and what the client needs.

The personal characteristics of the therapist and the relationship between the therapist and client are powerful influences for the client’s ability to change. Clients achieve better outcomes when we connect with their view of their world, and we are able to help them make sense of their issues. Clarification of where they are standing in life and where they want to move on to requires a sense of this is where I am, and this is where I am going. Then we can assist the process of helping them to know that they are alright and able to make the changes. Even though it is difficult, it is not impossible and there are ways forward.

Clients are empowered when they begin to take control and determine their own futures. To do this they require an understanding of what they need to do, and how they can go about achieving it. Paradoxically they need to be supported to be in their driver seat, and develop the competency to take charge, in order to take charge.

In order to work clients in this way, we need to develop a way of therapists becoming ‘outcome informed’. We need mechanisms to measure and inform us about the effectiveness of the therapy, and provide feedback at the time on what is working from the client’s perspectives.

The alliance factors in therapy are important to consider. The client’s perception of therapeutic relationship is responsible for most of the improvements and client gains.

The work of therapy is not the total responsibility of an expert therapist. Rather it is a partnership in which the therapist and client contribute to the process of developing the partnership and achieving the outcomes.

Research shows that a positive alliance between the therapist and client is one of the most critical predictors of outcome success. Where clients describe the alliance as positive, they have better outcomes.

Here are some tips and strategies to think about as you become attentive to doing the kind of therapy or developing relationships with clients.

You will notice that these strategies are useful to apply in all settings, where people endeavour to work effectively together and want to achieve outcomes together.

Validate the client’s point of view, and their need to be understood.

• Empathy, appreciation and a genuine interest help
• Define what the client wants from therapy
• Define your task in the therapy process from their perspective and ask how you can help them, what are they expecting or needing from you.
• Ask about the concern they have come with.
• Differentiate between the concern they have come with and the concern of those who sent them have. They are often different.
• Find out what their motivation for coming is, and validate their intentions.

Resist the temptation to be an expert on what is best for them.

• Ascertain what will make their situation better or improved?
• What resources do they already have and how have they coped so far?

Assume that the person already has resources and strengths

• Understand that everyone has survived so far in their lives.
• Find out the exceptions where they did cope better and how they did that.
• How often are they finding the problem occurs as against how often do they really cope okay.

Be prepared to do something different

• Seek ongoing feedback from the client about how effective the therapy is; what is working and what is missing in the sessions you do.
• If the therapy you are doing isn’t being helpful, seek the client’s advice on what would improve it.
• Stop doing the same ineffectual therapy session after session and expecting a better result.

Become client directed outcome informed

• Involve the client in all phases of the therapy
• Obtain their feedback in all stages of the therapy
• Offer the client choices about the actions they will make, and check out that they are competent and or supported to carry out those actions.
• Review the information on utilising the DCOI approach and measuring tools being developed by the Institute for the Study of Therapeutic Change

Know the facts about therapy

• Change early on in therapy is the best predictor of client change and outcome. If the client isn’t making changes by session 3, and for sure by session 6, then it is very unlikely that they will make changes with the current therapy. A change in therapy or therapist is indicated.
• The client’s view of the relationship is a good predictor of outcome. The client’s rating of the alliance in the second session is the best predictor of success going. If the client doesn’t like you or the therapy you are doing, they are more likely to drop out.
• About 60 – 70% or mental health care expenditure is spent on 10% of the clients. The majority of health care funding is spent on clients whose situations are not changing. Partnering with clients to make therapy accountable is needed to turn this situation around.
• Therapists who are doing ARE NOT DOING effective therapy and achieving positive client outcomes often believe that they are effective. Partnering with clients to get instant and ongoing client feedback about whether the therapy is helping them is needed to turn this around.

If you want to consider ways of doing therapy that works, and would like more information, please contact me or follow up the links below.
Email: colleen@waysforward.com.au.

Bill Andrew’s web site audio stream links
www.effectivetherapy.org/training.html

Scott Miller for Client Directed Outcome Informed
www.talkingcure.com

www.waysforward.com.au for my article on Becoming Client Directed Outcome Informed (CDOI)

Rob McNeilly of Centre of Effective Therapy
www.cet.net.au for courses and training in Australia