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NP0018 Becoming a Smarter Therapist

This blog focuses on discussion regarding the course NP0018 Becoming a Smarter Therapist.
 
 

NP0018, Smarter Therapist, Session 3, Barry Duncan

 

What’s the most important key to improving as a therapist? How can we radically and consistently improve our effectiveness as clinicians? Get the answers to these questions and more in today’s session with Barry Duncan. He’ll go over ways in which we can improve as therapists, including what more than 1,000 studies have taught us about the science of the therapeutic alliance. You’ll learn what “healing involvement” is and how to achieve it with any client and how you’ll come away with a much better understanding of why outcome measurement is essential to improvement.

As always, we encourage you to take a few minutes after the session to comment—what was new, or most interesting to you about this session? What questions do you have or relevant experiences to share? And as always, if you ever have any technical questions, just email support@psychnetworker.org!


05.03.2012   Posted In: NP0018 Becoming a Smarter Therapist   By Psychotherapy Networker
8
Comments
 

  • 0 avatar Ruth Gordon 05.03.2012 12:58
    I have ALWAYS felt the cure was in the alliance -- what a pleasure to hear that point of view from one of the most respected therapists in out field. Thank You
    Reply
    • Not available avatar Barry Duncan 05.14.2012 04:53
      Hi Ruth,
      Sorry for the delay in response. Thanks very much for you kind comment. For too long, the field has given the alliance short shrift when it is far more important than model and technique--and far more difficult to achieve than many think. It is the main thing that separates the great therapist from the average one. I wish we all could say outloud that psychotherapy is a relational endeavor, not a medical one!
      Reply
  • Not available avatar art miron 05.05.2012 16:55
    If I'm correct, Lambert indicated that his use of outcome measures had significant impact on the treatment outcomes for the therapists working with the most acute clients, but had little impact for clinicians working with the 80% of clients falling within moderate acuity levels. This suggests that use of an outcome measure may not be as helpful for most clinician experiences. We tested an outcome measure at our large private practice and found that clinicians experienced benefit from its use less than 25% of the time. What are your thoughts about this. Thanks.
    Reply
    • Not available avatar Barry Duncan 05.14.2012 05:21
      Hi Art,
      Sorry for the delay in response. Thanks for your question. I am pretty familiar with Lambert's studies but I don't recall seeing anything that suggests that the feedback effect is limited to those of any particular acuity level but I could have missed that. I was just looking at Baldwin's (et al., 2009) analysis of OQ data and it doesn't reflect any differences in outcomes based on acuity if you are defining acuity as severity of distress at intake. Lambert's studies have typically found that the clients at risk are more likely to benefit from feedback while our studies have found a feedback effect across clients. In addition, our studies have found that 8-9 therapists out of 10 do benefit from adding feedback to their work. Lambert's use of the OQ is very different than our use of the ORS/SRS. We integrate the measures into the ongoing psychotherapy process and include a transparent discussion of the feedback with the client; We assess the alliance every session; and the Outcome Rating Scale, rather than a list of symptoms rated on a Likert Scale, is a clinical tool as well as an outcome instrument that requires collaboration with clients and clinical nuance in application.

      Regarding why your practice found outcome measurement only of benefit 25% of the time, I really can't comment given that I don't know what measure you used or how it was used.
      I am very confident in saying that using the ORS and SRS to include client feedback into the psychotherapy process does improve the outcomes of most therapists who give it a try.

      I hope you give a try. You can find lots of free stuff about using the measures at www.heartandsoulofchange.com.
      Reply
  • Not available avatar Graham Hocking 05.07.2012 19:12
    Thank you for continuing to promote your very sound advice. I am interested in following up a study you mentioned which was the re analysis of the NIMH depression study which showed with the top third of psychiatrists placebo was better than medication. Could you provide the reference for this study?
    Graham Hocking Australia
    Reply
    • Not available avatar Barry Duncan 05.14.2012 05:39
      Hi Graham,
      Thanks for yoru comment. The top third psychiatrists got better results with placebo than the bottom third psychiatrist got with antidepressants. The reference:
      Kim, D. M., Wampold, B. E., & Bolt, D. M. (2006). Therapist effects in psychotherapy: A random effects modeling of the NIMH TDCRP data. Psychotherapy Research, 16, 161-172
      Reply
  • Not available avatar Anne Fowler 06.04.2012 15:48
    Hi, I\'d appreciate any recommendations for books, accessible to lay people, on the therapeutic alliance. Thanks so much. Anne
    Reply
    • Not available avatar Barry Duncan 06.05.2012 22:49
      Hi Anne,
      My book, What's Rigtht With You, discusses the alliance and the importance of relaltionship to making changes. It covers many things but there is a chapter devoted to the power of relationship in the change process.
      Reply
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