The Effects of Client Feedback

Research consistently shows that asking clients how they think therapy is going, especially during their first five sessions, significantly improves outcomes. Moreover, feedback seems to work best with clients identified by the evaluation process as being at risk of dropping out or of not benefiting from therapy. So why don't more therapists place client feedback on a par with their own clinical judgments?

That question is even more clinically relevant in light of a new study by psychologists Morton Anker and Barry Duncan and marriage and family therapist Jacqueline Sparks reported in the August Journal of Consulting and Clinical Psychology, which extends the effect of feedback research to couples therapy. Couples who told their therapists in every session how they evaluated their therapy were significantly more likely to show improved marital satisfaction than couples who didn't offer feedback. Six months after therapy ended, just over 81 percent of the 126 couples who gave feedback were still together, as opposed to about 66 percent of the 119 couples who didn't.

Soliciting feedback from clients is surprisingly uncomplicated. The study used a simple, four-question form, on which clients marked a spot on a continuum indicating how heard and respected they felt in the session, how much the session addressed their goals, how good a fit the therapist seemed, and how the session seemed overall. (The form, the Session Rating Scale, and its companion, the Outcome Rating Scale, which also uses just four questions to assess how clients are doing on their goals outside of session, are available for free at www.heart
andsoulofchange.com.)

Duncan suspects that it's the collaborative, conscious process that therapists and clients go through in discussing the feedback that improves outcomes, and not necessarily the forms themselves. Soliciting feedback in each session on the therapeutic alliance and clients' goals focuses everyone on these two highly reliable predictors of successful therapy.

So if soliciting feedback is so easily integrated into each therapy session and takes under five minutes, why don't more therapists do it? Duncan and Sparks find that while many therapists believe they already do this informally, few of them actually do it. In addition, they speculate, the dismissal of client input has been "hardwired" into therapists' thinking and practice. Many clinicians may prefer to believe that if therapy works, it's because of their skill and insight, and if it doesn't, it's due to clients' lack of motivation or other deficits. But as the research on the power of feedback continues to accumulate, along with the growing self-recovery and informed-consumer movements among clients, deliberate, regular, formalized feedback is likelier to become a standard feature of treatment.

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PsychotherapyBrownBag  - Earning Respect   |Registered |2009-11-10 11:24:20 Very interesting stuff! I was directly to this site today and am very glad to have found a new resource for discussions of empirical research. I recently wrote on Psychotherapy Brown Bag about TFT and Monica Pignotti's excellent work to dispel misleading claims of efficacy. When I see situations like this, I understand why somebody passionate about a particular idea would be frustrated by a lack of acceptance by the psychological community. After all, this is their livelihood and they no doubt have come to believe that the approach offers substantial benefits. That being said, it is entirely unclear to me how somebody can look at the research on TFT and somehow conclude that it is empirically supported for any diagnosis. The very nature of science is captured by the direct competition between opposing hypotheses, the objective evaluation of subsequent data, and the development of newer, more precise follow-up hypothese...

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