But Will It Help "Those" Clients?

But Will It Help "Those" Clients?

November/December 2007

Measuring the fit between therapist and client and the outcome of treatment seems all well and good with high-functioning, private-practice clients. But what about clients who receive public behavioral health care—what about folks diagnosed as severely mentally ill, addicted to drugs or alcohol, or living on the streets? Well, we had these same questions as we embarked on a journey to address a recommendation from an accreditation body that our agency start measuring outcomes.

The work of Scott Miller, Barry Duncan, and Jacqueline Sparks came to our attention through presentations, word of mouth, and their book, The Heroic Client. After years of hearing all the hoopla about evidence-based practice, we resonated with the idea of involving clients in determining the "fit" and "effect" of services, or what the authors termed "practice-based evidence." And, frankly, we had to do something to comply with the recommendation.

We remained skeptical, however. Actually, skeptical doesn't quite capture the feelings of some of the addiction counselors in our pilot project who were asked to use the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) at an urban, an inner-city clinic. Some of the seasoned and talented group were downright cynical—and had the right to be. After all, this might well have been just another misdirected edict from above, following a conga line of new procedures and paradigm shifts. The group raised concerns that the…

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