Barry McInnes on Outcome Measures

We invited psychotherapist, coach and consultant, Barry McInnes, to write a series of guest blogs exploring the benefits of recording and analysing outcome measures as part of therapy. This is the first of those posts.

Over the coming weeks I’ll be addressing some of the issues and questions I see as key to assessing the quality and impact of therapy provision. These will range from the philosophical to the very practical, and include such areas as:

  • For whose benefit, exactly, is measurement?
  • What can measurement bring to my practice that I don’t already know from my clinical experience?
  • Can outcome measures be used in a way that doesn’t compromise my practice?
  • What outcome measures might I practically use, and can I use them in a collaborative way with clients?
  • How can I make sense of the numbers?
  • What else, besides outcome measures, will help to give me a sense of how clients experience the service that I provide?
  • How am I really doing?

Before we get started, however, it would be rude of me not to tell you a little about myself. In this case, context feels important. You should know that I’m not someone naturally drawn to numbers. But for an appointment to Head of Counselling for the Royal College of Nursing (RCN) in 1996, I’d most likely not yet have used an outcome measure in anger, nor any other reason.

The short version of the story is that a key part of my service’s remit was to promote the evidence base for staff counselling in the NHS. The reasoning was simple. With nine out of 10 of our clients presenting with work related issues, the RCN was plugging gaps in provision left by NHS employers.

We needed to persuade NHS employers of the value of providing their own services. All we needed was a robust evidence base. As I was to discover, at that time there wasn’t much of an evidence base of any kind, robust or otherwise. There began my journey.

That was nearly 20 years ago. In the intervening period evaluation, evidence, measuring, monitoring and research have touched every professional role I’ve occupied – as practitioner, service manager, advocate, writer, trainer, coach and consultant. I’ve learned much from all those roles, and probably forgotten more than I remember.

Perhaps the most important thing I’ve learned is the value of humility in our work, and not making claims for anything that we can’t evidence. I recall attending a seminar in the UK around 12 or so years ago offered by Professor Mike Lambert, one of our profession’s most eminent researchers of outcome. Mike recounted a study his team had carried out at the University of Utah, which – as I recall – asked the therapist team in the large university counselling service to say which quartile of effectiveness (effectively 25% slices) they thought they belonged to. Apparently 90% of the therapists placed themselves in the top 25% of effectiveness. So about 65% were going to be disappointed. But which 65%?

Whatever you may feel about measurement of quality and outcomes, I ask just one thing of you – an open mind. I’ve seen enough data, from research and from the data from hundreds of services and thousands of practitioners, to know that we are not all the same.

I’d be very interested to hear from you on the subject, and this is your chance to tell me: what do you want to know about quality and outcome evaluation in therapy?

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If you are a practising therapist in private practice and would like to contribute to the bacpac blog yourself, please don’t hesitate to get in touch using the contact form.