This post is one in a series of guest blogs from bacpac user, psychotherapist, coach and consultant, Barry McInnes, exploring the benefits of recording and analysing outcome measures as part of therapy. Click here to read the first part, second part and third part in the series.

Reason number 2 to for considering taking outcome measures with clients as part of your therapy session…

Measures might well save your (therapy) relationship

The therapeutic relationship which we prize and which figures so highly in successful outcomes is fragile and can be easily damaged.

In a revealing blog post, Tony Rousmaniere recounts how he systematically went about gathering feedback from clients about their experience of therapy with him:

“You understand me thirty percent of the time.”
“I need to you to slow down.”
“I was sad and you cut me off.”

“These words of dissatisfaction are from my clients. They weren’t easy to hear, but they have changed how I practice psychotherapy and have significantly reduced my dropout rate.”

I’m sure we’d all like to think this couldn’t possibly apply to us. On a different blog however, Scott Miller highlights studies which show that in 19-42% of sessions clients report tensions or actual breakdowns in the therapeutic relationship, figures which rise to 41-100% of sessions when trained observers are used to identify ruptures between clients and therapists.

Without measures, can we ever really know how our clients experience us in sessions? Of your last five clients that dropped out, is there anything that you could have anticipated? Anything that, had you had been aware, might have resulted in a different outcome?

Is it possible that using a short measure of how your client experiences sessions with you, like the Session Rating Scale (SRS) or the ARM-5, might help you to better understand and perhaps avoid the unexpected empty chair?

I’d welcome your thoughts and your feedback. Drop me a line by emailing barrymcinnes@virginmedia.com. You can also read more about what works in therapy from a research perspective on my website.

If you are a practising therapist in private practice and would like to contribute to the bacpac blog yourself, please get in touch using the contact form.

This is the third in a series of guest posts from bacpac user, psychotherapist, coach and consultant, Barry McInnes, exploring the benefits of recording and analysing measures as part of therapy. Click here to read the first part and second part in the series.

In my last blog, I introduced 5 compelling reasons to use outcome measures in therapy. Over the next few blogs, I’ll be unpacking each one.

Without further ado, reason number 1…

You may learn something about your client’s experience that you really, really need to know

Most of us see our clients for no more than one hour a week. Our clients experience the remaining 167 hours without us. However comprehensive our assessment of their needs may be, there will be always areas of their experience that are unknown to us, particularly in the early stages of therapy.

Global measures of distress such as the CORE-OM and GHQ-28 enable us to access areas of our clients’ experience that we may not otherwise discover. Some of these aspects may affect their capacity to engage with therapy, especially in the critical early stages.

Take, for example, the client who is chronically sleep deprived, or whose levels of despair and hopelessness may cause them to abandon therapy prematurely. For this client, these symptoms may be such a ‘normal’ part of their existence that they fail to mention them during therapy. As such, these factors escape our attention, but still have the capacity to affect the course of our work with the client.

Collecting outcome measures routinely during treatment could help to bring to the surface something that makes the difference between early termination and a successful outcome.

I’d welcome your thoughts and your feedback – drop me a line by emailing barrymcinnes@virginmedia.com. You can also read more about what works in therapy from a research perspective on my website.

If you are a practising therapist in private practice and would like to contribute to the bacpac blog yourself, please get in touch.

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 second of those posts. Click here to read the first blog in this series. 

Before we start talking about the questions of which outcome measures to use and how to incorporate measures into your practice, there are some attitudinal and ideological questions to discuss. Until these are addressed, the “how to…” is going to be largely irrelevant.

I wonder, of the three descriptions that follow, which best describes your current attitude to the merits of using measures in your practice?

1. I’m fully on board

2. I’ve no strong feelings either way

3. I believe measures have no place in the therapy process

If you fall into the first category then the chances are that what follows will be familiar to you. If you fall into the second, perhaps something here may convince you of the benefits of using measures. If you’re in the last category, and have got this far, please at least read the next paragraph before you abandon this blog!

As therapists, we pride ourselves on being open-minded, curious and willing to do what we know works for clients, right? This is true, except, it seems, when it comes to using measures. An Australian study of mental health service clinicians’ attitudes to using measures found that 67% would refuse the use of self-report measures even if they acknowledged that it would lead to better patient outcomes.

I’m probably very much like you in terms of changing my practice. Show me a compelling reason for doing something differently and, all other things being equal, I’ll at least consider it. Otherwise, forget it. In that spirit, below follow some arguments that I find compelling why we should consider using measures if we aren’t already doing so…

1. You may learn something about your client’s experience that you really, really need to know
2. Measures might well save your (therapy) relationship
3. A measure may be the only way you discover the true risk your client is at
4. Clients will likely sense if you’re going ‘through the motions’ so learn to use measures well
5. Therapist self-appraisal is not a reliable measure of effectiveness

Please note that these aren’t simply my opinion – for most there’s a decent body of evidence to back them up. I’ll be delving into each of these arguments in detail in upcoming blogs over the coming weeks.

Meanwhile, I’d welcome your thoughts and your feedback – drop me a line by emailing barrymcinnes@virginmedia.com. You can also read more about what works in therapy from a research perspective on my website.

If you are a practising therapist in private practice and would like to contribute to the bacpac blog yourself, please get in touch.

When I first started in private practice, I used protected word files and folders and locked filing cabinets to store my client notes, but was never completely comfortable with my ability to keep them secure.

I worked for IAPT for 5 years using Mayden’s iaptus patient management system,  and when I trialled bacpac it felt very familiar and easy to use. Most obviously I use bacpac to store my client details and notes, but there are loads more added extras.

To my surprise the calendar and auto-email reminder have been extremely valuable. I first had to get past the usual counsellor doubts about chasing clients or allowing clients to take responsibility for their therapy and appointments. I say surprise because I have never had a client refuse the service. My clients tell me they value the reminders particularly if they have busy or chaotic lives.  A word of caution though: when it comes to booking an appointment, bacpac shows a default time of 9am, so the therapist needs to input the actual appointment time. I’ll leave you to imagine the rest… My excuse is it helps the clients to see me as human and fallible. [Thanks Martyn! We’ve taken this feedback onboard and will be looking to improve the usability around this function.—Dawn, Product Manager]

The calendar also records the fee with the date, and cash flow is summarised in a graph on the home page. There is a facility to set a turnover target and it’s such a good feeling to see the graph tip through the target – it means I can eat!

Further accounting facilities are promised. This seems a logical extension to the service and I look forward to that upgrade.

It is important to me that in the event of my sudden death or serious incapacitation, my wife has minimal hassle from my practice. There is comfort in the knowledge that she only needs to make one call to my supervisor. My supervisor will then lo

g on, access my clients names and addresses and arrange ongoing work if they should so choose it. This is all easily set up within the bacpac system.  I have a contract for this with my clients and with my supervisors. I never want to have to use this service (sorry Mayden!) but it’s important that my obligations to my clients continue in the event of my death or incapacitation.

The fee is reasonable as long as you are getting a reasonable flow of clients. I’m not seeing bacpac being taken up by supervisees starting out in private practice, and wonder whether there could be a reduced fee for a limited service, say up to 4 clients?

Martyn Blair is a counsellor practising and supervising in private practice in Coventry. Martyn has been using bacpac for almost a year. Find out more on his website: www.martynblair.co.uk

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?

You can contact me at barrymcinnes@virginmedia.com. You can also visit www.barrymcinnes.co.uk

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.

When I first started in private practice, I used protected word files and folders and locked filing cabinets to store my client notes, but was never completely comfortable with my ability to keep them secure. Continue reading →