Running start… to a great career: Tracking your outcomes
By Rebecca A. Clay
How do you know if your clients are improving? And how do you know if you’re improving as a therapist? If you’re Seattle private practitioner Tony Rousmaniere, PsyD, you track your client outcomes.
Using an iPad in Rousmaniere’s office or their own device at home, Rousmaniere’s clients complete questionnaires about how they’re doing. The program then computes their scores and compares them to expected treatment trajectories, alerting Rousmaniere if clients aren’t progressing as expected or if they show signs of deterioration. “Many therapists ask, ‘Why don’t you just ask clients every session how they’re doing?’” says Rousmaniere, author of the 2016 book "Deliberate Practice for Psychotherapists: A Guide to Improving Clinical Effectiveness." “But sometimes clients feel more comfortable acknowledging things on a survey rather than face to face.”
Rousmaniere and others offer several tips for making the most of data collection:
- Measure what’s most important to you. Don’t try to measure everything, suggests Angela Cooper, DClinPsy, an assistant professor of psychiatry and family medicine at Dalhousie University in Halifax, Nova Scotia. Cooper suggests using two or three measures, including one that assesses the therapeutic alliance. To find a tracking system that works for you, see the review of nearly 50 systems in a 2016 paper by Aaron Lyon, PhD, an assistant professor in the University of Washington’s department of psychiatry and behavioral sciences, and colleagues in Administration and Policy in Mental Health and Mental Health Services Research.
- Keep an eye on clients’ progress. “It’s pointless collecting data … if it just sits in an Excel spreadsheet,” says Cooper, who creates graphs to chart clients’ progress. Talk to clients about any concerns the data reveal, whether it’s an uptick in anxiety or feeling misunderstood in a session. Above all, says Cooper, encourage clients to give honest feedback despite fears of giving offense or being unkind.
- Use data to hone your skills. It can be scary to get feedback, especially big-picture data showing overall success rates with clients, says Joshua K. Swift, PhD, an assistant professor of psychology who directs the Psychotherapy Process and Outcome Research Lab at Idaho State in Pocatello. “Look for patterns,” suggests Swift. “You might not be as skilled at working with a certain client demographic or certain diagnosis or client problem.” That information can alert you to the need for consultation, continuing education or supervision.
- Remember that tracking is just one source of information. “Research shows that when psychologists just go with their gut instinct, they’re often wrong,” says Swift, noting that clinicians can miss things as serious as risk of suicide. That said, don’t blindly trust the objective outcome data the computer is producing, say Swift and others. Tracking tools can have blind spots, Rousmaniere points out. “But their blind spots are different than mine,” he says.
- Use data to market your practice. Rousmaniere posts his outcome data on his practice website. “Clients can see what they’re getting,” he says.
For more information, read Rousmaniere’s article “What Your Therapist Doesn’t Know” in the April 2017 issue of The Atlantic.