Sometimes I write things and then forget what I’ve written. Today, as I’m putting together an article for the Journal of Mental Health Counseling, I came across (and then read) a small section from Chapter 1 of our Counseling and Psychotherapy Theories textbook. It’s a little dense (and referenced) for blog material, but otherwise I think it’s a pretty good guide for improving counseling and psychotherapy outcomes. So here it is:
There’s nothing like a good plan to help with goal attainment (see Chapter 9). Using the following plan can help you minimize negative outcomes and maximize positive ones.
1. As appropriate, integrate empirically supported treatments (ESTs) or evidence-based principles (EBPs) into your therapy practice: There are many ESTs, but to use them, you’ll need advanced training, supervision, and it’s impossible to become proficient in the vast array of ESTs available. Therefore, you should learn a few that serve you well as you work with specific populations (e.g., if you want to work with individuals suffering from trauma, learning both Trauma-Focused Cognitive Behavioral Therapy [TF-CBT] and/or Eye Movement Desensitization Reprocessing [EMDR] would be useful). However, there will always be situations where clients don’t perfectly fit a diagnostic category with a specific EST or you don’t think a manualized approach is best, or the client will not want to work using certain approaches. In those cases you should follow EBPs. For example, using Beutler’s systematic treatment selection model, you can systematically select both general and specific approaches that are a good fit for the client and consistent with empirical knowledge about how to address particular problems (Beutler, 2011; Beutler, Harwood, Bertoni, & Thomann, 2006; Beutler, Moleiro, & Talebi, 2002).
2. Understand and capitalize on evidence-based (or empirically supported) relationships and other common factors: As the common factors advocates have articulated so well, evidence exists for much more than psychological interventions or procedures (Norcross & Lambert, 2011). For better or worse, psychological procedures tend to be implemented within the crucible of interpersonal relationships. Consequently, the ethical therapist intentionally attends to the therapeutic relationship in ways consistent with the research base (e.g., by collaboratively setting goals and obtaining consistent feedback from clients about their perceptions of therapy process and content).
3. Avoid pitfalls and procedures associated with negative outcomes: To address potential negative outcomes, ethical therapists should: (a) engage in activities to facilitate awareness including, but not limited to individual supervision, peer supervision, and consistent client feedback; (b) individualize therapy approaches to fit clients—rather than expecting all clients to benefit from a single approach; and (c) avoid using high risk approaches by knowing (and avoiding) potentially harmful therapy (PHT) approaches (Lilienfeld, 2007).
4. Use flexible, but systematic assessment approaches to tailor the treatment to the client and the client’s problem: Much like good mechanics assess the engine before initiating change, ethical therapists conduct some form of assessment prior to using specific therapy interventions. As discussed in each chapter, the particular assessment process you use will likely be more simple or more complex, depending on your theoretical orientation. Nevertheless, empathic, culturally sensitive, and ongoing collaborative assessment helps guide therapeutic processes (Finn, 2009).
5. Use practice-based evidence to monitor your personal therapy outcomes: Practice-based evidence is a term used to describe when clinicians collect data, sometimes every session, pertaining to client symptoms and/or client satisfaction. Duncan, Miller, and Sparks (2004) refer to this process as client informed therapy. Regardless of the terminology, this is a process wherein clients are empowered to directly share their treatment progress (or lack thereof) with their therapists. This allows therapists to make modifications in their approach to facilitate more positive outcomes (Lambert, 2010a; Lambert, 2010b).
Working on positive family bowling outcomes