Collaborating with and becoming accountable
to our clients
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Client and extratherapeutic factors. Includes
clients resources, external support and ideas
about change
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The Therapy Alliance
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Wampold 2001- The great psychotherapy debate.
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In a study involving over 2000 therapists and
clients Brown found that therapeutic encounters
in which no improvement occurred by the third
visit did not on average result in improvement
over the entire course of treatment.
Clients who worsened by the third visit were
twice as likely to drop out as those reporting
progress
Variables such as diagnosis, severity and type of
treatment not as important as knowing if the
client believed they were making progress
Heart and Soul of Change p389-406
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Agreement on Goals
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Agreement on Tasks
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Relational Bond
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Congruent beliefs on how people change
(Client’s theory of change)
Bordin E S . (1979)The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory,
Research and Practice, 16, 252-260
Gaston L (1990). The concept of the alliance and its role in psychotherapy: Theoretical and empirical
considerations. Psychotherapy
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Counsellors need to monitor constantly the
clients experience of :
Change and improvement in the areas of their
life that brought them to therapy.
The strength of their alliance with the
therapist.
Ankar, Duncan and Sparks- The effect of feedback on outcome in marital therapy. Journal of
Consulting and Clinical Psychology 2009
Shimokawa K, Lambert M & Smart D (2010) – Enhancing treatment outcomes of patients at risk of
treatment failure: meta-analytic and mega-analytic review of Psychotherapy quality assurance systemJournal of consulting and clinical psychology 78 298-311
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We need to have measures which are:
 Reliable
 Valid
 Feasible
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Important that we are clear with the client
why we are asking them to do this
If counselling is going to help it should start
to help early
The client’s assessment of the therapy
alliance is shown to be the more directly
related to outcome than the therapist’s
assessment
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Discuss each line and the overall score with
the client
What is making them go up or down. What
needs to happen to make them start to
improve or continue to improve
Leave time at the end of the session to score
and discuss the SRS especially if it is on the
low side.
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If no progress shown on the ORS after 3 or 4
sessions it is time to discuss with the client
what this means
Go over each line in the SRS
Brainstorm with the client what would be of
more assistance. Different approach, different
counsellor or continue as we are for now.
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After 6 to 8 sessions and no improvement
time to look seriously at alternatives
Important to be able to fail successfully and
make a successful referral based on the
client’s feedback
Clients who fail to make progress with one
counsellor can frequently work successfully
with another one.
By not letting go we could be standing in the
client’s way to recovery.
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A score above the cutoff generally tells you
nothing
If the client scores below 36 or below 9 on
any line we need to acknowledge this and
invite a discussion
If the client scores above the cuttoff but
clearly lower than in previous sessions we
need to explore this with them
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Establish a culture of feedback
Take every opportunity to let clients know
that you need and value their feedback.
Let your clients help you become a better
therapist
Relationships Australia Mandurah
Tel 95836000
Email bill.robinson@wa.relationships.com.au
To download the measures go to
www.scottdmiller.com
For further support and ongoing discussion go
to www.centerforclinicalexcellence.com
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www.Fit-Outcomes.com
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www.MyOutcomes.com