IACP Inaugural Conference:

Strengthening Therapeutic Relationships

Dr. Marcella Finnerty, IICP

Friday October 16th, 2015

The Yearning for Connection

Carl Rogers

Plant, Nurture, Grow – and Harvest?

Yearning for Connection: What we do well

“How do Integrative Psychotherapists Integrate”

A qualitative study of 14 experienced Irish integrative psychotherapists : All considered the therapeutic alliance

as pivotal to the success of therapy

Interpretative Phenomenological Analysis (IPA): Participants’ Voice: Reflective and therapist-friendly

Therapist Awareness: How do we know?

How do we know if what we are doing is working?

And……

What do we do if it is not?

Session Rating Scale Exercise

Think of your last session with you as the client or supervisee and complete the form as client or supervisee

Marking the line nearest best fit

Use 10cm paper ruler – score from 0-10

Session Rating Scale

In pairs – discuss the process of completing the form

Can you see how (or if) this might be helpful to the therapeutic alliance?

A Pluralistic Perspective

Mick Cooper and John McLeod consider this pluralistic approach “starts from an assumption that different things are likely to help different people at different points of time” (2011, p.6)

The Blind-Folded Darts Player

A Reminder:

Clinicians must remember that …the improvement of psychotherapy may best be accomplished by

learning to improve one's ability to relate to clients

(Lambert & Barley 2001)

Some final thoughts to ponder upon…

How can we utilise our practice to inform research, improve client outcomes and ensure we do not

become less relevant as healthcare professionals?

One client: One alliance measure: One Conversation

NEXT WEEK

Role of IACP:

1. Create and resource a research culture

2. Establish and support practice research networks

3. Facilitate access to research journal articles

Fully Alive – Dawna Markova

Conclusion

Thank you

Contact details:

Marcella Finnerty (086-2609989)

email: marcella@iicp.ie

www.iicp.ie

Fully Alive

I will not die an unlived life.

I will not live in fear of falling or catching fire.

I choose to inhabit my days, to allow my living to open me,

to make me less afraid, more accessible,

to loosen my heart until it becomes a wing, a torch, a promise.

I choose to risk my significance; to live so that which came to me as seed

goes to the next as blossom and that which came to me as blossom,

goes on as fruit.

Dawna Markova

Pro Bono: Outcome Measures and General Research

Clinical Outcome Feedback Measures: CORE-34/CORE-10 www.coreims.co.uk Outcome Rating Scale (ORS) www.scottdmiller.com General Research:

www.google.com or www.googlescholar.com Alliance Outcomes Feedback Measures: Session Rating Scale (SRS) www.scottdmiller.com

Therapy Personalization Form (TPF)

mick.cooper@roehampton.ac.uk

References

Cooper M. (2008). Essential Research Findings In Counselling and Psychotherapy: The facts are friendly. London: BACP Sage.

Duncan, B.L., Miller, S.D., Wampold, B.E. & Hubble, M.A. (Eds.), (2010). The Heart & Soul of Change: Delivering what works in therapy. (2nd edition). London: APA.

Lambert, M.J. (2010). Prevention of Treatment Failure: The use of measuring, monitoring and feedback in clinical practice. Washington DC: APA

References

Orlinsky D.E. & Rønnestad, M.H (2005). How Psychotherapists Develop: A study of therapeutic work and professional growth. Washington: APA

Rønnestad, M.H. & Skovolt (2013), The Developing Practitioner: Growth and stagnation of therapists and counselors. London: Routledge

McLeod, J. (2001). Developing a research tradition consistent with the practices and values of counselling and psychotherapy: Why counselling and psychotherapy research is necessary. European Journal of Psychotherapy and Counselling, 14 (1), pp. 19-32.

References

Okiishi J.C., Lambert, M.J. Nielsen, S.L., & Ogles, B.M (2003).

Waiting for supershrink: An empirical analysis of therapist effects. Clinical Psychology and Psychotherapy, 10, pp. 361-373.

Schwartz,B., & J. V. Flowers (2010). How to Fail as a Therapist. California: Impact Publishers (2nd edition).

Unsworth, G., H. Cowie & A. Green (2011). Therapists’ and

clients’ perceptions of routine outcome measurement in the NHS: A qualitative study. Counselling and Psychotherapy Research DOI:10.1080/14733145.2011.565125

Google it!

Scoring the SRS

1. The Session Rating Scale is a four question measure of Therapeutic Alliance. 2. Clients are asked, at the end of the session, to be frank and offer their therapist feedback about

four specific areas of that session: 2.1. Relationship - the level to which they felt heard, understood and respected by the

therapist; 2.2. Goals and Topics – the level to which they worked on and talked about what they

wanted to work on and talk about; 2.3. Approach or Method – The fit of the therapist’s approach to the client; and 2.4. Overall – The general sense of the session.

3. This is achieved by clients marking on a line that is a continuum of low to high satisfaction in each area, for example:

Relationship

4. The client is asked to mark on the line nearest to the description that best fits for their experience of that session. For example;

5. The therapist then measures where they have placed the line, using a normal ruler. The four lines on the measure are each 10cm long, so you simply note the number where the client has marked. In the above example, it would be 8.7. This is repeated for each question and the four numbers are added together to obtain a score out of 40.

6. According to Miller & Duncan, we use the score out of 40 to measure alliance especially when the total score on the measure falls below 36. Scores of 34 or below always merit discussion as such clients are at significant risk for drop out and poor treatment outcome. In contrast high scores are not interpretable (e.g, good alliance, client is “faking it” or doesn’t want the

therapist to feel bad, etc). In fact, the presence of positive relationship qualities is not correlated with good outcome. Rather it is the absence of positive qualities that is strongly correlated. Therefore, it is imperative that negative feelings about the therapy be addressed openly with the client.

7. Research tells us that the process of responding to a client’s negative feedback, even about an

aspect of therapy that may seem relatively trivial, can contribute to the strength of the therapeutic alliance and set in place a strong foundation for future work. There is also evidence that therapists who elicit more negative feedback from their clients are able to forge a strong enough alliance that the clients feel safe in giving them honest feedback. In building a culture of feedback it is important that the therapist recognizes and believes in its importance. The quality and usefulness of the feedback therapists get from clients will depend on the degree to which the therapist genuinely wants honest feedback and the extent to which this is communicated effectively to the client.

I felt heard by the therapist, understood,

and respected.

I did not feel heard by the therapist,

understood, and respected.

I felt heard by the therapist, understood,

and respected.

I did not feel heard by the therapist,

understood, and respected.

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