Monitoring Therapists: Ethical Study Guide?

Monitoring the therapist throughout a study can be a complex and challenging task, but it is important to ensure the quality and effectiveness of the therapy provided. Regular client feedback, also known as routine outcomes monitoring, has been found to improve therapy outcomes and facilitate therapist self-assessment. However, there may be resistance to progress monitoring from therapists, and it is important to address concerns and find ways to make it feel more authentic and aligned with their theoretical orientation. While progress monitoring can provide valuable objective evidence, it is essential to recognize that it is not purely objective and should be interpreted in conjunction with the therapist's subjective experience and intuition. Additionally, the frequency of therapy sessions depends on individual needs and preferences, with some people opting for weekly sessions while others may prefer biweekly or less frequent meetings. Overall, finding the right therapist and establishing a comfortable therapeutic relationship are crucial for a positive therapy experience.

Therapists should be curious about their own resistance to progress monitoring

Therapists should be curious about their resistance to progress monitoring because it can be a valuable path to success in therapy. Therapists should reflect on their resistance and ask themselves: "How does viewing progress monitoring as objective evidence influence how I use client feedback?" and "As an evidence-based practice, what does progress monitoring add to my practice above and beyond the subjective methods I use to oversee my clinical decisions?". Therapists should also be curious about their resistance because it can help them improve. Over time, calibrating clinical intuitions based on client feedback can help therapists grow in several ways, including increasing their tolerance of clients' negative emotions and improving their ability to contain and address these difficult feelings.

Therapists should think about what client feedback is telling them

Therapists should also be aware of their own subjectivity when interpreting client feedback. A progress monitoring system cannot provide purely objective evidence for clinical decisions. Therapists should acknowledge their own subjectivity when interpreting client feedback and make room for the client's interpretation of the data. For example, a therapist might ask their client what they think their feedback means. Therapists should also be cautious about applying research very directly in therapy contexts, as research cannot necessarily be generalised from the group to the individual.

Therapists can also use client feedback to improve their interpersonal skills, model openness and improve accuracy in their clinical decision-making process. For instance, a therapist might increase their tolerance of their client's negative emotions and improve their ability to address these difficult feelings. Therapists can also become more open and transparent in testing their hypotheses through confirmation and disconfirmation.

Therapists should calibrate, not evaluate

Therapists should be open to calibrating their methods and practices, rather than evaluating them. Calibration is about fine-tuning and adjusting, whereas evaluation is about judgement and critique. Calibration is a more collaborative and less confrontational approach, which is beneficial for the therapist-client relationship.

Therapists should be encouraged to embrace progress monitoring, which involves collecting self-report data from clients on a regular basis. This can include monitoring symptoms, well-being, and the therapeutic alliance. Progress monitoring facilitates therapist self-assessment and acts as a system of checks and balances for intuitions about treatment progress and alliance quality.

However, therapists may feel some resistance towards progress monitoring, especially if it feels like increased oversight of their work. Therapists should get curious about their resistance and reflect on how it might be linked to their theoretical orientation and stance on the interaction between research and practice.

It is important to remember that progress monitoring is not purely objective evidence. Therapists should acknowledge their own subjectivity in interpreting client feedback and make room for the client's interpretation of the data. Therapists should also avoid using progress monitoring to compare their performance with that of other therapists. Instead, they should use it as a tool for self-assessment and improvement.

Therapists should also be mindful of the limitations of progress monitoring. For example, the algorithm that calculates a client's standardized trajectory may not take into account the severity of the client's core issue or personality factors that may impact their resistance to change.

Overall, therapists should view progress monitoring as a valuable tool for growth and improvement rather than as a form of evaluation or judgement. By calibrating their practices based on client feedback, therapists can improve their interpersonal skills, model openness, and increase the accuracy of their empathic and relational attunement.

Therapists should be authentic, creative, and forward-thinking

Authenticity

Authenticity in therapy refers to "matching one's inner thoughts, beliefs, and feelings with one's outer presentation and behaviours". It is an active process that therapists can move in and out of fluidly, rather than a static identity trait. Therapists who are authentic create a safe and empathetic space for their clients by being humble, allowing their feelings to show, and demonstrating that they are there for the client.

Research suggests that therapist authenticity matters to client outcomes and is desirable for clients, especially those who have experienced difficult interpersonal experiences or trauma. Being authentic also benefits the therapist, as masking one's true self can be exhausting and may lead to burnout.

Creativity

Creativity in therapy can inspire therapists to think outside the box and find innovative solutions for their clients. For example, art therapy or music therapy can provide an alternative way for clients to express themselves and explore their emotions. Creativity can also be incorporated into more traditional talk therapies, such as through the use of metaphors or experiential exercises.

Forward-Thinking

Forward-thinking therapists are open to new ideas and approaches and are willing to try different techniques to find what works best for their clients. They stay up-to-date with the latest research and are willing to incorporate new evidence-based practices into their work.

By being authentic, creative, and forward-thinking, therapists can provide their clients with the best possible care and improve therapeutic outcomes. These qualities can help therapists build strong therapeutic alliances, which research has shown to be a key factor in successful therapy.

Therapists should be aware of the benefits and barriers of progress monitoring

A national survey of 504 clinicians found that while they held positive attitudes towards monitoring and feedback, only 13.9% reported using standardized progress measures at least monthly, and 61.5% never used them. The survey also identified barriers to monitoring and feedback, including resource constraints, added time and paperwork, lack of training, and client willingness to complete measures.

Another study of 25 licensed clinicians found that they faced challenges related to administering measures, dissatisfaction with specific characteristics of progress monitoring measures, and negative responses from colleagues and clients.

Therapists who are interested in monitoring client progress but have yet to do so can try a few strategies. Firstly, find tools and systems that work for your practice setting. Secondly, provide an explanation of the purpose and benefits of the measures to clients. Finally, connect with experienced colleagues or through professional networks to address any feelings of anxiety or uncertainty.

Frequently asked questions