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I often say therapists can’t tell when clients deteriorate.
Here’s the evidence.
A thread on Mike Lambert’s classic article.
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Here’s the evidence.
A thread on Mike Lambert’s classic article.
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Not much research has been done on patterns of change in therapy.
When there’s no research clinicians believe folktales.
One folktale says clients get worse before they get better.
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When there’s no research clinicians believe folktales.
One folktale says clients get worse before they get better.
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But the research is clear.
Feeling worse ≠ getting better.
The vast majority of the time if people are going to recover because of therapy, they show gains early in therapy.
Getting better = getting better
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Feeling worse ≠ getting better.
The vast majority of the time if people are going to recover because of therapy, they show gains early in therapy.
Getting better = getting better
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In fact if you track your outcomes you’ll find that the majority of people who get better, show improvement by week 4.
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ML and friends wanted to see if therapists could do as well as machines for predicting outcome by week 4.
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So he got almost 50 therapists (trainees and professionals) to use their clinical judgement on their personal caseloads and say which clients would deteriorate by the end of therapy.
Overall they used their judgement on over 500 clients.
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Overall they used their judgement on over 500 clients.
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They were told before hand that, on average, at their clinic 8% (40 clients) would be worse off by the end of treatment.
When asked to analyze their caseloads how did the therapists do?
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When asked to analyze their caseloads how did the therapists do?
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Did the therapists guess the 40 clients who would be worse off?
No.
First they only guessed 3 clients would be worse off. They said all other clients would be fine.
Second out of the 3 they guessed to be worse off, only 1 actually was worse off.
(8)
No.
First they only guessed 3 clients would be worse off. They said all other clients would be fine.
Second out of the 3 they guessed to be worse off, only 1 actually was worse off.
(8)
The good news is, the research is clear. If we can actually tell which clients are deteriorating then we can make adjustments to the therapy and clients will get better.
So track your outcomes. It will help you help people.
So track your outcomes. It will help you help people.
