Frontiers Friday #87. Client's Point of View (Part IV) ⭕
Frontiers Friday #87. Client's Point of View (Part IV)
This week, we look at 2 other studies on youth's feedback and why they dropout of therapy, and 2 from my clinical practice.
In case you missed the first three parts of the Frontiers Friday series on "Client Point of View", here it is:
Btw, I would love to hear what you think about this series of Client Point of View. Simply hit Reply.
👓 Research: ‘I Just Stopped Going’: A Mixed Methods Investigation Into Types of Therapy Dropout in Adolescents With Depression
This study of 11-17 year-olds show 3 reasons why youths dropout of treatment prematurely:
i. Dissatisfied
ii. "Got-What-They-Needed"
iii. "Troubled" (i.e., lack of social stability beyond low moods)
The actual proportions weren't stated clearly in the paper, but let's do some simple calculation. Out of 99 youths, 32 were classified as dropouts. Out of the 32, we have 18 Dissatisfied (56%), 10 "Got-What-They-Needed" (31%), 4 "Troubled" (12%).
Isn't it striking (but maybe not surprising) that more that half of them were dissatisfied?
13-year-old Fiona describes her experience:
“I went to this therapist and they just sat there and hummed for an hour at everything that I said. I hated it. [My therapist] made me really angry because it just felt like I was talking to a brick wall and I wasn’t. I didn’t even want to talk because [my therapist] didn’t engage with me at all. It just felt like it was completely pointless.”
And here's her therapist's perspective:
“I think the session sort of stirred stuff up and the fear was that she’d feel worse again.”
Her therapist explained that things had already started to improve for her at an early stage in the therapy and the therapist suggests this may have impacted on her willingness to engage. She went on to suggest that Fiona believed she felt better which led her to stop therapy.
Before you "tsk tsk" this therapist, note that this could easily be you and me.
👓 Research: Therapeutic Relationship and Dropout in High-Risk Adolescents’ Intensive Group Psychotherapeutic Programme
This study look at dropouts in high-risk adolescents' intensive group therapy in the Netherlands.
While this study is not a qualitative research, its finding is useful to note in relations with the study mentioned in #1.
The researchers found that a significant decrease in therapeutic alliance (as measured by the child version of the Session Rating Scale ) in the last 3 sessions was a predictor of dropout.
Again, not a big surprise, but the implications are not trivial: Monitor outcomes and alliance session-by-session, and elicit the nuanced feedback.
✍️ From My Desk (Archive): How to Elicit and Receive Feedback
Given the 2 studies mentioned above, here are 3 relevent posts on how you can learn to elicit, receive, and use feedback from your clients.
- How Do You Get Better At Eliciting Feedback
- How to Receive Feedback
- To Get Useful Feedback, Seek Contrast(Hint: Compared to the averager therapist, more efficacious therapists seem to be able to obtain lower working alliance scores at the start).
👇 My Practice-Based Evidence
Once could be random, twice could be luck, and three times is likely to be a non-random pattern.
Recently, on 3 occasions, with 3 different clients, I've gotten lower scores on the Approach/Method subscale of a working alliance measure. Two of them said that they would appreciate more structure in the session.Admittedly, while this was something I was already working on to improve, I realised what needing more "structure" actually meant: I did not make clear my intentions and where I was proposing to go. I failed to "think aloud" and share my "why" and "where" we were heading.
As this has happened more than once, this is clearly something I can work on that has leverage, for me at least.
(Be mindful that deliberate practice is such an individualised process, and may not necessarily generalise for others).
⏸ Words Worth Contemplating:
“The single biggest problem with communication is the illusion that it has taken place.” ~ George Bernard Shaw.
Reflection:
Learning is the ability to generalise an input into other context. We may sometimes be able to learn from client feedback, and sometimes not. It's important to discern on when I need to be responsive and when I can generalise the learnings into other context.
1. When are the times I need to be responsive to each individual client?
2. What are some emergent patterns I notice in my clinical practice?
Special Free Webinar
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May 16, 2022 09:00 AM in Central Time (US and Canada)
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