You Need Structure. Frontiers Friday #187 ⭕️

Structure leads to impact, impact leads to engagement, and engagement leads to outcome. Start from the ground up.

NOTE:
This week, we take a pause from the Taxonomy of Deliberate Practice Activities (TDPA) topic. We will be back next week with Part III of the TDPA with a story about a clinical who has deployed the TDPA and leveraged it to improve her outcomes.

Today is the LAST day to register to the 4th cohort of the Structure and Impact course, which kick-off in a few days.

Kick-off: Monday, 3rd of Jun 2024
Last day for registration: Friday, 31st of May 2024
Format: Self-Paced, Lifetime Access + Cohort Based Delivery (1 Module per week, in a total of 4 weeks)

Fees: $300 (this is SGD)

For folks on the Frontiers of Psychotherapy Development (FPD) network, you get a $50 off!
Simply key in the promo code GIFT50 at Checkout.

Working Backwards

Walk backwards with me for a little while.

Much of my earlier work has focused on helping practitioners monitor and improve their outcome. It is important that we are keep our eyes on ultimately helping our clients, and when we are off-track, we must take the feedback and feed-forward to a more helpful direction.

However, focusing solely on the outcome will not get you to the outcome.

Take, for instance, in a recent ABC Australia article, A Dangerous Numbers Game, the push for policing quotes sent New South Wales police searches soaring. This is largely due to pressures of chasing the numbers, which led to disproportionate targeting of marginalised communities, including racial minorities and economically disadvantaged groups. When officers focused on meeting quotas, the quality of searches can decline, while eroding trust between these communities and law enforcement

Think about this in more general terms. The pursuit of happiness causes more suffering (more about this here in Full Circles). Happiness comes as a consequence, and not as a thing to pursue.

In the words of anthropologist Marilyn Strathern, Goodhart’s Law tells us that “when a measure becomes a target, it ceases to be a good measure.”

Keeping an eye on our client outcome is still vital, but it is what authors Chris McChesney, Sean Covey and Jim Holing¹ called a Lag Measure.

Lag Measures

Lag measures are the indicators of success that show whether you've achieved the desired outcomes. These are typically the end results of your goals and are often the metrics you want to improve. They "lag" because they come after the fact, reflecting the results of past actions.

Lead Measures

Lead measures, on the other hand, are actionable steps that influence the lag measures. They are the activities and behaviors that drive the achievement of lag measures. Lead measures are "lead" because they lead to the desired outcomes and are within the control of the team.

Lead measures have a direct impact on achieving the lag measure. They are both predictive and influenceable.

Lag Measure (i.e., Outcome) on the Left, Lead Measure on the Right

So we have to ask the question: What leads to good outcome?

Engagement.

In fact, it is not just “good alliance” that predict outcome, existing evidence² suggests that improvement of engagement over time is more predictive outcome.

OK. Engagement leads to Outcome… So what leads to good engagement?

Creating an impactful experience in session.

But as Joan Chittister said,

Every impactful person brings to you themselves and not needing to prove ‘how impactful I am’, ‘how smart I am’, and ‘how needed I am.’"

We must not get caught up with trying to sound smart and impactful, but we need to think about how each client experiences the session on an inner level.

Finally, if engagement leads to outcome, and impact leads to engagement, what leads to an impactful experience?

Structure is the scaffold that allows us to create something impactful.

Why Structure

Structuring your sessions is something you have control of—and you can facilitate that—regardless of the therapeutic modality that you using.

Previously I mentioned,

Whenever we think of how to structure a session, we turn to therapy approaches. This is why models like cognitive behavioural therapy (CBT) and mindfulness-based approaches are alluring to trainees. EMDR, or eye movement desensitisation reprocessing is also very appealing to clinicians of various experience levels. This approach provides a step-wise sequence protocol. These approaches provide a recipe on “what to do”.

(However) …this is a conflation between structure and models. Models can provide a sense of structure, but structure need not be confined to restricting ourselves to particular approaches.

In other words, structuring your sessions does not mean following a therapy model.

Structure does not mean to you need to be rigid, not abide by a formula. Structure provides you a scaffold to form and shape the work together with your client.

Without structure, it is much harder to build anything on firm foundations.

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Structure and Impact Teachings

Not everyone might be interested in taking part in this course. It’s a commitment on time, money and effort.

And that’s ok.

But I think this topic on Structure and Impact is important; it can not only help you side-step the “do this specific model” (e.g., CBT vs. IFS, etc, etc) vs. “do common factors” (there’s no such thing) debate, but also help you make each session come alive for your clients.

Common Challenges

Here are some common challenges faced by therapists:

“My client just goes on and on, and we seem to be going nowhere…”

“I’m often going overtime…”

“There seems to be no clear focus or direction.”

“I feel like I’m working harder than my client.”

This is what I will address… and more.

Just to be clear. Structure is not the be-all-and-end-all. Builders use scaffolds to help them build, and afterwards, it is stripped away.

Photo by Hush Naidoo Jade Photography

I’ve compiled everything I’ve written on the topic of Structure and Impact below. We go into much greater detail and application in the course.

I hope you find these useful. Join us to learn more.

P/S: If you are joining us in the S&I course, don’t forget to use the coupon code at checkout: GIFT50.

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For more resources on the topic of Structure, see our past missives:

Daryl Chow Ph.D. is the author of The First Kiss, co-author of Better Results, The Write to Recovery, Creating Impact, and the latest book The Field Guide to Better Results.

1. The Four Disciplines of Execution.

2. Owen, J., Miller, S. D., Borg, V., Seidel, J. A., & Chow, D. (2016). The alliance in the treatment of military adolescents. Journal of Consulting & Clinical Psychology.