ChapterThreeDiscussionSlides

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Barry Duncan,Barry Duncan, Psy.DPsy.D. www.heartandsoulofchange.com. www.heartandsoulofchange.com954.721.2981 www.whatsrighwithyou.com954.721.2981 www.whatsrighwithyou.com

[email protected]@comcast.net

On Becominga Better Therapist

Chapter ThreeDiscussion


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Winter Getaway!Training of Trainers

Winter Getaway!Training of Trainers

HSCP Training of Trainers(TOT): Jan. 31- Feb. 4,2011 (24 hours of CEs)This intensive trainingexperience gives you all youneed to train others andimplement CDOI. And itprovides the first step inbecoming an HSCP CertifiedTrainer of CDOI.

HSCP Training of Trainers(TOT): Jan. 31- Feb. 4,2011 (24 hours of CEs)This intensive trainingexperience gives you all youneed to train others andimplement CDOI. And itprovides the first step inbecoming an HSCP CertifiedTrainer of CDOI.

Skill Building/Deliberate PracticeBecoming Outcome InformedSkill Building/Deliberate Practice

Becoming Outcome Informed

3 Skills of OutcomeInformed Practice (TheThree I’s)

Introducing theMeasures

Integrating ClientFeedback into Practice

Informing and TailoringServices Based on ClientFeedback

3 Skills of OutcomeInformed Practice (TheThree I’s)

Introducing theMeasures

Integrating ClientFeedback into Practice

Informing and TailoringServices Based on ClientFeedback


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Consumer Participation CriticalNot a Perfunctory Piece of PaperConsumer Participation Critical

Not a Perfunctory Piece of Paper Administering, But Don’t Get It. Clients must

understand purpose (monitoring outcome,privileging their perspective); Therapists mustunderstand same + make them meaningful

Administering, Using Some. But not theclinical cutoff or numbers…Heuristic clinicaluse but no continuity or coherence

Administering, Using Some. But notconnecting to the client’s experience orreasons for service

Administering the SRS. But seeing it asreflective of competence rather than analliance building tool

Administering, But Don’t Get It. Clients mustunderstand purpose (monitoring outcome,privileging their perspective); Therapists mustunderstand same + make them meaningful

Administering, Using Some. But not theclinical cutoff or numbers…Heuristic clinicaluse but no continuity or coherence

Administering, Using Some. But notconnecting to the client’s experience orreasons for service

Administering the SRS. But seeing it asreflective of competence rather than analliance building tool

Helping Every Client—MarciaIt’s Addictive

Helping Every Client—MarciaIt’s Addictive

She told me that focusingon outcome hadsensitized her to thepossibility of clients notbeing helped & thatwasn’t acceptable. Sowhen things were notchanging, she ramped upthinking of options, incl.moving the client on.

That’s what I’m talkingabout.

She told me that focusingon outcome hadsensitized her to thepossibility of clients notbeing helped & thatwasn’t acceptable. Sowhen things were notchanging, she ramped upthinking of options, incl.moving the client on.

That’s what I’m talkingabout.


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XX

X

X

Now we’re ready to be better therapists,but first we must heed the words of a notedpsychotherapy scholar

Granted, at firstblush, thesehardly seem likewords fortherapists to liveby—but, as itturns out, theyare.

Sage Psychotherapy Scholar:Mae West?

When I’mgood,I’m verygood,but whenI’m bad,I’m better.


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Becoming BetterHelping Every Single Client


When clients are notbenefiting provides theopportunity to do yourbest work—gives youthe possibility of beinghelpful to everyone yousee. Sound too good tobe true? It’s not.

When clients are notbenefiting provides theopportunity to do yourbest work—gives youthe possibility of beinghelpful to everyone yousee. Sound too good tobe true? It’s not.

Becoming BetterIdentifying Clients Not Responding

Becoming BetterIdentifying Clients Not Responding

When outcome is badin other words, youcan make it better bychanging somethingabout the therapy toturns things around;and if things don’t turnaround, by moving theclient on to a differentprovider or service

When outcome is badin other words, youcan make it better bychanging somethingabout the therapy toturns things around;and if things don’t turnaround, by moving theclient on to a differentprovider or service


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Becoming BetterTwo Choices: Not Rocket Science

Becoming BetterTwo Choices: Not Rocket Science

Either the client isimproving or not. If not,the client is at risk.

Engage client in discussionabout progress, and whatshould be done differentlyif there isn’t any.

Keeps clients engaged sothat a new direction can beplanned.

Either the client isimproving or not. If not,the client is at risk.

Engage client in discussionabout progress, and whatshould be done differentlyif there isn’t any.

Keeps clients engaged sothat a new direction can beplanned.

Becoming BetterWhen I’m Good, I’m Very Good

Becoming BetterWhen I’m Good, I’m Very Good

When ORS scoresincrease, when you’regood, a crucial step tobe very good is helpclients see gains as aconsequence of theirown efforts and makesense of its meaningso repeat in thefuture.

When ORS scoresincrease, when you’regood, a crucial step tobe very good is helpclients see gains as aconsequence of theirown efforts and makesense of its meaningso repeat in thefuture.


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Becoming BetterLinking Outcome to Treatment

••See clientsSee clients moremorefrequently when thefrequently when theslope of change isslope of change issteep.steep.

••Begin to space theBegin to space thevisits as the rate ofvisits as the rate ofchange lessens.change lessens.

••See clients as longSee clients as longas there isas there ismeaningful changemeaningful change& they desire to& they desire tocontinue.continue.

Involve the client inmonitoring progress & thedecision about what to donext, to elicit his or her ideas& formulate a plan.

The discussion repeated in allmeetings, but later ones gainsignificance and warrantadditional action: Checkpointand Last Chance Discussions.

Involve the client inmonitoring progress & thedecision about what to donext, to elicit his or her ideas& formulate a plan.

The discussion repeated in allmeetings, but later ones gainsignificance and warrantadditional action: Checkpointand Last Chance Discussions.

Becoming BetterWhat to Do NextBecoming BetterWhat to Do Next


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Becoming BetterWhen to Say WhenBecoming Better

When to Say When

Stimulates both clientand therapist tostruggle withcontinuing a processthat is yielding little orno benefit.

To support what isworking & challengewhat is not. Urgencyincreases over time

Stimulates both clientand therapist tostruggle withcontinuing a processthat is yielding little orno benefit.

To support what isworking & challengewhat is not. Urgencyincreases over time

Checkpoint Session:An Opportunity to Be Better

Checkpoint Session:An Opportunity to Be Better

Be transparent—comment about thelack of progress andseek feedback fromthe client about whathe/she thinks it means

Be transparent—comment about thelack of progress andseek feedback fromthe client about whathe/she thinks it means


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Becoming BetterFirst, the AllianceBecoming BetterFirst, the Alliance

“It doesn’t look like we aregetting anywhere. Let’s goover the SRS to make sureyou are getting exactlywhat you are looking for.”Going thru SRS and elicitingclient responses in detailcan help you & the clientget a better sense of whatmay not be working.

“It doesn’t look like we aregetting anywhere. Let’s goover the SRS to make sureyou are getting exactlywhat you are looking for.”Going thru SRS and elicitingclient responses in detailcan help you & the clientget a better sense of whatmay not be working.

Checkpoint ConversationDo Something DifferentCheckpoint ConversationDo Something Different

Nothing may come out oftalk re alliance. Don’t worry.Making effort helps.

Invite others from supportsystem, use a team or co-therapist, a differentapproach; referral to anothertherapist, religious advisor,self-help group—whatever!

Any ideas are implemented,and progress is monitored.Matt

Nothing may come out oftalk re alliance. Don’t worry.Making effort helps.

Invite others from supportsystem, use a team or co-therapist, a differentapproach; referral to anothertherapist, religious advisor,self-help group—whatever!

Any ideas are implemented,and progress is monitored.Matt


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Becoming BetterThe Last Chance Discussion


Driving into desertrunning on empty,“last chance for gas.”

Depicts the necessityof stopping anddiscussing theimplications ofcontinuing w/ochange.

Driving into desertrunning on empty,“last chance for gas.”

Depicts the necessityof stopping anddiscussing theimplications ofcontinuing w/ochange.

Becoming BetterNever the LAST CHANCE

Becoming BetterNever the LAST CHANCE

Doesn’t mean the“last chance” foryour client—butrather the lastchance of a changeplan or pairing. Nolast chance for yourclient—referral canmake thedifference!

Doesn’t mean the“last chance” foryour client—butrather the lastchance of a changeplan or pairing. Nolast chance for yourclient—referral canmake thedifference!


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1.What does the client say?2.What have you done

differently?3.What can be done differently

now?4.What other resources can be

rallied?5.Is it time to Fail Successfully?

Last Chance ThoughtsThe Longer w/o Change, the Quicker to #5



All clients can’t benefit. Stilla way to be helpful.

Might have felt like afailure. But when I’m bad,I’m better. Now successfulwhen client achieveschange & when, in theabsence of change, I getout of the way.

All clients can’t benefit. Stilla way to be helpful.

Might have felt like afailure. But when I’m bad,I’m better. Now successfulwhen client achieveschange & when, in theabsence of change, I getout of the way.


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At the least, consultation

Referral seriously discussed.

Rarely justified to continuepast typical period.

Rarely is not never. Highlyidiosyncratic & uniquelynegotiated. Keeps us honest,addresses the lack of changetransparently—new for me.

At the least, consultation

Referral seriously discussed.

Rarely justified to continuepast typical period.

Rarely is not never. Highlyidiosyncratic & uniquelynegotiated. Keeps us honest,addresses the lack of changetransparently—new for me.

When I’m Bad, I’m BetterFailing Successfully

When I’m Bad, I’m BetterFailing Successfully

Repeat commitment tohelp them achieve goals.

Failure says nothingabout them or theirpotential.

If client wants, meet untilarrangements are made.

But rarely continue withclients who show noimprovement.

Repeat commitment tohelp them achieve goals.

Failure says nothingabout them or theirpotential.

If client wants, meet untilarrangements are made.

But rarely continue withclients who show noimprovement.


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Last ChanceLast Chance

Alicia

4 on the ORS

Tried a lot of different things

Ultimately failed successfully

By third session with new provider, a19 on the ORS

Six months later, scholarship reinstatedand a score of 28.9

Alicia

4 on the ORS

Tried a lot of different things

Ultimately failed successfully

By third session with new provider, a19 on the ORS

Six months later, scholarship reinstatedand a score of 28.9

Watershed ClientFailing SuccessfullyWatershed Client

Failing Successfully

I believed in PBE, but…

Awakened me to thepitfalls; taught me to failsuccessfully.

Avoid a “chronic” client—the iatrongenic effects ofcontinuing therapy w/obenefit.

ORS allows us to askourselves hard questions.

I believed in PBE, but…

Awakened me to thepitfalls; taught me to failsuccessfully.

Avoid a “chronic” client—the iatrongenic effects ofcontinuing therapy w/obenefit.

ORS allows us to askourselves hard questions.

I wish my helper hadfailed successfully


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Where You Are HeadedMyOutcomes & ASIST

Where You Are HeadedMyOutcomes & ASIST

Web-based systemsfor therapists andagencies to trackoutcome and providereal time feedback

myoutcomes.com

clientinnovations.com

Web-based systemsfor therapists andagencies to trackoutcome and providereal time feedback

myoutcomes.com

clientinnovations.com

Being BadCan Make You Better

Being BadCan Make You Better

Helps clients you are alreadyeffective with by empoweringchange—helps those notbenefiting by enabling otheroptions and, in absence ofchange, the ability to movethe client on.

When we’re good, we’revery good, but whenwe’re bad, we can beeven better.

Helps clients you are alreadyeffective with by empoweringchange—helps those notbenefiting by enabling otheroptions and, in absence ofchange, the ability to movethe client on.

When we’re good, we’revery good, but whenwe’re bad, we can beeven better.

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