Routine outcome monitoring in couple and family therapy The empirically informed therapist 1st Edition by Terje Tilden, Bruce Wampold 3319506749 9783319506746

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ISBN 10: 3319506749

ISBN 13: 9783319506746

Author: Terje Tilden, Bruce E. Wampold

This research-to-practice manual introduces Routine Outcome Monitoring (ROM), a feedback-based approach to preventing impasses and relapses in couple and family therapy as well as within other psychotherapy approaches. This book discusses how ROM has been developed and experienced within the Norwegian couples and family therapy community in line with international trends of bridging the gap between clinical practice and research. Locating the method in evidence-based systemic practice, contributors describe the core techniques, tools, and process of ROM, including examples of effective uses of feedback over different stages of therapy, with individuals in family context, and implemented in different countries. Giving clients this level of control in treatment reinforces the concept of therapy as a collaborative process, fostering client engagement and involvement, commitment to treatment, and post-treatment progress. ROM is applicable across clinical settings and clinician orientations for maximum utility in work with clients, and in building therapeutic self-awareness. Features of the book: •Theoretical and empirical context for using ROM with families and couples. •Tools and procedures, including the Systemic Therapy Inventory of Change. •Guidelines for treatment planning, implementation, and evaluation. •Common challenges in using ROM with couples and families. •Supervisory, training, and ethical issues. •Examples and vignettes showing ROM in action. With its deep potential for promoting client progress as well as therapist development, Routine Outcome Monitoring in Couple and Family Therapy: The Empirically Informed Therapist will attract practitioners and research professionals particularly interested in clinical practice, client-directed methods, and couple or family therapy.

Routine outcome monitoring in couple and family therapy The empirically informed therapist 1st Table of contents:

1 How Do I Know Whether My Efforts Are Helpful for the Client? Implementing Feedback in Norway

Introduction

Our Mission and Challenge

The Professional Development of Systemic Practices

Evidence-Based Practice and Levels of Evidence

The Governmental Guidelines

The Characteristics of Feedback

The Implementation and Dissemination of ROM in Norway

Practice-oriented Research

The Pros and Cons of ROM

The Pros

The Cons

Concluding Section

References

Couple and Family Therapy in Norway

2 The History of Family Therapy in Norway

What Paved the Ground for the Development of Family Therapy in Norway?

Overarching Themes—Trends and Headlines Seen as Historical Processes

Family Therapy in Norway Through the Decades

Family Therapy in the 1960s and 1970s

The 1980s

The 1990s

After 2000

The Important Working Contexts for Family Therapists

Family Counseling Services

Child and Adolescent Psychiatry

Adult Psychiatry

Modum Bad

History

The Treatment

Evaluation and Research

Diagnostic Challenges

International Contacts and Inspirations

The Research Institute

Publishing About Family Therapy

Norsk Forening for Familieterapi (NFFT)

Family and Family Therapy Research in Norway

Research Concerning Family Therapy with Children and Adolescents

Educating Family Therapists

Family Therapy in Norway—Is There a Future?

References

3 A Sociological Perspective on Changes in the Family in Norway

Introduction

Background Information on Norway

A Snapshot of Contemporary Norwegian Families

“Liquid” Relationships

The Gendered Division of Labor, Homemaking, and Money

“New” Fatherhood and Motherhood: Intensive Parenting

Family Changes and Couple/Family Therapy

Concluding Remarks

References

4 Family Therapy and Philosophy: Inspiration and Frustration

Introduction

My Journey to Family Therapy and Norway’s Family Counseling Service

Family Therapy Education: Constructivism and Anti-psychiatry

Change and Second-Order Cybernetics

Constructivism + The Legacy of Descartes = Epistemological Skepticism?

The Therapy Room as a Space of Freedom

The Profession’s Three Philosophical Pillars

A Paradox

Fiction Versus Reality

Constructivism + Social Constructionism = Relativism

Pragmatism and Evidence-Based Practice

Language and the World: There Is also a Correspondence Theory

First Preliminary Summary

The Problematic “Not-Knowing” Position

Both Therapy and Counseling?

Socratic Approach: The Midwife Method

Kierkegaard and the Art of Helping

The Not-Knowing Position and Solipsism: No Man Is an Island

Second Preliminary Summary

The Informed Versus the Not-Knowing Therapist

Proximity Ethics and Second-Order Cybernetics Go Hand in Glove

Proximity Ethics Challenge: An Inadequate Therapist

Courtesy, Respect, and Sound Methods May Be Enough

Conclusion

References

Practice-Oriented Research and Routine Outcome Monitoring

5 The Systemic Therapy Inventory of Change—STIC: A Multi-systemic and Multi-dimensional System to

The STIC System

The STIC Initial

The STIC Intersession

The STIC Online Data Collection and Feedback System

An Evolving Measurement and Feedback System

The STIC as a Research Tool

The STIC as a Clinical Tool

The Collaborative Use of the STIC

Collaborative, Empirically Informed Assessment

The Big Six and the Big Three

Individual Versus Couple Versus Family: Whom to See?

Creating an Empirically Informed Problem Narrative

Creating an Empirically Informed Intervention Plan—What to Address When?

Empirically Informed Progress Evaluation

Collaborative, Empirically Informed Termination Assessment/Planning

Empirically Informed Multi-systemic Therapy

The Clinical-Research Loop

The STIC System as a Comprehensive Clinical and Research Tool

References

6 The Norwegian Directorate for Children, Youth and Family Affairs’ Efforts to Implement Feedback

Introduction

Evidence-Based Practice in FCS

“The Norwegian Study”

Decision to Implement KOR in All FCS Offices

PCOMS, the Measures ORS and SRS, and the Norwegian Term KOR

Clinical Cutoff of the ORS

Electronic Systems for Administering and Scoring the KOR Measures

The Validation of ORS and SRS

Implementation

Implementing KOR in the FCS: Model and Pilot Project

Pilot FCS Offices

The Role of the Coordinator

Skill-Building Conferences

Consultation

The Four Phases of the Implementation from 2009 to 2012

KOR Supervision

Implementing an Electronic System

Positive Experiences

Objections from the Clinicians

Problems and Challenges that Occurred in the Implementation Process

The Importance of Adequate KOR Introduction

Clinical Autonomy Versus User Involvement

Looking into the Mirror of Implementation Research

Lessons Learned

References

7 Feedback as Means to Enhance Client–Therapist Interaction in Therapy

Introduction

A Very Short History of the Introduction of Routine Outcome Monitoring and Service User Feedback in

Client-Directed, Outcome-Informed Therapy in a Family Therapy Context

The Outcome Rating Scale and The Session Rating Scale as Conversational Tools

The CD of the CDOI—The Question of Service User Participation

The OI of the CDOI—The Question of Being Informed by Data

What Could Be New in Client–Therapist Interactions as a Result of Feedback?

To Follow the Client and Be Challenged by Data

Closing Remarks

References

8 Does Feedback Enhance User Involvement in Therapy?

Introduction

User Involvement Through Structured Feedback

The Systemic Therapy Inventory of Change (STIC) Feedback Procedure

Three Ways of Making Meaning from a Feedback Questionnaire Procedure

The Study

Expectations About the Use of STIC

Experiences with the Use of STIC

Feedback Procedures Give the Opportunity to Ask Difficult Questions

Feedback Procedures Give the Opportunity to Explore Multiple Meanings

Feedback Procedures Give the Opportunity to Share Information with Everyone in the Room

Conclusion

References

9 Empirically Informed Therapy Conducted at the Family Unit, Modum Bad

Introduction

The Modum Bad Context

Theoretical and Empirical Background

The CFT Treatment Approach

The Use of ROM at the Family Unit

Treatment-Planning and Building Alliances

Collaborative Approach to Therapy Enhances Change

Addressing Lack of Changes and Alliance Ruptures

Clinical Judgement

Closing Remarks

References

10 Family Therapy and Holistic Complexity—An Ethnographic Approach to Therapeutic Practice in a No

Introduction

Our Ethnographic Approach

Dilemmas of Symmetrical Reciprocity

Autonomy and Boundaries

A Therapeutic Agora

Perspectivism

Contextual Complexity in Therapy

Summing Up

References

11 An Anthill of Questions that Made Me Prepare for the First Session: A Clinical Vignette of the Us

Introduction

Our Context

Our Theoretical Platform and the STIC Procedures

Answering Before Meeting the Therapist in Person

Too Burdensome for a Family in Crisis?

To Become Visible

Forced to Be Clearer

To Be Exposed

Does STIC Open Up for Untold Stories?

Changes Displayed and not Displayed on the STIC Graphs

STIC Works Outside the Therapy Room

Youth, Truth, and STIC

Is STIC in the Way?

One Size Fits All?

Alliance

Conclusion

References

12 Lessons Learned from the Implementation of a Feedback System in Couple and Family Therapy

Introduction

Background

Implementation

Studies on ROM Implementation

Lessons Learned from Our Project

The Honeymoon Phase

From Initial to Action Phase

The Downturn Phase

The Upturn Phase

The Consolidation Phase

Implications

Conclusion

Acknowledgements

References

Reflections from Abroad on Couple and Family Therapy in Norway

13 How, When, and Why Do People Change Through Psychological Interventions?—Patient-Focused Psycho

Introduction

Dose–Response and Phase Models of Therapeutic Change

Decision Support Rules

Rationally Derived Methods

Empirically Derived Methods

Nearest Neighbors Techniques

Detecting Typical Patterns of Patient Change

Rationally or Empirically Derived Decision Rules

Mediators and Moderators of Psychometric Feedback Effects

Therapist and Patient Differences

How Does Feedback Work?

Summary

References

14 How to Use Research to Become More Effective Therapists

The Contextual Model

Initial Therapeutic Bond

The Real Relationship

Creation of Expectation Through Explanation and Treatment

Enacting Health Promoting Actions

The Three Pathways in Summary

Actions of Effective Therapists

Alliance

Facilitative Interpersonal Skills

Delivery of a Cogent Treatment

Professional Self-doubt and Deliberate Practice

Characteristics and Actions of Therapists that Are not Related to Outcome

Conclusions

References

15 How Can Outcome Data Inform Change? Experiences from the Child Mental Health Context in Great Bri

Introduction

Use of Outcome Data in Direct Clinical Work (Decision Making in Relation to Individual Children and

Which Measures to Choose?

How to Use Measures Clinically and Meaningfully

Decision Making for Service Development

Time and Resources Involved

Data Quality, Reporting and Using Information from Measures

Research

Summary

References

Concluding Remarks

16 Epilogue

Changed, but Still the Same?

CFT Part of the Psychotherapy Family?

Evidence-Based Practice

One Size Fits All?

ROM/POR

Where Are We Heading?

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