This book, as well as others from The Heart and Soul of Change project, are perhaps the most important developments in the history of clinical psychology since Freud. That's the good news. The bad news is that the vast majority of therapists view outcome measurement with the same level of enthusiasm that a turkey views the approach of Thanksgiving. After all, it is scary to actually measure how your clients are or are not improving, and whether they feel understood and heard by you. At the back of a therapist's mind lie questions such as "What if my clients really aren't improving? What if they don't feel comfortable in session with me? And what if I find I can't improve?" It's far easier to jump onto the latest fad bandwagon and market oneself as EFT-trained or specializing in Trauma, or DBT, ACT, Problem-Solving Therapy, Mindfulness or whatever. "Once I learn the latest and greatest techniques, THEN my clients will all improve."
Unfortunately, as Barry Duncan and his colleagues have pointed out in various books, the Dodo Bird Verdict still holds true: research shows that the 400 or so flavors of therapy all have approximately the same level of effectiveness. That's because 40% of change comes from the client and their life variables, 30% from the relationship with the therapist, 15% from hope, expectancy and placebo, and only 15% from the therapy model or technique. So if you're finding that a lot of clients drop out of therapy, and others stay but seem not to improve, learning the latest fad is unlikely to help much.
What WILL help is measuring the strength of the therapeutic alliance and the progress of the client in every session. This feedback will enable you to discuss with the client what is going right and what is going wrong, and to adapt. This strengthens the therapeutic alliance and engages the resources of the client (which is what accounts for 40% of change in any case). In one study quoted in the book, simply getting feedback enabled nine out of ten couples therapists to improve the outcomes of their clients.
On Becoming a Better Therapist is a clear, well written, research-based guide explaining why feedback is important, how to obtain it, and what to do with it. It should be required reading for every therapist, and in every training program. Of course, as with every profession, self monitoring is a highly charged subject. Perhaps it will only happen when it is imposed from outside by insurance companies interested in knowing whether they're spending their money wisely.
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