Questions for all therapists/psychologists in the outpatient world...

[wellnesswarrior123]

Hi,

Two questions for all you therapists in the outpatient world:

1. How helpful would it be if your client did daily mood tracking, recording their lowest and highest mood of the day, the associated emotions and contextual factors?

2. Generally speaking, if you could have your clients do one piece of homework before their sessions, what would it be, and why?

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[WisNeuro]

All depends on what we're working on, and even with mood tracking, usually only helpful in early stages of treatment.

 

[wellnesswarrior123]

All depends on what we're working on, and even with mood tracking, usually only helpful in early stages of treatment.

Thanks for your email. Can you elaborate on this?

When you mention that it would only be helpful in the early stages of treatment, is this assuming that over time, your client's mood would improve, so perhaps the utility of daily mood tracking would be less helpful (the client is assumed to be more stable, with less fluctuations in mood).

For clients who are also seeing a psychiatrist, I would imagine that in the midst of medication adjustments/interventions, it would be helpful to obtain subjective daily mood tracking, as it may mitigate recall bias at the time of the appointment, help to deliver more data-driven/measurement-based care and avoid reckless psychotropic prescription/up-titrations.

Would love to hear your thoughts.

 

[WisNeuro]

Are you trying to run a free focus group?

 

[wellnesswarrior123]

All depends on what we're working on, and even with mood tracking, usually only helpful in early stages of treatment.

 

[wellnesswarrior123]

Are you trying to run a free focus group?

As someone who is early in my career (currently working on building up clientele in a private practice group), I'm trying to get a sense from those who have more outpatient experience if requesting new clients to daily mood track is worthwhile.

 

[summerbabe]

In an ideal world, homework will provide both continued data for the provider AND help facilitate some type of desired change for the patient. DBT is a great example - patients are expected to practice skills and complete a weekly diary card which documents behaviors, moods, and skills that were practiced.

For a mood tracker, is the assignment itself a useful intervention (like helping patients gain more insight into their moods or emotional processes) or not? And what will you do it with? Does it inform treatment (like teaching a specific coping skill based on what's coming up) or does it just get filed away?

2. Generally speaking, if you could have your clients do one piece of homework before their sessions, what would it be, and why?

IMO, this seems like both too broad of a question as well as one that is looking for a simple, cookie cutter type response.

Rather, I want patients to do something intentional and specific that moves them toward their defined goal for therapy. Now what that looks like will vary and I try to collaborate with the patient to find something potentially beneficial that they will commit to attempting (unless it's a protocol with pre-defined HW).

 

[wellnesswarrior123]

In an ideal world, homework will provide both continued data for the provider AND help facilitate some type of desired change for the patient. DBT is a great example - patients are expected to practice skills and complete a weekly diary card which documents behaviors, moods, and skills that were practiced.

For a mood tracker, is the assignment itself a useful intervention (like helping patients gain more insight into their moods or emotional processes) or not? And what will you do it with? Does it inform treatment (like teaching a specific coping skill based on what's coming up) or does it just get filed away?

IMO, this seems like both too broad of a question as well as one that is looking for a simple, cookie cutter type response.

Rather, I want patients to do something intentional and specific that moves them toward their defined goal for therapy. Now what that looks like will vary and I try to collaborate with the patient to find something potentially beneficial that they will commit to attempting (unless it's a protocol with pre-defined HW).

"For a mood tracker, is the assignment itself a useful intervention (like helping patients gain more insight into their moods or emotional processes) or not? And what will you do it with? Does it inform treatment (like teaching a specific coping skill based on what's coming up) or does it just get filed away?"
--> My thought is that a daily mood tracker would serve dual purpose--helping the client recognize the links between their environment, thoughts, and feelings and also help the therapist gain better understanding of their client's experiences between sessions which would guide treatment/interventions.

I've been talking about this with some colleagues and therapy supervisors. Many of them feel that asking their clients to do daily mood tracking (asking them to 1. rate their worst mood, the emotions related to it and it's intensity, and the contextual factors, as well as asking them to 2. rate their best mood with the same series of questions as mentioned before) would be of high utility, however adherence to daily tracking may make this challenging.

 

[PsychPhDone]

As someone who is early in my career (currently working on building up clientele in a private practice group), I'm trying to get a sense from those who have more outpatient experience if requesting new clients to daily mood track is worthwhile.

Are you a psychologist? Like doctoral level?

 

[Fan_of_Meehl]

Hi,

Two questions for all you therapists in the outpatient world:

1. How helpful would it be if your client did daily mood tracking, recording their lowest and highest mood of the day, the associated emotions and contextual factors?

2. Generally speaking, if you could have your clients do one piece of homework before their sessions, what would it be, and why?

Assessment should be driven by an individualized clinical case formulation (which, itself, should be rooted in the relevant constructs from the relevant clinical literature). So, it depends. Think of this task (of determining 'what homework should I ask them to do') as a conceptual 'funnel.' Begin with the raw data of their complaints (why did they come see you? where are they saying that they are suffering?). Build the therapeutic relationship and do open-ended questioning and motivational interviewing processes to distill down to the things that are causing them the most suffering and/or they are most motivated to do something to change. This gets you to 'goals' for therapy. Now build a basic model (based on what this individual client has shared with you and the relevant clinical and scientific literature) of what needs to be changed (and why). Now figure out a relatively low-impact (on the client) way of them routinely gathering that information and bringing it into sessions to assess whether or not treatment is helping. A simple example would be a client coming in complaining of lack of energy, insomnia, weight gain, worry, negative self referential thoughts (for example, about weight and health). Work with them to develop an individual clinical case formulation targeting, for example, increasing their activity level (combine it with socialization type activities if they used to be social and miss that part of their lives). Collaborate/negotiate with them (this is important, do not just 'prescribe' or tell them what to do) with respect to 'how are we going to measure that so we know that it's being done, that changes are being made in your routine? How would you prefer to keep track of that? How have you done this before and what has worked for you?). Explain the phenomenon of 'behavioral activation' as an approach to understanding and treating depression. Get them to understand and buy in to (and contribute to) their own individualized clinical case formulation and treatment plan.

Also, I find that most models and care delivery systems severely underestimate the challenge of influencing the average client to complete 'homework' (or 'between-session-assignments') on a routine basis (or at all). This is particularly egregious within the VA system and it is often neglected in workshops, grad school, or formal training experiences.

 

[AbnormalPsych]

Are you a psychologist? Like doctoral level?

I would highly doubt it, from their posts. But the question is, is this a mid-level or student.

 

[R. Matey]

Are you trying to run a free focus group?

These posts smell like MH tech start up, IMHO.

 

[AbnormalPsych]

These posts smell like MH tech start up, IMHO.

Ah, yes.

 

[psych.meout]

These posts smell like MH tech start up, IMHO.

Oh my god, it makes so much more sense now.

 

[PsychPhDone]

These posts smell like MH tech start up, IMHO.

That's how I first read it.
I charge for consulting.

 

[PsyDr]

Hi,

Two questions for all you therapists in the outpatient world:

1. How helpful would it be if your client did daily mood tracking, recording their lowest and highest mood of the day, the associated emotions and contextual factors?

2. Generally speaking, if you could have your clients do one piece of homework before their sessions, what would it be, and why?

My questions:

1) Are you trying to obtain my professional services for free through misrepresentation?
2) Where can I send my invoice?