• Set Yourself Up For Success Webinar

    October 6, 2021 at 2 PM Eastern/11 AM Pacific
    SDN and Osmosis are teaming up to help you get set up for success this school year! We'll be covering study tips, healthy habits, and meeting mentors.

    Register Now!

  • Site Updates Coming Soon

    Site updates are coming next week on Monday, Wednesday, and Friday. Click the button below to learn more!

    LEARN MORE

Woes of Routine Outcome Monitoring (ROM) and Feedback Informed Therapy (FIT) in Private Practice

FreudianSlippers

Full Member
2+ Year Member
Nov 28, 2016
159
157
116
I was trained heavily on the importance of monitoring client outcome and assessing feedback. I'm a huge proponent of the work by Scott Miller, Michael Lambert, and the like. I think it's so important for therapists to objectively track treatment outcomes and intervene if clients deteriorate or stagnate. If you haven't looked into this, i'd highly encourage you to. There are eye-opening studies showing how god awful clinicians are at subjectively assessing the how therapy is going. Anyway, that's all to say that during my training I have been fortunate that these measures were typically included in the organizations (e.g. OQ-45, CAPPS, etc). However, now that I have my private practice, I feel that I am essentially flying blind by not having these measures. I'm trying to use free, symptom focused measures (e.g. DASS-21), but they don't come close to the utility of real, standardized, ROM and FIT measures (e.g. Scott Miller's SRS/ORS, OQ-45). It's tough because as a small, growing practice, I don't know if I can yet justify spending hundreds of dollars every year on purchasing a license for these measures (when my practice is BARELY paying for itself right now). Anyways, I just thought I would share my frustration and wonder if others have run into similar difficulties or have any guidance in the matter.
 
  • Like
Reactions: 1 user
Upvote 0

MamaPhD

Psychologist, Academic Medical Center
10+ Year Member
Aug 2, 2010
2,355
2,633
276
  1. Psychologist
I'm trying to use free, symptom focused measures (e.g. DASS-21), but they don't come close to the utility of real, standardized, ROM and FIT measures (e.g. Scott Miller's SRS/ORS, OQ-45).

First off, kudos to you for taking outcome monitoring and feedback seriously. It is an attitude that's pretty rare in private practice. What alternatives have you tried?

MyOutcomes is $228 per year for unlimited use. That doesn't seem that expensive, especially if you feel like you're "flying blind" without it.
 
  • Like
Reactions: 4 users
Upvote 0

Fan_of_Meehl

Full Member
5+ Year Member
Oct 22, 2014
1,273
2,019
176
  1. Psychologist
First off, kudos to you for taking outcome monitoring and feedback seriously. It is an attitude that's pretty rare in private practice. What alternatives have you tried?

MyOutcomes is $228 per year for unlimited use. That doesn't seem that expensive, especially if you feel like you're "flying blind" without it.
I was just thinking that it would be nice if the VA would have considered some of these (apparently) more refined measures of outcome. I remember an intern mentioning research supportive of the OQ-45. What I found sadly hilarious is that--for an institution that appears to have the closest thing to a 'blank check' from the American people (VA is requesting a total of $243.3 billion in fiscal year (FY) 2021, a 10.2 percent increase above fiscal 2020 enacted levels)--the minute that any form of fee was suspected of being associated with use of the measure, any proposal to consider it was sure to be dead-in-the-water. What makes this reality more than perverse is the omnipresent and obvious waste of money (on useless programs, slogans, redundant positions, inefficiences, etc.) that pervades the VA system.
 
  • Like
Reactions: 2 users
Upvote 0
About the Ads
Nov 18, 1999
2,035
1,483
376
  1. Attending Physician
Uh, I'm a dinosaur so I just use a paper and pencil therapist eval (David Burns' Evaluation of Therapy Session).
My old institution used to provide access to charted results of symptom measures over time, which was useful. My current one doesn't so I just write the scores into my clinic note now and chart them in my head. I don't find it that terribly different, though it was cool to be able to show patients their charts so they could see their own progress.

I feel like the therapist eval form is more critical than the symptom measure. I've tried a few different ones and really hated most of the other therapist eval forms I tried besides the one I use, but I kind of feel like a symptom measure is a symptom measure regardless and I've gravitated towards using the shortest one that is appropriate for whatever we are doing. (I took some scorn on another thread for this recently I admit, so fire away.)

I looked at Scott Miller's site and his forms appear to be free to administer using paper and pencil for individual practitioners, it's just that you have to buy the software to do more complex evaluations of the data. But if you're that committed and that poor, could you not just enter your paper and pencil data into SAS or even Excel (it looks from the website like they're just plotting change over time) for the same result? No? Is there some more complex analysis they're doing that isn't obvious from the website?
 
  • Like
Reactions: 1 user
Upvote 0

FreudianSlippers

Full Member
2+ Year Member
Nov 28, 2016
159
157
116
I looked at Scott Miller's site and his forms appear to be free to administer using paper and pencil for individual practitioners, it's just that you have to buy the software to do more complex evaluations of the data. But if you're that committed and that poor, could you not just enter your paper and pencil data into SAS or even Excel (it looks from the website like they're just plotting change over time) for the same result? No? Is there some more complex analysis they're doing that isn't obvious from the website?

Yeah I was totally thinking of doing that. But they seemed pretty strict on the website about absolutely not using it in electronic form without a license...and I want to respect his work and the copyright. But you make a great point, maybe i'll shoot him an email and ask.

Also, do you use David Burns Brief Symptom Questionnaire also or just the therapist feedback form? Do you use it every session with clients or less frequently? Sorry for all the questions, ive been on an outcome tracking binge lately and desperate for info lol
 
Upvote 0

FreudianSlippers

Full Member
2+ Year Member
Nov 28, 2016
159
157
116
First off, kudos to you for taking outcome monitoring and feedback seriously. It is an attitude that's pretty rare in private practice. What alternatives have you tried?

MyOutcomes is $228 per year for unlimited use. That doesn't seem that expensive, especially if you feel like you're "flying blind" without it.

Thanks for the positive feedback MamaPhD :biglove: Now i'm using the DASS-21 (which I have not found helpful), and for my OCD clients I use the OCI-R. For feedback I check in verbally, but I know it would be better to have it standardized. Perhaps the 228 would be worth it..I found a measure used in the UK called the CORE-OM which is free and has 32 items, and a brief version that has 10 items. Maybe i'll try that first
 
Upvote 0
Nov 18, 1999
2,035
1,483
376
  1. Attending Physician
Yeah I was totally thinking of doing that. But they seemed pretty strict on the website about absolutely not using it in electronic form without a license...and I want to respect his work and the copyright. But you make a great point, maybe i'll shoot him an email and ask.

Also, do you use David Burns Brief Symptom Questionnaire also or just the therapist feedback form? Do you use it every session with clients or less frequently? Sorry for all the questions, ive been on an outcome tracking binge lately and desperate for info lol

I do use both a symptom eval and a therapist eval in every session when I do psychotherapy. I don't use the intake Symptom Questionnaire because my regular intakes have a pretty full structured review of psych symptoms and I find it more valuable to get that information face to face. Also my current clinic has a huge wad of useless paper they have to fill out anyway and I don't want to add to that burden.

I used to use the Brief Mood Survey (not the Symptom Questionnaire) at each visit in the past but honestly I didn't find it so much more useful than other types of symptom questionnaires. Our clinic went to a model where everyone got PHQ9/GAD7 automatically before the visit and symptoms over time were centrally tracked and charted, so after that happened I stopped using the Brief Mood Survey because it seemed redundant.

I never found a therapist eval I liked as much as the Burns one though. Besides asking about the therapeutic alliance, it has these very clever questions that ask whether the person would feel uncomfortable criticizing the therapist, which are kind of a check on the validity of the more straightforward questions about the alliance and the utility of the work, intention to do HW etc. I have even had patients comment on the value of those items, and if I ever see high scores on those items it's a huge sign pointing directly to Change the Focus, which invariably has a major positive impact on the direction of the work.
 
  • Like
Reactions: 3 users
Upvote 0

FreudianSlippers

Full Member
2+ Year Member
Nov 28, 2016
159
157
116
I never found a therapist eval I liked as much as the Burns one though. Besides asking about the therapeutic alliance, it has these very clever questions that ask whether the person would feel uncomfortable criticizing the therapist, which are kind of a check on the validity of the more straightforward questions about the alliance and the utility of the work, intention to do HW etc. I have even had patients comment on the value of those items, and if I ever see high scores on those items it's a huge sign pointing directly to Change the Focus, which invariably has a major positive impact on the direction of the work.

Interesting...thanks for sharing your experience. Can I asked 2 quick follow-ups?
1. Do you give the Burns alliance questionnaire after every session, or just once in a while?
2. I'm assuming you process it with clients? I've heard Burns talk about how he just has clients fill it out after session and discusses it next session, but it feels like it would be better to talk about it then and there.
 
Upvote 0
Nov 18, 1999
2,035
1,483
376
  1. Attending Physician
1) yes therapist eval at every session. Even when we have a good alliance, sometimes I might say something that just lands wrong or implies something I didn't mean, and even though I might not have noticed it all, internally the patient may be ruminating over it. This usually shows up in the session eval and it's good to address it quickly so it doesn't poison the work.

2) I agree it would make sense to discuss immediately but it's just not logistically feasible. I usually start the next session by saying I've noticed some concerns about the efficacy of our work together and I wanted to discuss those to make sure that what we are doing is helpful to you, etc.
 
  • Like
Reactions: 2 users
Upvote 0
Nov 18, 1999
2,035
1,483
376
  1. Attending Physician
At the risk of igniting another firestorm, I am interested to observe that everyone on this thread seems to agree that data-informed psychotherapy is a good thing. Which is great!

This is quite at odds with the reception I received recently on a different thread, where when I mentioned that I worked in this way, several posters immediately jumped in to say that my measures were invalid, my approach was creating social pressures on patients to report improvement, my patients were probably lying on their forms, I was using a thermometer to measure climate change, etc.


Can anyone explain this? Was it just an irritated reaction to my immodestly made claim of being a good therapist? Or is the idea of data-informed psychotherapy (or ROM/FIT or whatever the whippersnappers are calling it these days) truly still so controversial?
 
Upvote 0

FreudianSlippers

Full Member
2+ Year Member
Nov 28, 2016
159
157
116
This is quite at odds with the reception I received recently on a different thread, where when I mentioned that I worked in this way, several posters immediately jumped in to say that my measures were invalid, my approach was creating social pressures on patients to report improvement, my patients were probably lying on their forms, I was using a thermometer to measure climate change, etc.

God....people can be so ****ing ignorant. You triggered me tr! Now i'm going to get on my soap box...hang tight. In this day and age it seems like anybody can say anything based on their experience rather than hard, scientific data. Let's look at what we know shall we (i'm not going to cite these studies due to laziness, but a 2 second google scholar search will answer any questions:
1. Therapists of all backgrounds are horrible at intuiting how their clients are feeling/doing
2. Almost all therapists consider themselves well above average
3. Therapists do NOT get better after about 1 year of practicing (due to lack of "deliberate practice...again see Scott Miller, Wampold, and Daryl Chow...to practice deliberate you need immediate and consistent fee
4. It's widely accepted that ROM and FIT both improve outcomes and prevent deterioration.

Now..i've tried having this covo with colleagues I really admire who are total naysayers. Its so frustrating. I think...as a matter of my values...i'm going to start coming down harder on people from now on....errrr I mean informing them of the relevant status of empirical data :laugh:
 
  • Like
Reactions: 3 users
Upvote 0

thebalmofhurtminds

Full Member
Nov 18, 2019
228
327
66
  1. Psychologist
I think we may be missing some context from the prior thread. From my interpretation, the above mentioned previous post was referring pretty specifically to a complaint about the VA and their supposed emphasis on "measurement based care." I won't go into the details, but most people who have worked at the VA have experienced what is predominately an arbitrary and politically-motivated so-called emphasis on measurement-based care, which essentially boils down to throwing a PHQ-9 at everyone and acting like that provides a full picture.
 
  • Like
Reactions: 7 users
Upvote 0

beginner2011

Beginner's Mind
10+ Year Member
Apr 13, 2011
467
534
266
  1. Post Doc
Curious where you landed on this @FreudianSlippers
Did you end up purchasing a license or decide to do something else?
I like the David Burns Brief Mood Survey and Evaluation of Therapy Session, but it looks like it'll cost ~$300.
It looks like Scott Miller's measures are ~$200 per year.

Neither would break the bank, but I'm curious what others have decided to do.
 
Upvote 0
Nov 18, 1999
2,035
1,483
376
  1. Attending Physician
Not the OP but one of the clinics I work in has started using this and it's great. It's stunningly cheap ($5/month), they will add any measure you like to their options, and it is very easy to look at trends over time and download as .csv for more complex analyses.

 
  • Like
  • Love
Reactions: 5 users
Upvote 0
About the Ads

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.