Counseling Outcomes

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Counseling Outcomes

• Achieving Success with Clients

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Why do people seek counseling?

• Abuse/Addiction
• Mental Health Issues
• Depression
• Anxiety
• Sleep Disorders
• Sexual Issues
• Cognitive Problems
• Eating Disorders
• Personality Disorders
• Psychotic Disorders

• Career Development
• Crisis Intervention
• Stress
• Athletic performance
• Relationship Issues
• Death/Grief Issues
• School/Educational problems
• Developmental Issues

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The problem
is not always the problem.
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Linking Process to Outcomes
Outcomes
Process
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Why are outcomes important?

• Provide evidence that therapy is beneficial and
  is working
• Guide therapy process
• Increasingly being required by payees
• Can assist in seeking additional funding
• Competitive advantage

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Examples of outcomes?

• Days abstinent from substance abuse
• Number of continuous days without hospitalization
  (psychotic or bipolar patient)
• Employment
• Developmental maturity
• Homeless to having housing
• Measures QOL, OQ45, SCL-90, BDI

Measurable, Time-Bounded, Reasonable
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Goals of Most Therapy Relationships are Linked
to Outcomes

• Crisis stabilization
• Symptom reduction
• Long-term pattern change
• Maintenance of change, stabilization, prevention
  of relapse
• Self-exploration
• Development of coping strategies to handle future
  problems

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Process
Process
Outcomes
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Tools of Therapy

• Relationship skills
• Activation of the patients observing self
• Knowledge of basic patterns of psychological
  difficulties
• Inductive reasoning
• Persuasion

Bernard Beitman (1997) Psychiatric Times, VOL.
XIV, Issue 4
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Processes of Change

• Covert and overt activities that people use to
  progress through the stages of change.
• Ten processes have received the most empirical
  support.
• First five are classified as experiential
  processes and used for the early stage
  transitions. The last five are labeled behavioral
  processes and used in the later stages.

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Experiential Processes

• Consciousness Raising (Increasing awareness)
• I recall information people had given me on how
  to stop smoking
• Dramatic Relief (Emotional arousal)
• I react emotionally to warnings about smoking
• Environmental Reevaluation (Social reappraisal)
• I consider the view that smoking can be harmful
  to
• the environment
• Social Liberation (Environmental opportunities)
• I find society changing in ways that make it
  easier
• for the nonsmoker
• Self Reevaluation (Self reappraisal)
• My dependency on cigarettes makes me feel
  disappointed in myself

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Behavioral Processes

• Stimulus Control (Re-engineering)
• I remove things from my home that remind me of
  smoking
• Helping Relationships (Supporting)
• I have someone who listens when I need to talk
  about my smoking
• Counter Conditioning (Substituting)
• I find that doing other things with my hands is
  a good substitute for smoking
• Reinforcement Management (Rewarding)
• I reward myself when I dont smoke
• Self Liberation (Committing)
• I make commitments not to smoke

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Process
Outcomes
Outcomes
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Major Patient Outcome Variables

• Client readiness to change
• Symptom type, severity and chronicity
• Strength of the working alliance
• Number of sessions
• Patient strengths/limitations
• Patient courage

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What Influences Outcome?
General effects due to factors common to
all therapies
22
70
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Wampold, BE (2001). The Great Psychotherapy
Debate Models, Methods, and Findings. Mahway,
NJ Lawrence Erlbaum Associates.
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What really matters
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40 Years of Outcome Data
www.talkingcure.com
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Focusing

• Eugene Gendlin
• 1978

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What is Focusing?

• Mode of inward bodily attention
• Occurs exactly at the interface of body-mind
• Specific steps for getting a body sense of how
  you are in a particular life situation
• Body sense is unclear at first, but eventually a
  felt shift in the body will occur
• Over 100 research studies showing the six steps
  are teachable

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Six Steps to Focusing

• Clearing a space
• Felt sense
• Handle
• Resonating
• Asking
• Receiving

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Final Thought In once-weekly therapy, there are
167 hours outside of the therapists office.