Eight years ago, I was in Calgary, Alberta Canada, listening to psychologist Wolfgang Lutz talk about his research on using feedback in therapy. Others, including myself, had already presented data documenting the benefits of feedback-informed treatment (FIT), including lower dropout rates and improved outcomes. Dr. Lutz agreed, but was focused elsewhere.
Then, as now, studies of FIT have been limited to comparing groups of clinicians. Typically, that means some are assigned to a feedback condition (i.e., using measures of engagement and progress), others to providing “treatment as usual.” So far, so good. Except, such designs, while useful for documenting a general effect, tell us nothing about why an intervention works or the impact of the individuals involved. And there was reason for concern –overall, results of studies on feedback were highly variable — ranging from zero to absolutely mind blowing effects.
One reason? Apparently, like our clients, we helping professionals have a hard time changing our minds and behavior — even when the data indicate what we think and how we are acting is either not helping or making matters worse! Dr. Lutz provided the evidence. In his study, when feedback showed an individual was deteriorating in their care, therapists endorsed:
- Discussing it directly with the client less 60% of the time
- Adjusting their therapeutic approach or assisted with resources 30% of the time
- Working to improve the therapeutic relationship less than 10% of the time
- Seeking additional sources of help (e.g., supervision, literature review, continuing education) roughly 5%
Many of us, it seems, are not swayed by … evidence!
(I know, I know, not you or me. Others! What’s wrong with them anyway?)
Seriously though, I was reminded of Dr. Lutz’s results when I came across a study described in a recent Facebook post by NYU Professor Jay Van Bavel. The good news, according to this research, is people are capable of updating their beliefs in light of new evidence. More, doing so, frequently serves to improve performance.
The bad news?
The more that changing our mind conflicts with our “identity” — our core self or values — the greater the tendency is to devalue rather than accommodate new evidence, ultimately leaving us where we were before: status quo. So, a client calls to reschedule an appointment citing a conflict with another obligation (e.g., work, childcare). No conflict with our identity as compassionate, understanding mental health care professionals. Easy peasy. However, when their feedback on a rating of the therapeutic relationship (e.g., Session Rating Scale) indicates they find you less understanding and empathic than you believe yourself to be? MUCH MORE CHALLENGING. In the first instance, we reach for our appointment book; the latter . . . the DSM.
Dr. Van Bavel has been investigating the conflict between evidence and identity for a number of years, documenting the life-threatening consequences that can result when the latter dominates the former. In his new book, The Power of US, he not only writes about this problem but offers detailed, evidence-based solutions. Given the findings cited above, I think his work is vital for mental health professionals. Check out the interview below and let me know your thoughts.
Until next time,
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
P.S.: Registration is now open for the 2023 Online Feedback Informed Treatment Intensive! Click the icon below for more information or to register: