Take a look at the graphic to the left.  It shows the use of the Outcome and Session Rating Scales (ORS & SRS) from the beginning of this year to the present by users of one of the three , authorized FIT software programs.

What do you see?

A couple of things stand out for me.  First, a steady rise in administrations of the tools beginning in late January and continuing to the third week of March when use significantly dropped.  You can literally “see” the pandemic coming.  In the weeks and months that followed, use of the measures steadily recovered and is, as of today, up nearly 30% over its record high in the weeks before virus mitigation efforts brought the world to a standstill.

The cause of the rise in online use of the ORS and SRS is no mystery.  The number of therapists seeing clients virtually has, virtually, exploded.  In this “brave new world” of clinical practice, its clear clinicians are looking for concrete, evidence-based ways to augment the two-dimensional sensory input (sight and sound) characteristic of video conferencing.

In a previous blog, I summarized the research on the effectiveness of online behavioral health services.  The data are clear: it works.  More, a brand new meta-analysis, released just this week, adds to the body of evidence documenting that being physically present is not essential for successful outcomes.

The ORS and SRS are particularly well suited for online service delivery.   Indeed, the original validation studies of the two scales were actually conducted in a teletherapy setting.  It was the era before high-speed broadband and Zoom.  Therapists spoke with their clients by landline, administering the measures orally using a standardized script.  Since those early days, scores of studies have documented the impact of routinely soliciting formal client feedback on both outcome and retention in behavioral health services.  In one recent study, clients of therapists using the ORS and SRS were 2.5 times more likely to experience a successful outcome.  Using standardized measures as part of service delivery is now considered a “standard of care” by Joint Commission and SAMHSA.  Next year, the State of California follows suit, allowing psychologists to use the tools to earn required continuing education credits (see top of page 4, under “Practice Outome Monitoring [POM]”).

If you don’t have copies, you can get them for free here.   Looking for detailed instructions and “how to” videos on integrating the ORS and SRS into online services, click here — all free.

It’s rarely good news when the phone rings in the wee hours of the morning.  This time, it was a colleague calling to let me know that Rich Simon — the founder and editor of the Psychotherapy Networker and long time friend — had died.

To say the news came as a shock would be a gross understatement.  In the early 1990’s, I sent an unsolicited article to the magazine for consideration.  Rich called me saying he liked the piece and wanted, with some minor revisions, to publish it.  After that, we began talking regularly by phone.  Sometimes the calls were brief.  Others went on for several hours spread out over days and weeks.

How best to describe Rich?  He was insatiably and infectiously curious, always hunting for whatever might improve the reach and effectiveness of psychotherapy.  I can hear his warm, distinct voice in my head right now, “Hey buddy,” he always started our conversations, quickly cutting to, “So, what you working on?”  And then, he’d listen, intently, following up with questions and a gentle challenge or two.  Throughout, it was clear Rich cared — about ideas, the field, people, and me.  I always left our conversations feeling as though I mattered, that I was contributing something vital and important to the field.  In the days since his death, I’ve learned I was not unique.  In fact, everyone I’ve spoken with said they had the same experience.  As one put it, “Rich had this uncanny ability to make you feel like you were his favorite.”

Our last conversation took place just a few weeks ago.  He called to thank me and my co-authors, Mark Hubble and Birgit Valla, for the article we’d written for the latest issue of the magazine.  None of us could imagine then what we would be experiencing now when we titled the piece, “Braving the Unknown.”  At this moment, I don’t have the words to describe what life will be like without him, without his dedication to, and genius in, bringing together the best ideas about the helping profession in one place.

If you never had a chance to meet Rich, or simply want to relive a few moments of his charm and wit, watch the memorial video below.

Here is a smattering of the articles I wrote for Rich over the last 30 years:

Braving the Unknown: The Search for New Solutions (September/October 2020)

Meet You in McGinnis Meadows (January/February 2020)

How Psychotherapy Lost its Magic: Healing in the Age of Science (March/April 2017)

Burnout Reconsidered (May/June 2015)

The Road to Mastery (2011)

Supershrinks: Learning from the field’s most effective practitioners (November/December, 2007)

How Being Bad Can Make your Better (2007)

Exposing the Mythmakers: How the soft sell has replaced hard science (2000)

Their Verdict is Key (1999)

No More Bells and Whistles (1995)

The Resistant Substance Abuser: Court Mandated Cases can Pose Special Problems (1992)

Eighty three million, six hundred fifty thousand, thirty seven.

Can you guess what this number represents?

No, its not the net worth of the latest tech millionaire.  Neither is it the budget of a soon-to-be released Hollywood blockbuster.

Guess again.

Give up?

It’s the number of adults in the U.S. who reported struggling with mental health or substance use resulting from efforts to mitigate the SARS-COV-2 virus.

By the way, that figure is from the last week in June, three months ago.  Since then, the isolation, job losses, and economic and political uncertainty and social unrest have continued.

According to the Center for Disease Control, “Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use, and elevated suicidal ideation,” with a staggering 25% of 18-24 year-olds having seriously contemplated suicide in the weeks prior to completing the survey.

One glimmer of hope amidst these dire statistics is that access to mental health care has expanded during the pandemic.  In March, U.S. government agencies expanded Medicaid telehealth coverage.  In turn, the U.S. Department of Health and Human Services relaxed HIPPA privacy rules, further reducing barriers to accessing treatment remotely.  Many third party payers have followed suit.  As it is, the dramatic increase in those seeking mental health care and shift to virtual service delivery fit squarely with the theme of this year’s World Mental Health Day.  Falling on Saturday, October 10th, it calls for “ensur[ing] that everyone, everywhere has access to mental health care.”

Of course, increased demand and easier access to care are placing a strain on therapists.  As one recent story noted, “Therapists and counselors are facing the same anxiety, uncertainty and financial stress that are troubling those who seek their services.”  The risk of a “parallel pandemic” of burnout is, according to recent studies, rising.  Consider this, prior to the outbreak, available evidence indicated between 21 and 67 percent already were experiencing high levels.

Not long ago, my colleague Mark Hubble and I reviewed the research on the subject noting that most of currently fashionable approaches (e.g., practice mindfulness meditation, eat healthy snacks, go for short walks, exercise regularly, get enough sleep, join a service organization, take up a hobby, attend a continuing education event, learn to say no, see a therapist, and take time out to value oneself) not only don’t work but often make matters worse.

What does work?

I hope you’ll read (or re-read) the article.  It’s free and provides a detailed review.  That said, all things being equal, one key finding is that effectiveness mitigates risk.  Said another way, the better a therapist’s results, the less likely they are to burnout.  The challenge, particularly in these troubled times, is that we care. People matter to us. We want to make a difference.  In this effort, we place ourselves at risk whenever what we’re there to accomplish takes a back seat to the caring, empathy, and compassion we provide, no matter how lovingly extended.

Bottom line: keep outcome front and center in your work.  After all, genuinely and demonstrably helping people improve is the entire point of therapy and, in the end, the best of all ways to show that we really, deeply care.  One way to do that, of course, is to measure your results.  If you haven’t already done so, you can get my two, evidence-based progress and relationship scales for free by clicking here.  If you need some help learning how to integrate the tools into your online work, check out the many blogposts, how-to videos, and webinars my colleagues and I have produced since the start of the outbreak (1, 2, 3, 4)– again, all free.

If you are looking for a way to improve your effectiveness, my colleague and co-author, Daryl Chow, have launched a self-paced, e-learning workshop on deliberate practice, based on our new book, Better Results.   Every Monday and Friday for nearly three months, you’ll receive links to brief videos and other goodies aimed at helping you design and execute your own deliberate practice plan.  To ensure you get the individualized help you need, its limited to 40 participants.  Interested?  Click here to watch a short, introductory video.