“Why don’t more therapists do FIT?” a grad student asked me during a recent consultation. Seated nearby in the room were department managers, supervisors, and many experienced practitioners.
“Well,” I said, queuing up my usual, diplomatic answer, “Feedback informed treatment is a relatively new idea, and the number of therapists doing it is growing.”
Unpersuaded, the student persisted, “Yeah, but with research showing such positive results, seems like ethically everyone should be doing FIT. What’s all the hesitance about?”
What’s that old expression? Out of the mouths of babes . . .
Truth is, a large, just released study showed FIT — specifically, the routine monitoring of outcome and relationship with the Outcome and Session Rating Scales — improved effectiveness by 25% over and above usual treatment services (1).
In a second, pilot study conducted in a forensic psychiatric setting, use of the ORS and SRS dramatically reduced dropout rates (2).
What other clinical practice/technique can claim similar impacts on outcome and retention in mental health services?
Needless to say, perhaps, the student’s comments were more pointed. Use of FIT at the agency was decidedly uneven. Despite being a “clinical standard” for more than two years, many on staff — practitioners and supervisors alike — were not using the tools, or had started and then, just as quickly, stopped.
Here’s where the recent study might offer some help. The impact of FIT notwithstanding, researchers Bram Bovendeerd and colleagues found its use in routine practice was easily derailed. In their own words, they observe “implementation is challenging … and requires a careful plan of action.”
Even then, fate can intervene.
In their next paper, they describe how, even when organizational culture is receptive to FIT, contextual variables can get in the way. At one clinic, for example, it was the unexpected illness of a key staff member leaving everyone else to take up the slack. Curiously, when asked to explain the decline in use of the measures that followed, the therapists did not cite the increase in workload. Rather, in what appears to be a classic example of attempting to reduce cognitive dissonance — we know using the measures work, but we’re not doing it anyway — they developed and expressed doubts about the validity of the measures! Anyway, loads more interesting insights in the interview (below) I did with the lead researcher not long ago.
We’ll be addressing these and other implementation challenges at the next FIT Implementation coming up in August. Registration is open. Generally, the training sells out a month or more in advance. Click here for more information or to register.
Until next time, please share your thoughts in a comment.
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence