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Counseling Outcomes

Counseling Outcomes. Achieving Success with Clients. Abuse/Addiction Mental Health Issues Depression Anxiety Sleep Disorders Sexual Issues Cognitive Problems Eating Disorders Personality Disorders Psychotic Disorders. Career Development Crisis Intervention Stress

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Counseling Outcomes

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  1. Counseling Outcomes Achieving Success with Clients

  2. 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 Why do people seek counseling?

  3. The problem… is not always the problem.

  4. Linking Process to Outcomes Process Outcomes

  5. 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

  6. 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

  7. 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

  8. Process Process Outcomes

  9. Tools of Therapy • Relationship skills • Activation of the patient’s observing self • Knowledge of basic patterns of psychological difficulties • Inductive reasoning • Persuasion Bernard Beitman (1997) Psychiatric Times, VOL. XIV, Issue 4

  10. 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.

  11. 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

  12. 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 don’t smoke • Self Liberation (Committing) I make commitments not to smoke

  13. Process Outcomes Outcomes

  14. 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

  15. Other effects including client differences Specific effects due to the specific ingredients of a given therapy What Influences Outcome? General effects due to factors common to all therapies 22% 70% 8% Wampold, BE (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. Mahway, NJ: Lawrence Erlbaum Associates.

  16. What really matters…

  17. Hope and Expectancy 1. Therapist credibility 2. Client-model fit 3. Future focus Extratherapeutic Factors 1. Client factors 2. Chance events 15% 40% 15% Model and Technique 1. Structure/focus 2. Extra-therapeutic focus 3. Encourage responsibility 4. Empowerment/self-efficacy 5. Novelty 30% Relationship Factors 1. Client participation 2. Therapeutic alliance 3. Collaboration (vs. dictation) 40 Years of Outcome Data www.talkingcure.com

  18. Focusing • Eugene Gendlin • 1978

  19. 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

  20. Six Steps to Focusing • Clearing a space • Felt sense • Handle • Resonating • Asking • Receiving

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

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