Description: Clinical Psychologists who are involved in providing therapy to people have a number of ethical standards to which they must adhere (you can download the Canadian Psychological Association Code of Ethics here: https://www.cpa.ca/docs/File/Ethics/CPA_Code_2017_4thEd.pdf) . One of those standards states that practicing psychologist should “Strive to provide and/or obtain the best reasonably accessible service for those seeking psychological services. (paragraph II.18)” Adherence to this part of the ethics code involves assuring that one stays critically informed about the current research looking at therapy approaches, practices, techniques, and outcomes. Basically, being up to date on what works in therapy. Related to this, psychologists are to monitor the effects of their interactions with clients. Basically, so they can see if what they are doing with each of their individual clients is helping make things better for the client. So, how should they do this do you think? It is certainly true that monitoring their client’s psychological processes and progress are core part of the therapeutic connection. However, should individuals in therapy be monitored using status and outcome measures on a regular basis? It has been suggested that a such monitoring (using at least somewhat objective means) will be a prerequisite for the inclusion of psychological therapy as a service within the general health care system in Canada. Sound reasonable? Would it surprise you to hear that such routine status and outcome assessments (think of them as like vital signs such as heart rate, blood pressure or blood sugar levels) are not used by most practicing clinical psychologists? Think about why that might be and think a bit about how this would be measured and then read the article linked below to fond out about British experiences with these questions and about how they may be spreading across Canada.
Source: Rethinking therapy: How 45 questions can revolutionize mental health care in Canada, Erin Anderssen, The Globe and Mail
Date: April 7, 2018
Photo Credit: Ming Wong/The Globe and Mail
While the idea of monitoring psychotherapeutic “vital signs” may seem obvious, straightforward, and desirable some of the concerns raised about the rudimentary and perhaps generic nature of such status and outcome screens are worth thinking hard about. On the other hand, a commitment to regular monitoring of client status and outcomes as a check on the efficacy of therapy is also worth thinking hard about. The observation that it took physician 200 years to incorporate systematic use of the thermometer into their practice is frankly somewhat alarming. At least clinical psychologists have an ethical commitment to staying up to date with current research on therapeutic practice, technique, and client status and outcomes so it is unlikely to take 200 years for these questions about the potential universal use of status and outcome measures to be resolved.
Questions for Discussion:
- How to clinical psychologists know if their clients’ issues and symptoms are improving, staying the same or getting worse?
- What are some of the advantages and disadvantages of the efficacy monitoring strategies you noted above?
- Should clinical psychologists be required to regularly assess the status and outcomes of their therapy clients? Should this be viewed as an issue in practice ethics or as a matter of health care system policy?
References (Read Further):
Davey, Graham C.L. (2014) Are some psychotherapies better than others? Psychology Today, https://www.psychologytoday.com/us/blog/why-we-worry/201409/are-some-psychotherapies-better-others
Castonguay, L. G., & Hill, C. E. (2017). How and why are some therapists better than others?: Understanding therapist effects. American Psychological Association.
Clark, D. M., Canvin, L., Green, J., Layard, R., Pilling, S., & Janecka, M. (2017). Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. The Lancet.
Fortney, J. C., Unützer, J., Wrenn, G., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2016). A tipping point for measurement-based care. Psychiatric Services, 68(2), 179-188.
Walfish, S., McAlister, B., O’donnell, P., & Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110(2), 639-644. http://clinica.ispa.pt/ficheiros/areas_utilizador/user11/43._an_investigation_of_self-assessment_bias.pdf