Academic journal article Canadian Psychology

Cautionary Notes on Power Steering for Psychotherapy

Academic journal article Canadian Psychology

Cautionary Notes on Power Steering for Psychotherapy

Article excerpt

Power steering enables the driver to turn the steering wheels in contact with the road not just with his or her own strength applied to the steering wheel but with extra power from the engine which moves the wheels to where the steering wheel says the driver wants them. Applying this principle to psychological therapies is a new area that is developing fast and showing interesting potential. This has obvious appeal for therapy commissioners and researchers, particularly in financial recession as it appears to provide a very low cost route to high volume data collection, improved outcomes and shortened therapies. This article argues that these methods need to be evaluated more carefully to avoid problems seen when the physical health field used proxy outcome measures and sought zealous control and normalization through use of measurement and corrective action. The article suggests mat psychotherapy and psychotherapy research methods are bound up with social, political and technical change that have unintended direct consequences and wider sociopolitical ramifications than intended. The author argues that development of servo-control methods in psychological therapies must be tempered by consideration of their compatibility with therapy theories and practices and with research methods and theories and seen as part of a host of complementary and interwoven paradigms in our field, not as a dominant new paradigm used to denigrate and disenfranchise work that does not fit with a rationalist Zeitgeist. Finally, this article argues that practitioners, and particularly trainers and trainees, need to be very careful that the uniqueness of the individual, and of every single client-therapist relationship, is not sidelined by a reassuring focus on the score data that replaces attention to the feelings and challenges of empathy.

Keywords: progress tracking, CORE system, progress monitoring, psychotherapy, assessment

This issue of Canadian Psychology is devoted to the very important new development in which psychotherapists use information from client self-report measures to provide a servo-control mechanism to help the psychotherapies. I believe that this can be genuinely useful for appropriate tiierapies. However, I suggest diat, as with many well-intended developments, we must beware problems. I first spell out the extent to which change in this area is shaped by - but also shapes - sociopolitical currents, and then spell out concerns in relation to specific areas: routine clinical work; training of therapists; and research, bodi empirical and theory related.

My own interest in self-report outcome measures is shaped by my enthusiastic involvement over the last 18 years in coaudioring and the continued development of the CORE system: Clinical Outcomes in Routine Evaluation (inter alia, Barkham et al., 1998; Evans et al., 2000; Gray & Mellor-Clark, 2007). The CORE system is one of those associated with this servo-control approach to psychotherapy and rightly so: we originally built two short forms, the CORE-SFA and CORE-SFB, into the system for session by session measurement of change. However, I have substantial concerns about too uncritical an acceptance of power steering for psychotherapy. This article approaches these concerns partly through discussion of the CORE system. A great strength of the CORE system has been mat the original authors, and now the CORE System Trust that holds the copyright on the measures, have always been a diverse group and have tolerated and gained from diverse views; it should be understood that what follows is a personal view and is not representative of the view of anyone else involved with the CORE system.

The CORE System

The CORE system was launched in 1998 and comprised a small set of instruments designed to provide a minimal common set of tools to help therapists measure change across a wide diversity of therapies and to be acceptable to clients, practitioners, and commissioners as a useful but always approximate index of change. …

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