July 2024 Clinical Supervision Topic: Therapist Effect

See our previous years here.

Therapist effect is the part of the research that is unknown, it seems, but it basically says that we know that therapy is different based on the clinician. Seems pretty straightforward, right? But how do you enhance your therapist effect? Besides becoming proficient with the common factors, what else can you do?

Let’s explore this together. What are you curious and passionate about in your work? What elements of it excite you or pique your interest? What are you experimenting with? What are you hoping to bring to your clients?

For me, I’ve been thinking more about:

• humor in clinical practice

• self-disclosure as it relates to what I’m feeling on a somatic level in response to my clients’ experiences

• and always, the practice of self-compassion both for the practitioner and the client.

Looking forward to hearing your ideas!

April 2022 Clinical Supervision Topic: Unconditional Positive Regard

Hey! Glad you are here.

Have you ever known someone who just seemed to adore you? Who held a big space for you to exist in? I’ll be honest, my golden retriever Annie is a pro at this.

Carl Rogers popularized the term unconditional positive regard, and he really believed that with this (in addition to five other necessary and sufficient conditions) in place, a person could fully self-actualize.

My sense of unconditional positive regard is that it is this beautiful emphasis on acceptance, on coming home to yourself, on permission to exist, to let go of any rejecting, judgmental messages. In some ways, it’s an invitation to let go and be loved or at least held safely, and by doing so, return to the truest self. As a clinician, providing this space for clients is, of course, an ongoing practice.

A few resources I like that I feel embody this concept include:

• The Kind Eyes exercise from Diane Poole Heller’s DARE work.

• Sonya Renee Taylor on body image and acceptance.

• Resmaa Menakem and contextualizing trauma, especially racialized trauma.

Check out our discussions on this topic from 2020 and 2021. Please feel free to bring your own resources to share around this!

Sept 2021 Clinical Supervision Topic: Eliciting Feedback

Eliciting feedback is so closely related to the therapeutic relationship. Why?

First, let’s talk about the therapeutic relationship. You already know it’s one of the best predictors of progress. In this article (which I highly recommend), they note that:

• 54% of the variance of outcomes in therapy can be tied directly to the relationship

• Client change is due to the relationship 7x more than it is due to any specific therapeutic modality.

• client ratings (not the therapist’s!) of the relationship are better predictors of outcomes.

• clients who express even low levels of disagreement/dissatisfaction with their therapist have better progress and relationship.

So what does the article add to this conversation?

Again, the therapeutic relationship is QUEEN. And, our assessment of it doesn’t matter as much as our client’s. The article also notes that relationships in which a therapist has access to client’s opinions on outcome and alliance are less likely to deteriorate, more likely to last longer, and 2x as likely to reach clinically significant outcomes for the client.

So what do we elicit feedback on? How do we get access to the client’s take on things? How do we get that negative feedback? I first learned some of these skills from one of my clinical mentors, Susie Snyder, LCSW. Here are a few of her handouts that are basically gold. [Handout 1, Handout 2]. Best practices include eliciting feedback regularly in a way that feels authentic and organic to you and your client.

Some examples:

How’s our relationship feel for you? (do they feel heard, understood, respected)

How confident are you that therapy will help you change?

How certain are you that I will be helpful to you?

Did we talk about what you wanted to today? What did we miss?

Where am I understanding you most/least?

Which parts of my approach are a good fit for you? Which parts are neutral or even a bit negative?

Where do we agree on how change will happen for you?

What are our shared goals here?

Bottom line: When we’re eliciting feedback, we’re not effing around. We’re ensuring our clients reach their goals of establishing safe and stable housing, connecting more with their truest self, experience sobriety or stability, deepen healing, find liberation or whatever other life-changing experiences they are seeking.

August Clinical Supervision Group Topic: Eliciting Feedback from Clients

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Hi All!

This month in our clinical supervision groups we’ll be learning about how to elicit feedback from the wonderful people we serve. Why does this matter? The process of eliciting feedback actually leads to greater clinical outcomes. Clients are happier, and more likely to reach their goals. Eliciting feedback leads to a greater alliance between client and clinician, and the therapeutic alliance contributes to at least 50% of the quality of your intervention outcomes. In fact, alliance is a stronger predictor of outcomes than any single therapeutic modality. (If you’re interested in learning about alliance, check out Scott Miller’s website as he is one of the leading researchers on this topic.) You may be nervous about eliciting feedback, for fear you may receive negative information. Be comforted by the fact that when clients share some degree of negative feedback with you, it will actually lead to -you guessed it- greater clinical outcomes as well.

I’ll be bringing handouts on specific clinical tools you can use in session. Handouts were created by my very own clinical supervisor Susie Snyder, LCSW- one of the most skilled social workers and clinicians in Portland- who has kindly agreed to let me share them with all of you. Be sure to read our article for this month here. You’ll see the Session Rating Scale at the bottom; consider how this would work in your particular setting and with your specific population. I’ll be curious to hear about how you’ve effectively elicited feedback, as well as how you’d like to do it going forward!

Send any questions my way in the comment sections or by phone or email (arianalloydlcsw@gmail.com).