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Utilizing Patient Feedback (and Therapist Civility) to Improve Psychotherapy Outcome. Dan Buccino JHBMC JHUSOM BPI June 27, 2006. Civility and Healthcare. Through the 20 th Century, science has opened the body. Into the 21 st Century, civility will reopen the person.

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utilizing patient feedback and therapist civility to improve psychotherapy outcome

Utilizing Patient Feedback (and Therapist Civility)to Improve Psychotherapy Outcome

Dan Buccino

JHBMC

JHUSOMBPI

June 27, 2006

civility and healthcare
Civility and Healthcare
  • Through the 20th Century, science has opened the body.
  • Into the 21st Century, civility will reopen the person.
  • To do even better science.
  • Pro-civility practice and policies
civility and therapy
Civility and Therapy
  • Good therapists born not made? =
  • Good manners come from a good heart.
  • Good therapists made not born? =
  • Good heart comes from good manners.
  • Legislating civility and public health? (NYC: quality of life, tobacco, obesity)
  • Teaching and Practicing “Relational Competence.”
civility and risk
Civility and Risk
  • Good relationship with pt and family best prevention against malpractice suit, even if adverse event.
  • Injured patients 50% less likely to sue when an error was disclosed and there was an apology. (Annals Int. Med. 2004)
  • Move in OR & CO to make it illegal to use doctors’ apologies against them in court.
  • Acknowledge, apologize for outcome, not necessarily take blame.
osler s golden rule
Osler’s Golden Rule
  • “Alter the Golden Rule: What you do not like when done to yourself, do not do to others.”

- Sir William Osler, JHUSOM

  • “Others bruise as easily as we do.”
one step beyond the golden rule
One Step Beyond the Golden Rule!
  • Think first of others’ (comfort and convenience).
  • If not OK for others, don’t insist.
  • Restrain Yourself!
  • “presenteeism”
slide12

Updating the Wheel:

Recent Research

  • Treatment:
  • 60% due to “Alliance” and Relationship (“common factors”:
  • 8% of 13%)
  • 30% due to “Allegiance” Factors (4/13%)
  • 8% due to model and technique (1/13%)
  • Extra-therapeutic

Wampold, B. (2001). The Great Psychotherapy Debate. New York: Lawrence Erlbaum.

slide13

Relationship Factors

  • The Therapeutic Alliance:
    • Agreement on goals;
    • Agreement on tasks;
    • “Rogerian” core conditions.

60 %

Hubble, M., Duncan, B., & Miller, S. (1999). The Heart and Soul of Change. Washington, D.C.: APA Press

r h p formula for success
(R+H+P) Formula for Success
  • Practitioners’ Contributions:

Relationship

Hope and a

Plan

super shrinks
Super Shrinks
  • Do better than other therapists. Period. Regardless of caseload mix, severity, training, experience, degree, etc.
          • Interpersonal facilitative skills

(civility) best.

          • Most open to feedback.
therapy effectiveness
Therapy Effectiveness
  • Super Shrinks effective with 75%.
  • Least effective with 25%.
  • Improve least effective by 65% with active, formal patient feedback (re customer satisfaction, service, and outcome).
  • Least effective can then become effective with 41% of cases.
  • All therapy works sometimes with some patients.
  • What will work with this patient and this therapist at this time?
slide17

The Outcome Rating Scale

  • Scored to the nearest millimeter.
  • Add the four scales together for the total score.
  • Client places a hash mark on the line.
  • Each line 10 cm (100 mm) in length.
slide19

The Session Rating Scale

  • Scored to the nearest millimeter.
  • Add the four scales together for the total score.
  • Client places a hash mark on the line.
  • Each line 10 cm (100 mm) in length.
jhbmc student therapist outcomes 2003 06
JHBMC Student Therapist Outcomes 2003-06
  • 9 students; passive collection of data
  • N=89 cases (n=75 ≥2 sessions)
  • Mean # sessions: 6.4
  • Mean intake ORS: 18.9
  • Mean D/C ORS: 25.1 (recovered ≥ 25 clinical cutoff)
  • Mean RCI: 6.2 (improved ≥ 5 points)
jhbmc student therapist outcomes 2003 06 cont d
JHBMC Student Therapist Outcomes 2003-06 (cont’d)
  • 48% improved (RCI ≥5) (36/75)
  • 59% recovered (D/C ORS ≥25) (44/75)
  • 86% of improved also recovered (31/36)
  • Preliminary data 6/26/06
  • Progress comes quickly. Tx is beginning of end.
  • Deterioration comes over time.
jhbmc student therapist outcomes 2003 06 cont d1
JHBMC Student Therapist Outcomes 2003-06 (cont’d)
  • Mean RCI with intake ORS < 25 (clinical cutoff) (72%, 54/75) : 9.7 (cf. 6.2)
  • More symptomatic populations improve more in tx.
  • 61% (33/54) improve.
  • 50% (27/54) recover.
  • Big improvements even without complete recovery.
  • Therapy works!
jhbmc student therapist patient satisfaction 2003 06
JHBMC Student Therapist Patient Satisfaction 2003-06
  • 9 students; passive collection of data
  • N=89 cases (n=75 ≥ 2 sessions)
  • Mean # sessions: 6.4
  • Mean intake SRS: 34
  • Mean D/C SRS: 35.6
  • Preliminary data 6/26/06
thank you
Thank You!

Questions, comments, concerns?

Dan Buccino

410.550.0105

DBuccino@jhmi.edu

counterintuitive civility
Counterintuitive Civility
  • It may be simple, but it’s not easy.
  • Common sense isn’t always common practice.
  • Changing surface changes depth.