Preventing Drop Out
In a
previous post “Helping People”, we looked at variables that can impact client
retention within the therapist. As we
continue to study ‘client drop off’ with the intent of preventing it, we must
consider the question “is there anything I can do to prevent client’s from
dropping out of therapy”.
This question
may be uncomfortable for many of us. I
mean we have spent so much time as a profession making ourselves less
responsible for client’s change and empowering them to take that responsibility
for themselves. What if both can happen…
what if we can take responsibility and they can take responsibility for that change. Whew…I can feel anxiety rising from
here. But before you stop reading
consider a better question… where does my responsibility end and theirs begin?
I recently
attended a webinar with Scott Miller around outcomes based treatment
approaches. I have heard this concept
over the past few years and have allowed the concept to percolate in my mind. But it wasn’t until recently, during this,
webinar that I feel like I truly grasped the concept to it’s fullest in terms
of my responsibility and the client’s responsibility. So bear with me as I try
to put into words my ‘light bulb’ experience.
Clients are
coming to therapy for something to change.
Either a loved one has encouraged (or forced) them to come in the hopes
of change, or they themselves have come in again with the hopes of change. So if that is the product….change, then I
have a responsibility to that client to: 1) understand the change they want 2)
Identify if I’m the best person to help them get to that change 3) Know who are
other people in the community that could help get them that change if I can’t.
The client
has a responsibility to 1) Tell me the type of change they are wanting 2) Tell
me if and/or when that change is occurring 3) Provide feedback on the customer
service they are receiving through the change process.
So you may
say ‘how does this prevent drop out?’
Well imagine with me what could happen differently if you were to add 3
simple things to what you are already doing…just three. What if you added a
brief assessment of the change the client is desiring into every session. This
gives them the responsibility of looking for their change and reporting that it
is or isn’t happening. Second, what if
you had a way of getting feedback on your customer service, again giving client
the responsibility of telling you what is/isn’t working for them. Finally, what if you had a structured
protocol to follow when change isn’t happening, giving you the responsibility
to direct client to where change may better happen. The only thing that will
happen differently when you add these three things is catching potential drop
out clients early, before drop out. With
the prevention of drop out, clients get the opportunity to share what is not
working for them, and can collaborate with you on what may work better.
When
considering these three additions, here are some helpful tools:
Outcome Questionaire (OQ-45)
Partners for Change Out5come Management Systems (PCOMS)
2.
* Customer Feedback Assessment (Therapeutic Alliance) - Session Rating Scale (SRS)
* Customer Feedback Assessment (Therapeutic Alliance) - Session Rating Scale (SRS)
3.
* * Structured
Protocol –
·
If after 3 visits no change – staff case with
colleague/supervisors
·
If after 5 visits no change – Start looking for
other places/referrals and begin talking to client about that option. (Referral
may include medication management, psychological assessments etc.)
·
If after 8 visits no change- Recommend referring
Based on research that
if change has not occurred by the 12 week of treatment a decline or drop out
most likely will occur.
Resources: http://www.scottdmiller.com/wp-content/uploads/2014/06/The-Outcome-of-Psychotherapy-2013.pdf
