Interview With Barry L. Duncan
Interviewer [Female Voice]: What's the most important advice you can give a clinician who wants to become a better therapist?
Barry Duncan: The answer is very simple: monitor your outcomes with your clients over the course of your career so you'll know whether or not you're developing as a therapist and getting better at your outcomes over the course of your career as you learn new things, not only from your clients but from training, from supervision. You'll actually see whether it makes a difference if you track your outcomes with your clients.
Interviewer: How important are the therapist's theoretical approach and techniques?
Barry Duncan: Well, they are important but you have to keep them in context of other far more important aspects about how psychotherapeutic change works. And that is you have to keep in mind that the client is the central aspect of all the treatment, and what they bring to the table and your ability to engage what they bring to the table, to enlist, recruit, harvest, however you want to think about it, but how do you engage them in purposeful work, combined with this thing that we call the alliance. And that's the thing that distinguishes the best therapists from the rest, is their ability to form strong alliances across clients. So your ability to engage what the client brings and form strong alliances will probably get better as you go throughout your career. But the only way you'll know if you're getting better at those things over the course of your career is to monitor how your clients are changing in your practice right now by using outcome measures.
Interviewer: How would you counsel the therapist who is frustrated because he doesn't feel he is making much progress with a client?
Barry Duncan: This is where outcome management really brings a lot to the table for you because it will identify those clients that aren't responding to your therapeutic business as usual. So you'll know early on, in the first three to four sessions, whether or not clients are changing, so you can start to have a discussion with your client about that. So the first thing to do is to say to the client, "What do we need to do about this? Do we need to go kind of steady as she goes? Is this going to take a little bit longer? Do you think that maybe I'm not getting part of this? Is there something that you haven't told me that would be helpful for me to know? Do you think that we're on the right tract? Should we kind of change the way we're working on the problem?"
So the first thing is to have that heart to heart with the client about what they think about what could be changed to make the situation better. But if that continues to go on and there's a lack of change, and the outcome measures are showing that the client isn't actually benefiting, it's time to begin talking about referral with the client to another provider that may be a better fit for them. Because keep in mind, the number one reason for therapy not working is not a good fit or a good alliance between the therapist and the client.