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APA Psychotherapy Training Videos are intended solely for educational purposes for mental health professionals. Viewers are expected to treat confidential material found herein according to strict professional guidelines. Unauthorized viewing is prohibited.
In Client-Directed Outcome-Focused Psychotherapy, Dr. Scott D. Miller presents a meta-approach to talk therapy that is designed to help tailor the treatment to fit the client's particular therapeutic goals. Technique is deemphasized in favor of developing a strong therapeutic alliance and using the client's experience of the treatment as a guide for where treatment should go. This requires checking in with the client frequently to see whether therapy is working and using this formal feedback to guide treatment and evaluation. In this session, Dr. Miller works with a young woman diagnosed with bipolar disorder who, because of pregnancy, has been off of her medication and is wrestling with her depression. This video shows a typical first session.
This meta-approach focuses on two things: building an alliance with the client and getting feedback from the client. The therapist who applies this meta-approach listens to what the client wants from the therapy and reworks the course of therapy so that it is aimed toward attaining the client's goals. This involves frequent eliciting of feedback from the client in the form of assessment measures and checking in to see what the client's experience of the therapy has been. Research shows that using client feedback can reduce dropout and enhance outcome of cases most at risk for a poor outcome by as much as 65%. The goal of therapy is to reach the goals set by the client using means designated by the client.
Scott D. Miller, PhD, is a cofounder of the Institute for the Study of Therapeutic Change, a private group of clinicians and researchers dedicated to studying "what works" in treatment. He also works as a therapist providing clinical services pro bono to traditionally underserved clients.
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