progress measurement helping clinical oversight

Using progress measurement tools to pick up on clinical oversight in therapy

When it comes to assessment, symptom detection, and treatment planning, therapists need to be attentive to details and have a keen eye for potential red flags in their clients’ mental health. While social workers and psychotherapists are not qualified to diagnose mental health disorders in the province of Ontario, it is still important for these clinicians to be aware of the various disorders and symptomology in order to tailor their treatment approach to the specific needs of each individual client.  With that being said, even the most thorough intake assessments can miss important details regarding clients’ presenting concerns if clients choose not to self-disclose.

This gap in assessment is highlighted by the research of Lotito and Cook (2015) who note that clients often omit certain information—such as the presence of suicidal ideation—due to discomfort in discussing these concerns verbally. However, Lolito and Cook point out that for many patients who are uncomfortable disclosing thoughts of suicide during a session, these patients are often willing to disclose the thoughts of suicide in screening questionnaires. This information is important to the field of psychotherapy as it highlights the importance of screening tools such as those used for progress measurement in order to detect areas of concern which would have otherwise gone unnoticed.

The effectiveness of progress measurement tools for detecting sensitive information is further supported by a 2015 study which found that patients are more likely to self-disclose sensitive behavioral health issues which might be viewed as socially undesirable, if the mode of disclosure is through electronic questionnaires rather than other modes of self-reporting (Gnambs and Kaspar, 2015). This research in combination with the work of Lolito and Cook suggests that when discussing concerns which a patient perceives to be stigmatized or socially unacceptable, the patient may be more forthcoming with information using a self-report questionnaire rather than during a standard intake session with their therapist.

Additionally, in terms of detecting ruptures or weaknesses in the therapeutic alliance, many patients will feel uncomfortable bringing up issues with the therapeutic relationship but may be more forthcoming with this feedback in a progress measurement questionnaire. As a result, the use of routine progress measurement tools in psychotherapy can reduce patient drop-out or cancellations stemming from issues in the therapeutic alliance by enhancing therapists’ ability to effectively detect and respond to therapeutic ruptures.

While there are many benefits to the use of progress measurement tools in psychotherapy, the increased likelihood of patient self-disclosure is not only beneficial to the process of therapy, but in the case of individuals experiencing thoughts of suicide, the proactive use of progress measurement tools could potentially save lives.


References

Gnambs, T. & Kaspar, K. (2015). Disclosure of sensitive behaviors across self-administered survey modes: a meta-analysis. Behavior Research Methods, 47(4), 1237-1259.

Lotito, M. & Cook, E. (2015) A review of suicide risk assessment instruments and approaches. Mental Health Clinician: 5(5), 216-223.

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