Needs-Beliefs-Behaviours

See too Nissen-Lie et al's "Patient and therapist perspectives on alliance development: Therapists' practice experiences as predictors" with its finding about the toxic effects on client rated therapeutic alliance produced by the "leaking" of unspoken critical therapist. 

"Humble warmth" "Therapist predictors of early patient-rated working alliance: A multilevel approach"

Pre-session 'meditation' on client strengths & resources.  Compassion work.

Work on compassion both for self and for others and its effects on self-esteem ... and note too the benefits of "saying turquoise" and other emotional intelligence aspects.

Yesterday I wrote a blog post "Routine Outcome Monitoring can really help therapists clarify where they need to try harder".  Today's post extends this extremely important point.  About twenty years ago Howard and colleagues (Howard, Moras, Brill, Martinovich, & Lutz, 1996) introduced a crucial new approach for improving our outcomes.  They wrote "Treatment-focused research is concerned with the establishment of the comparative efficacy and effectiveness of clinical interventions, aggregated over groups of patients.

I recently wrote a couple of blog posts - "Psychotherapy (and psychotherapist) outcomes are good but largely stagnant" and "Fascinatingly, therapists themselves vary considerably in their effectiveness".  In the second of these posts I commented "A paper published just last month (Green, Barkham et al.

I wrote a post yesterday on the good, but largely stagnant, outcomes currently being achieved in psychotherapy.  In today's post I highlight the fascinating finding that psychotherapists themselves vary considerably in their effectiveness.  If we can help those with poorer outcomes to begin matching those with better, great gains are possible and the log jam in trying to improve psychotherapy's effectiveness can be eased.  In later posts I will argue that this improvement looks eminently achievable.

I have been asked to write a chapter on the importance of obtaining regular feedback on client progress in a book on psychotherapist self-practice & self-reflection.  This initial section (see below) of a draft of the chapter comments on the current state of psychotherapy itself:

(Note the ideas in this blog are explored in more detail in the chapter "Client feedback: an essential input to therapist reflection" in the forthcoming Haarhoff, B. and Thwaites, R. (2016) "Reflection in CBT: Increasing your effectiveness as a therapist, supervisor and trainer." London: SAGE Publications Ltd.)

I wrote a blog post yesterday entitled "Therapeutic alliance ruptures: common, very challenging & a key area for increasing therapist (and personal) helpfulness".  I think this area is so important that I'd like to spend additional time exploring it more thoroughly. 

We had another of our small peer Emotion-Focused Therapy supervision/practice groups yesterday evening.  Half a dozen of us were able to make it.  We'd agreed we would look particularly at "therapeutic alliance ruptures" at this meeting.  As a doctor, I can't help finding the term "alliance rupture" rather giggle-inducing.  I have all kinds of pictures of unwanted extrusions, metaphorical trusses and possibly extreme interpersonal surgical cures. 

I had lunch with a health professional friend the other day.  Later he emailed me saying "The last few times we have met you have mentioned the importance of attachment style in determining aspects of the interaction between patients and health care professionals."  He went on to raise a series of questions about health professional-patient relationships, about the way that the attachment style of both health professional and patient can affect outcomes, about how adult attachment is measured and the possibility of improving attachment patterns, and about links between attachment & mindfulness.  Gosh a lot of interesting questions being raised here.