Client Directed Outcome Informed Therapy (CDOI) Analysis

Client Directed Outcome Informed Therapy (CDOI) Analysis Taryn Slaughter Throughout the years, therapies have transitioned through different theories of change, model development and extensive research. For decades evidence based models of therapy were argued to be the best treatment for clients. Whilst therapy programs continued and expanded the rates of success did not. Slowly the perception of traditional models and treatments began to change and therapists began looking for alternatives to best suit the needs of their clients. Gradually the roles of therapist and client have changed and the client now has more involved in their treatment process. The client is no longer just a recipient of treatment; they are a partner in the planning, implementing and the outcomes. This essay will describe client directed outcome informed therapy and how it benefits clients with consistent positive treatment outcomes. The concept of Client Directed Outcome Informed therapy (CDOI) was developed through collaboration between Scott Miller and Barry Duncan (Duncan, Miller Sparks, 2004). After reviewing years of outcomes research, CDOI therapy was created in an attempt to meet the needs of individuals who had not responded to traditional models of therapy (Duncan, Miller Sparks, 2004; Duncan Moynihan, 1994). Through further studies and collaborations other forms of outcome and client directed models emerged. These other forms of therapy have been called Feedback Informed Therapy (FIT) and Partners for Change Outcome Management System (PCOMS) (Miller, Duncan, Sorrell Brown, 2004). All three forms of therapy focus on the same principle of providing treatment for clients that is best suited to their individual needs. CDOI therapy has no fixed treatment, model, practice or intervention. The client directed aspect of CDOI therapy ensures that the differences between individuals are understood (Duncan, Miller Sparks, 2004). Practitioners performing CDOI therapy with clients acknowledge that each individual is different by structuring treatments to meet the needs of each client (Duncan Moynihan, 1994). The process of structuring treatment for each individual requires an understanding of the client’s strengths weaknesses and resources to obtain the best possible outcome (Norcross Wampold, 2010). Once these are understood, the client and therapist are then able to outline the desired goals of the client and implement treatments best suited to the client. The relationship between client and therapist enables the process of establishing goals and treatment options in any therapy. The relationship (or alliance) is built early in the initially stages of therapy (Barber, Connolly, Crits-Christoph, Gladis, Siqueland, 2000). The strength of the alliance is determined on the ability of the client and therapist to work together in a mutually respective, trusting and supportive environment (Klee, Abeles Muller, 1990). A therapist must be able to overcome any early resistance to therapy or formation of alliance to ensure the treatments being provided will meet the needs of the client. Research has shown that the strength of the alliance is a significant indicator to the outcomes of treatment. A meta-analytical review conducted by Martin, Garske and Davis (2000) examined a number of studies which observed alliance and outcomes of treatment. It was found that the alliance formed between therapist and client was the most significant indicator of outcome. These findings are consistent with the other alliance focused research (Klee, Abeles Muller, 1990; Krupnick et al., 1996; Meier, Barrowclough Donmall, 2005) which shows that a strongly built alliance results in more positive outcomes then those client/therapist relationships with inconsistent or weakly formed alliances. The outcome informed aspect of CDOI therapy involves the process of compiling feedback throughout treatment. This process provides indicators on whether the selected treatment is affective for the client and meeting their needs (Duncan, Miller Sparks, 2004). A number of studies have shown the effectiveness of ongoing feedback between counsellor and client and positive outcomes of treatment (Claiborn, Goodyear Horner, 2001; Lambert Shimokawa, 2011). Therapists can use the information gathered through feedback to either continue with current treatments or make adjustments where required to continue to work towards treatment goals (Duncan, Miller Sparks, 2004). The most important aspect of this process is that the client is the one expressing how the treatment is working for them, maintaining to the principle of CDOI therapy. There are many different terms used in professional practise when collecting feedback. There are also a number of different methods used when compiling information transmitted between therapist and client. In CDOI and other client and outcome focused therapies many therapists use the Outcome Ratings Scale (ORS) and Session Rating Scale (SRS) (Miller, Duncan, Sorrell Brown, 2004). Both scales allow the therapist to gain an understanding on the level of alliance formed and the success of the treatment being utilised. Consistent feedback from the client ensures that the alliance is still strong and the treatment is being effective in reaching the clients goals (Shaw, 2014). Other models of treatment and therapies such as Counselling and Medical models have more specific structures and guidelines. These models of therapy use the process of diagnosing a problem and then utilising a specific therapy to treat that problem (Mozdzierz, Peluso Lisieki, 2011). Through evidence based practise, problems and therapies are linked together from previous studies and research in the areas where there have been previous successful outcomes. Therapies such as Cognitive Behaviour Therapy (CBT) are linked with previous results in treating diagnosed disorders such as anxiety and depression (Butler, Chapman, Forman Beck, 2006; Tolin, 2010). These therapies are classified under the medical model of treatment and would be used by therapists after diagnoses of anxiety or depression has been made. The difference between these models and the CDOI therapy model is that there is no distinct diagnoses and treatment structure. Each client is evaluated on their own strengths, weaknesses and ideas about treatment. Goals and treatment options are set by both the client and the therapist to ensure all needs of the client are being met, not just the symptoms of a disorder that may be present resulting in a diagnoses (Duncan, Miller Sparks, 2004). Other models of therapy are more restricted in the types of treatments provided and do not allow for individual characteristics of each client. When adopting the CDOI method there is no need to completely discard other models such as the Counselling Model of treatment. CDOI therapy can draw from these different models and modify the structure to suit the client, instead of following the guidelines that may not be appropriate in every case (Duncan Moynihan, 1994). There have been many cases of successful outcomes for clients using evidence based therapies in the past (Butler, Chapman, Forman Beck, 2006; Tolin, 2010). However CDOI therapy is an alternative to these therapies that can be structured to meet the needs of any client by minimising the risk of negative outcomes. There are a number of strategies that can be used by a professional counsellor to improve their outcomes when using CDOI therapy. The importance of alliance between client and therapist has been proven to be a significant indicator of outcome. To build an alliance a professional needs to build a strong, safe and trusting relationship with the client (Norcross Wampold, 2010). A professional counsellor needs to understand the processes involved to build and maintain a strong alliance throughout treatment. Building strong interpersonal skills is one way a professional can achieve a strong alliance. To assess interpersonal skills, a professional can use the Social Skills Inventory (SSI) and the Facilitative Interpersonal Skills (FIS) Performance task questionnaires (Anderson, Ogles, Patterson, Lambert Vermeersch, 2009). These questionnaires measure social and emotional aspects of individual’s interpersonal skills. These aspects are important in building a successful alliance between professional and client which has shown to be a strong indicator of positive outcome. Building on interpersonal skills can be achieved through continuing regular training and education. By continuing education, a professional counsellor can remain current with ongoing research, therapies and treatments and build on existing skills (Norcross Wampold, 2011). By utilising further education a professional can use new ideas to improve outcomes in future cases. One other strategy relates to the feedback process between therapist and client. A successful indicator of outcome, the feedback process is important (Claiborn, Goodyear Horner, 2001). A professional counsellor needs to use a simple and quick system of collecting feedback so that the process doesn’t become overwhelming for the client (Lambert Shimokawa, 2011). 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