Feedback Informed Treatment – FIT

Over the last several months, I’ve been writing a series of short, but true stories from my life and work. I’ve been surprised by and am grateful for the positive response. All of the stories can be found on my substack account, called “Snippets.” Here’s one from early on in my career, a lesson about — read more

Over the last several months, I’ve been writing a series of short, but true stories from my life and work. After some gentle encouragement from Carrie Witta of Very Bad Therapy podcast fame, I created a substack account and have been posting the “Snippets” once a week or so. Some are drawn from encounters in — read more

In 1997, Wampold and colleagues published a study that revolutionized psychotherapy outcome research. It addressed a question that had long divided the field; specifically, were some therapeutic approaches more effective than others? Each side in the debate claimed the data supported their position — and, like a Rorschach ink blot, the available evidence could be — read more

“History” has a way of feeling as though it happened long ago.  Selfies are such a ubiquitous part of our culture it’s hard to believe the technology that gave rise to them appeared only 15 years ago. One more example.  Seatbelts.  On entering the car, my kids and grandkids fasten theirs without thinking.  Amazing given — read more

“Your reach should exceed your grasp,” was one of my dad’s favorite sayings.  Smile on his face, he would often add, “be prepared to end up empty handed” – which reminds me of a memory. I was seated on the right side of the room, in the aisle seat, second row from the front.  As — read more

You’ve heard of it, right? Lake Wobegon? The fictional town in Minnesota made famous by master story-teller, Garrison Keller. The place where, “all the people are strong, good-looking, and above average?” Turns out, if the city were “Psychotherapy,” it would not be a fictional place. Since 2012 when the first study appeared in the literature, — read more

All of us have them. Key developmental experiences. Ones that stick in our memory, make a permanent “dent” in our thinking or behavior. I was sitting behind a one-way mirror watching a therapy session. The young man being interviewed was dying, his immune system failing due to the AIDS virus. It was the early days — read more

I’m not sure what was going on in our field last week. From the emails I received, it seemed something big — no, monumental. Here are just a handful of the highlights: “The single modality that’s transforming how clinicians do therapy … and making them so successful.” A new approach for “Getting to the heart — read more

She’d started young. At age 3, she was named “Miss Beautiful Baby.” Shortly thereafter, she became a regular –“Bubbles Silverman” — on the Uncle Bob’s Randbow House radio show. Voted “most likely to succeed” by her high school classmates, she sang everywhere and anywhere before landing a position as “house soprano” at the City Opera — read more

Once upon a time, a nickel (the U.S. 5-cent coin) had value. As a kid, I could get a generous scoop of ice cream at Sav-On, Big Hunk candy bar at Bock’s variety store, or a super-sized glazed doughnut at the Donut Man shop on Route 66. At that time, a nickel was considered so — read more

Its the biggest update to Feedback Informed Treatment (FIT) in two decades. In the beginning, all we had were the measures. Clinicians administered the outcome and session rating scales at each session and then compared client scores to the clinical cutoffs (CCO) and reliable change index (RCI) to determine whether care was “on or off — read more

How difficult could it be? One scale to assess progress, a second to solicit the client’s perception of the therapeutic relationship. Each containing four questions, administration typically takes between 30 to 60 seconds. Since first being developed 23 years ago, scores of randomized-controlled and naturalistic studies have found the use of simple tools in care — read more

Dr. Danilo Moggia is a psychologist and researcher working at the University of Trier in Germany. Over the last several years, he’s been devoted to studying how “machine learning” (ML) can be used to improve the fit and effect of mental health services. Wikipedia defines ML as, “an area within artificial intelligence which uses data — read more

Type the title of this post into Google and you get 275 million results. Scroll through the pages and you’ll find most are links to the hit song by Ed Sheeran — videos, fan pages, or stories about the 100 million dollar copyright lawsuit filed by the estate of the Ed Townsend, co-writer of Marvin — read more

I remember her. My very first, real client. Cynthia — not her real name, her real name was Susan, but I’m not supposed to tell you that! (Just kidding, that wasn’t her name either) Early thirties. Married. Couple of kids. Depressed. I was still a student, a therapist-in-training — and I desparately wanted to be — read more

Despite happening decades ago, I remember it as though it were yesterday. My oldest, Kirk, was fiddling with a cassette tape recorder. He was four at the time and wanted to listen to “his music.” You know, the kind all parents regret having given to their kids at some point? “Wheels on the bus,” “B.I.N.G.O.,” — read more

The evidence shows that using standardized measures to solicit feedback from clients regarding progress and their experience of the working relationship improves retention and outcome. How much? By 25% (1) And now, major news out of California. Psychologists — who are required to earn 36 hours of continuing education credits every other year — can — read more

I never met my uncle Marc. He died decades before I was born. I did know him, however. His mother –my maternal grandmother — made sure of that. One story has stayed with me from the first time I heard it. It was about the day he passed. He was eleven. According to Grandma Stena, — read more

Decades of research shows the client’s experience of the relationship is one of the best predictors of their engagement and progress in care (1).  As such, when outcome and alliance data indicate a course of treatment is “at risk” for a negative or null outcome, or drop out, it makes sense to explore the helper’s — read more

“It is an uncomfortable fact,” observes physician John Birkmeyer in Lancet, “that a patient’s odds of undergoing surgery often depend more on where [they] live than on [their] clinical circumstances.” Indeed, studies have consistently shown that the number of tonsillectomies, prostatectomies, hip replacements, hysterectomies, even days spent in hospital, varies between two to twenty fold — read more

At first, we simply hand scored the measures. Next came an Excel® spreadsheet. It not only automated administration and scoring, but plotted progress from session to session on a graph. Purple represented the client’s actual score. The blue, green, and red lines showed the 50th, 75th and 25 percentile, respectively, for clients with the same — read more

I’ve never been enthusiastic about categories, whether aligning myself with a particular therapeutic approach or assigning a diagnostic label to a client. Any order achieved seemed to come at the expense of freedom and possibility. Lately, however, I’ve found myself feeling an affinity for a particular classification scheme. Maybe its my age. In July, I — read more

It’s a question that comes up at some point in most trainings on feedback-informed treatment (FIT): “Can I use FIT with all my clients?” Having encountered it many times, I now have a pretty good sense of the asker’s concerns. Given our training as mental health professionals, we think in terms of diagnosis, treatment approach — read more

The date was August 26th, 1910. The place, Leyden, Holland — better known as the “City of Discoveries” owing to its long scientific heritage. The people present were two giants of Viennese society, composer Gustav Mahler and psychoanalyst, Dr. Sigmund Freud. By the time of their meeting, the method Freud had pioneered for the alleviation — read more

The data are clear: working feedback-informed improves both retention and effectiveness (1). Studies further show FIT achieves these effects, in part, by improving responsiveness to the individual client — particularly those at risk for a negative or null outcome or dropout from treatment (2, 3). Such positive results notwithstanding, what happens when an outcome measure — read more

Books, blogposts, interviews, and “how to” manuals … Each covers a topic in a particular way. I honestly love them all. That said, despite the massive amount of information available to practitioners interested in FIT and deliberate practice, certain questions pop up time and again. At some point along the way, I started keeping a — read more

Eight years ago, I was in Calgary, Alberta Canada, listening to psychologist Wolfgang Lutz talk about his research on using feedback in therapy. Others, including myself, had already presented data documenting the benefits of feedback-informed treatment (FIT), including lower dropout rates and improved outcomes. Dr. Lutz agreed, but was focused elsewhere. Then, as now, studies — read more

I know, I know. You’re thinking, “A post about the next pandemic?!” Some will insist, “We’re not done with the current one!” Others will, with the wave of a hand counter, “I’m so tired of this conversation, let’s move on. How about sushi for lunch?” Now, however, is the perfect time to assess what happened — read more