Therapist Materials for Continuing Progress into the Future

The main point of this final session is to review key concepts from this treatment program and to help the client prepare for what comes next. This session looks at relapse prevention and reviews the important takeaway messages of the program. Clients learn a quick method of applying skills when taking action in the future by reviewing an emotion skills action plan and creating their own practice plan. Clients and therapist evaluate client progress and revisit client treatment goals created at the beginning of treatment. Studies on this treatment have shown that clients continue to see additional improvements in their symptoms for up to a full year after completion.

How Do We Decide Which of Two Case Formulations Is Correct? Commentary on Westerman and Critchfield et al.

This commentary takes a meta-view of the articles in this module by Westerman (2021a), and by Critchfield, Dobner-Pereira and Stucker (2021a), which offer two overlapping but also different formulations of the same case. It raises the question of whether there is only one true formulation of a clinical case (correspondence theory), or whether any one of several would qualify as accurate (coherence theory). A third alternative is that the truth-value of a formulation is a function of its ability to predict which therapist interventions will most help the client (pragmatic theory). A study is described in which the relative accuracy of two different formulations of the same case was put to the test in predicting which therapist interventions led to client progress. I propose that the current authors compare the pragmatic value of their formulations in a similar manner.

Some Tenuous Assumptions and Conceptions

In Some Tenuous Assumptions and Conceptions the authors explain how the myth of certainty affects the therapist. Therapists may often be overconfident in their ability, experience, and approach to counseling. As a result, therapists’ interpretations often lack the accuracy or understanding of clients’ feelings or behaviors. Therapists tend to underestimate the role of parallel processes, in which the impact a therapist believes to be having on a client is also impacting the therapist. Understanding that expertise, experience, and approach do not necessarily guarantee success with a client or even that the therapist has an accurate understanding of the client. Therapists are encouraged to embrace uncertainty when working with a client, as this type of vulnerability may actually enhance the working alliance and serve as a catalyst for client progress.

Do As I Say and As I Do: Reflections on Three Methods of Evidence-Based Clinical Supervision of Graduate-Level Trainees

The clinical training many therapists received during graduate school ranks among the most intensive periods of direct feedback in their careers. We believe the efforts of supervisors in this pivotal developmental stage often receive too little attention. Supervisors may not know which training methods will be most effective for trainees with diverse clinical backgrounds and varying levels of prior knowledge and ability. This is in part because training in supervision remains limited or unavailable in a surprisingly large number of programs, leaving many supervisors to rely on their own experiences of supervision during clinical training. Despite these limitations, our clinical supervisors successfully implemented developmentally-appropriate supervision methods based on available research evidence and established theoretical frameworks. Here we describe and demonstrate, in order of increasing developmental demands, three methods our supervisors used to scaffold our training: deliberate practice, feedback on client progress, and embodying the spirit of the treatment. These methods are grounded in the research and theory of learning, relatively straightforward to apply in graduate practica, and flexible enough to adapt to diverse trainee backgrounds and abilities.

Collecting and Delivering Client Feedback

This meta-analysis examines the impact of measuring, monitoring, and feeding back information on client progress to clinicians while they deliver psychotherapy. It considers the effects of the two most frequently studied routine outcome monitoring practices: the Partners for Change Outcome System and the Outcome Questionnaire System. Meta-analyses of 24 studies produced effect sizes from small to moderate. Feedback practices reduced deterioration rates and nearly doubled clinically significant/reliable change rates in clients who were predicted to have a poor outcome. Clinical examples, diversity considerations, and therapeutic advances are provided.