Measuring the effectiveness of our work at the Resilience Centre

By Ruth Fordyce
Psychologist
Alpha Psychology and the Resilience Centre

At the Resilience Centre, we strive to provide an excellent psychological service for people from all walks of life. We are therefore committed to measuring and assessing whether our services are effective in meeting our clients’ goals.

One way that we do this is by asking clients to complete some brief measures as part of each visit to see their psychologist. The measures we use are called the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS). These scales were created by two American researchers, Barry Duncan and Scott Miller, with the aim of finding a brief yet effective method of assessing whether therapy was helping clients to achieve the changes they were looking for. The ORS and SRS can be completed with pen and paper, but more recently we’ve been using a digital version that can be completed on an iPad.

We ask clients to complete the ORS at the beginning of their first session with us. This provides a ‘snapshot’ of how they are doing when we begin working together. The ORS is comprised of four scales – personal wellbeing, close relationships, social wellbeing (including friendships, work and/or school) and overall functioning. Usually clients are asked to complete the ORS at every subsequent visit. Immediately clients are able to review with their psychologist how things are changing and progressing. There is a good body of research indicating the validity of the ORS against other longer questionnaires. This means that an increasing score on the ORS is a reliable and valid indicator that therapy is leading to improvement’s in the client’s wellbeing. The advantage is that the ORS is so simple to complete – it only takes about a minute! Research also indicates that if working with a psychologist is to be effective, there is typically some positive change within the first few sessions. This is why completing the ORS at every session is so useful. It ensures that we are accountable to our clients. If they are not experiencing the positive changes they are looking for, we are happy to discuss trying a different approach, or referring to another psychologist in the practice who may be more suited to the client’s needs.

At the end of the session, we ask our clients to complete the Session Rating Scale (SRS). Again this is very quick and simple to complete. It asks for feedback from the client about their experience of the session and whether they feel the psychologist is addressing their needs and goals. At the Resilience Centre, it is essential to us that clients are able to talk to us honestly about any concerns they have or improvements that need to be made. Each person is unique, and effective psychological work needs to be tailored to the client’s own goals, personality, learning style and so on. The client’s input and feedback is therefore invaluable in creating a really effective partnership with the psychologist.

Since 2011, we have been using My Outcomes, a secure online program, for entry and analysis of our ORS and SRS data. This program allows each practitioner to track the progress of individual clients, but also enables us to generate statistics about our effectiveness as a whole practice. All data is de-identified before being entered online (i.e. a user number rather than the client’s name is entered), which maintains the anonymity and confidentiality of our clients. However, we respect and understand that some people do not want to participate even in this confidential way. When they first come to the Resilience Centre, clients are asked to complete some paperwork, and this includes a question about whether they are willing for their de-identified data to be used in our analysis. Of course, any questions about this process are always welcome.

Many psychologists and therapists around the world are now using the ORS and SRS to ensure that they are providing an effective service that meets their client’s needs. Research indicates that when these measures are used, clients are more likely to achieve their goals and are much more empowered and engaged in the process of change. At the Resilience Centre we have experienced many benefits from using the ORS and SRS with our clients. For example, we work with a lot of children and young people, who are at times reluctant to come and see a psychologist, or nervous about what the process might involve. Using the ORS and SRS shows that we take their opinions seriously and are willing to open up a down-to-earth conversation about what will help them to feel comfortable and involved in the process.

So if you are thinking of seeing a psychologist at the Resilience Centre, please know that your feedback is not only welcomed – it’s essential! We look forward to partnering with our clients and doing our very best to meet their goals and needs.

Websites with further information and articles about the ORS and SRS:
https://heartandsoulofchange.com
http://scottdmiller.com/performance-metrics/
http://www.myoutcomes.com

Ruth Fordyce is a Registered Psychologist at Alpha Psychology and The Resilience Centre. Find out more about Ruth by clicking here.

The Balance between Compassion & Courage

Its not often that comments stop me in my tracks and get me thinking for days on end. Recently however I attended a yoga class and as I lay there in the ‘relax and notice your breath’ moment, the instructor made a comment. She asked us to place one hand on our heart, and the other on our stomach. Then she said; “You need a balance between compassion that comes from your heart and courage from your belly. If you have too much courage you can become destructive to yourself and to others, but if you have too much compassion you can be paralyzed by your desire to please others. It is finding the balance that is best.” Fascinating.
Fear – our dictator?
As I was walking out of this yoga session, my little psychologist brain started ticking into overdrive. There was truth to her statement, but maybe I had just never thought of it in those terms. Everyday I work with clients with significant anxiety. This doesn’t just come out of nowhere, we live in a society motivated by fear. The media purports to parents that if they don’t parent in a particular way then there are terrible consequences. Pregnant women are fearful they eat the wrong thing, or give birth in the wrong way. Companies are fearful of being sued for minor accidents that could’ve happened anywhere. People are told to be wary of traveling overseas without particular booster shots or checking the travel warnings online. Monkey bars are being removed from playgrounds for fear children fall and get injured. Food intolerances are increasing all the time. We are a society of worriers.

What happened to courage?
I had always thought fear was on one end of the continuum and hope was on the other. It had never occurred to me that courage and compassion needs to be balanced to live our life in hope. If we are compassionate for fear of negative perception then the fear is imprisoning us to behave in a particular way, in this example, to be compassionate. If however we have courage, courage to be the person we were made to be, then fear doesn’t dictate how we respond to others. Rather we are free to be compassionate when and where we are inspired to do so. This type of compassion is all giving without any strings attached, without any expectations of repayment.
Compassion, Courage, Parenting and Balance
In parenting research they discuss the need for a balance between disciplining and setting boundaries with our children and showing them affection with warm responsiveness to their needs. A parent may not have the courage to say no to a child for fear that the child then considers him/her to be mean or unfair or a bad parent. A courageous parent who wishes to show compassion will do so in a way that they know is best for the child. True compassion is motivated by the needs of the receiver not the needs of the giver. To show true compassion the parent requires courage in knowing that there is a risk that the child will express their disapproval. It takes courage and a strong sense of self worth for times when tough parenting is needed. Compassion and courage balanced is certainly required for the ‘tough love’ parenting technique.

Too Many Life Choices?
When working with young adults, and some mature teenagers, so many questions are asked about meaning of life, options for the future, purpose, direction, identity, spirituality, and many more. Anxious people tend to be super sensitive to their own feelings and this is what many understand, but it works the other way as well. That is, if we are sensitive to our own feelings then often we are also sensitive to picking up on the feelings of others, particularly those we love. Anxious young people share their ideas for their future with me, but I notice the fear of parental disapproval or fear of being judged by peers or fear of not following the cookie cutter society of who they ought to be. There are also those who are very involved in their religious community who may be fearful of not doing what their community expects of them. It takes courage to follow what you feel you are called to do. If the compassion you have for others, and your desire to satisfy their expectations/wishes for you motivates your decisions, then you will be paralysed into living for them. The question is then, are you living your own authentic self or are you living the self they wish for you? To be who you are and then be compassionate within the context of freedom is to be walking towards the hope that is truth and authenticity. This authenticity will be felt by those around you, when they sense your motives for compassion are pure.

Teresa of Calcutta
The story of Mother Teresa from Calcutta is astounding. She is an example of someone who walked towards the hope (or the dream or ideal), with a balance of courage and compassion. At 18 years old she told her mother she wanted to become a nun, but this upset her mother who tried to deter her from joining a convent. Had Teresa not been courageous, or had she been overwhelmed with compassion for her mother, then she would not have joined the convent. She did join the convent and was sent to one in India, where she saw overwhelming poverty. She was inspired to be a sister of the streets and leave the walls of the convent so that she could dedicate her life to helping the poor. This request was not met warmly by the church and she was strongly encouraged to withdraw her request. Had she been so concerned with keeping others satisfied (in this case her ‘colleagues’), she would not have pushed forward. She had a balance of compassion and courage, she was compassionate to those around her but not so much that she enabled their wishes to dictate her life, instead she was courageous to follow her heart. Eventually the church conceded and she was able to work directly with the poor.

Too Bold?
On the flip side, there are adolescents and young adults who are ‘all courage’, that is they act without thinking, without consideration of possible consequences. This too can be problematic, creating a path of destruction for themselves and possibly also for others. I’ve heard people say you’re more likely to regret what you didn’t do rather than what you did do, but how true is this?

Balance
I have many clients laugh at me in session when I bring up the word ‘balance’, because to them it seems to be my favourite word. Although we need to work hard to achieve goals we also need to be kind to ourselves and allow our bodies to rest. Although it is important to be courageous and push forward despite fears of the unknown, we need to be balanced and consider consequences. Although studying hard for the HSC exams is imperative, we need to be balanced and continue to care for our bodies through rest, exercise and enjoyable activities – BALANCE. I think this seems to get better with practice, and although we can endeavor to make a change – awareness is the very first step. Awareness of our actions and motivations is first and action is second. Courage and compassion, I will endeavor to have both and move forward towards the hope.

Always wondering, Christina.