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Client-directed outcome-informed (CDOI) therapy is a specific type of behavioral health outcomes management that attempts to involve the client more actively in determining the course and goals of the therapist-client alliance than other more traditional methods. Largely developed by Dr. Scott Miller and Dr. Barry Duncan, the goal of this method is to develop a system for assessing the outcomes of psychotherapy treatment which improves both the client's own experience and the measurable outcome of the therapy process, the latter being particularly relevant in situations of court-ordered drug and alcohol abuse courses.
CDOI is centered on two principles which its developers contend are supported by it's research. First, that a client's rating of the client-therapist alliance has a greater association with the involvement in and the outcome from the therapeutic alliance than the therapist's rating of that alliance,[1] and second, that a client’s own perception of progress early on is an important predictor of the success of the therapeutic alliance and/or treatment course.[2]
Building from this, the CDOI method uses two scales, one given at the start, which is referred to as the Outcome Rating Scale (also referred to as ORS), and the other, which is referred to as the Session Rating Scale (also referred to as SRS), is given just before the close of every treatment session. The Outcome Rating Scale asks the client to note any progress they may have experienced since the last visit. While the Session Rating Scale asks the client to note the success of the client-therapist alliance.[3] Both scales involves four queries or questions so the total time required to complete the process per session is estimated to be no more than two to three minutes. However, as these scales are consistently utilized at every therapy session, this will optimally allow the therapist the opportunity to modify the method if needed. The CDOI client is also able to feel more vested in the direction of the treatment as compared to a more traditional therapist-directed process.
The CDOI method has been utilized by several drug treatment courses, such as Arizona's Health Services Department.[4] At the same time, critics stress that the therapist must resist a narrow focus on outcome and must maintain an openness to the entirety of the client's trajectory and be informed by more than one therapeutic method. [5]
More recently, the CDOI method has become known as the Partners for Change Outcome Management System, or PCOMS.[6]
Sources[edit]
- Duncan, Barry L., Scott D. Miller, and Jacqueline A. Sparks. The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client-Directed, Outcome-Informed Therapy (John Wiley and Sons, 2011).
- Duncan, Barry L., Jacqueline A. Sparks, Scott D. Miller. "Recasting the therapeutic drama: A client-directed, outcome-informed approach. Comparative treatments for relationship dysfunction" in Comparative treatments for relationship dysfunction. Springer series on comparative treatments for psychological disorders. (pp. 301–324) New York, NY, US: Springer Publishing CoDattilio, Frank M. (Ed); Bevilacqua, Louis J. (Ed), (2000).
- Lambert, M.J. & D.A. Vermeersch. (2008). Measuring and improving psychotherapy outcome in routine practice. In S.D. Brown & R.W. Lent (Eds.), Handbook of counseling psychology (4th ed, pp. 233-248). Hoboken, NJ: John Wiley & Sons
- Miller, Scott D. & Barry L. Duncan. "Paradigm lost: From model-driven to client-directed, outcome-informed clinical work." Journal of Systemic Therapies, Vol 19(1), 2000, 20-34.
- Miller, Scott D., David Mee-Lee, William Plum, and Mark A. Hubble. "Making Treatment Count: Client-Directed Outcome-Informed Clinical Work With Problem Drinkers" in Handbook of Clinical Family Therapy (John Wiley and Sons, 2005).
- Miller, Scott D., Barry L. Duncan, Ryan Sorrell, George S. Brown. "The partners for change outcome management system." Journal of Clinical Psychology Special Issue: Enhancing Psychotherapy Outcome Through Feedback, Volume 61, Issue 2, pages 199–208, February 2005
- Saggese, Michael L. "Maximizing Treatment Effectiveness in Clinical Practice: An Outcome-Informed, Collaborative Approach." Families in Society: The Journal of Contemporary Social Services (2005) Volume 86, No. 4, p. 558-564.
References[edit]
- ^ But see Baldwin, S.A., Wampold, B.E. & Imel, Z.E. (2007). "Untangling the alliance–outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance". Journal of Consulting and Clinical Psychology, 75(6), 842-852.
- ^ Harmon, S.C., Lambert, M.J., Smart, D.M., Hawkins, E., Nielsen, S.L., Slade, K. & Lutz, W. (2007). "Enhancing outcome for potential treatment failures: Therapist-client feedback and clinical support tools." Psychotherapy Research, 17(4), 379-392.
- ^ Duncan, B. L., Miller, S.D., Sparks, J.A., Claud, D.A., Reynolds, L.R., Brown, J. & Johnson, L.D. (2003). "The Session Rating Scale: Preliminary psychometric properties of a 'working' alliance measure." Journal of Brief Therapy, 3(1), 3-12.
- ^ Division of Behavioral Health Services, ADHS/DBHS Best Practice Advisory Committee: Client Directed, Outcome Informed Practice (CDOI) http://www.azdhs.gov/bhs/cdoi.htm (accessed 6 Jan 2012)
- ^ Carol A Stalker; Judith E Levene; Nick F Coady. "Solution-focused brief therapy--one model fits all?" Families in Society: The Journal of Contemporary Human Services, 09/01/1999, Vol. 80 No. 5; p. 468 http://www.dr-rock.com/SWG613D006.PDF (accessed 9 Jan 2012)
- ^ Miller, S.D., Duncan, B.L., Sorrell, R. & Brown, G.S. (2004). "The Partners for Change Outcome Management System." Journal of Clinical Psychology, 61(2), 199-208.
Category:Psychotherapy Category:Clinical psychology
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