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.

Get Help With Your Essay

If you need assistance with writing your essay, our professional essay writing service is here to help!
Find out more about our Essay Writing Service

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). This process can only lead to positive outcomes for the professional and client.

Conclusion-

No one model has proven superiority over another

References

Anderson, T., Ogles, B M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist Effects: Facilitative Interpersonal Skills as a Predictor of Therapist Success. Journal of Clinical Psychology, 65(7), 755-768.

Barber, J. P., Connolly, M. B., Crits-Christoph, P., Gladis, L., & Siqueland, L. (2000). Alliance Predicts Patients’ Outcome Beyond In-Treatment Change in Symptoms. Journal of Consulting and Clinical Psychology, 68(6), 1027-1032. doi: 10.1037/0022-006X.68.6.1027.

Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioural therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31. doi:10.1016/j.cpr.2005.07.003.

Claiborn, C. D., Goodyear, R. K., & Horner, P. A. (2001). Feedback. Psychotherapy:Theroy, Research. Practise, Training, 38(4), 401-405. doi:10.1037/0033-3204.38.4.401.

Duncan, B. L., Miller, S. D., & Sparks, J. A. (2004). The Heroic Client. A revolutionary way to improve effectiveness through client-directed, outcome informed therapy. Sanfrancisco, California: John Wiley & Sons.

Duncan, B. L., & Moynihan, D. W. (1994). Applying Outcome Research: Intentional Utilization Of The Clients Frame Of Reference. Psychotherapy, 31(2), 294-301. doi: 10.1037/h0090215.

Johnson, L., Brown, J., & Anker, M. Becoming Outcome Informed. In Duncan, B. L., Miller, S. D., & Sparks, J. A. (2004). The Heroic Client. A revolutionary way to improve effectiveness through client-directed, outcome informed therapy (pp. 81-118). Sanfrancisco, California: John Wiley & Sons.

Klee, M. R., Abeles, N., & Muller, R. T. (1990). Therapeutic Alliance: Early Indicators, Course and Outcome. Psychotherapy: Theory, Research, Practise, Training, 27(2), 166-174. doi: 10.1037/0033-3204.27.2.166.

Krupnick, J. L., Sotcky, S. M., Simmens, S., Moyer, J., Elkin, I., Watkins, J., & Pilkonis, P. A. (1996). The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal Of Consulting And Clinical Psychology,64(3), 532-539. doi: 10.1037/0022-006X.64.3.532.

Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. Psychotherapy, 48(1), 72-79. doi:10.1037/a0022238.

Martin, D. J., Garske, J. P., & Davis, M. (2000). Relation of the therapeutic alliance with outcome and other variables: A meta-analytical review. Journal of Consulting and Clinical Psychology, 68(3), 438-450. doi: 10.1037/0022-006X.68.3.438.

Meier, P. S., Barrowclough, C., & Donmall, M. C. (2005). The role of the therapeutic alliance in the treatment of substance misuse: a critical review of the literature. Addiction, 100(3), 304-316. doi: 10.1111/j.1360-0443.2004.00935.x

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. doi: 10.1002/jclp.20111.

Mozdzierz, G. J., Peluso, P. R., & Lisieki, J. (2011). Evidence-Based Psychological Practices and Therapist Training: At the Crossroads. Journal of Humanistic Psychology, 51(4), 439-464. doi:10.1177/0022167810386959.

Norcross, J. C., & Wampold, B. E. (2010). What Works for Whom: Tailoring Psychotherapy to the Person. Journal of Clinical Psychology, 67(2), 127-132. doi. 10.1002/jclp.20764.

Norcross, J. C., & Wampold, B. E. (2011). Evidence based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98-102. doi: 1037/a0022161.

Shaw, S. W. (2014). Monitoring Alliance and Outcome with Client Feedback Measures. Journal of Mental Health Counselling,36(1), 43-57.

Tollin, D. F. (2010). Is cognitive-behavioural therapy more effective than other therapies? A meta-analytic review. Clinical Psychology Review, 30(6), 710-720. doi:10.1016/j.cpr.2010.05.003.