Below is a post I made to a listserve of psychotherapists therapists that I am involved with. We have a method of practicing therapy in common called CDOI (client directed outcome informed). Simply put we use really brief scales to begin and end therapy thus formalizing client feedback rating how they are doing across sessions and how they rate the sessions themselves. It sounds very simple and it is, but it is a rarity in my field to be accountable in this way. We refer to the scales as PCOMS. The folks over at http://talkingcure.com , Barry and Scott and others, got the ball rolling with this. Someone asked about the limitations of CDOI on the listserve, and this is my response. Hopefully it is intelligible for a non-therapist. One term I use that you probably won’t understand is the dodo-bird factor. This refers to the dodo bird from Alice in Wonderland who proclaims that “…all are winners and everyone wins prizes.” This refers to the research finding that no one type of therapy has demonstrated itself to be better in terms of client outcomes than any other after meta-analysis of the research in the field of therapy (ie. all are winners). However, some therapists are demonstably better than others. Of course, as in many specialist human endeavors, more therapists consider themselves to be ‘above average’ than is statistically possible. I fall between average and just above average depending on what cohort I am comparing myself too. Anyways, read my post in reponse to the question – what are the limitations of CDOI?
I am also in a medical setting, so maybe we feel the divide a little more than others.
Ironically, the first book I read by Barry and Scott was Escape from Babel. I still feel like I am in Babel. This book described the multitude of therapy theories out there and the need for a unifying language that emphasized the common factors . But the common factors are still generally seen as just more trees in the forest.
Since the dodo bird factor continues to apply , no one tree is taller than any other so no one can see the forest as long as they stay in their tree. I see CDOI as a deliberate step back from the trees and the forest and into the client’s world. The language spoken in each client’s world takes time for the therapist to learn. Each is a miniculture unto itself. You have to immerse yourself in it, and PCOMS offers an essential tool allowing the client to inform you when they don’t understand you, or you them. PCOMS helps catch the linguistic glitches sooner so that they are less likely to blow up into full fledged and irreparable ruptures to the alliance. Beware the polite nodding by the inwardly exasperated client!
The more I get into my clients’ unique worlds and languages, the more I feel like an oddball with my colleagues, this list being an exception.
As my interaction with my clients gets more and more sophisticated and nuanced, my interaction with my colleagues more banal and primitive. You know the drill: “suicidal or not, depressed or not, compliant or not, borderline or not, drug seeking or not”. ugghh
I am becoming more aware of how thinking in this way has done violence to my mind, not to mention that of my clients. And as was mentioned in another post by someone, many clients come to us heavily influenced by the current psychobabble. I think they are put in danger when they misapply this binary thinking to their own worlds, but I realize they are just trying to muddle through in planet mental health. I can make a bad situation worse if I disrupt their equilibrium too soon. I do hold to the tenet that in the long run they will need their own voice and language to go where they really want to go in their world. Their voice is always there, if I listen for it, and tolerate the frustration of not being completely in the know while I pick up some meanings.
I am not sure of any remedy that won’t take away valuable time from my ‘language studies’. For their part, most of my colleagues are very busy teaching their languages to their clients, so I don’t think I am missed.