Literature Review on Feedback-Informed Therapy
Description
The advent of FIT, or Feedback Informed Therapy, has really created a buzz in the contemporary world; it must have significant potential for ensuring greater therapeutic outcomes through the synthesis and systemic integration of clients’ feedback in the therapeutic process. This evaluation further critically examines the literature on FIT to assess its effectiveness in addressing premature dropout in the clinical setting. Several research studies have reported the effectiveness of FIT in reducing treatment cases. For instance, Miller et al. (2015) and Shimokawa et al. (2010) concluded that feedback-informed therapists were literally half as likely to experience client dropout across them as those who were not feedback-informed. That is, soliciting and integrating feedback might bring a thicker therapeutic alliance and help dispel potential concerns before they reach a level at which clients drop out.
FIT models were further emphasized for their importance in maintaining therapeutic engagement by providing ongoing feedback to avoid premature closure. FIT improves treatment outcomes, including client retention, while enabling therapists to increase flexibility in their approach through real-time client feedback (Solstad et al., 2019). Some limitations and difficulties of using the FIT method in practice persist despite the promising findings so far.
A significant question is whether it is possible to have access to and manage feedback in all fast-paced, transient clinical environments (Miller & Wampold, 2016). It is likely to create logistical issues for therapists and to prompt clients to be reluctant to provide honest feedback to one another in return for receiving it (Miller et al., 2015; Solstad et al., 2019). Furthermore, the generalizability of these findings across different client samples from varied broad therapeutic modalities remains questionable (Miller & Wampold, 2016). On the one hand, the effectiveness across varied settings is demonstrated through the use of FIT; however, generalizability to other cultures and approaches to treatment remains an uncertain proposition.
Clinical Example
In terms of an illustrative clinical example, I can take Sarah, a 32-year-old woman with a depressive condition and comorbid signs of anxiety. She had a positive initial response and has also done well with therapy overall. However, she also began to pull away during the sessions and missed quite a few.
Seizing on Sarahâs concerns about not improving as reflective of poor treatment by the therapist, her treatment could be adjusted through the FIT techniques that guided the session, including regular feedback and negotiated goal-setting (Murphy et al., 2020). In such an approach, at its forefront, it focused solely on preventing early dropout, allowing time for a more collaborative and effective development of a therapeutic alliance.
Clinical Application of the FIT with a Client Prone to Dropping Out of Therapy
Benefits
A diverse potential area of psychotherapy has increasingly embraced client feedback as a key ingredient in enhancing treatment outcomes and developing a firm therapeutic alliance. An approach is Feedback Informed Therapy (FIT), which involves systematically collecting information from clients about a wide range of factors to help tailor interventions. These forms (TPFs) scaffold the elicitation of client feedback and the development of roadmaps for therapeutic interventions within the FIT framework (Gevaert et al., 2020). The next section will explore, in turn, how the use of TPFs may contribute to the process and outcomes of therapy for the client. It will consider the validity, feasibility, and reliability of this approach to FIT.
The TPFs provide a guideline for therapists to gain information on valid instances, progress, challenges, and the clientâs experience during the therapy process. Frequent use of the TPFs provides therapists with approaches to draw valuable feedback from clients on their perspectives regarding the therapy, which can guide possible treatment options and revisions (Bowen-Salter et al., 2022; Gevaert et al., 2020). However, the validity and reliability of the TPFs are greatly enhanced by the accuracy or honesty of clientsâ responses (Gevaert et al., 2020). Clients may be less than forthcoming in the first place or may view gathered data through biased lenses, thereby cultivating an inaccurate record that prevents the provision of an effective therapeutic process.
This explains why a trusting, non-judgmental environment between a client and a therapist is essential. Here, clients can open up and view the situation with honesty. In addition, therapists should generalize several methods of data collection and triangulate the evidence from TPFs with other information to make the data more valid and reliable (Bowens & Cooper, 2012). Being proactive in such challenges, therapists may therefore optimize the use of TPFs to tailor interventions and promote positive therapeutic outcomes for their clients.
Process
During my clinical practicum, I attempted TPFs with a client through the various stages of his persistent depressive symptoms. At first, he was very shy about expressing what he really felt for fear that it might be judged or disregarded. On the contrary, it is the very structured nature of TPFs that provided a perfectly safe, non-judgmental space in which he was best able to share his experiences and concerns with us (Bowen-Salter et al., 2022). Over time, David grew increasingly comfortable offering his feedback to us, so that together we brought into visibility areas of focus where interventions might best address his needs. By using the TPFs, David truly felt valued and empowered as an active agent in both the perception and progress of his therapeutic work.
Limitations
Despite TPFs sounding like a promising option, practical challenges regarding their implementation may arise at the clinical level. For instance, therapists may encounter actual barriers such as a lack of time or inadequate resources, which can hinder their ability to administer TPFs regularly. Additionally, clients may perceive TPFs as burdensome or intrusive, potentially leading to resistance or reluctance to fully engage with the process (Bowen-Salter et al., 2022).
Practitioners need to anticipate and proactively address these challenges, adapting their approach as needed to ensure the effective application of TPFs in therapy. Ongoing supervision, reflection, and practical experience remain essential components throughout the therapeutic process (Bowens & Cooper, 2012). These elements help therapists identify blind spots, refine their approach, and navigate challenges related to TPF implementation. By leveraging supervision and reflection, therapists can uncover valuable insights from client feedback that might otherwise be missed, thereby facilitating the development of the therapeutic alliance and promoting positive treatment outcomes.
References
Bowen-Salter, H., Whitehorn, A., Pritchard, R., Kernot, J., Baker, A., Posselt, M.,… & Boshoff, K. (2022). Towards a description of the elements of art therapy practice for trauma: A systematic review. International Journal of Art Therapy, 27(1), 3-16.
Bowens, M., & Cooper, M. (2012). Development of a client feedback tool: A qualitative study of therapistsâ experiences of using the Therapy Personalisation Forms. European Journal of Psychotherapy & Counselling, 14(1), 47-62.
Gevaert, A. B., Adams, V., Bahls, M., Bowen, T. S., Cornelissen, V., DĂśrr, M.,… & Kränkel, N. (2020). Towards a personalised approach in exercise-based cardiovascular rehabilitation: How can translational research help? A âcall to actionâ from the Section on Secondary Prevention and Cardiac Rehabilitation of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology, 27(13), 1369-1385.
Miller S. D. & Wampold B. E. (2016). Creating a climate for therapist improvement: A case study of an agency focused on outcomes and deliberate practice. Psychotherapy, 56(3) 367-375.
Miller, S. D., Hubble, M. A., Chow, D., & Seidel, J. (2015). Beyond measures and monitoring: Realising the potential of feedback-informed treatment. Psychotherapy,52(4), 449â457.
Murphy, M. G., Rakes, S., & Harris, R. M. (2020). The psychometric properties of the session rating scale: A narrative review. Journal of Evidence-Based Social Work, 17(3), 279-299.
Shimokawa K., Lambert M. J., & Smart D.W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78(3), 298â311.
Solstad S. M., Castonguay L. G. & Moltu C. (2019). Patientsâ experiences with routine outcome monitoring and clinical feedback systems: A systematic review and synthesis of qualitative empirical literature. Psychotherapy Research, 29(2), 157-170.