One Small Step for MyOutcomes, One Giant Leap for Therapists

| April 3, 2015
myoutcomes evidence based therapy, detecting early change in therapy

Detecting early change in therapy predicts success!

One question debated in evolutionary science is whether change occurs gradually over long periods of time or do dramatic events bring about dramatic changes in short periods of time? Resolving this question isn't simple as an incomplete geological record provides evidence for both. Given that these two explanations of change are not mutually exclusive, it may very well be that both are correct.

The scientific process typically finds answers by eliminating alternative explanations. A scientist finds support for their pet theory by searching through the “noise” to find a “signal” that other theories can't predict.

The geological record could be incomplete for two different reasons. One reason is that records have been destroyed by the destructive forces of nature. Alternatively, evolutionary scientists may not have yet been able to extract the relevant, historical signal from all of the other historical noise.

How this signal-to-noise ratio impacts the ability to detect “facts” is something that affects all sciences. Although he may not have known at the time, John Stuart Mills began addressing this problem with his Primary and Secondary Laws. Primary Laws are big, powerful laws that can be easily observed and directly measured. They can make big, powerful predictions because nothing impacts them. Until recently, physicists believed that they were studying a deterministic system which they could reduce down to laws that governed events that were the result of single, or primary, causes.

Secondary Laws, according to Mills, are the source of secondary causes. They are less easily detected, often mediating or modulating primary laws and each other. Their actions contribute to a system that is probabilistic rather than deterministic. Psychology is a science of Secondary Laws and secondary causes. This is the reason why from its scientific beginnings, researchers, such as Wundt and Helmholtz, had to develop strategies to amplify the signal and minimize the noise. This has been the challenge for psychologists ever since.

Detecting a signal in the complex mishmash of an individual's psychology is challenging. Detecting changes in that signal can be an even greater challenge. This is because changes in psychological events are not always big, powerful, Eureka moments. Although there are some events that appear to be the result of a singular, dramatic change occurring in a brief moment, other psychological states are more subtle and demonstrate small, gradual change over a period of time.

Undoubtedly, most therapists would love to be able to guide their clients into having one of those sudden epiphanies when the problem and its solution become crystal clear. Having their clients say, “Ah-ha. I get it!” would be hugely satisfying. Unfortunately, successful change can be far more subtle; typically being the result of a more gradual, time-dependent process. This can make change difficult to detect.

This difficulty in measuring change in a person's psychological experience can pose a major problem since change is critical to the therapeutic process. Early change, even if it is small and gradual, plays a major role in predicting successful outcomes. Put another way, if change doesn't occur, the client is at increased risk for dropping out before reaching their therapeutic goal.

A therapist's goal is to help their clients achieve their therapeutic goals. It stands to reason, then, that therapists will do everything they can to keep their clients from dropping out. Of course, how can they do this, if they aren't able to measure change? It is only by measuring change that one can become aware of the lack of change.

The trick is having an instrument that is capable of detecting a signal, in this case a psychological state that is changing, in the entire milieu of psychological noise. Not only does such an instrument need to be able to detect the psychological state, it needs to be sensitive enough to detect changes, no matter how small and gradual.

MyOutcomes provides that tool. The Outcome Rating Scale, or ORS, measures the client's psychological distress as well as changes in that distress. Measuring psychological distress makes sense. After all, it is the client's psychological distress that usually brings them into therapy to begin with. The logical conclusion then is that if psychological distress is reduced and/or eliminated, the client has recovered sufficiently to reclaim their life.

The power of MyOutcomes, the automated, web-based application of PCOMS, to help the therapist and the sensitivity of the ORS in measuring client change lies in its inherent simplicity. Other measurement tools attempt to measure virtually everything under the sun, sometimes to the point that they are reassessing the client every time they are administered. This can result in a poorer signal-to-noise ratio. MyOutcomes' ORS, on the other hand, is focused on measuring one thing: psychological distress. It is this simple, direct approach that allows the ORS to amplify the signal over the noise. It is also what enables the ORS to detect change, even if it is small and gradual. Being able to detect these small changes is why MyOutcomes is the ideal partner to help therapists take a giant leap in helping their clients.


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Category: Agencies, Early change in therapy, MyOutcomes, ORS / SRS, Outcome Rating Scale, PCOMS, Private Practice, SAMHSA

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