Feedback Informed Treatment (FIT)

| November 5, 2014
myoutcomes evidence based therapy

‘Scott Miller with ICCE has championed this common sense approach called Feedback Informed Treatment (FIT)’

…to increase our efficacy in psychotherapy, by asking the client for feedback and responding to this rather than pushing our favourite approach and explaining any lack of response to resistance, or lack of readiness, or secondary gain.

Karl Thom said years ago that there are no resistant clients. So called resistant clients are just doing what they are doing. We say they are resistant because they are not doing what we say the should be doing.

There is some irony however, since Scott, bless his Viking spirit, has called for a shift of emphasis from evidence based therapy to therapy based evidence, only to have this therapy based evidence become an accepted evidence based treatment. How's that for circularity?

But what is new here? Anyone trained in Gestalt Therapy falls back on “What's happening now?”. Milton Erickson stressed the importance of observing when he said the three most important skills for us are to observe, to observe, and to observe! Anyone who has renovated a house is likely to come across a brand of paint – Cabot – which has on the lid of every can “When all else fails, read the instructions”.

I wrote in a previous blog about the importance of listening, which can in this context be another word for observing.

I notice that I am reluctant to use Scott's ORS and SRS even though they are supported by evidence, and wonder if we can find a more human way of eliciting feedback. Is it naive to ask? Could we ask at the beginning of a session “What's changed since our last meeting?” or “What changes have you noticed since you made this appointment?”. Could we ask during a session “What's happening as we are talking?” … or at the end of a session “What's different now compared with when you arrived?”.

Perhaps in an age of accountability, we need the numbers as evidence, even if only to convince the insurance companies so they will finance our work, but using scales or not, feedback is shifting the emphasis away from competition between schools of therapy and towards the client and their experience.

I think Erickson would have approved, perhaps with some bemusement about the “science” of this process.

This article first appeared online at To know more about Rob McNeilly, click here

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Category: Feedback Informed Treatment

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