How Skillful is your Shrink! Now you can find out!
The Exciting Recovery Coefficient–
and the FEAR the grips the hearts of the therapists who are afraid to use it!
People often wonder how skillful or effective their therapist is, but until now, there was no very valid or precise way to know. But now there is, and it has fantastic implications for psychotherapy.
Today, we feature an interview with Kevin Cornelius, a therapist at the Feeling Good Institute in Mountain View, California. Kevin Cornelius is a Licensed Marriage and Family Therapist in private practice at Feeling Good Institute, with in-person counseling for teens. Kevin is a Certified Level 4 Advanced TEAM-CBT Therapist and Trainer.
I asked Kevin to write a brief description of his evolution from a career in acting to his career as a shrink. Here’s what he wrote:
After many years of working as an actor I was ready for a change. After some painful personal events, I saw a therapist who was quite helpful to me. She helped me see that changing to a career as a therapist could be a great thing for me.
I went to school and got my Master’s in Marriage and Family Therapy. Just before I began applying for internships to complete licensure, I learned that the children’s theatre group I had grown up in was looking for a new supervisor to lead the group following the death of its beloved founder and leader. This was a wonderful opportunity for me to use my theatre skills and my desire to help young people in their growth and development.
I was very fortunate to be hired and worked as the director of the children’s theatre group for 19 years. Towards the end of my years with the children’s theatre, I was ready for a change and thought it might be time for me to finish getting my therapy license.
It had been 15 years since I had worked with a patient in a therapy session, so I had a lot to learn! I was so lucky to discover David Burns and his amazing TEAM-CBT. The testing element of TEAM enabled me to see right away where I needed to improve so I could focus my efforts on improving specific skills.
Being able to study with David in his Tuesday group at Stanford was a golden opportunity. Here was a framework designed to make therapy as effective as possible being taught (for free!) by one of the world’s greatest therapists.
I’m so happy I followed David’s advice to get involved at Feeling Good Institute while I was still pre-licensed. Learning TEAM while I was completing the process to earn my license as a therapist enabled me to start my career in private practice with confidence and a stable foundation. Now, I get to continue learning from mentors at Feeling Good Institute, from the wonderful Feeling Good Podcast, and the valuable lessons I get from my patients.
I’ll sum up my good fortune with a theatre reference and quote the Gershwins: “Who could ask for anything more?”
Kevin recently made the courageous decision to find out exactly how he was doing as a therapist. And the results surprised him tremendously.
Background Information for today’s podcast
Outcome studies with competing schools of psychotherapy in the treatment of depression have been disappointing. They all seem to come out about the same, slightly better than placebos, but not much. For example, in the British CoBalT study of 469 depressed patients treated with antidepressants vs antidepressants plus CBT, only 44% of the patients treated with antidepressants plus CBT experienced a 50% improvement in depression after six months of treatment, and the multi-year follow-up results weren’t any better. This was better than the patients treated with antidepressants alone, (only 22% experienced a 50% improvement), but still—to my way of thinking—very poor. We see more improvement than that in just one day in patients using the Feeling Good App.
Here are just two of many online references to that landmark study:
Because of the disappointing results of research on the so-called “schools” of psychotherapy, the focus is switching, to some extent, to the effects of individual therapists, since even within a school of therapy, there can be huge differences in therapists’ effectiveness. Some therapists seem to have the proverbial “green thumb,” with many patients improving rapidly, while others seem much less effective.
Is there a way to measure this? Now there is!
And do patients have a right to know how effective their shrinks are? That’s what I’m proposing!
For at least twenty years or more, I’ve been trying to sell therapists on my Brief Mood Survey with every patient at every session. That’s because you can see exactly and immediately how depressed, anxious, or angry, etc. your patient was at the start and end of today’s session.
This allows therapists to see, for the first time, exactly how much the patient improved in various dimensions within the session, as well as how much the patient relapsed or continued to improve between sessions.
Here’s a simple example. To make things really clear, let’s imagine that your depression test goes from 0 (not at all depressed) to 100 (the worst depression imaginable, and your patient has an 80 at the start of today’s session. That would indicate a horrendously severe depression, similar to patients hospitalized with depression.
And yet, your patient might be functioning effectively, and might appear reasonably happy. So, bonus #1, you can see exactly how your patient was feeling at the start of the session. You might think of the BMS as an “emotional X-ray machine.”
Now, let’s assume you have an excellent session, and feel like you’re clicking with the patient, and the patient scores 40 on the end-of-session BMS. That would be a phenomenal 50% improvement. Of course, a score of 40 means that the patient is still moderately depressed, and has a way to go, still the goal is a score of 0 on the depression test and a huge boost in the patient’s score on the happiness test on the BMS.
Keep in mind that in the dozens of psychotherapy outcome studies that have been published worldwide, the very highest levels of improvement in months and months of therapy are never higher than this.
So, I call this the Recovery Coefficient (RC), and it is a very precise measure of any therapist’s effectiveness in treating anything you can measure accurately.
In an informal study of de-identified data of more than 10,000 therapy sessions at a local treatment center about two years ago. I discovered that the RC the first time therapists met with their patients predicted the improvement over the entire course of therapy. In addition, different therapists had vastly different initial RC scores, which can range from -100% in a single session (meaning a complete elimination of symptoms) to +100% in a single session (meaning severe worsening.)
Sadly, because all patient or therapist identifying information was removed to protect identities, I had no way of letting the therapists know their skill levels!
But today, we are joined by a therapist who had the guts to calculate his RC in ten patients to see how he was doing.
He was initial incredibly demoralize with his percent reductions (RC) of 45% for depression and 47% for anxiety in 50 minute sessions, He reasoned that a 44% in a class would be a failing grade, but I pointed out that this isn’t the right comparison. After all, if you had a contract to build the Brooklyn Bridge, and could complete nearly half of it in 50 minutes, you’d be doing something incredibly amazing.
Kevin’s Depression and Anxiety Recovery Coefficient Calculations
for the First Session with Ten Patients
And indeed, Kevin’s scores actually showed he was outperforming all the published outcome studies on depression by a factor of several hundred. Which was, I think, a well-deserved pleasant shock to his system! I’ve always had tremendous admiration and respect for Keven because of his obvious great skill and intelligence combined with world-class compassion and humility.
In addition, patients complete the Evaluation of Therapy Session (ETS) immediately after the session, and rate the therapist on Empathy, Helpfulness, and other crucially important dimensions. Kevin’s Empathy score was 19.6 (96.5%), indicating near perfect empathy ratings from his patients. This is extremely impressive, since most therapists get failing Empathy scores from nearly all of their patients when they start using the ETS scales.
In the chart below, you can see how these same ten patients did from the start to the end of therapy. You can see a pattern of substantial improvement within sessions followed by a partial “give back” between sessions, along with the total improvement in depression and anxiety, and the mean Empathy Scale scores as well. The mean total length of treatment was 11.7 sessions.
Kevin’s Depression and Anxiety Recovery Coefficient Calculations
from the Start to the End of Treatment for Each Patient
|Session Length: 50 Minutes|
|Depression||Anxiety||Empathy||Average # of Sessions|
However, what was really cool is that Kevin brought the Daily Mood Log he prepared prior to the podcast. As you can see if you check the link, recording his intense negative feelings and self-critical thoughts when he initially completed his calculations. This helps to explain the fear that so many therapists—nearly all—feel when it comes to being accountable for the first time in the history of psychotherapy.
Here’s what he was telling himself:
I’m not doing well enough.
I’m fooling myself.
I’m letting my patients down.
I’m a fraud.
I should be better.
I should charge less.