Talking to Patients as Part of Measurement-Based Care
As we have discussed previously, measurement-based care (MBC) involves assessing patient progress and the therapeutic process throughout the course of treatment to improve the quality of the service being delivered. Of course, the clinician will naturally gather many of their own insights from interacting with the patient. MBC supplements this information by providing the patient’s perspective on their symptoms, well-being, and their relationship with the clinician.
One important application of this information is using it to guide clinical decision-making (which I will cover in the next blogpost), but more important perhaps is that it serves as the starting point for a discussion between the patient and the clinician. A Norwegian colleague refers to MBC as a conversational tool, meaning that the information gathered should facilitate a meaningful discussion about various aspects of therapy, which in itself can have a therapeutic effect.
There are three primary aspects that make this conversation therapeutic.
Focus on the patient’s progress. People’s lives are complex, as is the process of psychotherapy. As we delve into these complexities, we can lose focus on what is most important: patient progress! The therapeutic work—whether changing maladaptive thoughts, reducing avoidance of feared situations, or recognizing and tolerating difficult emotions—is in service of the patient feeling less distressed and experiencing greater well-being. The conversation that MBC provokes puts this progress front and center. By reminding patients that the therapist is keenly aware of their progress and its importance, MBC builds trust and augments motivation.
Collaborative work and patient agency. The most robust finding in the psychotherapy literature is that collaborative work by the therapist and patient is key to successful outcomes. In medicine, adherence to prescribed medication or procedures depends to a great extent on the relationship with the physician as well as confidence that the treatment will be beneficial. In psychotherapy, engagement in treatment, whether in the session or completing assignments between sessions, also depends on the collaborative relationship. Discussing how therapy is progressing augments the collaboration between therapist and patient. Offering the patient the opportunity to examine and discuss their confidence in the therapist and the treatment strengthens their sense of agency. If the patient believes, “My views of therapy matter to the therapist and to the therapeutic process,” they will feel more empowered to take an active role in achieving their desired outcomes.
Reconciling misperceptions. Inevitably, there are discrepancies between different sources of information. For example, a patient might report to the therapist that they are having as much or more distress than they have had previously, although their MBC assessment scores indicate that they have been progressing well. This could be due to a number of different reasons. Patients often come to therapy with a distorted view of themselves and the world, and thus they may be fearful that if they report “all is well” they will be encouraged to terminate. Or, they may have a pessimistic personality and resist the notion of “improvement.” Of course, the discrepancy could be in the other direction—reporting in session feeling much better than they indicate on the assessments. In either case, it is vital to discuss any such discrepancies with the patient in order to understand the reasons behind them, so therapy can move forward. The patient might not even be aware of these discrepancies until they are pointed out, and simply becoming aware of them can bring important insight into their internal state.
To wrap up—the information provided by MBC is not only important for clinical decision-making, but is an important conversational tool. Discussing MBC with the patient focuses therapy on patient progress, creates collaboration and patient agency, and helps to reconcile discrepancies among different indicators of progress.