Measuring progress in therapy requires an objective analysis of the big picture.
When new clients book a visit with me because they’re considering a switch from their current therapist, one of the most common reasons they offer for switching is that they have “gotten into a rut.” Their first few sessions went really well and they talked a lot about goals, but then somehow it drifted away from an organized pursuit of those goals and got into sessions “where I just basically talk about how my week went and the therapist nods.”
These clients are coming to my practice because they’ve heard I’m beyond energetic and focused on helping clients to stay on track and get results. However, the growth of my practice has meant that many clients in my practice work with one of my associates who has evening or weekend hours. My associate therapists often work with clients to implement the therapy plan I create for clients during early phone calls or initial therapy sessions. This allows the client to draw from my expertise during the initial treatment planning stage, and then see an associate in order to save money on fees or have appointments during evenings or weekends.
I have found that many clients often appreciate when I offer to check in with them after they had a few sessions with their associate therapist, to make sure things were unfolding like we had planned during initial sessions or phone calls. Those check-ins help the client and associate alike to pay special attention to the therapeutic goals, so much that I decided to formalize the process into something I offer to nearly every client at my practice.
The Check-In Program
For any client that opts into the program, after every five sessions with an associate therapist from my practice, I offer the client a 20-minute call with me.
The program is strictly optional, and clients can decide for themselves if it feels right for them.
In order to encourage a positive trajectory and keep the gains already made in therapy, I have developed this review plan to periodically assess the efficacy of the work already done, with an eye toward even more success in the future. This option for clients provides an added layer to their therapy to help ensure fidelity to the therapeutic goals we identified at the start of treatment. It also provides a built-in accountability check for the therapist and client alike, which often makes therapy even more engaging and effective. Some clients feel no need for it, and that is completely fine – the program is optional.
Here’s an example of how it works within a given therapy plan:
A client calls my office seeking help with a panic disorder. I listen to their particular symptoms and outline a 2-phase course of treatment:
Cognitive-behavioral breathing techniques and thought management exercises to help the client master basic panic attack symptoms
A broader discussion of why and how the client became stressed to the point of panic in the first place, and strategies for how the client can manage stressors more effectively
The client agrees to the plan above, and I refer him to an associate because he needs evening appointments or wants to save money by working with an associate – he just wanted me to outline the initial course of treatment and monitor his progress. The client and associate therapist will proceed with the therapy plan I created, both knowing that after 5 sessions, I will follow up with the client to confirm he has learned the breathing techniques and cognitive interventions we discussed, and is progressing to the next phase involving preventive stress management. We can also use our check-in call to identify future goals. Once clients are liberated from panic attacks, they feel free and excited to focus on new goals that had previously felt impossible. Clients may also want to discuss therapeutic issues; I can then give appropriate feedback to the therapist.
The Check-In Program helps to hold both players – my associate and my client – accountable for the work they are doing together. This usually keeps the work fresher and more engaging for everyone involved – most importantly for the client.
Clients pay closer attention to their behavior when they know somebody is watching them, and frankly, so do the therapists. Giving your very best effort when you know someone is watching is part of human nature – this pattern is called the Hawthorne Effect in psychology literature, and knowing how to take advantage of the Hawthorne Effect is just one of the many tools at the disposal of my associates, my clients and me.
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Do you feel a periodic review of your therapy goals would be helpful? Feel free to contact my office and learn more!
Chloe Carmichael, Ph.D., is a clinical psychologist, dating coach, and the founder of Carmichael Psychology in New York City. She specializes in cognitive behavioral therapy for anxiety reduction in every aspect of your life. Her new series of online tools allows her clients to master CBT techniques for anxiety on their own schedule.
Dr. Chloe Carmichael Peet