To measure means to manage

all of us, patients and caregivers, human beings. And as such, we tend, many times, to see reality as we would like to see reality, and not, necessarily, “as it really is.” 

90% of psychotherapy therapists rank themselves in the 25% group of the best therapists in the field. This surprising statistic, which shows that therapists tend, roughly speaking, to see themselves as much better than they really are, echoes the human nature of therapists. Just like any other professional, they too want to be “in the group of 25% of the best therapists in their field”, and therefore, 90% of them see themselves as such. This figure is particularly surprising in light of the fact that these are intelligent professionals, entrusted with self-criticism and caution. And perhaps more than this statistic is surprising, it underscores how important it is to drive a process in which therapists “will truly realize how good they are, and how much they really help their patients”; A process that will prevent them from seeing reality “as they want to see reality”, and will allow them to see reality “as it really is”. This process, in which the therapist realizes how effective the treatment he is giving the patient is called “outcome monitoring”. 

The simplest form of result collection is called “before-after result collection”. It is the minimalist approach to examine how well treatment works. In “Collecting results before-after” the patient’s condition is examined before and after the treatment. When the results are collected systematically (that is, done with all patients receiving treatment in a given framework, a method called systematic outcome monitoring), it turns out that the quality of treatment increases as a whole. The patient (receives better treatment) benefits, the therapist (who feels more effective) benefits, and the entire system (which seeks effective treatments to enable more and more patients to receive treatments) benefits. 

Another form of data collection, more extensive and in-depth, is called routine outcome monitoring or progress monitoring. Instead of collecting data at the beginning and end of treatment, data is collected after each session. The patient and therapist evaluate after each session parameters of the session that took place. In addition, the therapist receives the monitoring data, that is, he is informed of the progress (or crashes, and in final cases – even the withdrawal) of the patient he is treating. 

Routine result collection is, of course, more accurate than “before-after” result collection. It allows the therapist to “close the circle”: the patient arrives, receives treatment, and based on the routine results the therapist can correct, improve, direct himself better, and streamline the treatment. Many studies have shown that routine data collection increases the effectiveness of treatment, greatly reduces the harmful treatments and supports the development of therapists when they bring the results of routine data collection to guidance.

What metrics are collected in routine results collection?

An ideal measure should be a short, simple measure, one that does not burden the patient, a measure that is reliable and sensitive (i.e., variable in a way that can reflect relatively subtle changes). Different metrics refer to different aspects of treatment: symptoms (e.g., anxiety level), how the patient experiences and relates to the therapist (e.g., therapeutic alliance evaluation), and evaluation of the session that was (e.g., whether there is a sense that a breakthrough was achieved at the session). 

So what’s the problem? ….

The main problem with routine results collection is the therapists’ opposition (just like that!) To the application of the process. Some therapists just do not understand “why is it good ?!”, others feel it is an oppressive process that has practical problems, and others, let’s face it, are afraid to find out they are not as good as they thought they were good. But the main resistance stems from the fact that many therapists feel that the very act of measuring is foreign to the therapeutic process. “It’s turning something delicate and sensitive into something technical, and it just doesn’t fit.” This statement is significant, and there is truth in it. Psychotherapy is really a very delicate process, in which there is a measured dance of rapprochement and distancing. The thought of “measuring it” is really naive. 

 Is it possible to find a way to conduct a routine collection of results without bothering about the treatment? Without bothering the patient and therapist to fill out questionnaires and evaluate what is happening? Is it possible to collect results continuously “in the background”, in such a way that the patient and therapist will not feel at all that the collection of results is being carried out? 

This question sounds fundamentally paradoxical: how can one collect results without collecting results? That is, how can one assess whether the treatment is progressing without asking the patient and the therapist whether it is indeed progressing? 

Despite the paradox in the question, the answer to it is definitely yes. It is possible to assess whether the treatment is progressing, and even expect what its future direction of progress will be (for the benefit, for lack of effect or, God forbid, for the aggravation of the patient’s condition) only from the hours of treatment themselves. Careful analysis of various parameters, which are “hidden” within the hours can reveal their results.

Here is an example. Psychotherapy is characterized by the fact that as it progresses, the degree of synchronicity, that is, the degree of matching, between the patient and the therapist increases. It’s like two tango dancers dancing together. As this “tango dance unit” develops well, the two dancers become more and more aligned with each other. Mutual sensitivity increases, the ability to compensate for mistakes improves, and the couple becomes a body that acts in synchronicity and each of the dancers empowers his partner. So is the treatment. As it develops, the patient and therapist “synchronize” with each other: sensitivity increases, the ability to compensate for mistakes improves, and the patient and therapist reinforce each other. And this, the degree of synchronism of the patient and the therapist, can be measured and evaluated. The Matrix is ​​a coding tool, found in the background of psychotherapeutic treatments. The Matrix converts the conversation into codes, and analyzes the relationships between them so that it can give the therapist vital information at the end of the session, which answers critical questions: Is the treatment progressing? And if so, is the progress at a measured and safe pace? And if the treatment is not advanced, why is it not advanced? Is the “breakdown” repairable? And how?

The Matrix supersedes the use of session by session questionnaires (i.e., questionnaires that must be completed after each session). Maybe like the Wise software, the Matrix does not drive a car but based on collecting a lot of data, it allows the therapist (who drives the car …) to drive safely and efficiently.

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