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How do I administer the questionnaires?

The outcome questionnaires are intended to be administered prior to the session, so that the clinician can make use of the information during the session. The questionnaires are brief and face valid. Most clients do not object to the use of questionnaires, particularly when the therapist appreciates the client's effort and values the information.

Some practices ask their receptionist to offer the questionnaire to clients in the waiting room. If the questionnaires are present as part of the routine provision of care, clients readily comply.

The Alliance items on the questionnaires requires more skill to administer. The reason for this is that clients tend to respond in a very positive manner. The Session Feedback Form, however, provides greater value when the clinician can induce the client to give honest feedback; in effect, when the client rates the therapist and session as less than perfect.

The Center for Clinical Informatics recently performed a series of analyzes on a large sample of clients, who completed an alliance measure at every session. Results revealed that a pattern starting with a less than perfect alliance that improved over time was associated with a good outcome. In contrast, clients who rated the alliance almost perfect at the start of treatment and then only slightly less than perfect at the end had much worse outcomes. Beware of condemnation with faint praise.

Use Alliance items appears to be associated with a higher return rate and positive outcomes, overall. Skillful use of the Alliance items to engage the client in a discussion about the treatment process may be particularly helpful for patients who have not improved as much as hoped for or who may be demoralized.

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