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How do I administer the questionnaires?

The questionnaires may be administered either in paper and pencil form or using any device with a browser, such as an inexpensive tablet. If the questionnaire is administered online using a browser enabled device, the results are available to the clinician during the session via the Toolkit account. If the questionnaire is on a paper form, these may be faxed to a secure HIPPA compliant fax server for software assisted data entry and validation. In the case of faxed forms, results are typically available within a few hours, depending on the time of day.

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 communicates to the client that they appreciate the client's effort and that they value the information it provides them. Most organizations ask their receptionists 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 require more skill to administer. The reason for this is that clients tend to evaluate their therapists very positively. The Alliance Scale, however, provides greater value when the clinician can convince 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 analyses 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.

Using Alliance items appears to be associated with an overall higher return rate and positive outcomes. 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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