This video defines client directed, outcome informed ideas and practices (CDOI), not as model of treatment but rather as a way of working that priviledges consumer voice, embraces social justice, and expects recovery for all individuals. This video is a teaser for an hour free webinar of the same title found on this page also.

Barry describes his new book, On Becoming a Better Therapist. Purchase the book at the bookstore and register to participate in free monthly webinars.

Saul Rosenzweig, founder of the common factors and author of the first known article detailing the common factors in 1936, receives the Heart and Soul of Change Award for his contributions. Download the original article as well as an interview with him by Barry Duncan.

People have asked me about my appearance on Oprah for many years. It was way back in 1992 just after I published my first book (with my best friend Joe Rock), a self help book called Overcoming Relationship Impasses. (That book, now called The Lone Changer, is available as a download in the bookstore. No matter what I put in my bio, the first thing that is commented on is my Oprah appearance. So in deference to an interest that has mightily stood the test of time, here are snippets of my Oprah debut in the world of TV media. Please be kind, I was a complete media neophyte.

Barry interviews the principal investigator, Dr. Morten Anker, of the Norway Feedback Study, the largest randomized clinical trial (RCT) ever done with couples. Morten presents the design features that make the study noteworthy as well as the incredible findings. For example, four times more couples achieved clinically significant change in the feedback condition over couples in the treatment as usual condition, and at six month follow up, couples in the feedback condition separated nearly 50% less. Morten and Barry also discuss the national roll out of CDOI in Norway Family Counseling Offices.

This video provides an overview of the status of the psychotherapy field (overall effectivness as well as the problems of drop outs and therapist variability in outcomes) and presents a solution to address the noted problems: practice based evidence or the collection of data with clients to monitor both the benefit and fit of psychotherapy services.

For more information, read the consumer-driven outcomes management summary.

This video is an introduction to the ASIST software offered by Client Voice Innovations.

ASIST is used to retain and analyze results from the Outcome and Session Rating Scales, the hottest psychotherapy measures in use today.

Therapists don't care much about research because it doesn't much inform their work. This story captures that sentiment as a prelude to the research presented on the research page that does actually inform therapy practice—the kind of research done with clients, or practice based evidence.

Part 1 of the FIAMC presentation at Lourdes, France about psychiatric drugs. Barry addresses the question of whether the clinical trial evidence supports the rising rates of prescriptions. He also presents the five fatal flaws of drug research.

For more information, read the summary of the presentation and view the slides.

Part 2 of the FIAMC presentation at Lourdes, France about psychiatric drugs. Barry addresses the question of whether the clinical trial evidence supports the rising rates of prescriptions. He also presents the five fatal flaws of drug research.

For more information, read the summary of the presentation and view the slides.

Barry describes the essential elements of What’s Right With You in this lively, brief interview. Purchase the book at the bookstore.

Part 1

In a more in-depth interview, Barry identifies the six steps of change described in the book What’s Right With You. This interview includes a lively discussion about psychiatric drugs and a brief debate between Barry and a very nice Harvard Psychiatrist. Purchase the book at the bookstore.

Part 2

In a more in-depth interview, Barry identifies the six steps of change described in the book What’s Right With You. This interview includes a lively discussion about psychiatric drugs and a brief debate between Barry and a very nice Harvard Psychiatrist. Purchase the book at the bookstore.

Part 3

In a more in-depth interview, Barry identifies the six steps of change described in the book What’s Right With You. This interview includes a lively discussion about psychiatric drugs and a brief debate between Barry and a very nice Harvard Psychiatrist. Purchase the book at the bookstore.

Client directed, outcome informed services contain no fixed techniques or causal theories regarding the concerns that bring people to treatment. Any interaction can be client-directed and outcome-informed when the consumer’s voice is privileged, social justice is embraced, recovery is expected, and helpers purposefully form partnerships to: (1) enhance the factors across theories that account for success; (2) use client’s ideas and preferences (theories) to guide choice of technique and model; and (3) inform the work with reliable and valid measures of the consumer’s experience of the alliance and outcome.

This video was made by Robyn Pope, a certified CDOI trainer of the Heart and Soul of Change Project, of staff at Wesley Community Action. Wesley is a broad based social service agency in New Zealand that provides culturally sensitive and socially just services in non traditional settings. Robyn solicits staff reactions about the use of the Outcome Rating Scale and Session Rating Scale, including how they have grown professionally and personally as well as the challenges they have faced in implementation.

Morten Anker and Barry Duncan discuss the JCCP article that found the alliance predicted outcome over and above early change and that ascending alliance patterns were associated with better outcomes.

Have you ever been reading a book and had a burning question you would like to ask the author? I know I have. This is the first of seven webinar discussions of my new book, On Becoming a Better Therapist. I started with a 25 minute overview and then I turned it over to you for your questions, comments, and reflections. Over a hundred folks joined me for this first webinar. It was definitely fun and a lively discussion occurred. Purchase the book at the bookstore and register to participate in free monthly webinars.

Have you ever been reading a book and had a burning question you would like to ask the author? I know I have. This is the second of seven webinar discussions of my new book, On Becoming a Better Therapist. I started with a 25 minute overview of using the measures in the first session and then I turned it over to you for your questions, comments, and reflections. It was definitely fun and a lively discussion occurred. Purchase the book at the bookstore and register to participate in free monthly webinars.

Have you ever been reading a book and had a burning question you would like to ask the author? I know I have. This is the third of seven webinar discussions of my new book, On Becoming a Better Therapist. I started with a 25 minute overview of using the measures to tailor services and then I turned it over to you for your questions, comments, and reflections. It was definitely fun and a lively discussion occurred. Purchase the book at the bookstore and register to participate in free monthly webinars.

Have you ever been reading a book and had a burning question you would like to ask the author? I know I have. This is the fourth of seven webinar discussions of my new book, On Becoming a Better Therapist. I started with a 25 minute overview of using the measures to tailor services and then I turned it over to you for your questions, comments, and reflections. It was definitely fun and a lively discussion occurred. Purchase the book at the bookstore and register to participate in free monthly webinars.

On Becoming presents a five-step method of integrating outcome management with therapists' long-term professional development. In this fifth of seven webinars corresponding to the seven chapters of the book, I present chapter five, and discuss the main ways to improve your outcomes via the heart (the client) and soul (the alliance) of change. The webinar begins with a 25 minute overview followed by your questions, comments, and reflections. Purchase the book at the bookstore and register to participate in free monthly webinars.

On Becoming presents a five-step method of integrating outcome management with therapists' long-term professional development. In this sixth of seven webinars corresponding to the seven chapters of the book, I encourage you can to keep the pedal down on your development by reflecting about your identity as a therapist as well as how you describe what you do. The webinar begins with a 25 minute overview followed by your questions, comments, and reflections. Purchase the book at the bookstore and register to participate in free monthly webinars.

On Becoming presents a five-step method of integrating outcome management with therapists' long-term professional development. In this seventh of seven webinars, I discuss the Treasure Chest, a way to buffer burnout and chronicle your development. I also present the controversial topics of the day as they pertain to therapist identity. The webinar begins with a 25 minute overview followed by your questions, comments, and reflections. Purchase the book at the bookstore and register to participate in free monthly webinars.

Most of us became therapists because we wanted to be helpful to other human beings, and most of us carry an inextinguishable passion to become better at it. But how do we get better? On Becoming answers that question in a pragmatic and clinically nuanced way, presenting a five-step method of integrating outcome management with therapists' long-term professional development. In this first of seven webinars corresponding to the seven chapters of the book, Barry presents chapter one: including the pitfalls of the search for the Holy Grail, the rationale for outcome feedback, a model of therapist development, and an overview of the common factors setting the stage for the chapters and webinars that follow.

This webinar details the first session. Introducing the ORS/SRS: 1) Building a culture of feedback; 2) Understanding that there is no bad news on the measures; 3) Fitting the introduction into your own style; and 4) Scoring the measures. The clinical nuances: 1) Discussing the client’s score in relation to the clinical cutoff and allowing the client to make sense of it; 2) Connecting the client’s described experience of the reason for service to his or her marks; 3) Ensuring that you have a good rating on the ORS; and 4) Discussing the client’s score on the SRS, thanking him or her for the feedback and either inviting the sharing of any future concerns or exploring any noted concerns.

This webinar charts the ins and outs of tailoring psychotherapy based on feedback: 1) Plotting the ORS scores on a graph, comparing the current ORS score with the last, and looking at the progression of change or lack thereof. Only two options: there is change or there isn’t. If there is change, work with clients to take responsibility for the change and empower their ability to continue progress. If there is no change, discuss what needs to happen next. If no change persists, the discussions increase in urgency, represented by the Checkpoint Conversation and the Last Chance Discussion, both intended to brainstorm options and entertain the possibility of referring the client elsewhere. If no change persists, it is time to fail successfully.

In this fourth of seven webinars corresponding to the seven chapters of On Becoming a Better Therapist, Barry discusses the three sources of Orlinsky and Rønnestad’s empirically derived concept of Healing Involvement: First, tracking your cumulative career development with outcome data ensures that you benefit from your experience and not merely repeat it. Regarding theoretical breadth, the second source, it is suggested that you drop the belief in the “truth” value of any given approach. Finally, the primary source of Healing Involvement is your currently experienced growth. This webinar helps you examine your work with your clients, and apply a strategy of empowerment and reflection to harvest the lessons of clinical experience.

In this fifth of seven webinars corresponding to the seven chapters of On Becoming a Better Therapist, Barry discusses the main ways to improve your outcomes via the heart (the client) and soul (the alliance) of change. It boils down to two attitudes: first is a dependence on clients and what they bring as the most potent aspect of change—to rally, recruit, or harvest client’s existing resources in service of client goals. The second attitude is the understanding that the alliance is the therapy, and that everything you do must be strained through the alliance filter. Does your behavior build or risk the alliance? This webinars details the best ways to get started to jumpstart your outcomes.

In this sixth of seven webinars corresponding to the chapters in On Becoming a Better Therapist, Barry encourages you to envision your identity as a helper and further contemplate this unpredictable and complexly human enterprise called therapy. To inspire your continual reflection about your identity and how you describe what you do, Barry describes his journey, presenting psychotherapy as a discovery-oriented process, a non-cookie cutter search for what works for each unique client. Feedback provides a comforting compass, a way to manage the uncertainty that is just as characteristic of therapy as it is of life.

In this seventh of seven webinars corresponding to the chapters in On Becoming a Better Therapist, Barry discusses the fifth and final step to keep your development on the front burner, the Treasure Chest. This collection of client comments about your work with them also includes a look at your development through narrative accounts of the clients who taught you the most. Barry will also discuss the controversial issues of the day—managed care, evidence based practice, psychiatric drugs, and the medical model—and encourage you to take a stand to protect the aspects of your identity as a therapist that you hold dear.

This workshop provides a no nonsense discussion about how to get started using feedback in your agency—not sometime, next month, or even next week—but in your next day back at work. Based on his experience implementing outcome management at the largest public behavioral health agency in Arizona, Dr. Bob Bohanske addresses the nuts and bolts of getting started. Results from several public agencies demonstrate that it is indeed not mission impossible!

We live in a world pervaded by the unspoken attitude that we are all basically flawed, broken, incomplete, scarred or sick: we’re labeled as dysfunctional, codependent, depressed, you name it. Contrary to popular perception and drug company ad campaigns, fifty years of research shows that positive change does not primarily emerge from examining the disorders, diseases, or dysfunctions—all the stuff that’s wrong with us—that allegedly plague the masses. Change, in truth, comes from what’s right with the people attempting it—their strengths, resources, ideas, and relational supports. In this webinar Barry translates CDOI into a six step plan.

Dr. Makungu Akinyela describes therapeutic conversations that recognize what some identify as "non-compliance" and "resistance to change" as clients striving for dignity in the face of oppressive relationships. These oppressive relationships often occur in the context of racial, class, gender or sexual differences between the counselor and client that are de-emphasized. This talk encourages you to include a social justice frame-work in your therapeutic practice based on witnessing the testimony (desired story) told by clients about their lives and collaborating with clients in the fight for dignity.

A sharp departure from customary discourse on mental illness, recovery-driven services shift away from professional-directed treatment based on diagnostic labels and prescriptive practices to individually tailored, consumer-authored plans. After telling her personal story of recovery, Dr. Lori Ashcraft asserts that moving from illness toward recovery means that counseling professionals must be both responsible and responsive to their customer base and directly involve clients in decision making. This webinar calls for recovery-focused services that recognize clients as the primary movers of change, that require the unique tailoring of intervention to their preferences, and that call for relationships that are collaborative and respectful.

Based on the persistent belief that young people and their caregivers are capable of remarkable changes when invited to and actively participate in services and to apply their “natural resources” toward solutions, Dr. John Murphy describes practical ways to put the principles of CDOI and recovery into action in schools, counseling agencies, and other child/youth settings. Real-world examples are used to illustrate the power of partnership and the benefits of client-driven/strength-based practice.

Feedback pioneer Dr. Michael Lambert answers the question he and his colleagues posed in an influential article: “Is it time for psychotherapists to routinely track outcome?” He reviews the evidence about client based outcome feedback or practice based evidence, particularly his own five RCTs using the Outcome Questionnaire 45.2, and makes a strong case for an affirmative reply. His research has shown time and time again, that systematic feedback significantly improves outcomes, doubling the effectiveness of clients headed for treatment disaster. Join the person most responsible for the greatest innovation in psychotherapy outcomes ever.

Barry interviews the principal investigator, Dr. Morten Anker, of the Norway Feedback Study, the largest randomized clinical trial (RCT) ever done with couples. Morten presents the design features that make the study noteworthy as well as the incredible findings. For example, four times more couples achieved clinically significant change in the feedback condition over couples in the treatment as usual condition, and at six month follow up, couples in the feedback condition separated nearly 50% less. Morten and Barry also discuss the response to the study and the national roll out of CDOI in Norway Family Counseling Offices. This webinar presents the first RCT using the ORS and SRS—the study that put CDOI on the map of academic credibility.

Barry recently conducted a briefing for government officials and funders regarding consumer driven outcomes management, a different way of saying client directed, outcome informed therapy. Trying to make the most compelling case possible to influence these decision makers to consider the ORS and SRS, Barry presents the rationale related to the amazing benefits of feedback and the push for consumer input in decisions that affect their care.

In an interview recorded before the current SRS was developed, Dr. Morten Anker, of the Norway Feedback Project fame and Certified Trainer of the Heart and Soul of Change Project, talks with Barry about practice based evidence. Although much of the research about feedback had not yet been conducted, this interview reflects the great promise of feedback that ultimately became a reality. This video showcases the concepts and practices of outcome management in a conversation between friends sharing a passion for feedback.

This workshop explores the ground-breaking expansion of the use of feedback to case management services. Based on her eight years of experience in extending the use of outcome management to settings other than traditional therapy, Mary addresses the unique benefits and challenges of incorporating client feedback in community-based work with adults.

Although often ignored, the fact of the matter is that the alliance is our most powerful ally and represents the most influence that we can have over outcome. The alliance is an all-encompassing framework for psychotherapy—it transcends any specific therapist behavior and is a property of all aspects of providing services. This webinar addresses the components of the alliance and illustrates how difficult it can be with an adolescent client who began the session by telling Barry to go f himself. Audio of this compelling encounter is presented along with Barry’s commentary about relational connection and the agreement with goals and tasks.

“Recovery,” as defined by the SAMHSA National Consensus Statement, has become the buzz word of mental health and substance abuse services. While the Consensus Statement is a decidedly upbeat and cogent description, how to translate the Statement into everyday practice is not clear. Based on his extensive experience in public behavioral health, Dr. Bohankse discusses the Consensus Statement and how it is a natural fit with client directed, outcome informed (CDOI) practices. He describes how one large agency, using CDOI, has operationalized recovery and in the process improved outcomes and increased productivity across programs.

Supervision helps therapists experience the benefits of feedback firsthand—that conversation they have never had before that turns things around or that stretches them outside of their comfort zone to try something for the first time based on client preference and cultural values. This webinar discusses the three responsibilities of supervision (protecting client welfare, agency liability, and therapist development) as well as the four steps of outcome informed supervision; a supervision based on outcome data not theory or pontification that is aimed at early identification of clients at risk as well as training and encouragement of therapist growth.

This webinar highlights an application of CDOI to alcohol and drug recovery-oriented systems of care. Building on Georgia’s seminal work on mental health peer specialists, the webinar focuses on the service delivery tools used by peer recovery coaches who have completed the Certified Addiction Recovery Empowerment Specialist (CARES) Academy. Mr. Braucht combines his extensive experience in the peer recovery movement as well as his personal recovery to offer lively discussion of yet another pathway of change for persons struggling with alcohol or drug abuse.

Graduate training has traditionally involved the supervision of trainees in assessment and implementation of treatment techniques. However, standard clinical training is often based on assumptions that lack empirical support, including the effectiveness of techniques without client input, the degree to which skills training translates into improved practice, the impact of supervision on outcome, and the equating of clinical hours accrual with improved effectiveness. This webinar will describe how one graduate training program in couple and family therapy has integrated CDOI practice, from day one to graduation, throughout curricula, paperwork, procedures, and evaluation to train effective therapists.

The "what works" research conducted over the last 40 years identifies several key principles that contribute to reducing criminogenic factors and recidivism. This webinar focuses on implementation of three key principles and the vital role of client-directed and outcome-informed recovery services. George Braucht is a Certified CDOI Trainer who’s three-decade career has blended work in academic, behavioral health and criminal justice fields.

The pharmaceutical industry has made it very difficult to know what the clinical trial evidence actually is regarding psychotropics. Consequently, primary care physicians and other front-line practitioners are at a disadvantage when attempting to adhere to the ethical and scientific mandates of evidence based prescriptive practice. This presentation calls for a higher standard of prescriptive care derived from a risk/benefit analysis of clinical trial evidence. Guidelines are offered to raise the bar of care equal to the available science for all prescribers of psychiatric medications. The presentation is based on an article of the same title written by Barry and David Antonuccio.

Unlike other measures where clinical expertise or paying attention to nuance is not required (e.g, questionnaires that simply list symptoms and require Likert Scale responses), using the Outcome Rating Scale (ORS) in a clinically meaning way demands much more. The ORS begins as a general snapshot of the client’s perspective of his or her life but then evolves into an idiosyncratic, client specific measure of the client's reasons for service and progress in therapy. This webinar shows how looking at the data can be used to not only insure data integrity but also identify clinicians who need additional support and training. A high percentage of scores over the clinical cutoff, scores between 35-40, and a "saw" pattern of scores are discussed.

This webinar discusses couple therapy in which at least one partner is ambivalent about the viability of the relationship. Commitment is vital for couples to successfully develop a secure emotional base and maintain a healthy relationship. When commitment wavers it affects nearly all aspects of the relationship, such as communication, couple identity, willingness to sacrifice, as well as respect, trust, and safety. Treating couples with wavering commitment is rarely discussed in either the theoretical or empirical literature. This webinar covers: (a) cutting-edge research on the importance of assessing couples’ initial relationship goals as a facet of the working alliance; (b) a theoretical framework to understand couples’ commitment; and (c) treatment guidelines for treating couples when at least one partner desires to clarify the viability relationship.

You’ve been inspired by her in Barry’s workshops and read about her in his books. You’ve asked for a copy of this video for years. And now, it’s finally available—the incomparable Molly, from the “Impossible” Case project, explains what successful therapy is all about. This entertaining video depicts the story of Molly, a veteran of failed therapy, and how she ultimately triumphs when given a chance to enlist her own resources and apply her own ideas about change.

Professionally-produced video from the Best Horizons Foundation, Comfortably Numb is an award winning short documentary that portrays the devastating risks of psychiatric drugs for children. Barry is interviewed in this provocative winner of the “Best Social Documentary” award of the New York Film Festival.

The folklore of our field has drawn us toward the more pathological account as the only or best version of client stories. It is neither. This video tells the heroic story of Sam. On one side, there are the problem stories—suicidal and homicidal ideation, depression, and self-loathing. But these accounts were not the only ones and not the most representative of his identity. There was another tale of a reflective man who wanted to contribute to society, a leader, an inner warrior who controls his impulses. This video demonstrates how clients’ heroic stories pave the way for change by showcasing abilities and making them available for use.

There are many ways to harvest, recruit, or enlist client strengths and resources. Telling heroic stories is one way, this video offers another. This delightful mother and daughter in the midst of reunification illustrate the benefits of “Listening for a Change” and the magic of the word “anymore.” Their many resources come to light as they explain how they are not screeching at each other anymore—things have improved. Both articulate what they have done to make things better and a discussion ensues about how they can apply their successful strategies to remaining difficulties. Listening for a Change shines a spotlight on client strengths, and in this instance, rapidly turns the discussion to more productive ends.

This video illustrates how to integrate the ORS into the clinical work: totalling the score and contextualizing the client's score in reference to the clinical cutoff, connecting the client's described experience to the marks on the ORS and the reason for service, and using the marks to inquire about client ideas about the next step.

This video illustrates that although "breaking up is hard to do," it is necessary at times to prevent clients from languishing in a therapy in which they are receiving no benefit. In a compelling video of two people facing a difficult situation in which no is to blame, Barry and the client struggle and finally agree on a referral which proved to make all the difference for the client.

This video illustrates a variety of aspects of the clinical use of the Outcome Rating Scale with families, starting with asking a reluctant client to do the ORS as a favor to the therapist. This video shows how the ORS can be used to not only keep a focus on change but also structure a session toward client movement toward his or her goals. In addition, the ORS brings an initial understanding that these clients are ready to move on, that they both score over the clinical cutoff and likely can handle things on their own.

This video demonstrates the kind of discussion that is made possible by using the Session Rating Scale. Not all clients articulate what they like and what they are looking for as well as this one, but the SRS allows the possibility for a transparent discussion to occur while simultaneously building the alliance.

Given that at its heart, PCOMS is a collaborative intervention, everything about the use of the measures and the results attained are shared with clients. Consequently, the client needs to understand two points: that the ORS will be used to collaboratively track outcome in every session and that it is a way to make sure that the client’s voice is not only heard but remains central. This video demonstrates the introduction of the ORS and discussion of the intake score with a client who scored 23.1. Note how the client marked the Social Scale the lowest and that is what he is prepared to discuss.