Vivian Baruch

Estimated reading time: 6 minutes

In this 4 minute video

Dr. Nathan Castle speaks with couples therapist, Vivian Baruch about the applicability of Feedback Informed Treatment (FIT) across different therapeutic modalities.

NC – One of the things that strikes me as I’m thinking about who’s going to watch this video, is that we are an eclectic bunch, us therapists. Some of us are maybe CBTers (Cognitive Behavioural Therapists), some of us psychodynamic, some of us use EMDR (Eye Movement Desensitizing & Reprocessing), or often, what’s probably the most common, I think it’s around 70% of us, we kind of just grab little things from everywhere. And I think that some people out there might say, well Feedback Informed Treatment (FIT) is for this model, that’s for CBTers…I can see you already shaking your head. Because I actually like the other models as well, like psychodynamic. In terms of your work using FIT, do you feel constrained at all to any models that you need to learn, or do you feel free to learn whatever you want? Whether it’s EMDR, psychodynamic… I’d love to hear about that.

VB – Absolutely. In the article that I’ve written, I quote Bruce Wampold from his interview What Actually Makes Us Good Therapists. He said if a therapist has two or three bona fide treatment models that make sense to you and that you feel competent in, and you can provide your client with a rationale for its use which makes sense to them, that’s all you need. The model is something to come back to, but ultimately as Wampold says about the Dodo Bird Effect, all models work about the same. The Dodo Bird Effect was introduced by Saul Rosenzweig in 1936, and suggests that all empirically validated psychotherapies, regardless of their specific components, produce equivalent outcomes. It draws on imagery from Lewis Carroll’s Alice’s Adventures in Wonderland. You know the data shows, when comparing models against models, they’re all about equally effective. So, it doesn’t really matter which model we use.

The Taxonomy of Deliberate Practice Activities

It’s like what the TDPA is saying (Taxonomy of Deliberate Practice Activities in Psychotherapy). First off, it’s up to us therapists to provide a structure so that the client feels held in some way, whether it’s CBT, EMDR, whatever. But it must be an evidence-based practice, not just waving hands or doing something that doesn’t really have anything behind it. So the structure is very important and the other things are the art of psychotherapy. Like providing hope and expectancy. The second thing is how do you provide a little bit of hope or let clients know what they can expect. We can do this by saying something like “Given what you’re saying and what’s being going on for you, this isn’t something unusual. I’ve seen this before, it doesn’t feel like it’s going to be unfixable, if we can work well together.” So, you kind of weave that into the discussion about clients’ issues, in some way or another.

Then the third factor in the TDPA, you’re really working on the alliance, the relationship factors between you and the client. In Feedback Informed Treatment (FIT) the client’s view of the relationship with us is vitally important. It’s not how we therapists think the relationship is going. We must ask the client in every session whether they felt heard, understood & respected; whether we talked about what they wanted to talk about; whether the approach taken fitted for them, made sense to them; and for any feedback about anything at all that was missing for them.

Then you must take into account the client, that’s the fourth aspect. The client factors are their context, their preferences, identity, relationships, community, worldview etc. It’s whatever you may be impacting positively or negatively in the work together. And then the fifth factor is us, the individual therapist, such as our ability to relate to a wide variety of clients, work with a range of issues, to be appropriately empathic, to manage our own emotions and reactivity. It’s learning what do we need to do to be flexible enough, and in the moment enough, with this client, in this session to help them towards their goals, hopes and expectations. We have to flexibly adapt our approach to honour each client’s unique needs.

The FIT Alliance Stool

The International Center for Clinical Excellence founded by Scott D. Miller, uses an image called the FIT Alliance Stool (below) to show the essential components of forming a good working alliance (relationship) with our clients. Feedback Informed Treatment (FIT) checks with the client in every session whether these components have been met well enough for the client. Their feedback is essential for us to course correct what we’re doing, as soon as possible, to help our clients achieve their chosen outcomes, to prevent treatment failure or early drop-out from therapy.

FIT provides freedom in our therapy work

So these are all the things that give me an immense amount of freedom in my work using Feedback Informed Treatment (FIT), it’s not constraining at all. I don’t have to follow a protocol. I’ve trained in so many models, I don’t have to “do” this model or that model. I’m trying this and I’m checking out if this making sense (to my client). I ask them “Is this something that you want to explore more today?” (If they say no, I say) “Okay, what do you want to talk about?” and follow up with “What’s worked before, where did it get stuck, what else might you know (about what you need my help with)?” So, I’m just going to pull up whatever, I’ll do whatever it takes to help them (reach their goals, find their purpose or meaning). It’s very freeing, it’s not constraining at all.

NC – Wonderful.

VB – So it allows creativity basically.

NC – Yeah, that’s absolutely what I hear from you, creativity for you and flexibility to the attunement to the client.

Upcoming online FIT training in Australian time zones

Watch my mentor Scott D. Miller explain more about the upcoming online Feedback Informed Treatment (FIT) in Australian time zone. The early bird rate expires on 31st March. For booking information, go to this link.

See also What Makes a Good Psychotherapist?