Dr. Carnazzo utilizes a Client-Directed Outcome-Informed (CDOI) approach to therapy. CDOI is an effective and efficient way to tailor treatment to meet the individual needs of each client. CDOI was developed by Drs. Scott Miller and Barry Duncan. They recognized that "Improving your performance starts with knowing your baseline; that is, determining exactly how effective you really are as a clinician. In truth, most practicing psychotherapists have no hard data regarding their success rates with clients. Fewer still have any idea how their outcomes compare to any other clinician or to national norms for progress in care." Thankfully, they had designed a simple and quick solution. CDOI has been adopted by large and small system throughout the world and my practice integrated this system to improve the quality of care to my clients.
In practice, CDOI simply means that I ask each of my clients to complete a four-question Outcome Rating Form (ORS) at the beginning of each session. The ORS assesses areas of life functioning known to change as a result of therapeutic intervention. At the end of each meeting I also ask clients to fill out the four-question Session Rating Scale (SRS), which is assesses key dimensions of effective therapeutic relationships. Both forms take less than a minute to complete and provide very valuable information that helps us track progress. The results also let us know when we might need to try something new to improve things. The SRS helps us have a transparent, ongoing dialogue about what is helping and what is not. This process helps my clients have the input they need and the immediate feedback I need to help promote the best possible outcome.
The system I utilize to track client progress provides visual feedback to my clients and myself. I helps us notice how and why you have improved and it is entirely based on your own assessment of your progress. An example created for educational purposes (and is not data from an actual client) is below.
Outcome Data Tracking Client Progress
The Yellow line indicates the client's own ratings of how they are feeling and functioning personally, in their relationships, and overall. The Orange line indicates the client's ratings of how well they feel understood by the therapist, how well the therapist is helping them address their goals in treatment, and the goodness of fit ith the therapist. Both sets of ratings are then compared against a large database of other client's in therapy and the progress they are making with their therapists. Overall, it provides an idea about how well therapy is working to address the client's needs. The regularity and immediacy of the feedback also helps me, as a therapist, improve what I'm doing to meet the needs of my clients.