In my experience, many issues that arise in therapy can be traced back to a single problem—a lack of directness.

We’re scared for clients to see the real nature of their suffering, and the coping responses that cause it.

Otherwise, we wouldn’t blink at the prospect of asking them to complete a questionnaire…

Even a doctor applies physical pressure that is painful—in order to get to the root of the patient’s problem.

But if you’re afraid to press, they won’t get better. And may even get worse.

So we need to stop tiptoeing around our clients, and start pressing.

Compassionately, but firmly.

Because it is true that clients can have feelings activated by completing outcome measures. They can become “triggered”.

Clients may may dislike certain questions and feel restricted by others:

Client: “Isn’t there a 4th option I could select?”

Therapist: “No, I’m sorry to say there isn’t. And you can’t provide background context to your answers either, I’m sorry.”

(Except with Measurely they can)…

But we shouldn’t be afraid of stirring up feelings in our client. Rather, we should fear the harmful strategies they use to avoid them…

But we shouldn’t be afraid of stirring up feelings in our client. Rather, we should fear the harmful strategies they use to avoid them…

And that’s why you can always ask your client how he or she felt about completing the PROMs you sent. Something like:

“I’m wondering how you found the assessments I sent you? Did you have any reactions to the process?”

If they say, “well, I did feel worse afterwards” — then this is an incredible opportunity to make a therapeutic intervention from the very start.

Therapist: “In what way did you feel worse?”

Client: “I started to think I must really be messed up you know—there’s so much wrong with me”.

Therapist: “Sounds like you noticed some self-attack coming in. Good catch”.

Client: “Oh, right… I hadn’t thought about it that way before”.

I’ve found that most breakthroughs in therapy take place when I’m willing to make myself uncomfortable as a therapist.

To wander into unfamiliar and rough terrain.

But I’ve trained myself not to turn back. And you should too.