User:Engelhardt/Client-Directed Outcome-Informed therapy

Client-directed outcome-informed (CDOI) therapy is a specific type of behavioral health outcomes management that attempts to involve the client more actively in determining the course and goals of the therapist-client relationship than other more traditional approaches. Largely developed by Drs. Scott Miller and Barry Duncan, the goal of this approach is to develop a system for measuring psychotherapy treatment outcomes which improves both the client's subjective experience and the measurable outcome of the therapeutic process, the latter being particularly relevant in situations of court-ordered substance abuse programs.

CDOI is centered on two principles which its developers contend are supported by the research literature. First, that a client's rating of the therapeutic relationship (or "alliance") has a higher correlation with engagement in and outcome from the therapeutic relationship than the therapist's rating of that alliance, and second, that a client’s subjective experience of progress or change early in the process is one of the more important predictors of the success of the therapeutic relationship and/or treatment program.

Building from this, the CDOI approach utilizes two brief, distinct scales, one given at the start and the other given just before the close of each session. The first scale, given at the beginning and referred to as the Outcome Rating Scale or ORS, asks the client to measure any experienced change or progress since the last visit. The second scale, given at the close of the session and referred to as the Session Rating Scale or SRS, asks the client to measure the effectiveness of the client-therapist relationship. Each scale is brief, comprised of only four questions, so the total time required to complete the process per session is estimated to be no more than two to three minutes. However, the fact that these scales are consistently used at each session will optimally allow the therapist the opportunity to modify the approach if needed. The CDOI client is also able to feel more vested in the direction of the treatment as compared to a more traditional therapist-directed process.

The CDOI approach has been utilized by several drug treatment programs, such as Arizona's Department of Health Services. At the same time, critics stress that the therapist must resist a narrow focus on outcome and must maintain an openness to the entirety of the client's trajectory and be informed by more than one therapeutic approach.

More recently, the CDOI approach has become known as the Partners for Change Outcome Management System, or PCOMS.