Barry L Duncan

• Psy.D.
• CEO at Better Outcomes Now

Despite the overall efficacy of psychotherapy, dropouts are substantial, many clients do not benefit, therapists vary in effectiveness, and there may be a crisis of confidence among consumers. A research paradigm called patient-focused research--a method of enhancing outcome via continuous progress feedback--holds promise to address these problems....

Abstract This study investigated whether routine monitoring of client progress, often called "client feedback," via an abbreviated version of the Partners for Change Outcome Management System (PCOMS) resulted in improved outcomes for soldiers receiving group treatment at an Army Substance Abuse Outpatient Treatment Program (ASAP). Participants (N =...

Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates (Baldwin & Imel, 2013), are poor judges of negative outcomes (Chapman et al., 2012), and grossly overestimate their...

Proposes an intentional utilization of the client's frame of reference for the explicit purpose of influencing successful outcome. The client's frame of reference is discussed in terms of the client's perceptions and experience of (1) the therapeutic relationship and (2) the presenting complaint, its causes, and how therapy may best address the cli...

Consumers of psychotherapy outcome literature consider meta-analysis the gold standard for assessing the efficacy of interventions across disparate studies. Many assume that findings are valid, especially when published in journals with research credentials. Uncritical acceptance, however, can result in real-world consequences, including whether in...

There have been great strides in psychology regarding diversity, equity, inclusion, and multicultural competence, but a need remains to translate these values into actionable practices in psychotherapy. While the case has been made that measurement-based care is an evidence-based intervention that improves outcomes and reduces dropouts (de Jong et...

Objective The culturally salient fear of losing face might influence Chinese therapists' attitudes toward and use of routine outcome monitoring (ROM). We tested a model wherein self-face concern is associated with ROM use by way of attitudes toward ROM, and whether this process is weakened when therapists report high counseling self-efficacy and pe...

Studies have consistently shown that formal client feedback helps improve the effectiveness of psychotherapy. Several client feedback systems have emerged, but only one has both extensive randomized clinical trial support and is feasible for every client, every session, clinical use: the Partners for Change Outcome Management System. PCOMS employs...

Østergård and Hougaard (2020) reiterate the flawed conclusions of their meta-analysis of the Partners for Change Outcome Management System (PCOMS) and obfuscate the main point of our critique (Duncan & Sparks, 2020). Despite the lauded statistics and selection criteria, the inclusion of six significantly confounded investigations resulted in a misl...

Introduction: Many suggest that the next step for integrated care is widespread implementation of measurement-based care (MBC). Although the measures most associated with MBC are standardized, no randomized clinical trial has demonstrated their use to improve psychotherapeutic outcomes with embedded behavioral health providers in integrated care. T...

The Session Rating Scale (SRS) is a widely used clinical tool to measure the client-therapist working alliance. This study investigated the psychometric properties, the cut-off value, and longitudinal invariance of the SRS in a Chinese clinical population. The analyses were conducted separately in a sample of college students in counseling (n = 403...

Introduction: Routine outcome monitoring or systematic client feedback (SCF) continues to garner empirical support. The Partners for Change Outcome Management System (PCOMS) is one application of SCF with significant research support but no studies have been conducted in Spain. This research describes the effects of PCOMS in routine practice via a...

Research demonstrating the effectiveness of treatment with youth from low socioeconomic backgrounds is limited. To address this limitation, we evaluated pre-post psychotherapy treatment outcomes with youth presenting with depression-related diagnoses (N = 469) at a public behavioral health agency after they implemented a systematic client feedback...

Purpose Many psychometrically sound measures exist but feasibility makes real-time use difficult. This study validates two ultra-brief, patient-rated instruments, the Wellness Rating Scale (WRS) and the Provider Alliance Scale (PAS). Methods The WRS and the EuroQol visual analogue scale (EQ VAS) were completed by patients in a primary care practic...

Although client feedback has been demonstrated to improve psychotherapy outcomes in over a dozen randomized clinical trials, no studies to date have investigated the feedback effect outside of the United States or Europe. This study examined the impact of a client feedback intervention, the Partners for Change Outcome Management System, in a colleg...

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Part...

Critics claim that current psychiatric diagnostic systems lack reliability, validity, and clinical utility; are incompatible with known evidence of how change occurs in psychotherapy; are compromised by bias; and risk harmful effects for clients. This article argues that the Partners for Change Outcome Management System (PCOMS), a transparent, egal...

High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as “patient centered.” Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer...

Method: This exploratory study of adult primary care patients compared an ultra-brief, and widely used measure of global distress across life functioning, the Outcome Rating Scale (ORS), with the Patient Health Questionnaire (PHQ-9 and PHQ-2). Results: Correlations between the ORS and the PHQ-9 and PHQ-2 indicated agreement between the measures...

This chapter describes a way that supervision technology can address Stein and Lambert's (1995) question in both practice and research via systematic client feedback. After a summary of Partners for Change Outcome Management System (PCOMS) practice and empirical support, including its application to supervision, available technology is reviewed and...

Objective: The purpose of this study was to evaluate the effectiveness of a large public behavioral health (PBH) agency serving only clients at or below the federal poverty level that had implemented continuous outcome feedback as a quality improvement strategy. Method: The authors investigated the post treatment outcomes of 5,168 individuals se...

This study examined gender differences in session one alliances and in the trajectory of the alliance over the course of couple therapy. Additionally, this study examined the association between men and women's pre‐therapy relationship adjustment and alliance at session one and over the course of therapy. A total of 316 couples seeking outpatient c...

Chapter One of On Becoming a Better Therapist

Background: Although ultra-brief outcome and process measures have been developed for individual therapy, currently there are no ultra-brief alliance measures for group therapy. Method: The current study examined 105 clients in group therapy for issues related to substance abuse or with issues related to the substance abuse of a significant other....

The purpose of this review is to assess whether evidence supports a favorable risk/benefit profile for pediatric antidepressant use and reconsideration of the black box. The review examines studies post-black box purporting to show declines in pediatric antidepressant use and rising youth suicide, summarizes evidence for efficacy and safety of pedi...

Abstract This study examined whether therapist gender, professional discipline, experience conducting couple therapy, and average 2(nd) session alliance score would account for the variance in outcomes attributed to the therapist. We investigated therapist variability in couple therapy with 158 couples randomly assigned to and treated by 18 therapi...

Dans leur réaction à Duncan (2012), Halstead, Youn et Armijo (2013) posent la question d’ordre psychométrique suivante : qu’est-ce qui constitue une mesure trop courte pour l’évaluation du progrès? Ils suggèrent que les mesures doivent être suffisamment longues pour assurer fiabilité et validité, sans toutefois offrir de définition de ce qui consti...

Over the past decade, solution-focused therapy has undergone dramatic growth in interest and popularity. At the same time, there continues to be a dearth of empirical evidence of its purported effectiveness. Moreover, available data indicate that any effectiveness of solution-focused therapy is likely due to both the shared and unique ways the appr...

Outlines the steps to revitalize psychotherapy by harnessing the client's own powers of regeneration and enlisting the client's own perceptions, and thereby making treatment more effective and accountable. This approach advocates for the client's voice in all aspects of therapy and shows how to tailor both relational stances and treatment approache...

Describes the principles of a client-directed, outcome-informed approach to couples therapy. This approach is based on outcome research that identifies 4 factors common to effective therapies: extra-therapeutic or client factors; a positive therapeutic relationship; placebo, hope, and expectancy; and factors related to models and techniques, which...

Accountability via the application of research to practice is the raison d'être of the empirically supported treatment (EST), evidence-based treatment (EBT), and evidence-based practice (EBP) movements. Although basing practice on empirical findings seems only reasonable, application becomes complex when unfurled in the various social, political, e...

Deux modèles de surveillance et de rétroaction en continu révèlent des gains dans le cadre d'essais cliniques aléatoires (ECA) : le Outcome Questionnaire (OQ) System, de Lambert, et le Partners for Change Outcome Management System (PCOMS). L'article rappelle l'évolution du PCOMS, depuis une façon simple de discuter des avantages des services avec l...

The purpose of this study was to investigate the relationship between client initial goal for couple therapy (i.e., improve the relationship or clarify the viability of the relationship) and the outcomes (including their relationship status, i.e., separated or together) at posttreatment as well as at 6-month follow-up. Two hundred forty-nine couple...

This book exposes the skyrocketing rate of antipsychotic drug prescriptions for children, identifies grave dangers when children’s mental health care is driven by market forces, describes effective therapeutic care for children typically prescribed antipsychotics, and explains how to navigate a drug-fueled mental health system. Since 2001, there ha...

This study explores client experiences in couple therapy through analysis of written client responses at 6-month follow-up. A subsample participated in a randomized trial comparing outcomes for couples that used routine client feedback with no-feedback couples. Thematic analysis indicates that clients prefer personable and active therapists who mai...

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 article cal...

The purpose of this study was to explore the relationship between the alliance and outcome in couple therapy and examine whether the alliance predicted outcomes over and above early change. The authors also investigated partner influence and gender and sought to identify couple alliance patterns that predicted couple outcomes. The authors examined...

This volume continues to highlight the common factors and honors the pivotal role of clients in successful psychotherapy. As seen, this volume also documents a major innovation in psychotherapy: the development and use of monitoring and feedback systems. When used routinely, outcome measurement and management mobilize the common factors and facilit...

On Becoming a Better Therapist redirects our attention from specific treatments to our behaviors and attitudes as therapists, offering a refreshing look at improving treatment that operates outside the contemporary solution of providing the “right psychological treatment for the right disorder.” This book provides simple but elegant solutions for b...

Continuous client feedback offers great promise for improving treatment outcomes. Because of their feasibility for everyday clinical use, the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) enjoy popularity in the US and have been translated in various languages, including Dutch. The present study investigated the psychometric propert...

A critical review of three articles reveals flawed empirical evidence underpinning the case for integrating pharmacotherapy and psychotherapy. Medical model dominance favors biology in a diathesis/ stress framework, creating myths of valid diagnosis, underlying biological causes, and targeted pharmacological treatments. Meanwhile, a for-profit phar...

Prescriptions for psychiatric drugs to children and adolescents skyrocketed in the past ten years. Meanwhile, concerns of suicid- ality and industry bias in research have prompted regulatory investigation to assess claims that selective serotonin reuptake inhibitors (SSRIs) are safe and effective for children. Family clinicians may be unaware of th...

The existing literature on the integration of family and individual approaches, largely analytic in orientation, consists of models which, for the most part, are not brief in application. An alternative, brief model is presented which integrates an individual, cognitive-behavioral approach with a strategic approach at both pragmatic and theoretical...

Although ethical criticisms have been leveled against strategic therapy for some time, the current intensification of such criticisms indicates the need for continued dialogue about ethical strategic practice. This article presents ethical directions in two broad areas often seen as inherent in the strategic approach: (a) conscious deception and (b...

The development of an integrative individual and family therapy approach has been hampered by fundamental differences in philosophy and theoretical conceptualization among approaches. Given these largely irreconcilable differences systemic framework for a technical eclecticism may represent a logical step toward a more flexible consideration of bot...

Policy makers and payers are insisting that to be paid, therapists must "deliver the goods." Concurrently, there is a worldwide movement to involve consumers in their care. Consequently, the measurement of change, from the client's perspective, has become an important topic. Unfortunately, no self-report outcome measure has been available for child...

In the first position paper of this chapter, Michael E. Addis and Esteban V. Cardemil first provide an argument in favor of the use of treatment manuals in clinical practice. Addis and Cardemil conclude by arguing that existing debates about treatment manuals largely miss the mark by (a) stereotyping treatment manuals as overly rigid; (b) misrepres...

There is an industry-wide trend toward making outcome evaluation a routine part of therapeutic services, yet most measures are infeasible for everyday clinical use. Consequently, the Outcome Rating Scale (ORS) was developed and recently validated by its authors (Miller, Duncan, Brown, Sparks, & Claud, 2003). This article reports the findings of an...

A critical review of three articles reveals flawed empiri- cal evidence underpinning,the case for integrating pharmacotherapy,and psychotherapy. Medical model,dominance,favors biology in a diathesis/ stress framework, creating myths of valid diagnosis, underlying biological causes, and targeted pharmacological treatments. Meanwhile, a for-profit ph...

Research has found that client change occurs earlier rather than later in the treatment process, and that the client's subject experience of meaningful change in the first few sessions is critical. If improvement in the client's subject sense of well-being does not occur in the first few sessions then the likelihood of a positive outcome significan...

A number of systems provide feedback regarding client progress and experience of the therapeutic alliance to clinicians. Available evidence indicates that access to such data improves retention and outcome for clients most at risk for treatment failure. Over the last several years, the team at the Institute for the Study of Therapeutic Change has w...

Prescriptions for psychiatric drugs to children and adolescents have skyrocketed in the past 10 years. This article presents evidence that the superior effectiveness of stimulants and antidepressants is largely a presumption based on an empirical house of cards, driven by an industry that has no conscience about the implications of its ever growing...

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Industry-wide, there is a trend toward making outcome evaluation a routine part of therapeutic services. Although various multidimensional assessments of outcome are valid and reliable, their methodological complexity, length of administration, and cost often render them infeasible for many service providers and settings. The present article descri...

Over 1,000 research findings (Orlinsky, Rønnestad, & Willutzki, 2004) demonstrate that a positive alliance is one of the best predictors of outcome. Paradoxically, despite the robust connection between the alliance and outcome, no alliance measures have been developed specifically as clinical tools for therapists to use on a day-to-day basis with t...

Comments of the article by S. Rosenzweig (see record 2002-02374-002). This article provides commentary on Rosenzweig's classic 1936 paper, "Some Implicit Common Factors in Diverse Methods of Psychotherapy," with particular emphasis on his clever and prophetic invocation of the dodo bird verdict from Alice in Wonderland. The impact of this seminal...

In preparation for a commentary on Saul Rosenzweig's classic 1936 paper, "Some Implicit Common Methods in Diverse Forms of Psychotherapy," an amazing discovery was made: Saul Rosenzweig is not only alive but also still contributing to science and society at age 93. This article sets the stage for a conversation with the incredibly prolific Dr. Rose...

This article provides commentary on Saul Rosenzweig's classic 1936 paper, "Some Implicit Common Factors in Diverse Methods of Psychotherapy," with particular emphasis on his clever and prophetic invocation of the dodo bird verdict from Alice in Wonderland. The impact of this seminal contri- bution is discussed by a comparison of Rosenzweig's origin...

This article casts a critical eye upon the integration literature and asserts that, as in psychotherapy in general, the client has been woefully left out of the therapeutic process. An alternative that privileges the client's voice as the source of wisdom and solution is presented. It is proposed that conducting therapy within the context of the cl...

At the root of many controversies surrounding therapy is one key question: What works? Is efficacy based on the singular curative powers of specialized techniques, or do other variables account for patient change? This book proposes the answer, which is not to be found in the languages, theories, or procedural differences of the field's warring cam...

[This book] is an explicit account of how to efficiently approach clients who have had negative experiences in therapy. While this book is devoted to the specifics of working with difficult cases, the approach rests on a conceptualization of psychotherapy that intentionally maximizes the known curative factors. (PsycINFO Database Record (c) 2012 AP...

Similar to the mission of police S.W.A.T. teams, mental health professionals intercede To safeguard life. Contrasting with the weapons and military style interventions employed by the celebrated law enforcement units, clinicians rely on other methods. Specifically, they employ special words and tactics (S.W(ords).A.T.). The successful use of S.W(or...

The authors want readers to shake their allegiance to masters and models and focus on . . . basics, from which emerges a unifying language for psychotherapy practice. So what does matter? First, respect for the client's point of view, understanding of the problem, ideas about its solution, and interaction with chance events that affect its course...

Explores the ideas of intervention and collaboration through a case study of the treatment of a 10 yr old girl. In the face of the intervention–collaboration contest, the concept of accommodation is proposed, which emphasizes flexibility and accommodating the therapeutic approach to the client's ideas (above the therapist's ideas) of what will be h...

Perhaps solely by virtue of bringing an additional person into the therapeutic context, marital therapy may be the most challenging of clinical practice. The dramatic intensity with which couples may present, the polarization of their viewpoints, and the difficulty inherent in validating each person’s perspective without disconfirming the other’s c...

Although profoundly influencing the field of family therapy by highlighting the deficiencies of pathology-based views, strategic therapy (ST) has come under fire in 2 general areas: (1) adherence to a "black box" philosophy that discounts the value of intrapersonal phenomena and attends solely to interpersonal variables and (2) interventions that a...

Given the comparable outcome of short and long term therapy and the pressure of cost effective treatment, brief therapy is spreading rampantly and threatening our profession. Like other epidemics, brief therapyism is producing casualties by exponential growth. This article will examine this bewildering addiction through a process of historical revi...

Proposes a technical eclecticism that extends the strategic model of the Mental Research Institute (R. Fisch et al, 1982) to include contributions of diverse psychotherapy approaches. Strategic eclecticism is conceptually based in systems theory and constructivism and attempts to (1) maximize common factor effects and (2) enable the selective appli...

The growing concern regarding the prevention of nuclear war has generated Interest among researchers to define and understand the current attitudes and beliefs of individuals across age groups. The results of these studies have consistently shown that when questioned about nuclear issues all age groups express concern. Van Hoorn and French (1988) c...