Feedback-Informed Counseling

I recently stumbled on “Feedback Informed” therapy research, and the findings are very compelling, so much so that I now ask all my clients for feedback on every single session.

Why is feedback so important? A few key reasons:

  • Most therapists think they’re awesome as therapists! Seriously. In the studies conducted on therapists where they were asked to rate their own performance, most therapists believed they were excellent with their clients. None of them rated their performance as below average! This tells me that, as counselors, we just don’t always know how we’re doing with each client. That’s where Feedback-Informed Treatment comes in.
  • Most therapists believe they’re asking for their clients’ feedback much more often than they actually are! 
  • Most clients have a bit of reluctance to say when something feels “not quite right,” so clients often bolt before therapists even know that anything was wrong! Getting feedback facilitates conversations, and in the studies where feedback was asked for, more clients stuck around and got better outcomes in therapy. Clients who are asked their honest opinion on what’s working and what isn’t are much more likely to stay, talk it out, and get the results they’re looking for.
  • Asking the client some very simple questions at the end of each session makes the client far more likely to mention it if something wasn’t quite right in session.
  • If counseling isn’t working as you’d like it to, we can change course, or look in a new way at what we’re doing and why. If I notice a client isn’t getting the results she’s looking for, I know we have a few things to talk about: Have we been talking about what’s most important to the client? Is the approach we’re using right for the client? Am I doing or saying something that is making things more difficult?

For the reasons above, I’ve started to use feedback in every therapy session. It’s very simple.

In the beginning of the session, (if you’re my client!), you rate how your life is going in a few different areas. And, at the end, you rate how the session was for you — Did we talk about things that were important to you? Did you feel heard and respected? Was the approach I used right for you? Overall, how did things go? Each questionnaire is intuitive, and it takes less than a minute.

So far, this feedback is a wonderful tool for my clients and me.

My clients and I get to discuss what worked and why it worked so well, and when something doesn’t go as well, we get to have that discussion, too.

I like it for the feedback I get,and I also like the way these kinds of questions empower the client. Counseling is a partnership. A counselor should not be doing some intervention to you. They should not stand over you, as a judge or self-proclaimed expert.

The research shows that therapy works better the more you feel like your therapist is with you as your ally. Interactive counseling where you feel valued, where your voice is heard, and where you can feel that your counselor is on your side, gets results.

Why is it so important that you feel like your therapist is on your side? Research shows:

What’s called the “therapeutic alliance,” this sense of the therapist being on your side and working with you on what’s important to you, is so important, that:

  • In studies where clients felt like their therapists understood them and cared, placebos worked better than real medication worked when the clients worked with counselors they perceived as less caring.
  • Therapeutic alliance impacts a clients’ success far more than the therapists’ credentials, years of experience, and approach.
  • In one-year follow up studies, the extent to which a client had felt cared about by his/her therapist was the biggest predictor of success.

The good news for therapists is this: By using feedback, we can find out how well we’re really doing by our clients, and our willingness to take in this feedback and adjust accordingly is worth more than our years’ of experience, how many trainings we’ve taken, or what credentials we have.

The good news for clients searching for a good counselor is this: You can find a counselor who really cares about your feedback, and who will work with you to make sure you’re getting the help that’s right for you. Your counseling isn’t something you have to just go to and settle for, with the hope that it works.

Good counseling is collaborative, and therapist and client get to talk regularly about what’s working and what isn’t, to make it better. Better counseling makes for better results. And better results in counseling lead to a better life!

My outcomes and what they mean

The feedback system I use is able to compare the results my clients get with average results and with the effects of a placebo. My clients, on average, show what the feedback system calls a “reliable clinical change” — far better than the change expected if you got no counseling at all. In terms of average results in counseling, my clients’ average results exceed those.

One of the markers of therapy where clients stay is that they notice some of the most dramatic changes in just the first three sessions. The results my clients typically get bears that out. It’s part of why my clients pay me for  a month in advance: After just 4 sessions, we almost always know that we’re a good fit and on the right track, or if it’s time to shift gears or refer a client to someone whose approach is a better fit for their needs.

By the way, this doesn’t mean I’ll kick you out if you don’t get those results the first month. It does mean we’ll both have a barometer of what’s going on, and a natural way to discuss what’s next.

I believe the very good results that clients often get in our work together is due to a few things, and they’re not all about me:

  • My clients choose to see me rather than just finding a nearby counselor or being assigned a counselor in an agency. This shows greater motivation from the start! By the time they sign on to work with me, they’re usually sure we’re a good fit. Especially when they’ve read my web content or watched my videos, or heard me speak. This makes a big difference in their outcomes!
  • I seek out client feedback every session, and if something isn’t working quite right, we work together to make things better the next time. This accelerates the counseling quite a bit, as we both know if our work is on the right track.
  • I receive expert consultation and trainings, so the clients who see me get the benefit not just of my experience, but of the experience of experts and other counselors I respect.

All of this helps a lot with the outcomes my clients most often achieve in therapy.

Want more information? Check out more about the system I use by looking at “”. And to find out about my scores and what they mean, just ask me, and I’ll be happy to tell you more details about how my data is looking, what my averages indicate, and what that means for my clients – and potentially for you!








Author: Michaela Lonning

I'm a counselor in Corvallis, Oregon, and I work mostly with intelligent and sensitive people who are struggling with a sense of connection to themselves or in their relationships. Near Corvallis? Come see me. Not near Corvallis? I work with clients around the world via Skype: Come see me.

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