Season 2, Episode 13: Enhancing Counselling Through Research
In this episode, we welcome Derek Caperton, research officer at Calgary Counselling Centre, to talk about the role of research and data in mental health counselling. He’ll give his perspective on how studies and data analysis are shaping the future of counselling. Our conversation covers how research improves counselling outcomes, how counsellors apply these insights in practice, and what limitations might exist in the field of counselling research.
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Katherine Hurtig
Welcome to Living Fully, a podcast dedicated to enhancing your mental well-being. Each episode explores valuable insights and practical strategies to help you lead a more fulfilling life. I'm your host, Katherine Hurtig.
Today, we have a special guest joining us to explore the role of research and data in mental health counselling. Derek Caperton, the Research Officer at Calgary Counselling Centre will be sharing his insights with us. We'll talk about how research studies and data analysis hold the potential to revolutionize counselling practices, ultimately enhancing the lives of clients. We explore questions around how research can improve the effectiveness of counselling, how counsellors are integrating research findings into their practice, as well as the potential limitations around counselling research.
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I'm here today with Derek Caperton and he is the Research Officer at Calgary Counselling Centre and Counselling Alberta. Thanks for joining me today, Derek.
Derek Caperton
Thanks, Katherine. Happy to be here.
Katherine Hurtig
And yeah, we're going to talk about the whole idea of research and advancing counselling practices and outcomes. So yeah, I'm excited to get into that.
Derek Caperton
Me too. My favorite topics.
Katherine Hurtig
Derek, tell us a bit about yourself, your background, how you got started in the field, and how you got started at Calgary Counselling Centre.
Derek Caperton
So going farther back, I was an undergraduate in psychology and I got my bachelor's at Gonzaga University. I grew up and was trained in the States. And so I went to Western Washington University and got my master's in experimental psychology.
Katherine Hurtig
Okay.
Derek Caperton
Which is just sort of pure research, right? It's statistics and it's methods and it's mostly quantitative.
Katherine Hurtig
Were you just looking at data or were you working with people?
Derek Caperton
Yeah, it was just data basically, like, you know, working with people and that they were research participants, right?
Katherine Hurtig
Yeah.
Derek Caperton
And it was, it felt a little bit disconnected from like actually helping people out. And so I applied to counselling psychology PhD programs. So I interviewed a bunch of places and then found a great advisor match in Zach Emel at the University of Utah. And so then I studied the psychotherapy relationship there and psychotherapy process with him. Yeah. So five years of study. And then I did a - y'all call them a residency up here. I did a residency at the University of Tennessee in Knoxville, practicing this entire time, and I was a full-time clinician and it became time, you know, looking for a job. And I was like, okay, do I want to continue down the clinical route? I really enjoyed working as a clinician, but I also had some great research experience behind me. And so through Bruce Wampold, who's one of our collaborators and was my advisor's advisor, I interviewed for this position when it opened up when I was, I think…
Katherine Hurtig
At Calgary Counselling Centre?
Derek Caperton
Yeah, sorry. Yep. Thank you. The position at CCC. And it was just such a great fit. And I just, it was really enamored. You know, I'd read a couple of the papers that Simon Goldberg had done using Calgary Counselling Centre's data.
Katherine Hurtig
Okay.
Derek Caperton
And I was just like, oh man, this is just sort of a one of one, you know, research job that I can kind of going all the way back to, you know, the thing that I didn't like about just pure experimental stuff is I can do research that then the next day is influencing clinical practice and helping with fund development, you know, so you can get subsidized counselling. So I'd be able to do research and science and use those skills that I had that would actually be helping folks out immediately.
Katherine Hurtig
Yeah. You can see the result of what you're, you're studying right away.
Derek Caperton
Yep. And then, so I came up here and we are two and a half years into it. Yeah.
Katherine Hurtig
Nice. So Derek, at Calgary Counselling Centre and Counselling Alberta, we have a research department that kind of sets us apart from other agencies or facilities that are doing counselling. Can you kind of explain what that looks like, what you guys do in the department?
Derek Caperton
Yeah, yeah. Well, like you said, it really is one of one. It's why I came up here for this job is because there's not really any other community mental health centres or kind of non-academic settings that have an entire department devoted just to research and to science and clinical science. So it is really cool and really unique. So right now there's… we have three full time employees, including myself. And so we do a lot of reporting around outcomes and the work that we're doing, the demographics of clients that we're seeing and then how well they're actually performing in counselling. Right. Are they getting better? Are they improving? Are they recovering over the course of treatment? We also provide in-house reports and outcomes reports to counsellors so they can track and understand sort of on aggregate how their caseloads are improving over time and see what their overall effect sizes are for a given period of time and how their quality of the work is going. In conjunction with consultation and supervision, they can look at what areas they might be able to improve based off of what clients and their caseloads are getting better or not. So it's just another tool to kind of help with consultation supervision.
Katherine Hurtig
Yeah, that's kind of where I'm hoping we can take this discussion and talking about how research and how your role kind of helps us see how clients are improving and also help counsellors improve what they're doing.
Derek Caperton
Yeah, that's the, you know, the ultimate goal. And so it happens in some ways with providing hopefully timely feedback, right, on this is how your cases are progressing. This is what you've been doing the last, you know, last four months of the last year, whatever the time period might be. And then the other feature, the other role that we take on is conducting original research for publication out to a grander audience. And so we do research studies that basically helps inform the greater mental health community on different processes that are happening here and different ways that we're, well, just different things you can learn about the things that are happening here. For example, last year, we published a paper that looked at the efficacy of in-person versus online counselling. To kind of compare like, okay, so are we doing just the same quality of work or is one better than the other if you're in person versus online? And what we found after matching clients between those two groups is that they both work equally as well, which is really good news.
Katherine Hurtig
So let's get into a bit more detail about how research is actually helping to improve like the client experience and like counselling as a whole, if that makes sense. Like how does it, How is it improving client results? How is it improving counselling processes? That kind of thing.
Derek Caperton
Yeah, yeah. So here at CCC, it's helping in that we're providing feedback on how cases are progressing for counsellors. So you can see sort of in aggregate what your effect size is. And effect size is a statistic for being able to understand how much change is happening and whether that change is meaningful within your client caseload. And then so that information can then be used in conjunction with supervision and consulting to see like, OK, so what are some, you know, what are the patterns I'm seeing in terms of the improvement with my caseload to see, you know, who can I do better work with? Are there any sort of patterns in here maybe regarding their presenting concerns where I'm doing really well or not so well with certain presenting concerns or different backgrounds of clients, things like that. Counsellors also get sort of a feedback report that happens with every single client, but it's basically a tool that allows therapists to track when a client comes in for their first session, what sort of trajectory of change you would expect them, like what the pace of improvement would be from a session to session basis. And that allows therapists to notice then when maybe working ahead of schedule and a client is improving at a greater pace than you might expect or might hope for. Or if there's some deterioration happening or they're not sort of improving at the rate that you would expect, then maybe you need some more consultation or supervision specifically on that case, which is a really, really nifty tool for counsellors.
Katherine Hurtig
Okay. You've mentioned that a few times, the consultation and supervision.
Derek Caperton
Yeah.
Katherine Hurtig
What's, what is that?
Derek Caperton
Yeah. Great question. So the ideal sort of pathway here would be is if you notice, say, you're three sessions in with a client and that client isn't reporting through these self-report measures that we use where they were reporting sort of their levels of distress. If that distress isn't going down, then the counsellor can say, OK, so something I'm doing here doesn't seem to be working. Right. And so I can then go to a peer or supervisor and we can talk about this case. We can talk about all sort of the nitty gritties that are happening here. Maybe they're presenting with a certain, maybe a personality trait or a presenting concern that I'm not so well versed in. I need sort of more coaching and training on that.
Katherine Hurtig
Yeah.
Derek Caperton
Those sort of things. So it just, we're actually sort of a warning system of like, hey, like we want this person to be improving at a greater rate than what's happening. So here's sort of your signal to do a deeper dive on what might be going on with that person. And then ideally with another pair of eyeballs on it, right. From someone else who's trained.
Katherine Hurtig
Yeah, I feel like, I mean, it would always be good at some point to get a second opinion.
Derek Caperton
Yeah, absolutely. Yeah. I mean, I think the research shows that, you know, the best that most of us are as clinicians is right after we graduate. When we've got all of this coaching and training and all this other stuff, we're really sharp. We're up to date on methods. You know, we've been seeing a lot of clients. And then, you know, we've had expert eyes on our stuff for several years. And so we're really, really good. And then the challenge really for, you know, newly licensed folks is maintaining that level of performance throughout. And that's what CCC has done. And there's published research showing that as opposed to any sort of like deterioration of skills is that in 2016, a paper showed that Calgary Counselling Centre therapists sort of maintains that quality of work over time, as opposed to having any sort of deterioration of skills, presumably because of what's called Feedback Informed Treatment, which is this thing that I've been talking about, I guess, around. without labeling it, which is, you know, taking feedback from the client in terms of, via self-reports of distress and then doing something with that information. And then ideally with the help of a peer to give you fresh perspective on things.
Katherine Hurtig
So let's get into that, this self, what did you call it? Self-reported…
Derek Caperton
Yeah. Self-reported levels of distress.
Katherine Hurtig
Yeah. Cause I know that, I know that it's called the Outcome Questionnaire, but let's, can we, And we've talked about this in previous episodes, but let's do like a rundown for our listeners. What is the outcome questionnaire? Yeah. What does it measure?
Derek Caperton
Yeah. So the outcome questionnaire is developed in the 90s from researchers out of BYU (Brigham Young University). And it is 45 questions that measures a whole bunch of different, mostly psychological, but some physical indicators of distress. Because obviously to our bodies are linked to our psychological and mental well-being. So things like anxiety, depressive symptoms, sleep quality, I believe is in there. The quality of sort of your ability to function in work or school, the quality and health of your interpersonal relationships.
Katherine Hurtig
Right.
Derek Caperton
All of those are in those 45 items. And then we aggregate all those together into one score that represents sort of an overall level of distress. And so if you have a lot of distress in a lot of areas of your life, you're going to be at a certain level of distress beyond what we would call a clinical amount of distress. And then, you know, maybe you have some domains of your life that are more stressful for others. So the subscale for like, say, social support might be particularly high and you have more distress in that area. But yeah, it's a it's a self-reported form where, you know, a client before every session will fill this out.
Katherine Hurtig
OK, so they're filling it out before every session?
Derek Caperton
Yeah.
Katherine Hurtig
I've talked about this dozens of times on this podcast already, but before I worked here, I was a client. And so I'm familiar with the questionnaire. And I just, I'd like to get your perspective on this. Because, I mean, it is, it's a self-reported thing. So it's, you know, clients are coming in and I feel like it's not always an accurate measurement, if that makes sense. Especially if people come in and, you know, like they catch on, like they're the same questions every time, and they don't have the buy-in thinking that this has anything to do with their improvement, they could just be checking boxes. So, you know, how accurate is this? Does it, how do you convince clients that this is, you know, a good tool to use?
Derek Caperton
Yeah, totally. So I think, you know, the OQ is among the best, what we would call outcome measures out there, and that it provides a really nice and kind of complete look at mental health overall. But you're right that it does require buy-in from clients to fill it out completely and honestly and thoughtfully, right? And so that really leans on the therapeutic relationship and the ability of the counsellor to kind of relate to the client, the importance and utility of this tool for their work. And so being able to kind of relate to the client, that's a really important thing is ultimately up to the counsellor, right? And the quality of that relationship.
Katherine Hurtig
Yeah, I can see that.
Derek Caperton
And then also, it has, of course, has its limitations, right? So a self-report measurement of distress, right? of how you're feeling and how bad you might be feeling is limited. And it's not the only outcome that really matters, right? So for example, you know, we can look at distress, but maybe you're in here because your romantic relationship is on the rocks and it's not going so well. So another outcome that might not be fully captured by the OQ, those items that relate to it, would be what's the quality of that relationship now, right? Are you, you know, do you have a more stronger bond because of the skills you might've been learning in counselling, or maybe it's your ability to perform at work, right? And so again, the OQ will kind of get at that, but really the outcome is going to be like, are you showing up to work? And are you able to kind of perform your responsibilities? You're getting more security that way.
Katherine Hurtig
Right.
Derek Caperton
So it is, you know, in some ways limited and there's important outcomes that are not tracked by it, but it kind of gets at a little bit of everything. And in terms of a sort of mostly non-invasive way of measuring outcomes, it provides something that's pretty quick and reasonably complete.
Katherine Hurtig
That makes, yeah, that makes a lot more sense to me.
Derek Caperton
Yeah. Yeah.
Katherine Hurtig
For sure. Derek, can you share some examples of how maybe research that you've done here at Calgary Counselling Centre, like you and the team, can you share how like maybe something you found out has been successfully put into practice?
Derek Caperton
Yeah, yeah, totally. So something that's been happening since I got here is we've been doing what's just been called in-house “the supervision study”. Supervision is sort of the mentor-mentee relationship that exists between a licensed clinician, a licensed provider, and a trainee who's still learning this trade and is pre-licensure.
Katherine Hurtig
Okay. And I guess that's something that we can kind of explain is that another thing that sets Calgary Counselling Centre apart is that, you know, we have these licensed counsellors, but we also train. Yeah. We train counsellors as well.
Derek Caperton
Yeah. It's a big training centre. Yeah. I think we have over 100 trainees that come through the door every year.
Katherine Hurtig
Yeah. Anyway, sorry. Back to the supervision study.
Derek Caperton
So it's really important, right? So the supervision study and supervision in general is how we get quality clinicians into the field, right? Is based off of the quality of their, you know, their training program and their classes, of course, but then also their clinical experiences during that placement. And so CCC invested a lot of time into this study about clinical supervision that compared three different types of clinical supervision. And we put them head to head by having different supervisors be coached up by experts in those three different types of supervision. And then we tried to see kind of downstream, so multiple layers later. So going from the supervision coach at the highest level to the supervisors, to the trainees, and then all the way down to the clients and then their outcomes to see if we could see any downstream effects and differences between those supervision approaches.
Katherine Hurtig
And what were these approaches? What were the differences in them?
Derek Caperton
So one of them was a very skills-based approach, which is about sort of getting practice and getting reps at the scenarios that you find yourself in as a clinician. So that was one of the areas focused on practicing skills. Another one of the areas was leveraging sort of what is the in-house sort of supervision as usual process that's been here at CCC for several years, which is really leveraging Feedback-Informed Treatment, right? And so that is where, that's kind of what I described earlier around a supervisor and a supervisee working together to look at the shape and the trajectory of outcomes, so how a client is improving or not, and then really focusing in on those folks that need some more help and trying to help sort of punch up that quality of work with that particular client and using the expertise of the supervisor to help influence sort of the path and the interventions that might be used in counselling by the supervisee. And then the third arm was what we called competency-based. And so that's sort of the method that I was trained in in the States, which is sort of like this gold standard way of just going through and understanding a bunch of different kind of competencies and skills you need in general to be a good practitioner of psychotherapy. And conversations and training around difficult conversations, like say around traction with a client or something like that. And so it's much more about sort of learning these things. You're not necessarily practicing the skills, but you're learning a lot about the different things that might be happening as a clinician. And giving the supervisors the best skills possible to help coach supervisees through those different possibly sticky situations. So you have skills-based. You're actually doing taking reps. You have feedback-informed treatment, which is you're looking at how a client is doing over time. Targeted coaching from the supervisor. And then the other one is sort of a lot of sort of knowledge and information that can be useful and then pulled from during counselling itself.
Katherine Hurtig
What came out of that study?
Derek Caperton
So this is where mixed methods become really important because quantitatively, what we found is that clients in each one of those arms did more or less the same. All of them improved and they all did really well, but no one supervision method seemed to do better than another. And so now what we've done though, is we've getting a lot of good feedback over the course of that study from the supervisors who were learning from the different coaches. And so now what we're starting to do is we're rotating the supervisors through different coaches because this entire time a given supervisor was just in one arm of the study, right? They were just doing the skills-based training and now they're rotating through and learning from another expert. And so the hope is then is that in aggregate, if you can kind of build in the skills-based with some of the competency-based stuff that's sort of this best practices of knowledge and then the feedback-informed treatment that you're going to get, you know, some really, really world-class supervision here because you're, you know, we're learning, each one of our supervisors are learning from the best in each of these domains and they all work really well. But now this next step of the study really is like what happens when you're able to sort of integrate all of those different approaches together.
Katherine Hurtig
What kind of specific ethical considerations come into play when you're studying counselling outcomes?
Derek Caperton
Yeah. So, I mean, you know, confidentiality and privacy is number one. So we're always trying to make sure that we're keeping all of our data secure and managing who has hands on it. I also consider competency to be an ethical issue. So that means making sure that all of the reports that we're sending out and the data that we're analyzing has really been scrutinized by, you know, multiple eyes to make sure that what we're saying about a given result is true, right? We don't want to be misleading or misrepresenting things that are happening. And so I think that level of competency is really an important ethical consideration. And then I also think it's important to be looking at at-risk populations and folks that might otherwise be marginalized and making sure that, you know, when we're talking about the CCC population, is there anybody else who might be getting left behind, right? That's not representative of, say, the overall improvement or the overall access, things like that.
Katherine Hurtig
Do you have examples of that?
Derek Caperton
So an example of sort of adhering to that would be before presenting an analysis of saying like this is what's happening with the overall CCC population is also doing that analysis by, say, client racial ethnic background in order to see like, OK, are there some folks from different backgrounds that are not doing as well in counselling? And then, you know, is there anything that we can be doing with that? Is there a deficit? Are there other factors that might be involved with that? Right. as well because it's, you know, any outcome has a lot of things that are going into it. But just doing analyses by different background variables, I think are important to be able to make sure that no one's sort of falling through the cracks when it could be something that we're doing to better treat a certain population.
Katherine Hurtig
So you, you'd said like through this data, we counsellors can see if they need to, you know, quote unquote, do something differently or make changes. So what would that look like? And that's, understanding that that's going to be so different with...
Derek Caperton
Well in a general sense with Feedback Informed Treatment, you know, a trainee might notice like, Hey, you know, this client is not improving over time, you know, I'm four or five sessions in and they don't seem to be getting better on the OQ. That is their ratings of distress aren't going down. And so they can go to the supervisor and they can then talk about who this client is and what the variables might be that they think might be contributing to the fact that this person isn't getting better. Is it certain circumstances in their life that are sort of not related to therapy? Maybe the trainee and the supervisor can contextualize to understand, okay, so what's happening here is not related specifically to therapeutic work that you were doing. Although you might be able to talk about, you know, any lessons from, you know, something bad happening and how that might be related to a person's anxiety. So the trainee might notice that Like, okay, so this, you know, this client seems sort of emotionally distant and I'm having a hard time connecting with them. And the supervisor would be able to help them sort of break down, alright, Is it something that's coming from the client or from you or from that interaction between the two of you that is sort of allowing any sort of real sort of authentic relationship between the two of you that might provide a catalyst for helping the client sort of engage in therapy and then get better with whatever content it is that you're working through, right? And that can look a whole bunch of different ways where like maybe, you know, maybe some identity or cultural background differences aren't sort of lining up and you're just missing each other, you know, language wise. You're not using the sort of verbiage that would be appropriate for that client. Or maybe the pace, you know, which you speak is not working for that client. You tend to speak more quickly and the client needs a more laid back pace. So, you know, that and a thousand other things could be something that is going on about why a client might not be improving, which is why I'm such a strong advocate for getting consultation from peers or supervision from your supervisors. Because it really sort of takes that human eye and that human level of experience to say like, okay, let's break down these variables and see what might be going on here.
Katherine Hurtig
It sounds there's so many factors to whether someone improves through counselling.
Derek Caperton
Oh my gosh, yeah. In research, you know, we break down what's called variance explained. So like, like how can, what can we attribute to a client's getting better or getting worse over time? And so we know that like actual differences between treatments is very, very small, like 1% or so. So that'd be like the difference between in general, CBT and DBT and psychodynamic and interpersonal process and all these other things. And then we know that say between like, I think it's seven-ish, seven, 8% is due to the between therapists, again, in general, when you average things out. And then there's a few other things. And then it's like 70 or something percent is due to clients, right? So the things that are going on with the client that is sort of outside of the therapist's control, or at least our ability to measure, right? And so, yeah, there's so many different things that can go on. And a lot of sort of the people that are interested in the same things that I am, a lot of what we're doing is trying to capture all of that information and try to make that sort of that unknown quantity that's sort of existing out there quantifiable at least a little bit more. And that's, you know, a lot of that is, you know, with some of the work that's happening with process research and process and sort of contrast and compliment to outcomes is research that is looking at what is actually happening in the room and what's happening between the counsellor and the client that then is influencing outcomes. That is whether or not the client is getting better.
Katherine Hurtig
And when you say what's happening in the room, what does that mean? What does that look like?
Derek Caperton
So many things, right? Between of eye contact, how much body language in general, how often the therapist is speaking in relation to how often the client is speaking.
Katherine Hurtig
Oh my gosh. That’s so detailed.
Derek Caperton
If the therapist is asking questions, are they closed questions where it's just like, you know, so did that make you sad? And that's sort of yes or no. Or is it open questions? Tell me more about that sadness or, you know, where are you feeling that in your body? Allowing some more sort of broader conversation on what that experience is if you're interested in focusing on sadness, right? All those things and so much more is what would be considered what's happening in the process. And I should note, too, that CCC does measure process using what's called the SRS, which is…
Katherine Hurtig
Session Rating Scale?
Derek Caperton
Yeah, thank you. Yeah, the Session Rating Scale. I have so many measures in my head that I sound like, wait, which one is that in the acronyms? So the SRS is a measure of, in general, alliance and the therapeutic relationship. And it's sort of our best predictor of outcomes. And that is asking clients, how much do you believe in the expertise of your therapist? How much do you like your therapist? How much do you feel like they understand you and are able to empathize with you? How much do you buy into the plan that you and your therapist have? And those things are really, really, really important. And when I was practicing, getting that sort of feedback was a gold to me to be able to see like, oh, like I got kind of a lower rating from my client last week on agreements that on sort of the right track and we're using a plan that they buy into. I mean, that's what I'm opening up my next session with, right? Is like, like, okay, well let's get on the same page about a plan that feels good for both of us, you know, as we're trying to help you get better.
Katherine Hurtig
That was another thing as a client. And again, I mean, this is going to be so different for everyone coming in, but I felt like, and maybe this is a Canadian thing too, like trying to be polite. I found when I got that, it was, it was a bit uncomfortable because it's like, the person is in the room next to me and I'm kind of rating them how they did. Yeah. And so it felt, it felt awkward to give them anything but like a rave review. Does that make sense?
Derek Caperton
Totally. Yeah. And a common issue, right? Yeah. You know, people want to be nice to their therapist and, you know, give them a good review. We have what's called a ceiling effect with that measure. So it's a score out of 40. And in general, the average is 37.
Katherine Hurtig
Oh, is it?
Derek Caperton
Yeah. So there's not a whole lot of variance in part because of what you're observing here of like, well, you know, I don't want to diss my therapist. We're working together. And even, you know, and as a client, when I've been filling out things like that, you know, at different centres, you know, I've been like, well, you know, I can empathize with and I might not agree 100% with the plan, but I get where they're going. So I'll give them the maximum score. Right. And that's really easy to do. But I mean, as a clinician, I certainly always appreciated whenever I got a lower score on something and it meant something that's like, oh, this is, you know, if this is authentic.
Katherine Hurtig
Right. It's something that we can actually change.
Derek Caperton
Oh, pure gold. Yeah. Pure gold. I never got offended by it. Like if I ever got a lower score on something, it was more like, oh, perfect. Now we have something to leverage, right? In order to hopefully improve what a client is getting out of this experience, right? But there's a lot of variables that go into it, many of them outside of our control.
Katherine Hurtig
Totally. When we talk about measuring the effectiveness of counselling, so I don't know, whether someone is benefiting. I don't know if that's the right term. What does that process look like?
Derek Caperton
There have been, so the measure that we use, the OQ45, is very, very well studied. And we have a big sample of people from places all over the world that help us understand sort of what the markers are for what we would consider to be reliable improvement. The OQ is measured in a number of points. And we know that, you know, above 64 points is what we consider to be clinically distressed. If you answer all the questions and you have more than 64 points, you're sort of at this clinical level of distress that's sort of warranting professional help.
Katherine Hurtig
Okay.
Derek Caperton
And so we're able to further describe improvement for clients based out of how many points they improve by, right? And so that number is 14 points over the course of treatment. So we consider reliable improvement to be wherever you started out, if you improve by 14 points or more, that's considered something that's, you know, that's meaningful change that happened over time is something that we can trust as something that'll be also resilient going into the future.
Katherine Hurtig
Is it like you reach 14 points, then, you know, your counsellor recommends that you don't need counselling anymore, or does the counsellor want to see that kind of 14 point change over a certain period of time? Like, does that make sense? Like see it after a few sessions?
Derek Caperton
Yeah. I mean, it has to be something that's sort of, again, you know, we talk so much about how sort of specific and personalizable this is to a client. So 14 points might mean something for one client and 14 points means another or someone else. You know, I should note that whenever we talk about, you know, these averages or these scores or something like that, like that's something that we've taken, you know, it is an average. It's the mean for a very large population of people. But, you know, you might be as a client, you know, 14 points might not mean that much, especially if you come in and really, really distressed or it might mean the world. Right. So there's obviously variances that exist on either side of that average. And I think it's really important to remember that as statisticians and researchers, as clinicians and as clients to really say like, OK, so we know what this means on average, but I might not be average. Right. So we have to consider how important is this change for this person? Right. And so if a client improves by 14 points over, say, four or five sessions, and they seem to have learned a lot during counselling, it seems to be something that's sort of stable. Then, yeah, a clinician might be able to move towards like, OK, you know, do you have enough to sort of wrap up this relationship and take what we've learned and move back into life without this relationship that we have between the two of us? Or is it something that might be feels a little bit more shaky? It's like, okay, so you improved by 14 points, but it sounds like, you know, just from our conversations that you're still sort of integrating a lot of what this improvement is. And sometimes that's maybe more stable and maybe we should do another session or two or whatever it might be for that relationship. Yeah. So again, that's where that human factor comes in. And we have data that, you know, provide, you know, averages and generalized abilities and all this other stuff. But you have to use that human expertise to provide a context. It's just sort of a gross guideline, you know, a general guideline that we can use. But yeah, all the idiosyncrasies of a person and a relationship has to be considered for sure.
Katherine Hurtig
So what role do the clients play in participating in counselling research?
Derek Caperton
Yeah, I mean, so like we talked about before, being really honest about where you're at, both with the relationship with your counsellor and then just where your level of distress is, is huge, right? because that's sort of, you know, that's the quantitative feedback. That's the number that we can use. That's a little bit simpler to understand, you know, for us to be able to use as a marker for understanding your improvement and then how you're feeling about counselling. So I think honesty and authenticity and feedback, both the quantitative version that happens in our surveys and then in the relationship too with the counsellor in the conversations is really, really important.
Katherine Hurtig
In what way generally do research findings influence the development of new counselling techniques? And have you seen that in the research that Calgary Counselling Centre has done?
Derek Caperton
Yeah. So, I mean, you know, the most influential stuff that Calgary Counselling Centre has done in my eyes is all around Feedback Informed Treatment and sort of establishing that, you know, this information that we gained in the 90s that was like, hey, if we give, you know, if we observe counsellors and what they're doing, they do better. And then if we observe the counsellors and then we give them feedback, they do even better. Right. And Calgary Counselling Centre has been one of the places at the absolute forefront to implement those sort of things. And so there's been really important research showing that Feedback-Informed Treatment, that is taking and soliciting information from the client about how they're doing and how things are going on between the relationship, and then building that into practice has been huge. There's also a body of literature that I'm less sort of familiar with, and I'm not as much of an expert on, with working with domestic violence populations and mandated clients. So as a result of that, then I know there's, gosh, there's been at least half a dozen publications or more that Robbie did over the years. So that's contributed as well. And I'm sure it influences the way that those programs are still being implemented now and working with that client population. Research is sort of where knowledge about counselling and what works and what doesn't work is institutionalized and recorded, right, in general. So we have decades and decades of research that suggests, you know, best practices and research. And as a clinician, you can, you know, you can go and you can look at published articles. Or if you're working with a client with a specific diagnosis or disorder, you can see what's the best practices and what's the research say about the best approaches to work with those people. Or maybe better understanding people of different, maybe racial or ethnic backgrounds than you and better understanding, you know, how to be multiculturally competent or multiculturally oriented in your work.
Katherine Hurtig
Yeah.
Derek Caperton
All those things can influence it. You can learn more about new different types of treatment. Like, you know, if you want to learn more about what, you know, you know, what are sort of the treatments that have the best efficacy for working with, say, just, you know, major depression, for example. Right. And so you can look at that published work. Yeah. So, I mean, you know, you can also to read about, you know, say you've mostly been working with individuals your entire career, but you'd like to start practicing with couples. You can read the research based on some of the best practices and the most innovative techniques for working with couples as well.
Katherine Hurtig
Right.
Derek Caperton
So, yeah, it's where knowledge gets stored, right, is in research, right? Yeah.
Katherine Hurtig
Are there any studies or projects that you guys in, you know, the research department are working on right now that you're really excited about?
Derek Caperton
Yeah. So I've recently been really interested in fit, right? And I think as clients in particular, we're always like concerned, like, boy, I hope I have a good fit with my counsellor, right? Like, hopefully sort of, I hope they get me, I hope this is a good match and that they understand me and they can kind of see and understand the perspectives that I have and the things that I'm going through and all these other things, right? And so I've been really curious about fit. And so we've just heard sort of the beginning stages of two studies regarding fit and how that works. And one of them is looking at the historical outcomes that different therapists have with clients of different backgrounds and different presenting concerns and different levels of initial distress in order to better understand who are the best and the worst fits for, say, that particular counsellor. And that's something that's really interesting because we can then learn about maybe some areas that that counsellor or that trainee can be trained more in, right? If they have a certain deficit in a certain area or maybe understand better their strengths and they work really well with certain people. Some of my favorite research recently has been around matching counsellors based off of their documented ability to work with different presenting concerns. So it's a really, really simple idea. I'll break that down a little bit. So say, you know, you've seen 250 clients, you know, working at this, a certain centre. And what we found is that you are really good at working with clients who present with high anxiety.
Katherine Hurtig
Okay.
Derek Caperton
And so this one research study did was Michael Constantino out of UMass Amherst and his colleagues found that if you just pair up, you know, counsellors that are really good with certain presenting concern with folks that have that presenting concern, They're going to do better than just sort of assignment of clients to counsellors as usual using, you know, client preferences and whatever might be sort of the usual method for other community mental health centres.
Katherine Hurtig
Yeah, that makes sense.
Derek Caperton
It makes perfect sense, right? But again, it's sort of we needed to document that to do anything with it, you know? And so he did the trials that sort of demonstrated like that does move the needle, which is always the holy grail for us and psychotherapy researchers. Like what is actually helping people get better? And this is one of those things. And so in thinking about that, I wanted to do research like that here at CCC. But first sort of looking back and seeing like, okay, are there particular patterns? Or do we have certain strengths or areas of growth for our counsellors? And learning more about that. So again, that we can help out people sort of train them up. Or maybe if we want to like, you know, way down the line, this is going to require a whole lot of extra research and implementation science. Or about, you know, assigning clients that come in to people that we think are going to be really good matches. because they've worked well with clients like that in the past. So that's one study that we're looking at that, again, sort of is looking at all the dynamics that go into fit. I'm really curious about.
Katherine Hurtig
Do we know anything at the moment? Like what kind of contributes to a good fit?
Derek Caperton
So we've run some initial analyses, and I want to kind of strengthen them up before I really trust those data. But like for one example, one thing that we're seeing now in these early analyses, So grain of salt is that there does seem to be a difference in how much comfort and ability different therapists have in working with clients with high suicidality. There actually seems to be some differences there where some clients are really good working with folks who are coming in with suicidal ideation and some folks not so much. So that's one sort of client demographic that's existing at intake that if that result turns out to be robust and we have to slice it a hundred different ways before I really trust it. You know, it could be a useful thing for training for folks that aren't doing so good with folks who come in with high SIs, suicidal ideation. And then maybe pairing up folks who are like, oh, they're just rock stars when working with folks who are dealing with that sort of tough space to be in.
Katherine Hurtig
Right. Yeah. We should give those folks to those clinicians. But yeah, it's a really multifaceted thing to kind of go from initial analyses and exploration of these data and these patterns all the way to implementing it as something that's a procedure used. And we're at the very early stages of it, but it's worth exploring, I think.
Katherine Hurtig
Maybe this isn't the right question for this discussion and it's one to like talk to, talk with like an actual counsellor about, but how, how would, you know, an average person like looking for counselling go about finding someone that's, they feel is a good fit? Are there questions that they should be asking? Are there characteristics that they should be picking out?
Derek Caperton
Yeah, totally. So I think there's a lot of sort of like categorical things you can look at, like do you have a preference in terms of gender or your therapist or age or maybe their treatment they do. Maybe you heard that EMDR is great from a friend and you'd like to give that a try. So you go find someone who has special training in EMDR. I think those things are really important. Maybe, you know, and obviously logistical things like if you want it in person, are they in your area? And then do they take your insurance if that's relevant? All those sorts of things. But, you know, really what I have always sort of vouched for is having an initial conversation with that person and being sort of critical about in that first session, does this feel like something that's a relationship that, you know, I can grow together and trust this person.
Katherine Hurtig
Yeah. So it's more about just kind of intuition?
Derek Caperton
You know, it's so multifaceted, right? It's like, you know, like what sort of friends do you want? Right. Like you can make categorical things like, oh, I want them to have X, Y and Z qualities or backgrounds or life experiences or values. But at some point you're going to have to, for lack of a better term at the moment, pass the vibe check to you.
Katherine Hurtig
Yeah, totally. Yeah.
Derek Caperton
And so I think sitting down with a given counsellor and being open to like, what is the possibilities that exist in this relationship between the two of us? And also recognizing, and I think this is really important, that no relationship is perfect.
Katherine Hurtig
Of course.
Derek Caperton
And I think sometimes it's really easy to be, I'm this way. You know, as a therapist who's also been a client, like I can be super critical of my therapists, right? Of just recognizing like, okay, a lot of what's at least half of this is me, right? So I have to be in a place where I'm open to working with somebody who might not be a perfect fit, but they're going to get the job done. So let me invest in this. Right. Because me and I'm sure other folks too have the temptation to just hop, right? And just transfer. But, you know, a lot of the gain is going to happen from investing in that relationship, whether it's absolutely picture perfect or not.
Katherine Hurtig
Yeah. Is there anything else that I haven't asked you? Anything about the work that you do that you want people to know?
Derek Caperton
That's a great question. You know, I think the thing that has always stood out to me about CCC and why I decided to come here and take this job is just how sort of practice-based the research and the science is. You know, we have three full-time employees that are really busy. We're working on stuff all the time to be able to supplement the quality and the amount of counselling that's happening. And so, you know…
Katherine Hurtig
Yeah, because at the end of the day, it's about improving the process for the clients, right?
Derek Caperton
Yeah, absolutely. It's this, you know, this overarching task of the entire field, which is, you know, how do you better serve the mental health of the people that are walking through your door?
Katherine Hurtig
Yeah. And it's a really complicated and demanding task, but it's also really, really, really engaging and fun because it's so hard, right? You know, I sometimes think that, you know, a lot of my task is trying to capture and describe something that's sort of uncapturable and undescribable. Like as a person who's worked as a clinician, like sometimes I think like, how are we ever going to distill down this stuff? But, you know, the hope is that you're able to move the needle a little bit, give counsellors a little bit more context so that they can make, you know, say that right thing at that right time, that one time, you know, and hopefully that helps out somebody down the line.
Katherine Hurtig
Thank you so much for chatting with me today. This is a topic that I didn't have a great grasp on it, and I somehow feel I have an even less of it because it's just so complex.
Derek Caperton
I'm so glad I could help.
Katherine Hurtig
No, but thank you, and thank you for the work that you do. And, yeah.
Derek Caperton
Thanks, Katherine. It was fun.
Katherine Hurtig
Good chat.
…
You've been listening to Living Fully. Thank you for tuning in. This episode was produced by Gus Hunt, Luiza Campos, Jenna Forbes, and by me, Katherine Hurtig. A special thanks to Derek Caperton.
To stay up to date on our latest episodes, be sure to subscribe. We're available in your favourite podcast app. Living Fully is a production of Calgary Counselling Centre and recorded in Calgary on Treaty 7 Territory. Living Fully Podcast is not a substitute or alternative for professional care or treatment. Calgary Counselling Centre and Counselling Alberta provide effective counselling for anyone in Alberta with no waitlist and no financial barriers. Find us online at calgarycounselling.com or counsellingalberta.com. For help across Canada and the United States, call 211. If you are outside of Canada and the U.S., seek help from your general medical practitioner.