Season 4, Episode 16: Could it be depression? What a screening quiz can tell you
Each October, Calgary Counselling Centre and Counselling Alberta host National Depression Screening Day, a week-long initiative that encourages people to check in with their mental health. This year, from October 5–11, anyone can take a free, confidential online depression screening quiz at areyoufeelingok.com that looks for common signs of depression.
It’s not always easy to recognize when changes in how we’re feeling, thinking or functioning may be signs of something more. In this episode of Living Fully, counsellor Sarah Rosenfeld takes a closer look at the depression screening quiz, exploring what it can help us understand, what the questions are really asking, and how it can be used as a first step toward recognizing when it may be time to seek support.
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Katherine Hurtig
Welcome to Living Fully. Each episode is a chance to talk about mental health in a way that's simple, honest, and helpful. We'll share stories, tips, and tools to help you feel supported and feel your best. I'm your host, Katherine Hurtig.
How do you know if you're making progress in counselling? Progress in therapy can be slow, subtle, and sometimes it even feels like you're taking a step backwards.
In this episode, I'm joined by psychologists Michael Barrett and Jelena Radan to talk about what real progress in counselling looks like, why it's rarely a straight line, and how you can recognize the signs that meaningful change is happening.
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So, in counselling, besides feeling better, how do we know when counselling is working? It's a little bit intangible. It's not exactly like going to the doctor and getting a cast when your leg is broken. That's what we're going to get into today, is the process of analyzing progress in counselling. How we know it's really working.
I'm here today with two of Calgary Counselling Centre and Counselling Alberta's psychologists, Michael Barrett and Jelena Radan. Thanks so much for being here.
Michael Barrett
It's great to be here.
Jelena Radan
Of course.
Michael Barrett
Thanks for having us.
Katherine Hurtig
Michael, new guest on the podcast. Tell us about yourself.
Michael Barrett
I'm a registered psychologist and I've been in the field for... coming up on two decades. And I've worked with a variety of client populations from at-risk youth, neurodiverse, and autistic individuals. And it's really great to be here at Calgary Counselling Centre where I have the opportunity to work with a variety of different people.
Katherine Hurtig
Awesome. Jelena, how about you?
Jelena Radan
I'm also a registered psychologist. I have worked at Calgary Counselling Centre for a while now, coming up on three years now.
Katherine Hurtig
Awesome.
Jelena Radan
Back at CCC, so that's pretty great. I work with diverse population and, you know, specifically working with clients experiencing domestic violence, as well as anxiety and depression, as well as anxiety and depression.
Katherine Hurtig
So, when people start counselling, and I mean, I can speak from experience, we want quick results. We want to feel better. We want things to be different. What does that progress actually look like in real life?
Michael Barrett
Great question, Katherine. That's such a common starting point, and it's completely understandable. When people are struggling, they want relief, and they want it soon. What I'd say is that progress often begins with small internal shifts that are easy to overlook. Things like noticing your own thoughts, taking a moment to pause before reacting, or being able to name what you're feeling more precisely. Instead of saying, perhaps, ‘I just feel bad.’ A person might start saying, ‘I notice I shut down when I feel criticized.’ And that kind of clarity is actually a big deal. Progress also shows up as different choices and not perfect outcomes. It's not about eliminating the struggle, but it's more about responding differently when that struggle comes up. A really meaningful example for me is when a client says that they're feeling anxious about something, let's say showing up for an event, but they challenge themselves to show up anyways. Or they're recovering from a setback faster than they would have before. And they would look at this setback as a possible opportunity for learning rather than seeing this as a failure. When I think about these subtle shifts, for me, they represent the foundation of lasting change.
Katherine Hurtig
Yeah. And like, again, I can speak from experience. I've had lots of counselling experience. And oftentimes the progress, the change, the growth, it's not linear. It's not like day one, I feel terrible. Next session, I'm, you know, 20 per cent better. Can you guys explain why that progress is gradual and maybe not that straight line?
Jelena Radan
Yeah, of course. So, that is an experience that many clients have in common. So, much like life, growth in counselling, it's a journey with stops and detours along the way. And perspective, it plays a very key role in that. Rather than perceiving a stop or a detour as a failure or a setback, one can treat it as a learning opportunity. From what we might initially think of as a failure or a setback, we can often learn the most.
Katherine Hurtig
We use the Outcome Questionnaire, that feedback informed treatment tool. What is it? What is this tool? Is it a 45-question questionnaire?
Jelena Radan
Yeah.
Michael Barrett
Yeah, that's correct.
Katherine Hurtig
What kinds of questions are people being asked? What is it measuring? And if it pumps out a number, what is it? What does that mean?
Jelena Radan
The Outcome Questionnaire, it shows us the level of stress that clients are experiencing when they are coming to counselling.
Katherine Hurtig
OK.
Jelena Radan
As you said, Katherine, they answer 45 items all on a Likert scale from ‘never’ to ‘almost always’ reflecting on the past week. The three different areas that the Outcome Questionnaire looks at is work stress or school stress, interpersonal relationship issues or concerns, and also any symptoms such as physical pain or any other mental health concerns like anxiety, depression. So, the experience of these.
Katherine Hurtig
OK. Yeah.
Jelena Radan
So, that overall score gives us an idea of where they're at currently and how much stress they're experiencing.
Katherine Hurtig
Yeah. Is it a score out of 100? Is it—
Jelena Radan
Oh, it—
Katherine Hurtig
Yeah, what is that?
Jelena Radan
The highest level of stress on the outcome questioner is actually 180.
Katherine Hurtig
OK.
Jelena Radan
Which is pretty high.
Katherine Hurtig
So, if someone got a 180, things are not going well.
Jelena Radan
Not at all.
Katherine Hurtig
OK.
Jelena Radan
So, their score, it's relative to the clinical cutoff at 63. A score of 63, it represents the average stress that the average person experiences on an average day.
Katherine Hurtig
OK.
Jelena Radan
So, if a client's score is above that, then we have an idea, you know, their level of stress is higher than the typical person, and they could definitely benefit from counselling. Everything below that average level of stress is expected stress.
Michael Barrett
Right.
Katherine Hurtig
Right, yeah.
Jelena Radan
So, everyday stressors like driving in traffic. Minor issues.
Michael Barrett
To add to what Jelena was saying, when you have a score that falls below the clinical cutoff of 63, the way I explain it to my clients is that everybody experiences some stressors in their lives. But when you're coming in below the clinical cutoff, it's almost suggestive that you have strategies that you've been trying that have been working for you.
Katherine Hurtig
OK.
Michael Barrett
Anything that we're noticing that's coming up above and beyond, this might be a good indicator that, you know, maybe having an extra set of eyes coming in and taking some opportunities to maybe slow things down. Having an opportunity to look at the challenge, maybe in a slightly different way, can be helpful in addressing that challenge and bringing that score a little bit lower.
Katherine Hurtig
And that literally gives you, as counsellors, and the client a kind of visual of this ‘progress.’ Can you talk a bit about how that's kind of brought up in session and how you kind of use that to show progress to the clients?
Michael Barrett
The way that I look at the Outcome Questionnaire, I present it to clients as more of a guideline. So, giving us more of an understanding of how they see progress for themselves as it unfolds in real time in their lives. And this, it's a way of us charting how they feel things are going for them over the course of our therapy, our journey together. One of the things I think that’re really helpful, the OQ brings up when things are... Stressful events are coming up for the individual. It gives us a moment to kind of pause and slow things down to ask, ‘I noticed here that, you know, your score has increased. Can you tell me a little bit about that? You know, what's been going on for you during those times?’ I want to be able to present the client with an opportunity to engage in a self-reflective process.
Katherine Hurtig
Yeah.
Michael Barrett
And give them that opportunity to think about, ‘What's been going on for me? Is there any consistency there? Are there things that are happening that maybe I haven't noticed in the past?’ And then we can start building out meaningful conversations from there. I guess in that sense, be able to target specific interventions and strategies to address those specific parts that they identify for themselves.
Jelena Radan
I do want to add that the Outcome Questionnaire allows us to monitor client progress.
Katherine Hurtig
Yeah.
Jelena Radan
From one session to the next, as well as throughout the course of counselling. And with clients, it's important to let them know that the score, it will fluctuate throughout the course of counselling. It is very common regardless of where you start.
Katherine Hurtig
I could see if a score... Is it increased?
Michael Barrett
You know, I'm glad you brought that up. Anytime I'm introducing the OQ assessment to a client, I liken it to kind of going off to the doctor's office and having your blood pressure taken.
Katherine Hurtig
Yeah.
Michael Barrett
Higher numbers are indicators; these are things that we want to be mindful of. So, anytime that we're starting to see higher numbers I'm going to ask the questions of like, ‘What’re the things that you're noticing during your week?’
Katherine Hurtig
OK.
Michael Barrett
You know, ‘What are the changes that you're seeing for yourself?’ I want to give you an example. I was working with a client who is like, ‘You know Mike, I'm seeing a lot of peaks and valleys in my numbers. What does that mean?’ We use the metaphor, ‘This is kind of like life.’ You know, you're going to have your ups and downs.
Katherine Hurtig
Yeah.
Michael Barrett
And what we want to be able to do is, you know, for your OQ scores, we want to decrease the peaks and valleys and have those nice rolling hills.
Katherine Hurtig
OK. Yeah.
Michael Barrett
You know, something where we're not seeing as much wild fluctuations.
Katherine Hurtig
Yeah.
Michael Barrett
And when I check in with clients, this is one of the processes that they can see, that things are feeling a little bit more under control.
Katherine Hurtig
A little more stable.
Michael Barrett
A little bit more stable and manageable.
Katherine Hurtig
Yeah. Because I could imagine if you've been explained how the OQ works, and you see your scores increase, it might be discouraging. ‘Oh, am I improving?’ But you guys take the time to explain the process and how that's to be expected?
Jelena Radan
When a client's score increases, that is expected. There could be different reasons for that. One reason could be, you know, there was something that they were dealing with over the last week that was outside of their control. And naturally, we would expect these things to be more difficult to manage. So, of course the stress is going to increase. Maybe a strategy or a skill that we tried to use didn't really land or work as well for the client as we had hoped, which happens, right?
Katherine Hurtig
Yeah.
Jelena Radan
So, that gives us the opportunity to check in with the client and see, you know, how did it go, what did they notice, what could we adjust, adapt, or could we try something new altogether?
Michael Barrett
Yeah. And to add to that, when we talk about the fluctuations of our OQ scores, I think it's really important for listeners to understand that we normalize this. It's been my experience that when working with clients, as their insight increases, the client might start to recognize these patterns, maybe losses or unmet needs, that they haven't fully acknowledged before. And sometimes this clarity can feel heavy before it feels more empowering for themselves.
Katherine Hurtig
OK.
Michael Barrett
Really giving that opportunity for self-reflection. And I love checking with my clients and saying, you know, ‘What does this mean to you? Have you had situations like this come up for you in the past?’ Kind of an expert for themselves to think like, ‘If this has come up for me in the past, what have I done before in the past that has worked for me? And is this something that I have that skill set that I can reapply to mitigate this challenge in front of me now?’
Katherine Hurtig
We talked about how this progress; it's not always going to be linear. How do you guys go about helping clients understand that their experience in counselling is going to be really personal and individual, and not something that can easily be compared to somebody else?
Michael Barrett
I think first and foremost, it's important to help the client understand that they are their own unique individual. And therapy, when I think about it, it works in multiple layers simultaneously. Clients might be working on their emotions, relationships, and their thoughts and identity all at once. When you think about it, sometimes progress in one area can temporarily stare up some discomfort in another. I want you to think of it as a two steps forward, one step back feeling that a lot of people can recognize and appreciate.
Katherine Hurtig
Yeah.
Michael Barrett
We learn through repetition. Any of our emotional or behavioural patterns or cognitive processes are deeply ingrained. And change requires practicing new ways of thinking, considering, and acting on a situation. It's completely normal to fall back into old habits while building new ones. And that's actually how part of that learning solidifies, and not a sign that things aren't working.
Katherine Hurtig
That idea is something that was just kind of revolutionary to me in my own counselling. That idea of, ‘I can change how my brain works.’ You know?
Michael Barrett
Yeah.
Katherine Hurtig
By acting differently, by making different choices and doing those repetitively.
Michael Barrett
Yeah.
Katherine Hurtig
I can think differently.
Michael Barrett
Definitely. And one of the things I love to orient clients to understand is that life doesn't pause for therapy.
Katherine Hurtig
Yeah.
Michael Barrett
We get that most people are going to be dealing with ongoing stressors, as Jelena had spoken to, work, relationships, health, the list goes on and on. I always try to let clients know that these things can affect how progress feels from week to week, but they also provide real-life opportunities to apply what's being learned, and that's the real valuable element.
Katherine Hurtig
Yeah, because that's the thing it's like, these conversations each week, a lot of insight can happen. But yeah, like you're saying, a lot of life happens outside the counselling room. So, you got to be able to apply what you're learning. Counselling sessions, they can be, as you know, very, very vulnerable, really heavy at times. While others might be more light with feelings of more hope. How can people make sense of these ups and downs?
Jelena Radan
These ups and downs, they are definitely part of the process. So, depending on what the client is working on, some sessions, they may feel heavy because maybe the person is disclosing something for the very first time, but they've never told anybody else. And it may feel uncomfortable, heavy, as you said.
Katherine Hurtig
Yeah.
Jelena Radan
Through continuing conversations, so in subsequent counselling sessions, what initially felt heavy could begin to feel a little bit lighter with time as the therapist and the client work together.
Katherine Hurtig
Yeah.
Michael Barrett
And to add to that, one of the things, again, I love to orient my clients to is understanding that different sessions oftentimes serve different purposes. Heavy and light sessions are both a normal part of the therapeutic process. When a client lets me know that they're processing pain, I help them to understand that this is a heavy session because we're touching on something that's important or a value to them. Other sessions that might bring insight, relief, or problem solving, they're going to feel a little bit lighter. But neither one is a sign that therapy is going well or going badly. They're both essential parts of the same process.
Katherine Hurtig
Is it possible, is it common to feel worse before it gets better in counselling? And if so, how do you go about explaining that to people?
Michael Barrett
I try to help clients understand the reality of counselling that sometimes it might feel a bit worse because sometimes that's the client learning to let go of familiar coping strategies, even the ones that haven't been serving them for some time.
Katherine Hurtig
Yeah.
Michael Barrett
A lot of clients have relied on these behaviours in the transition period, maybe from letting go of old ways that don't work for them anymore and establishing new strategies haven't been fully established yet. It can feel often destabilizing and uncomfortable trying to pick up and learn something new. I try to work on helping the client to understand that the goal of therapy is to gently reverse that. Rather than turning away from a concern, you're turning towards it, which is going to feel uncomfortable and can temporarily increase distress as those emotions come up and surface.
Katherine Hurtig
With the OQ, how can someone tell the difference between a few really difficult sessions and something that actually might not be working, and adjustments needing to be made?
Jelena Radan
I think throughout counselling, so we do encourage clients to look inwards. We ask them so many questions that they probably haven't been asked—
Katherine Hurtig
Yeah.
Jelena Radan
You know, in their day-to-day life. We ask them to reflect on how each of the sessions went for them, what the key takeaways were for them, and whether, you know, something may have been missed or overlooked. So, it's very much like bringing their feedback, their experience into that conversation.
Katherine Hurtig
Yeah. For a lot of us, we see counselling and therapy depicted on TV, movies, pop culture. If we haven't had our own experience, we kind of take those as like, ‘That's how it's going to be.’ I'm sure that some people come in with this kind of expectation that counselling is going to fix them, ‘cure’ them, or whatnot. And if someone has this idea, how do you go about reframing their expectation?
Michael Barrett
I think first and foremost, I start by shifting the language and helping the client to understand that counselling is not about fixing a person, because you're a unique individual and there's nothing broken about you. It's more about understanding the patterns that you've developed, healing wounds, and building skills to navigate life more efficiently and effectively for yourself. And that's a very different framework to have.
Katherine Hurtig
Yeah.
Michael Barrett
More of a solution focus, you know, getting the person to have more introspection about all the skills and the strategies they already bring to the counselling theater.
Katherine Hurtig
That reframe, that was another thing that was super impactful for me. I would have this idea like, ‘OK, I'm getting help for my depression.’ Weeks, months later, I felt like I wasn't doing as well, there were setbacks. So, that reframe of, it's not eliminating those feelings, it's learning how to cope with them, learning how to manage.
Michael Barrett
I couldn't agree with you more. I think it's important when working with clients to help them understand that the goal isn't about perfection. Some individuals will show up and like, ‘I got to get it right off the bat.’ And it's not about perfection, but more thinking about flexibility. Rather than eliminating all the distress, we're working towards becoming more resilient, more adaptable, and more self-aware. Helping the individual to understand that they have the skill sets that they can take on life's challenges with greater confidence.
Katherine Hurtig
And that's the thing, like building up the skills. You know, I'd go in thinking like, ‘I'm failing at this because I'm still having anxious thoughts.’ I'm going to. It's normal. It's just what are the skills that I'm acquiring to be able to handle those?
Michael Barrett
And to add to that, one of the things I really love in speaking with my clients is that process of collaboration where they're kind of like the senior partner in this relationship.
Katherine Hurtig
OK.
Michael Barrett
So, helping them to understand that they're that active participant and not a passive recipient. Therapy isn't something that gets done to you, but really harnesses their insight, their effort, and their self-reflection between sessions. It's those things that matter as much to them as what happens in the room.
Katherine Hurtig
I would assume that another kind of stereotype around counselling is that someone's going to come in, and you guys are going to tell them what to do. Have you guys run into that? Like, do clients kind of have that expectation sometimes?
Michael Barrett
That comes up often.
Katherine Hurtig
Yeah?
Michael Barrett
And anytime I'm talking with a client, I liken it as a collaboration between two experts. For myself, I happen to know a thing or two about mental health and support.
Katherine Hurtig
Yeah.
Jelena Radan
Really? (Laughs)
Michael Barrett
But more importantly, you're an expert of you.
Katherine Hurtig
Yeah.
Michael Barrett
Not only does that need to be acknowledged, that needs to be honoured. When that comes up, I want to make sure that we're checking in with clients and saying, ‘How does this work for you? Is this something that when you think about in the greater picture of your life, can this be a fit?’ Because if not, I always support a policy of failing fast.
Katherine Hurtig
Yeah.
Michael Barrett
And putting that in the rear view, and then really getting the strategies and the support that a client needs that resonates for them.
Katherine Hurtig
Yeah.
Jelena Radan
In working with clients, I believe that they already do have those resources and those skills that they might need in order to move forward. They just might not know how to utilize them to their full potential.
Katherine Hurtig
Yeah.
Jelena Radan
Or they may not know the steps along the way that are necessary in order to move forward.
Katherine Hurtig
What are some other common misunderstandings that you guys have run into? Things that people kind of assume or think progress in counselling is going to be?
Michael Barrett
We hear a lot. Some of the misunderstandings that come up between clients and myself are they might come and report like, ‘I need to be perfect and progress means no setbacks.’ Sometimes the client will say, ‘I failed, Mike. I didn't get it right 100 per cent.’ I think it's very important to be very clear and transparent around saying that setbacks aren't failures. Actually, they're part of the process. Helping the client to understand that revisiting old patterns can actually strengthen new learning when reflecting on situations, rather than avoiding them. Another common misconception is that change should be fast and obvious.
Katherine Hurtig
Yeah.
Michael Barrett
When in reality, it's slow and subtle.
Katherine Hurtig
We want it to be, but it's not always the case.
Jelena Radan
That immediate gratification that we are so used to.
Katherine Hurtig
Yeah.
Michael Barrett
I use the analogy, ‘When we slow things down, we make faster progress.’ What I mean by that, clients may recognize significant growth when they look back and realize how differently they're responding to situations that used to cause the stress and represent barriers in their life. So, if we're able to slow this down, then they could actually take some time to think about, ‘What changes did I make that have benefited me up until this point?’
Katherine Hurtig
Yeah, that's the thing. A lot of times, the changes, they aren't going to be super obvious. It's not like the flick of a switch. But it's when you look back months later, and like you said, kind of realizing how you're responding to things differently.
Michael Barrett
And my favourite, my personal favourite misunderstanding is when clients come and say, ‘It's been two weeks, I haven't made any changes and I'm not improving.’ Progress actually coexists with struggle.
Katherine Hurtig
OK.
Michael Barrett
You can still feel anxious, sad, sometimes overwhelmed, but at the same time, be much better equipped to handle those feelings in a much healthier, more constructive way.
Katherine Hurtig
We have this idea that good mental health means being happy all the time, but that's not the case. Like, it's human to experience all these emotions. It's just a matter of how we handle them.
Michael Barrett
If I had a dollar for every time a person wanted to say, ‘I just want to be happy.’ I'd be a very rich man.
Katherine Hurtig
What are some of those less obvious signs that counselling is helping, even if those big changes aren't happening yet?
Jelena Radan
Clients may, you know, see a change in their perspective or their outlook day-to-day. There might be greater awareness of their patterns of behaviour and how those behaviours are impacting them, as well as other people in their life. And they may be able to identify the role that they play in their many relationships.
Katherine Hurtig
Yeah.
Jelena Radan
Additionally, they may now be open to seeing situations from different perspectives and gain greater understanding from that.
Michael Barrett
And to add to that, one thing that I notice comes up a lot as a subtle sign of growth is when the individual starts to notice their inner dialogue becomes less harsh, less critical.
Katherine Hurtig
Yeah.
Michael Barrett
The client might start noticing a softer, more compassionate internal voice. To be clear, they still may struggle, but they're less self-critical, more understanding, and empathetic towards themselves.
Katherine Hurtig
And how might improvements in coping or emotional regulation, how might that show up?
Michael Barrett
This is a great question because when you think about it, this is where the rubber really meets the road. So, one thing I watch out for is whether clients are getting better at identifying their emotional states.
Katherine Hurtig
That's a big thing though, hey? Like, if you can identify it, then you can change it. Is that right?
Michael Barrett
Well, when you can identify it, you can change the outcome. So, for example, oftentimes I get clients who show up, ‘I got mad. I was angry. I got pissed off.’ Right?
Katherine Hurtig
Yeah.
Michael Barrett
One of the things I try to help clients understand is that anger is a secondary emotion. ‘What was going on for you before you became angry and upset?
Katherine Hurtig
Yeah.
Michael Barrett
You know, ‘Were you disappointed? Were you sad, hurt, feeling shame?’ This kind of awareness can change everything about how you respond to the situation and get your needs met.
Katherine Hurtig
Right. OK.
Jelena Radan
And that can actually even, you know, open up that conversation instead of the other person getting possibly defensive or not really wanting to engage.
Michael Barrett
I think one thing that's also helpful as well is that mindfulness piece. Encouraging mindfulness for the client and getting them to start thinking about how they're self-monitoring themselves. So, for example, I often will ask a client when they have a moment throughout their day to rate their mood. You know, create a scale for themselves. One: I'd rather still be in bed and just forget this day, 10: This is a fantastic voyage, I wish it could be Groundhog's Day and constantly be repeating it. Getting them to monitor that when next we meet, it's a good opportunity to say like, ‘Hey, are we noticing any fluctuations throughout the day?’ So, you know, if at 3 p.m., you're like, ‘Mike, I'm usually around a two.’ That gives us plenty of opportunity. We can actually do a deeper dive and see what's going on around that time.
Katherine Hurtig
Right.
Michael Barrett
We might come up with a strategy to help support them in those moments.
Katherine Hurtig
Yeah. We talked quite a bit about the Outcome Questionnaire, but I know that Calgary Counselling Centre and Counselling Alberta also use another tool called the Session Rating Scale. Can you guys explain that one, what that measures and how you use it?
Jelena Radan
The Session Rating Scale is used at the end of each of the sessions with the client.
Katherine Hurtig
OK.
Jelena Radan
So, we ask clients to complete the scale because it gives us an idea about how they see their relationship with the counsellor and how they believe that counselling is going for them.
Katherine Hurtig
OK.
Jelena Radan
Specifically, they are asked to reflect on whether they felt understood, respected, accepted by the counsellor, and also the extent to which their ideas about change were important in the session and were focused on. As well as whether there is alignment in terms of the goals that we are focusing on. And then that lets the therapist tailor their approach and ensure that they are on the same page, or on the same track, with the client.
Katherine Hurtig
That questionnaire, is that done in front of you guys?
Jelena Radan
Yes, definitely. In real time.
Michael Barrett
Yes. And I love this. I love the Session Rating Scale because it opens the door for a conversation around transparency and accountability. I've always been an advocate, any sort of mental health work that we do for members of the population, we do in service to them. And so, this is our way of checks and balances, and, you know, ‘How did today's session feel for you?’ I love having that opportunity. You know, if I'm noticing something's coming up, being able to get some clarity around how I can go back and think about how I can bring better value and more specific information to the client so they feel like, ‘I'm being heard in my sessions, and I'm getting what I need, and I'm being listened to.’ The Session Rating Scale for me, I think it helps to augment the therapeutic relationship and ensure that if anything's coming up, potential ruptures, it gives us an opportunity to be able to address that in the moment and to provide clarity for our clients moving forward.
Katherine Hurtig
I'm curious about your take on this. So, not going to lie, the Session Rating Scale, it was a little uncomfortable for me because the counsellor is right there. And it's asking basically like, ‘How'd I do? Rate me.’ Maybe it's the Canadian-ness in me, but it was just like, ‘Everything's good. Don't worry about it.’ How do you get client buy-in for that? How do you get them to be really honest, even if it's not always positive?
Michael Barrett
What I do, I'm a huge advocate of being as transparent as possible for the client. I might hint and bring things up. If we're having our first session and you give me 40 out of 40, I would want to go back and say, ‘Well, you know what, did we talk about your goals? Because we're just coalescing or framing them.’
Katherine Hurtig
Yeah.
Michael Barrett
I think one of the things I always advocate to my clients is the understanding that I'm here to be of service to you, and your feedback is going to help do that.
Katherine Hurtig
Yeah.
Michael Barrett
So, if you feel like you want to be nice to me, that is going to be a setback for the both of us.
Katherine Hurtig
OK.
Michael Barrett
Because I might not be bringing the information that you need or the strategies that you need to be successful. I always actually encourage my clients to be critical because their lives matter.
Katherine Hurtig
Yeah.
Michael Barrett
And I want to make sure I'm bringing value every time we sit down together.
Katherine Hurtig
Yeah. Now that I'm aware of the Session Rating Scale and what it actually does, I could see how giving a perfect score every time, it really doesn't help because it's not giving any information.
Jelena Radan
I think that it also has a lot to do with that relationship, the therapeutic relationship.
Katherine Hurtig
Yeah.
Jelena Radan
And, you know, that does take time to develop, of course. But it goes back to, ‘How comfortable is the client with rating the session?’
Katherine Hurtig
Yeah.
Jelena Radan
And at the end of the day, the value of it is that the client's voice is heard.
Katherine Hurtig
Yeah.
Michael Barrett
Yeah.
Jelena Radan
And that we are able to take that into account. And we'll always follow up with more questions and just try to learn about the client, and how we can best support them, as Mike was saying.
Michael Barrett
I think first and foremost, it's also important when we think about the Session Rating Scale to acknowledge that sometimes clients might need some guidance on how to think about it and conceptualize it. I want to go back to something that you said a little bit earlier, Katherine, about that sense of like, ‘Oh, you're rating me.’ Right?
Katherine Hurtig
Yeah.
Michael Barrett
I'm almost thinking about like, how do we reframe that as making sure that the session, in and of itself—So, it's not a rating of your therapist, but it's a rating of, ‘Did you get what you needed at the end of this session?’ You know?
Katherine Hurtig
Yeah.
Michael Barrett
I augment my Session Rating Scale by asking the questions about, ‘When you reflect on our session, what's one key takeaway that you took away from our session?’
Katherine Hurtig
OK.
Michael Barrett
Right? If they come up with, ‘I have nothing to take away from this session.’ I would question, ‘Why are you giving me 40 out of 40?’
Jelena Radan
Yeah.
Katherine Hurtig
Yeah, totally. If someone's feeling unsure about whether their counselling experience is working, how can they bring that up with the counsellor?
Michael Barrett
I think the short answer for that is to have a conversation with your counsellor. As I mentioned before, a good counsellor genuinely wants to hear feedback about how the client feels about the nature of the therapeutic process. The therapist should always be doing their work in the service of the client. And the client should always be encouraged to share their thoughts, feelings, and insights whenever possible because it's their life.
Jelena Radan
I would definitely agree with that. And we do really want to know if clients aren't sure about the direction or whether counselling is working.
Katherine Hurtig
Right.
Jelena Radan
Because that gives us another opportunity to discuss that, just to unpack that, and hear from the client's perspective and figure out a way forward together.
Katherine Hurtig
We've touched on this a bit, but how can looking back at where you've started in counselling kind of help you see the growth that you've taken and how it might not be obvious in the moment?
Michael Barrett
Growth can be really hard to notice when you're living it day-to-day.
Katherine Hurtig
Yeah.
Michael Barrett
Because change is usually gradual. It's kind of like watching a plant grow, right?
Katherine Hurtig
Yeah.
Michael Barrett
You don't see it every morning, but over time you notice the difference and the difference becomes more obvious. Clients can often forget how overwhelmed, maybe reactive, disconnected, or stuck they felt when they first entered our counselling arrangement. But over the course of time, when they can reflect and realize, or maybe even say to themselves, ‘Actually, I've handled things in a very different way now.’
Katherine Hurtig
I think that's probably one of the most important takeaways in this conversation is just that it might feel slow and not obvious, but those changes are happening.
Michael Barrett
And I would also say in my experience, some of the biggest signs of growth is kind of the recovery time. People might still experience stress, anxiety, or difficult emotions, but they start to notice that they're bouncing back quicker. And they're responding with more intentions or showing themselves more compassion in the process. And for me, that's really meaningful progress.
Katherine Hurtig
Thank you so much, Jelena, Michael. This has been an excellent chat, and we know a little more about how to see if our counselling's working.
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You've been listening to Living Fully, a Calgary Counselling Centre podcast. Thank you for tuning in. This episode was produced by Layla Ruggles, Luiza Campos, Julianna Adair, Jenna Forbes, and by me, Katherine Hurtig. A special thanks to Michael Barrett and Jelena Radan.
Tune in to our next episode on October 10. Do you think you might be depressed? We’re taking a closer look at a free, confidential quiz available October 5-11 that can help you understand whether you might be experiencing signs of depression and connect you with resources and support.
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 to anyone in Alberta with no waitlist and no financial barriers. Find us online at calgarycounselling.com and 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.