Sunday, June 28, 2009

What makes us great? And are we even as great as we think?

I've been obsessing about whether or not I'm providing meaningful and quality services to my clients of late. It started when I read an article in the Psychotherapy Networker on Supershrinks: What's the Secret of Their Success (written by Scott Miller, Mark Hubble, and Barry Duncan).

In 1974, researcher David F. Ricks coined the term
supershrinks to describe a class of exceptional therapists—practitioners who stood head and shoulders above the rest. His study examined the long-term outcomes of "highly disturbed" adolescents. When the research participants were later examined as adults, he found that a select group, treated by one particular provider, fared notably better. In the same study, boys treated by the "pseudoshrink" demonstrated alarmingly poor adjustment as adults.

The authors did research, based on the
work of K. Anders Ericsson, (a Swedish psychologist), trying to figure out how one becomes a supershrink, and they came up with this "formula for success":
(1) determining your baseline of effectiveness, (2) engaging in deliberate practice, and (3) getting feedback—depends on and is informed by the others, working in tandem to create a "cycle of excellence."

To me, this "formula" sounds a lot like quality improvement, which is something we really don't do a lot of- at least not consciously and deliberately- in the Music Therapy Unit at our facility.

The article further pointed out: shouldn't be surprised or disheartened when your results prove to be average. As with height, weight, and intelligence, success rates of therapists are normally distributed, resembling the all-too-familiar bell curve. It's a fact: in nearly all facets of life, most of us are tightly clustered around the mean. As the research by Hiatt and Hargrave shows, a much more serious problem is when therapists don't know how they're performing or, worse, think they know their effectiveness without outside confirmation. Unfortunately, our own work in tracking the outcomes of thousands of therapists working in diverse clinical settings has exposed a consistent and alarming pattern: those slowest to adopt a valid and reliable procedure for establishing their baseline performance typically have the poorest outcomes of the lot.

Gosh. I started to wonder whether or not I was thinking I was doing a pretty decent job when maybe I wasn't. Hm.

So this has me thinking a lot about how I can go about determining whether or not I'm providing a service that's going to make a difference in my clients' lives in the long term.

A number of years ago I went to a workshop at a music therapy conference given by Richard Scalenghe (who is both a music therapist and a quality assurance professional) called, "So You Think You Provide Quality Care? Quality Improvement for Music Therapists". I found it thought-provoking then, and as soon as I read the supershrinks article I rummaged through my collection of papers and handouts so I could look at this subject again.

I'm going to do some more reading and see where I can go with all this. In the meantime, if you are a music therapist (or a psychotherapist or a person who has experience with quality assurance/improvement), I'd love to hear what approaches you've used to determine the effectiveness and quality of the services you're offering.


John Lawrence MMT, MTA said...

I actually have two facilities that don't require any evaluation of my work at all (dangerous, IMHO). As a consequence, I voluntarily insist on an annual review involving my client work and paperwork. This not only gives me something to fall back on (should they decide that they no longer require my services), but also gives me an outside evaluation so that I don't fall into the "am I providing good service" trap and worry-cycle.

Another technique that I have found useful is continual and constant communication with my supervisors (non-MTs) regarding my efforts in continuing education. If I have a course, read a book related to MT (such as "This is your brain on music") or present/attend a MT conference, I tell them. This lets them know that I am not remaining dorment and that I wish to improve my current skill set and knowledge about "how to effectively work" with my clients!

Michelle Erfurt, MT-BC said...

I use the same constant communication technique with my supervisors as well by sending a short email with a recap on a recent activity (conference attended, presented at, even CMTEs attended) AND send a copy of any certificates of completion to be placed in my personnel file.

Roia said...

John and Michelle, thank you for your thoughts and suggestions!

I'll probably say more about it in a future blog (there seems to be an endless variety of things to think about with regard to quality improvement), but there are actually some measures in place at the facility where I work. After all, we receive federal and state dollars to run. As such, there are numerous rules and regulations with regard to paperwork. And someone is almost always looking to make sure the necessary papers and such are there.

I think the more difficult questions that came up for me (which I do talk about in the new blog post) were related to "do my *clients* (who don't use speech and who often receive music therapy because someone else deemed it necessary) feel they're benefitting and receiving quality services?" Of course, that's a very simplistic way of putting it, but the fact is, my clients don't come up with goals and objectives for their lives- their treatment teams do.

Hmm. Maybe what I'm really trying to get at by looking at quality improvement is "am I helping my clients to find meaning in their lives and supporting them to take ownership of their lives- even within the context of living in an institution?"
I absolutely agree with both of your suggestions that I keep my supervisor informed of classes, continuing education and so forth. In fact, I not only keep them in the loop as far as that, but I regularly discuss what I'm doing and why.

I think the institution (in general and on the whole) is perfectly happy with the services we provide. It's me who is agitating and thinking there's a need to be more conscious in how I'm providing services.

Thank you both, again, for your feedback!