Barry Duncan - Academia.edu (original) (raw)

Articles and Chapters by Barry Duncan

This chapters reviews the supervision literature and covers the four steps of PCOMS supervision.

This article, a magazine style version of a chapter that Jacqueline Sparks and I wrote in the fir... more This article, a magazine style version of a chapter that Jacqueline Sparks and I wrote in the first edition of The Heroic Client, was originally published in the Psychotherapy Networker, March/April 2000 and was recognized by Project Censored as one of the ten top underreported stories by mainstream media of 2000. This article also received recognition as one of the top ten most influential articles in the Networker’s first 20 years. It was inspired by a brochure that came in the June (1998) issue of the Family Therapy News. The splashy “Intimacy and Depression” brochure made our hearts sink when its exquisite design, original art, glossy photos, poignant text, heavy paper, and devastating message washed over us—profoundly disheartening us with the feel, look, and smell of creative marketing that could only come from big corporate money. But no it couldn’t be. Our national organization surely wouldn’t enter a relationship with a drug company or promote its products. Say it ain’t so. But it was. Glaxo Wellcome, a drug company, funded the project.It opened our eyes to the extent of drug company influence and fueled Jackie and my continued interest in mythmakers of psychiatric drugs.

Duncan, B. (2011). What therapists want. Psychotherapy Networker, May/June, 40-43, 47, 62. Duncan... more Duncan, B. (2011). What therapists want. Psychotherapy Networker, May/June, 40-43, 47, 62.
Duncan, B. (2011). Opening a path. Psychotherapy Networker, May/June, 46-47.
These articles discuss what motivate therapists and how PCOMS can serve those motivations.

BARRY DUNCAN elaborates on four questions about becoming a 'master' therapist posed by Jeffrey Ko... more BARRY DUNCAN elaborates on four questions about becoming a 'master' therapist posed by Jeffrey Kottler and Jon Carlson for their forthcoming book, 'Becoming a Master Therapist'. His answers, illustrated with clinical vignettes, integrate the latest research about what matters in effective psychotherapy to challenge the prevailing view that to be an accomplished psychotherapist one must be well-versed in evidence-based treatments. Psychotherapy is a relational endeavour, one wholly dependent on the participants and the quality of their interpersonal connection. After the client, the therapist is the most potent aspect of change in therapy, and in most respects is the therapy. Soliciting feedback engages clients in the collaborative monitoring of outcome, heightens hope for improvement, fits client preferences, maximises the alliance potential and client participation, and is itself a core feature of therapeutic change.

Brief overview published in The Iowa Psychologist of the common factors and feedback effect.

THIS CHAPTER DISCUSSES •The empirical evidence supporting a strengths-based approach •Specific pr... more THIS CHAPTER DISCUSSES
•The empirical evidence supporting a strengths-based approach
•Specific practice guidelines for recruiting client resources to promote change
•The link between pluralistic counselling and a focus on client strengths

THIS CHAPTER DISCUSSES •Systematic feedback and the Partners for Change Outcome Management System... more THIS CHAPTER DISCUSSES
•Systematic feedback and the Partners for Change Outcome Management System (PCOMS)
•PCOMS as a way to truly privilege clients, include them as full partners in decision-making and operationalize social justice and a pluralistic approach

This study examined gender differences in session one alliances and in the trajectory of the alli... more This study examined gender differences in session one alliances and in the trajectory of the alliance over the course of couple therapy. Additionally, this study examined the association between men and women's pre-therapy relationship adjustment and alliance at session one and over the course of therapy. A total of 316 couples seeking outpatient couple therapy were given the Locke–Wallace marital adjustment test at pre-therapy to measure relationship adjustment and the session rating scale after each session to measure alliance with the therapist. The results showed that men had lower alliance ratings after session one than women. Men's pre-therapy relationship adjustment was positively associated with their own session one alliance as well as their own alliance trajectory over the course of therapy. Men's pre-therapy relationship adjustment was also positively associated with their partner's session one alliance. Women's pre-therapy relationship adjustment showed no significant relationship with their own alliance or their partners at session one or the alliance trajectory over the course of therapy. The implications for how these gender differences may impact on the process of couple therapy with heterosexual couples are discussed.

Two continuous monitoring and feedback models have demonstrated gains in randomized clinical tria... more Two continuous monitoring and feedback models have demonstrated gains in randomized clinical trials (RCTs): Lambert's Outcome Questionnaire (OQ) System and the Partners for Change Outcome Management System (PCOMS). This article chronicles the evolution of PCOMS from a simple way to discuss the benefit of services with clients to its emergence as an evidenced based practice to improve outcomes. Although based in Lambert's model, several differences are described: PCOMS is integrated into the ongoing psychotherapy process and includes a transparent discussion of the feedback with the client; PCOMS assesses the alliance every session; and the Outcome Rating Scale, rather than a list of symptoms rated on a Likert Scale, is a clinical tool as well as an outcome instrument that requires collaboration with clients. The research supporting the psychometrics of the measures and the PCOMS intervention is presented and the clinical process summarised. Examples of successful transportation to public behav-ioural health are offered and an implementation process that values consumer involvement, recovery, social justice, and the needs of the front-line clinician is discussed. With now nine RCTs and American Psychological Association endorsements to support it, it is argued that client-based outcome feedback offers a pragmatic way to transport research to practice.

In K. J. Schneider, J.F. Pierson, & J.F.T. Bugental (Eds.) The Handbook of Humanistic Psychology (2nd Ed.), Sage Publishing Co.

This chapter reviews the clients who most impacted Barry Duncan's career and journey to a relatio... more This chapter reviews the clients who most impacted Barry Duncan's career and journey to a relational model of psychotherapy and away from a medical model. This chapter appeared in In K. J. Schneider, J.F. Pierson, & J.F.T. Bugental (Eds.) The Handbook of Humanistic Psychology (2nd Ed.), Sage Publishing Co.

Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Dunca... more Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates (Baldwin & Imel, 2013), are poor judges of negative outcomes (Chapman et al., 2012), and grossly overestimate their effectiveness (Walfish, McAlister, O’Donnell, & Lambert, 2012). Systematic client feedback offers 1 solution (Duncan, 2014). Several feedback systems
have emerged (Castonguay, Barkham, Lutz, & McAleavey, 2013), but only 2 have randomized clinical trial support and are included in the Substance Abuse and Mental Health Administration’s National Registry of Evidence-Based Programs and Practices: The Outcome Questionnaire– 45.2 System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012). This article presents the current status of PCOMS, the psychometrics of the PCOMS measures, its empirical
support, and its clinical and training applications. Future directions and implications of PCOMS research, training, and practice are detailed. Finally, we propose that systematic feedback offers a way, via large-scale data collection, to reprioritize what matters to psychotherapy outcome, reclaim our empirically validated core values and identity, and change the conversation from a medical model dominated discourse to a more scientific, relational perspective.

This study investigated whether routine monitoring of client progress, often called "client feedb... more This study investigated whether routine monitoring of client progress, often called "client feedback," via an abbreviated version of the Partners for Change Outcome Management System (PCOMS) resulted in improved outcomes for soldiers receiving group treatment at an Army Substance Abuse Outpatient Treatment Program. Participants (N = 263) were active-duty male and female soldiers randomized into a group feedback condition (n = 137) or a group treatment-as-usual (TAU) condition (n = 126). Results indicated that clients in the feedback condition achieved significantly more improvement on the Outcome Rating Scale (d = 0.28), higher rates of clinically significant change, higher percentage of successful ratings by both clinicians and commanders, and attended significantly more sessions compared to the TAU condition. Despite a reduced PCOMS protocol and a limited duration of intervention, preliminary results suggest that the benefits of client feedback appear to extend to group psychotherapy with clients in the military struggling with substance abuse.

Policy makers and payers are insisting that to be paid, therapists must "deliver the goods." Conc... more Policy makers and payers are insisting that to be paid, therapists must "deliver the goods." Concurrently, there is a worldwide movement to involve consumers in their care. Consequently, the measurement of change, from the client's perspective, has become an important topic. Unfortunately, no self-report outcome measure has been available for children under 13. This article describes the development, validation, and psychometric properties of a brief outcome measure, the Child Outcome Rating Scale (CORS), for use with children 6-12 and their caretakers as well as the Outcome Rating Scale (ORS), for youth 13 and above and their caretakers. Results indicate that the CORS/ORS represent a balanced trade-off between the reliability and validity of longer measures, and the feasibility of these brief scales, and that youth do indeed deserve a voice in the delivery of services. We argue that outcome management is a pivotal part of delivering consumer-driven services, the therapeutic relationship, and change itself.

Journal of Family Psychotherapy, 2007

A critical review of three articles reveals flawed empirical evidence underpinning the case for i... more A critical review of three articles reveals flawed empirical evidence underpinning the case for integrating pharmacotherapy and psychotherapy. Medical model dominance favors biology in a diathesis/ stress framework, creating myths of valid diagnosis, underlying biological causes, and targeted pharmacological treatments. Meanwhile, a for-profit pharmaceutical industry influences clinical trials, constructing an illusory justification for medical intervention and bolstering the integration hypothesis. The apparent logic of integration threatens to diminish the crucial, empirically supported role of clients in psychotherapy outcome. The authors call for the inclusion of client feedback in intervention choices, based on accurate, unbiased information, and a continued critique of pharmacotherapy.

Most therapists aspire to become better at what they do. However, research has shown that persona... more Most therapists aspire to become better at what they do. However, research has shown that personal therapy has nothing to do with outcome; there are no therapeutic approaches, strategies or interventions shown to be better than any other; professional training and discipline do not matter much to outcome; there is no evidence to show that continuing professional education will improve effectiveness; and, although it defies common sense, experience does not improve outcomes either. So what does 'professional development' mean and how do we accomplish it? In this edited extract from his recent book, On Becoming a Better Therapist, BARRY DUNCAN explores how we can remember our original aspirations, continue to develop as therapists, and achieve better results more often with a wider variety of clients.

Research has found that client change occurs earlier rather than later in the treatment process, ... more Research has found that client change occurs earlier rather than later in the treatment process, and that the client's subject experience of meaningful change in the first few sessions is critical. If improvement in the client's subject sense of well-being does not occur in the first few sessions then the likelihood of a positive outcome significantly decreases. Recent studies have found that there are significant improvements in both retention and outcome when therapists receive formal, realtime feedback from clients regarding the process and outcome of therapy. However, the most used instruments in these feedback studies are long and take up valuable therapy time to complete. It has been found that most therapists are not likely to use any feedback instruments if it takes more than five minutes to complete, score and interpret. This article reports the results of an evaluation of the use of two very brief instruments for monitoring the process and outcome of therapy, the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS), in a study involving 75 therapists and 6,424 clients over a two year period. These two instruments were found to be valid and reliable and had a high use-rate among the therapists. The findings are discussed in light of the current emphasis on evidence-based practice.

American Psychologist, 1987

... AUTHOR AFFILIATIONS. Barry L. Duncan, Dayton Institute for Family Therapy. M. Bernadine Parks... more ... AUTHOR AFFILIATIONS. Barry L. Duncan, Dayton Institute for Family Therapy. M. Bernadine Parks, Wright State University. Mary Ann Kraus, Bellefaire Residential Treatment Center, Shaker Heights, OH. © 1987 American Psychological Association. CITATION. ...

This chapters reviews the supervision literature and covers the four steps of PCOMS supervision.

Brief overview published in The Iowa Psychologist of the common factors and feedback effect.

In K. J. Schneider, J.F. Pierson, & J.F.T. Bugental (Eds.) The Handbook of Humanistic Psychology (2nd Ed.), Sage Publishing Co.

Journal of Family Psychotherapy, 2007

American Psychologist, 1987

Psychological Services, Apr 21, 2022

Reply to comments on an article by Duncan and Sparks (see record 2018-10637-001). Østergård and H... more Reply to comments on an article by Duncan and Sparks (see record 2018-10637-001). Østergård and Hougaard (2020) reiterate the flawed conclusions of their meta-analysis of the Partners for Change Outcome Management System (PCOMS) and obfuscate the main point of our critique (Duncan & Sparks, 2020). Despite the lauded statistics and selection criteria, the inclusion of six significantly confounded investigations resulted in a misleading overattribution of meaning to studies of questionable methodology that warranted exclusion. Further, their hypothesis that social desirability leads to inflated effect sizes on the Outcome Rating Scale (ORS) is insufficient. It is not supported by studies finding comparable results to the ORS on independent outcome measures or investigations reporting that change on measures of life functioning, like the ORS, precedes that depicted on symptom scales. While more research is needed, the totality of credible research supports the efficacy of PCOMS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Counselling Psychology Quarterly, Jul 25, 2019

The use of systematic client feedback tools are known to enhance outcomes in adults psychotherapy... more The use of systematic client feedback tools are known to enhance outcomes in adults psychotherapy clients, but their effects with children have yet to be adequately tested. Hence, we piloted a cluster randomised controlled trial of the Partners for Change Outcome Management System (PCOMS) with children aged 7-11 years old; comparing play-based counselling with, and without, the use of this tool. Ten UK 'primary' schools were randomly allocated to either the intervention or control condition. Data were available for 38 children in total: 20 girls and 18 boys, of predominantly a white ethnic origin (mean age = 8.5 years). Clinical outcomes were the total difficulties scores on the teacher and parent completed Strengths and Difficulties Questionnaire (SDQ). Fifty percent of the schools left the trial between initial recruitment and end of data collection, but participant dropout was low and recruitment rates were satisfactory. Participants in the PCOMS condition showed significantly greater reductions in parent completed total difficulties than those in the control condition, with small to moderate effect sizes on all outcomes in favour of PCOMS. Overall, our design appeared feasible, but needs to ensure adequate school retention and counsellor adherence.

Journal of Psychotherapy Integration, Mar 1, 2002

In preparation for a commentary on Saul Rosenzweig's classic 1936 paper, "Some Implicit Common Me... more In preparation for a commentary on Saul Rosenzweig's classic 1936 paper, "Some Implicit Common Methods in Diverse Forms of Psychotherapy," an amazing discovery was made: Saul Rosenzweig is not only alive but also still contributing to science and society at age 93. This article sets the stage for a conversation with the incredibly prolific Dr. Rosenzweig by tracing the impact of his seminal contribution on early common factors theorists. This review reveals Rosenzweig's unrecognized but profound influence on leading figures of not only common factors but also of psychotherapy itself. A conversation with Rosenzweig, the founder of common factors, is presented. This noted scholar and wise elder of psychology reflects on the evolution of his thinking from common factors to idiodynamics, and on topics ranging from his passion for literature to his 1965 Buick Skylark, from the history of psychotherapy to falling in love with ideas. There is no new thing under the sun.-Eccles. 1:9 A literature search in preparation for a commentary (Duncan, 2002) on Saul Rosenzweig's 1936 classic article, "Some Implicit Common Factors in Diverse Methods of Psychotherapy," uncovered puzzling findings. After the 1936 article, there seemed to be a great void-nothing from Rosenzweig in follow-up to his incredibly prophetic article and not much of anything else about common factors until the middle 1950s. Trying to make sense of the nearly 20-year hiatus as well as the surprising lack of reference to Rosenzweig's contribution by early common factor theorists, I pursued information about Rosenzweig's career to find some explanation.

Brief overview published in The Iowa Psychologist of the common factors and feedback effect.

Blueprint to Action. Aug 86 12p.; Paper presented at the Annual Convention of the American Psycho... more Blueprint to Action. Aug 86 12p.; Paper presented at the Annual Convention of the American Psychological Association (94th, Washington, DC, August 22-26). viewpoints (120) MF01/PC01 Plus Postage. *Activism; *Nuclear Warfare: *Peace; *PSychologists; *Social Responsibility; *War Recent evidence suggests that the 1982 American Psychological Association nuclear freeze resolution is reflective of a consensus among psychologists. The evidence also suggests that while the expressed attitudes of psychologists are supportive of the free%c, the attending demonstrative behaviors are not present. To facilitate_overcoming this behavioral impasse_and to emphasize that one psychologist can make a difference, a blueprint to action waS developed at the individual, family, local, community, national, and international levels and in the areas of education, research, practice, and organizations. A broad array of options is presented ranging widely in time commitment and level of influence. Options are available at several levels1 (1) individual (reflection,_prayer, and voting); (2) family (nonviolence, conversation, and books); (3) local community (civic participation,_school interest, and establishment of nuclear free zone); (4) national (letter_writing and peace initiatives); (5) international (cultural exchange and letter writing); (6) education (support local peace center, teach conflict resolution, and encourage students to write visions of peace papers); (7) research (role of mutual ignorance, mental health aspects of war, and conflict resolution); (8) practice (deal with clients' fears); and (9) organizations (join groups such as Psychologists for Social Responsibility). (Author/ABL)

American Psychological Association eBooks, May 5, 2014

Guilford Publications, Aug 1, 2007

Continuous client feedback offers great promise for improving treatment outcomes. Because of thei... more Continuous client feedback offers great promise for improving treatment outcomes. Because of their feasibility for everyday clinical use, the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) enjoy popularity in the US and have been translated in various languages, including Dutch. The present study investigated the psychometric properties of the Dutch translations of ORS and SRS and examined the cross-cultural differences between Dutch and US data. Results were largely consistent with the American studies, although some differences were found. This preliminary study of the Dutch translations supports the use of the ORS and SRS cross-culturally but additional research of other translations is needed.

With a simple focus on "what works, " this practical book spells out a compelling ratio... more With a simple focus on "what works, " this practical book spells out a compelling rationale and practical blueprint for time-efficient, collaborative problem solving in the schools. Demonstrating that every contact with clients is an opportunity for empowerment and change, the authors draw upon extensive hands-on experience and the latest findings in psychotherapy outcome research to present effective strategies for handling behavioral, academic, and psychosocial problems. Tables and figures highlight the building blocks of this unique approach, and extensive case examples and sample dialogues guide school practitioners and trainees through the interview and intervention process. Addressing a range of commonly encountered difficulties, such as recurring disciplinary problems, poor academic performance, and anxiety, chapters show readers how to build a positive relationship with students, teachers, and parents; concentrate on strengths and avoid exclusive focus on clients' deficiencies; assume alternative perspectives to encourage new solutions; alter problem cycles and validate clients' values and ideas about change; and evaluate and maintain progress.

Page 1. The Heart And Soul Of Change, 2Ed: Delivering What Works In Therapy Table of Contents Con... more Page 1. The Heart And Soul Of Change, 2Ed: Delivering What Works In Therapy Table of Contents Contributors Foreword David E. Orlinsky Preface Prologue: Saul Rosenzweig: The Founder of Common Factors Barry L. Duncan ...

How can therapists become better at doing what they love, avoid burnout, and prevent client dropo... more How can therapists become better at doing what they love, avoid burnout, and prevent client dropout? Respected therapist, trainer, and researcher Barry Duncan asserts that getting better at this work requires therapists to dedicate themselves to two key tasks: obtaining systematic client feedback and taking charge of their own development as a therapist. This book describes his 'Partners for Change Outcome Management System' (PCOMS), which provides systematic feedback from clients, thereby enabling therapists to identify and target clients who aren't responding to traditional treatment before they drop out. Duncan examines the common factors inherent to all successful therapies and details the importance of the therapeutic alliance as the foundation of effective therapy. He encourages therapists to expand their theoretical breadth, think deeply about the lessons they learn from their clients, and integrate these lessons into their performance. Scholarly yet deeply personal, with lively case examples and unfailing good humor, Duncan's work is essential reading for anyone who seeks to rediscover purpose in their work. New to this edition are two chapters, one demonstrating PCOMS with couples, families, and youth and the other presenting how to implement PCOMS on an organizational scale. This book also integrates the author's responses to many thoughtful questions raised by trainees and readers of the last edition.

Psychotherapy in Australia, 2008

T he ' boisea trivittatus', better known as the box elder bug, emerges from the recesse... more T he ' boisea trivittatus', better known as the box elder bug, emerges from the recesses of homes and dwellings in early spring. While feared neither for its bite nor sting, most people consider the tiny insect a pest. The critter comes out by the thousands, resting in the sun and ...

Journal of Strategic and Systemic Therapies, 1984

Journal of Systemic Therapies, 2000

Journal of Marital and Family Therapy, 1992

On becoming a better therapist: Evidence-based practice one client at a time (2nd ed.).

On becoming a better therapist.