Can Feedback-Informed Treatment Work in Practice?


Besides the common questions I addressed in my last note, many readers raised questions about the logistics of implementing FIT (feedback-informed treatment, in which therapists use computer surveys and algorithms to track clients’ progress and predict whether they’re at risk of deteriorating). This reader says my article ultimately convinced her it could work, though she was skeptical at first:

One thing I wish the author had discussed is how the computer assessment is presented to the patient. As I read the article, I realized that my university's student counseling office must have been using this method: Every time I went for a session, I had to go to a computer station and enter a great deal of personal information, including scaled responses to the kinds of questions this article mentions.

I would have loved to know that my answers were used to check my therapist's perception of my psychological state over time. Instead, no one ever volunteered information about the procedure. I wasn't sure my therapist ever looked at it, and I resented it as an unnecessary task that took time away from my session. If the counseling office and my therapist had been transparent about using the information to improve each of my sessions, I think it would have noticeably increased my confidence in the treatment I received there.

Indeed, FIT works best when therapists explain the process to clients and are personally invested in using the system. This article explores that topic.

On a similar note, this reader, who alludes to negative past experiences with therapy, raises two very important points:

I think it's an ethical MUST for such a program to also give the person who takes the test power—i.e. information on how they are being judged. I would not see a therapist using FIT (as it is) to be honest. It seems like a way to "extract" information I don't want to give, which can be used in ways I don't like and don't even find ethical—being locked away, being kicked out of therapy, being forced to use medication or being expected to work harder than I want to.

First, the client should be collaboratively involved in the FIT process. Clients should also have the right to decline to participate in FIT. Second, FIT data should not be used in isolation to make clinical decisions, such as medication, terminating therapy, hospitalization, etc. These decisions should involve a host of other data, including foremost collaborative discussions with clients, then also therapists’ clinical judgment, etc. FIT is just one data point (like a thermometer).  Barry Duncan has written about this topic in his book On Becoming a Better Therapist.

But FIT only works if agency directors support the process by making time and financial resources available, and this reader raises an important point about feasibility:

Something like this sounds fantastic, but I can imagine the difficulties of actually implementing it. First, not every agency can afford iPads. So people will be taking surveys on paper and someone is going to have to enter that data. Everyone at your typical mental health agency is already overburdened with work. Are patients going to show up early to take a survey before every session? If not, is that time is going to come out of their session time? Who is going to train clinicians on how to actually use the data collected?