Outcome ratings – What they are and why we use them
Outcome ratings were developed by Scott Miller at the center for clinical excellence. They are a measurement that tracks people’s progress over the course of their therapy, so both therapist and client are full aware of their development. For more information go to: http://www.centerforclinicalexcellence.com/.
This idea of measurement was adopted by the Clifton Practice Hypnotherapy Training school and is used widely by their therapists for research purposes.
Most sessions in Solution focused hypnotherapy the client will be asked to scale where they are with their problem that week, then at the end we compare that score with their overall general well being. This includes scoring Thoughts, Interaction, Activity, Confidence, Resourcefulness, Achievement and overall happiness.
These scores are logged onto a chart like the ones below.
Plotting each week how the client feels overall, when they start therapy they are usually (unless they have very high emotional intelligence EQ) below the dotted line. This line represents 2 things – 1) This where the average person is in respect of emotional wellbeing. 2)Below this line, the person is using far more of their primitive mind and responding to situations. Above the line, they are using more of the grey matter that enables us to look for solutions to problems.
The reason why someone may need to carry on seeing a therapist after achieving a high score after only a few sessions is to make sure those changes are long-lasting. Some of these graphs show that some clients will leave having therapy a bit late (e.g. exams, fear of flying, interview nerves) , or they break it off too soon only to have to come back again 6 months later.
Outcome ratings for EB
EB came for hypnotherapy because of jealousy issues with her husband and his ex-wife. She had been in a very bad relationship before and she was terrified it would end the same way. She had low self-esteem, lacked confidence and compared self to others all the time. Jealousy had been an issue since her teens when her sister “stole” one of her boyfriends. As we worked together she found some of the distraction techniques really useful to break the cycle and her relationship with her husband had improved hugely.
Outcome ratings for MG
MG came to see me about insomnia. He’d had some health issues including a heart attack and ever since then had problems sleeping. He filled in a sleep questionnaire which revealed he had high blood pressure. I explained about the brain, and how health scares could often trigger insomnia, caused by worrying about every heartbeat, or irregular beat.
He had already tried CBT and mindfulness but it hadn’t done much. He was also on anti depressants which he felt were not working. We started working on lowering anxiety, and improving motivation to sort out admin at home.
By session 5 we looked at going to bed much later and working backwards, this showed some improvement. He was due to go on a holiday which would throw out his normal routine, and when we met up for the 8th session it had helped, so we decided he’d just carry on listening to the CD for the next 3 months, then see how he was after that.
Outcome ratings for VJ
VJ came to see me about lack of confidence. She’d just finished a relationship and had realised she kept making the same choices in men and it just wasn’t working. In the first session she realised she was always trying to please people, and that any conflict made her feel nervous. We worked on personal boundaries and by session two she was feeling better and felt she was able to say no to people now. She also found her confidence at work had improved, and also her horse riding. Some of her friends had tried to convince her to join a dating website, but she felt she needed to have a break first.
By session 3 VJ realised how needy her last partner was, although he had moved in with someone else, he was forever calling, texting and emailing her and we agreed she should limit her responses to first thing in the morning and evenings. He had to learn to let go as well. In session 4 she had been contacted by someone who was interested in asking her out, but instead of jumping in, she had held off and was communicating at her pace, this proved to be useful as the man was insistent and she felt he wasn’t the right one for her. She realised she had been pressured by friends to have a man.
By session 5 she was quite happy with how things were panning out, and she decided to go on some speed dates to try out the confidence boosting work we’d done together. She was doing the 100 happy days challenge and having fun. To make sure she could maintain this I saw her twice more and said her friends had noticed the difference in her.
Outcome ratings for KL
KL came to me with a phobia of food. She had just come back from holiday abroad with her boyfriend and her phobia had been so bad she hadn’t eaten for nearly two weeks and on top of that she’d caught a bug and had lost over a stone in weight.
She felt her social life had ground to a halt as she couldn’t eat in restaurants and she couldn’t eat in front of her boyfriend. Tensions between them had come to a head as he couldn’t understand why she was being so difficult.
Session one, she said she wanted to be able to go out and eat more.
By session 2 She started to focus more on what she wanted to try and eat, and we spoke about fruit cocktails being one of the easiest ways of trying new fruit.
By session 5 she was loving a wide variety of foods, her colleagues at work had noticed she was now eating in the restaurant instead of eating just crisps. She was instigating going out eating in restaurants with her friends.
By session 7 she was nearly a 9. She had put on 7lbs since seeing me and needed about another 4lbs left to gain. She was very happy.
Outcome rating for JT
JT came to see me with IBS, but there were more complications than usual because she also had MS. When she learnt the connection between the mind and the bowels, she felt so much better and was determined to stay positive. Her outcomes show she starts high and carries on high. She had wonderful support from family and after many years of having a poor GP who had suggested much of her problems weren’t real, she now had a GP who was young and knowledgeable who supported her choice in using complimentary healthcare.
Before she came to see me she had stopped going out altogether, but by session 1 she had gone out shopping to Witney.
By week 2 she was sleeping better and had gone shopping in Newbury, the family were coming round and she was already reducing the number of times she had to go to the loo considerably.
The dip in week 3 was due to an infection and she was in considerable pain. Despite this she was upbeat and positive, in fact I found her inspirational.
By week 4, her other therapists had noticed she was doing better, she had even made it to John Lewis in High Wycombe.
Over the next few weeks, we had Christmas and New Year and JT felt so much better, sleeping was better, she’d had a cold, and by week 10 the infection was finally contained and she’d been given the all clear.
We then spread out sessions to once a month, and by May she felt she could manage it herself with help of the CD.
Outcome ratings for KT
This chart is of client KT, who came to see me because she stressed out with having a full time job, coping with 2 small children and doing a course to help her improve her future job prospects.
The dotted line on the chart represents what we consider to be the general well being score. To be under this line is feeling below par, to be above it shows coping is much better. With KT, she starts off fairly low but by session 3 she has really grasped the ideas of positive thinking and solving problems as they occur and not putting them to one side and ignoring them.
She had also started using the principles at work and using them with clients herself. This boosted her confidence.
Later on you can see with the scaling a lower score at session 7 – this was because of a death – apart from that she would have been an 8, well within normal parameters.
Outcome ratings for SS
This is the chart of SS. She came to me for weight loss. This is a classic example of how hypnotherapy works with losing weight. She was working part-time and in session 1 she admitted the problem was alcohol related. She was coming home from work and having a glass of wine while she cooked her dinner and she couldn’t stop. The one glass while cooking turned into drinking the whole bottle every night. I asked her what she wanted to achieve and she said control.
It gradually unfolded that she had been widowed the year before, had moved house and got herself a part-time job which she thought would bring her in touch with more people and bought a dog. It was obvious she felt lonely and she was trying to get the balance right, and it was becoming evident that the work, in particular, was not fulfilling the role.
In the same boat
We discussed her doing volunteer work in an area where she interacted with a lot more people. She decided to join a local group of women who were in the same boat. She also took up evening classes in the subjects that interested her. By Session 6 she had decided to retire. As soon as she made this decision her general happiness score started to rocket. She was starting to have control over the drinking. At first hiding the bottle, so it wasn’t there right in front of her when she went to the fridge. She put in it’s place a bottle of diet tonic and yummy fruit juices. SS found she had halved her intake doing this and even put some wine back on the shelves in the supermarket.
By session 9 she had lost half a stone in 3 weeks, she was feeling better for getting control of her eating as well as her drinking. She decided to do the 5:2 diet, replacing normal days with salad days and didn’t feel hungry. She knew she could do it and had the tools to carry on. By session 11 she was telling me she had to go on a shopping spree to replace her clothes and she was going away with friends. She’d lost over a stone and was over the moon.
Outcome ratings for NA
NA came to see me with Eczema covering a large part of her body, particularly joints hair and hands. I assured her that hypnotherapy could help, as I used it for the condition myself and in all the years I’ve been practising it, I have cleared up all the Eczema apart from one tiny patch on my palm, which is irritated by chemicals and soaps.
NA came out in hives when hot or in close contact with her partner, and found that listening to the CD had not only helped her sleep, but she had not broken out in hives from that moment onward.
A few blips
We had a few blips on the chart, and these were due to NA being involved in a number of stressful situations, which she recognised and so was able to change the way she approached certain tasks.
The last dip came about as she stopped listening to the CD at the end of the therapy and realising that she had to carry on for a long time yet. By her last session she had very little reddening of the skin and she was very happy.
Outcome ratings for MM
This is the chart of MM, she came to me as she found it difficult to swallow. She was getting married in the summer and was scared she wouldn’t be able to eat at her reception. She had been to her GP but they could not find anything physical as a problem, so she decided to try hypnotherapy.
I explained to MM about the relationship between tensing the muscles of the body and the swallowing mechanism. I had seen people in the past who could not speak when stressed and swallowing was no different.
When MM arrived at the first session. She had listened to her CD and had managed to eat out in a restaurant in London. She recognised it might be a “first-time lucky” experience. When I saw her for session 2, she had had only 1 incident. In the scheme of things wasn’t too bad. The scaling shows this as she marks session 2 a 5. She carried on into full recovery and went out eating at a restaurant again. This time reported there was no problem. By week 4, she had got a hang of the mindfulness exercises and had no further problems.
Outcome ratings for LP
August 2013 – the latest chart for LP, a lady who was experiencing obsessive thoughts. A form of OCD these thoughts would often manifest themselves by repeating a tune or a set of words over and over again.
At the initial consultation, I explained that high stress often causes some strange mental behaviour. When we lowered our stress levels she would find these subsided or she’d have greater control over them.
LP understood she had to reduce her stress levels. These were caused by taking responsibility for things which were not her’s to worry about. Once she was able to pass those back to the people in question and start practising stress management techniques, she rapidly made a recovery.
By week 3 she just needed to motivate herself in writing a major essay for her degree. By week four she was able to do this. In our last session 5, she said she was self-actualising and had increased her self-confidence much higher than it had been in a long time.
October 2013, latest results for RG. He’s a builder and suffered for 20 years with IBS after an incident. His life has been hampered by the problem and it means he can’t travel anywhere without having a detailed plan of toilet stops.
As we can see from the graph, he makes a good positive improvement. After 4 sessions he was able to go on a course without worrying and go on holiday without any stress what so ever.
Outcome ratings for JS
JS came to me to help change the way he felt about his father. He was almost at the top of his profession and felt this relationship problem was holding him back from the top position.
As you can see, his results are high to start with, which shows very high emotional intelligence.
Time was limited as he was about to be transferred to a different location. But in the 5 sessions, he was able to start changing the way he thought about his relationship. He realised how he felt had a lot to do with whether he slept well. Being a new father he wasn’t getting good quality sleep.
Outcome ratings for SL
This is the chart of SL, who came to see me about driving to and from work. She was having problems and wanted to overcome it.
It became evident that there was stress at work. So we focused on relaxation and how to cope with the demands of work. Also to find more outside pursuits to help with stress, such as running.
As we went through the weeks she started to feel more confident at work. She even started applying for other jobs. SL started to drive more often, locally at first. She still didn’t enjoy the drive to work. But then who does! At least she wasn’t petrified of doing it and she felt confident in her future.
Outcome ratings for GW
This chart of GW, a client who was having marriage problems. His anger was being a major problem. With stress management techniques and mindful meditation GW was able to cope with his partners’ behaviour. What is interesting is that his conscious score was lower towards the end because of a death in the family. His subconscious score, however, was above the average level.
Outcome ratings for JH
This chart is for JH, who initially came to me for driving phobia. She had been in a couple of accidents and was having flash backs.
There were other issues such as her job and her relationship with her now ex boyfriend. This was contributing to the stress. But as we went through the weeks JH was able to improve her driving. Her real problem was motorways. By week 8 she had managed to drive a couple of miles on the M4 between 3 junctions. She felt excited that it had now meant she could go looking for a new job further away.