When doing implementations of PCOMS, after I do an overview of what PCOMS actually is and show a video of what it looks like, I ask therapists, "Why don't you want to do this?" or "Why won't you do this" This gives permission for folks to give voice to all their concerns. I encourage any and all comments and then list all of the issues and problems that are brought up. Then I say that it's my job to address all of their concerns by the end of the training the next day. In this way, all concerns or obstacles are acknowledged, often validated, and dealt with in a proactive, positive way. At the end, after I ask them to address their own questions and concerns, I ask a different question: "Why will you do this now?" So, here are the top ten motivations to do PCOMS and the top ten reasons that therapists don't want to do PCOMS. These arose from trainings but also from conversations with other trainers of PCOMS, particularly my Norwegian friend, Morten Anker.
Top Ten Therapist Motivations for PCOMS
1. I want to improve my effectiveness.
2. I like the idea of client feedback and how that can help me improve and expand my skills.
3. I like the idea of consumer participation.
4. I like the structure and focus it provides.
5. I want to do evidence based practices.
6. I like this evidence based approach better than specific treatments for specific diagnoses or learning more models.
7. I like the research support (the 5 RCTs) for PCOMS and the empirical support of the importance of the client and the alliance to outcome.
8. I want to develop as a therapist and this allows me to know if I am.
9. I want to be accountable for my services.
10. I like the idea of client privilege/empowerment/social justice.
Top Ten Reasons Therapists Don’t Want to Do PCOMS
1. The results will be used against me.
2. I already know this information—whether clients are benefiting and if I have a good alliance.
3. It will Interfere with the relationship—it is just more paperwork.
4. It’s naïve to think that we can always follow client direction or privilege the client’s view.
5. This won’t work with my client population.
6. A 4-item measure is too simple to be valid.
7. People will lie on these measures or try to please
8. You can’t reduce people to a number.
9. Clients won’t do it; and insensitive to ask them when they are in crisis.
10. This doesn’t fit my therapy model; it’s for brief therapy only.