Responding to increases in symptom severity on measurement-informed care surveys

This article outlines strategies and tips therapists can use with clients to address increases in symptom severity identified by measurement-informed care (MIC) surveys.

Strategies for responding to increases in symptom severity

  • Actively address symptom severity increases. A rise in self-reported symptom severity can be cause for concern for both therapists and clients while simultaneously being a valuable and critical opportunity for exploration. It might signal issues outside of therapy like changes in medication or life events, or it could indicate that the treatment approach or level of care being provided needs to be adjusted. In some cases, it may suggest an increased risk of danger to self or others, and the need to engage in further risk assessment and response. This may include conducting a structured risk assessment, creating a safety plan, or connecting the client with emergency services (if clinically indicated).
  • Collaboratively determine next steps. Open communication is key to determining the next steps. The therapist and client should discuss what's working and what's not in treatment, using both symptom and therapeutic alliance scores to identify areas needing focus. This collaborative discussion aims to create a shared understanding of how to best meet the client's care needs moving forward. Adjustments may include modifying the treatment plan, changing clinical approaches, referring to a higher level of care, or referral for medication management.
  • Normalize shifts in care as a natural part of therapy. Therapy progress isn't always linear. Clients (and therapists!) may feel discouraged when symptoms worsen. However, educating clients that ebbs and flows in treatment are common, can be very helpful.  Setting this expectation early in treatment helps clients understand that adjustments may be needed as therapy progresses to help them obtain symptom relief or achieve treatment goals,  just like a doctor may adjust medications over time or refer them to a specialist. We're all complex, and our needs evolve – that's okay!

Key Takeaways

When we observe scores in measurement surveys increasing, the most important action is to collaboratively explore and address it. This is a valuable clinical opportunity to make any necessary adjustments to the treatment plan or services being provided, which ultimately is the best thing we can do for our clients.

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