How Do We Know It's Working?

Abraham Maslow wisely observed, “I suppose it is tempting, if the only tool you have is a hammer, to treat everything as if it were a nail” (p. 15, The Psychology of Science, 1966). I've often used that quote as an org development practitioner, reminding myself and my clients that we have to pay attention to the people and the situation, gather sound and current data, and co-create something uniquely fitting to the current dynamic in order to make real progress.

Now, as a coach, I remain mindful of what it really means to meet a client where they are. And I think about what will help the client most, in my own work and when I give referrals. Which approach is most effective? In which cases? We coaches claim that we help people … but how do we know our approach is working?

In Sweden, the State adopted guidelines that shaped the flow of money and limited treatment options for people who were suffering. They decided to train therapists in cognitive behavioral therapy (CBT) to cut down disability rates from depression and anxiety. Spending increased from 2 billion Swedish crowns to almost 7 billion crowns in just a few years. No funding was provided for training or treatment in other methods.

It didn’t work, and it’s not just Sweden.

The national auditing office in Sweden concluded, “Steering toward specific treatment methods has been ineffective in achieving the objective.” The widespread adoption of CBT had no effect whatsoever on the outcome. In fact, a significant number of people who were not disabled when they started CBT became disabled, and nearly a quarter of people treated with CBT dropped out.

The truth is that coaches and therapists are thrashing it out in the marketplace, offering similar services and claiming similar outcomes for similar people. Coaches refer people who are “mentally ill” — but many therapists and coaches work with basically healthy people who are having trouble with a part of their life that is important to them:  a major transition, a loss, relationship trouble, a big decision, committing to and maintaining healthier choices.

What is a client to do? On what basis does the individual consumer of services decide that a particular person, with a particular set of knowledge and skills, might be able to help them?

Here are some of the criteria being bandied about:

  • they’re certified
  • they’re licensed
  • they feel right to me
  • they’ve been through what I’ve been through
  • they specialize in my problem

Scott Miller is an advocate of feedback informed treatment.  Me, too.  As a coach, I wouldn’t call what I do treatment. That language implies the client is suffering from an illness. Coaches don’t treat people who are ill. We facilitate growth—positive adult development. We work with basically healthy people, and recognize that even healthy people have problems, feel overwhelmed or confused, and occasionally could use some support as they work through important aspects of their intentions, choices, and behaviors. As coaches, we cultivate health, happiness, and meaning in life—even in people who struggle and suffer.

Let’s promote evidence-based practices in the coaching profession. I think the session rating scale (SRS) and the outcome rating scale (ORS) could be used to evaluate the efficacy of a coaching session and a coaching alliance.

What do you think?

Join the discussion at CoachThink.