Typically, when individuals are engaged in psychotherapy, they spend time in sessions with providers discussing recent struggles, identifying goals, and learning new strategies for approaching their problems and challenges.
The portion of the therapy session that involves the therapist teaching the patient new ways to manage their stressors is often didactic, with the patient being provided what’s known as psychoeducation, essentially educational content about psychological issues.
While there are other very important components to the therapy experience, most notably, the relationship between the therapist and client, the educational aspect is critical. But what if there was a more efficient way to provide this content?
Taking a Cue from Educational Approaches
Recently, there has been a movement in education to “flip the classroom.. Flipping the classroom entails changing the environments in which students receive different educational components. Didactic or lecture content is delivered outside of the classroom, while activities that have traditionally been assigned as homework such as group activities are instead done in class, with the instructor serving as a facilitator.
Students are less frustrated in this model, because if they are having difficulty with an exercise, the instructor is present to troubleshoot and help them through the challenge. Professors are also able to revisit challenging concepts in the classroom.
Student affairs administrators and college counseling center directors alike recognize the supply/demand problem for mental health treatment in universities and are actively seeking solutions that go beyond simply hiring more providers.
Many realize that hiring more providers is not a feasible solution and acknowledge that rarely are counseling center resources efficiently allocated. We propose that Flipping Therapy in the counseling center represents a significant opportunity to improve the status quo.
By changing what is accomplished in the therapy room versus what is done outside, we believe that treatment efficiency and success can be increased.
How would this look in mental health treatment? There are several different ways that we envision “flipped therapy.”
The key differences are as follows: (1) providers start treatment with clients with quantifiable data on the client’s recent symptoms and emotional state; (2) time in the therapy session is spent collaboratively problem solving and practicing skills; (3) the patient has a greater sense of personal responsibility and agency in the process of treatment. We’ll break down each of these differences below.
Advantages to Flipped Therapy
With the advent of eHealth tools, individuals are empowered to collect data on themselves, such as their weight, blood sugar, etc. Increasingly mental health is included in the conversation, and people are tracking their mood, thoughts, and personal experiences.
When a student comes into a counseling center with a wealth of information on their recent struggles, the therapist is able to more quickly hone in on the appropriate course of treatment. Such data can also help identify the student’s level of severity or presenting problems so that the best possible therapist match can be found.
Though clinicians will still conduct intake interviews to get to know their patients and obtain more information about their more remote past, the addition of succinctly and usefully presented data, such as a DASS-21 score, mood ratings, or information about hours slept, can be valuable.
Pre-session education, about the therapy process, for example, or mood tracking can allow students to begin the process of understanding and improving their symptoms before they ever present to the clinic.
The combination of the therapist having more data and the client having done some homework before treatment begins could help make therapy more efficient and increase clinic throughput.
Time in the therapy session is often spent discussing new skills or approaches, with the therapist teaching the client new ways of thinking about their challenges or providing information about their diagnosis and coping skills.
These aspects of treatment are valuable, but may not be the most effective use of the therapist’s time. Often in evidence-based treatment, the therapist will assign “homework” to be completed between sessions.
One challenge therapists face is non-completion of these assignments for a variety of reasons. In the proposed Flipped Therapy, the therapist and the client work on activities such as exposures (e.g. talking to a stranger for someone with a social phobia) or thought records together in session.
The client receives their psychoeducation outside of the session, and comes to treatment with a greater understanding of the purpose of the in-session activities. The therapist can then work through the “work” of the session with the patient, reinforcing the purpose and value of the activities at that time.
Platforms which provide outside-of-session psychoeducation can also be used to monitor completion of these educational modules and send automated reminders if needed.
Another advantage of Flipped Therapy is the student’s having increased responsibility and personal agency in the process of treatment.
Rather than viewing therapy as something that is done to them, the student feels like a more active participant. By listening to educational content outside of the therapy room and focusing on collaborative or experiential activities with the therapist, there is some reduction of the power differential between client and clinician.
When the therapist is present for these activities, difficulties can be quickly identified and worked through, with the client less likely to abandon the exercise because of perceived difficulty.
There are certainly limits to the exposures that can be in a therapy office and it’s certainly important for clients to practice their behavioral activities in their “real life” in order to generalize their skills, but we believe that starting these exposures or exercises in session can help get the ball rolling and lower the patient’s resistance to practicing them between sessions as needed.
While Flipping the Classroom has been used for years now, the concept of Flipping Therapy in order to make treatment more effective and efficient is new. We believe that by giving students or other clients tools to receive psychoeducational content outside of treatment, providers can make better use of their limited time with clients.
Patients feel a greater sense of involvement in the process because they get to collaborate and work with the therapist rather than feel like they are being “educated.” A good working alliance is important for therapy to be successful and this potentially revolutionary approach can foster that alliance.
Christine Moberg, Ph.D. is Head of Psychology, Pacifica Labs, Inc.