Measure What You Are Actually Doing
Five levels of evidence, and why the no-time no-resources objection does not survive contact with the instruments.
This piece is adapted from the INSPYRD library as part of the Affective Memory Resolution series.
What would be meaningful to people suffering with depression, anxiety or trauma-related illness is if this industry, from legislators to insurers to colleges to practitioners, embraced the kind of process that helped rebuild Japan after the Second World War.
That process was led by W. Edwards Deming. He was an American statistician, an engineer and a management consultant who is recognized as the father of quality management and the total quality management movement.
Some of the standout processes in that movement include the PDCA cycle, plan do check act, also known as the Deming cycle, along with Kaizen and Six Sigma.
Plan-do-check-act presupposes the industry has a plan to help those who are suffering. Then it delivers the therapies: that is the do. Then we check the efficacy of what was delivered. Deming preferred to call it PDSA, plan, do, study, act. If we actually studied the delivery of many, many therapies, we would find efficacies far below 50% with massively high recurrence, especially in trauma. The act means iteratively changing the process to create ever-increasing efficacy. Mental health care has improved in places, but it is not running an iterative cycle. If it were, cognitive behavioural therapy for trauma would have improved radically over the last three decades.
Six Sigma works the other way. It identifies and eliminates defects using data. Extend that into psychotherapy and we would have to gather data, and we should be able to, in a world with this much technology. Pre and post data alone, on any given subject, would be massive. Where Kaizen is bottom-up and people-centred, Six Sigma is structured, top-down and project-based, with longer timelines, built to address complex quality problems.
Let me address two objections up front: no time, and no resources. If anyone argues that this is why we do not run rigorous assessment, then from my point of view they are making that argument because they do not want to be measured.
For depression there’s Patient Health Questionnaires, PHQ-9. You could do a PHQ-2 for rapid screening, or you could do a Beck Depression Inventory. There’s a number of internationally recognized depression scales. For anxiety there’s the General Anxiety Disorder 7 item, GAD-7. We have a Personality Assessment Inventory. There are multiphasic personality inventories.
In trauma there is the Clinician-Administered PTSD Scale for DSM-5, CAPS-5, considered the gold standard structured interview, a comprehensive assessment of symptom frequency, intensity and duration, both quantitative and qualitative. For self-report severity monitoring there is the PTSD Checklist for DSM-5, the PCL-5, and instruments that are less used but highly effective, like the PSSI-5, by Edna Foa.
But saying that is not enough. Measuring it is critical. Here is how I measure my work.
I have gathered 5 levels of evidence with every trauma client I have coached. 5!
These include the Zimbardo Time Perspective Inventory created by Doctor Phil Zimbardo from Stanford University and as presented in his co-authored book with Richard and Rosemary Sword titled The Time Cure, subtitled Overcoming PTSD with the New Psychology of Time Perspective Therapy.
Secondly I use the PSSI-5 in a format we have digitized for easy use. All of my clients score in excess of 25. I have not had a regular coaching client who scored less than 25 on the PSSI-5. 9 out of 10 of my clients no longer meet the diagnostic criteria for post-traumatic stress on the PSSI-5, meaning they score less than 10 out of 80. This is reflected in the pilot study that was done with women who had exited human trafficking, where we had an 86.6% reduction in symptoms and more importantly 10 out of the 11 women who completed the program no longer met the diagnostic criteria. The psychometric assessments in this study were done by an independent third party.
3rd I use behavioral evidence. My clients are traumatized — most of them severely. And most of them have been through 2, 3 or 4 other forms of therapy before they get to me. So when I meet them they have negative behaviors that they do because of the degree they’re traumatized. Obviously one of the behavioral evidences would be they no longer do those behaviors when we are finished. The most profound behavior they all have is difficulty falling to sleep, being woken up several times during the night, and getting less than 7 1/2 hours of sleep. And the sleep they do get is not restorative. There is also a full range of other behaviors like avoidance, anger management, inability to concentrate etcetera. There are also behaviors that they would like to do that they’re not doing because of the trauma. These might be socializing, sleeping, in a good relationship, and we monitor these pre and post.
I cannot imagine being a clinician carrying eighty or a hundred clients in a traditional psychotherapy clinic, knowing that six or eight or twelve months from now those clients still will not be sleeping through the night, and their health is going downhill.
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It would be better to measure what you are actually doing. Not just recording anecdotal evidence, measuring it in some meaningful way, with recognized psychometric assessments.
And if you are not getting seventy, eighty, ninety percent success with little to no recurrence, go and learn different techniques. Look at the literature. Look for the techniques with greater than ninety percent success. Be curious. Find the ones that include visual-spatial tasking. And maybe, inside the modality you already work in, you can introduce visual-spatial tasking into what you do. I guarantee it will increase your effectiveness.
If you run an evidence-proven practice, where you do rigorous assessments that are internationally recognized, and you can point clients to external research supporting your claims, you can confidently answer any question a client asks you. That is the position worth being in.
If you work with clients, this is the level we teach inside the INSPYRD certification.
About the Author
Allen Kanerva is a trauma intervention trainer and the founder of INSPYRD. A former Royal Canadian Air Force tactical helicopter pilot, UN peacekeeping course director, and co-author of Canadian humanitarian security policy work, he developed Affective Memory Resolution (AMR) and Visual-Spatial Tasking (VST), a clinical protocol for nervous-system-level trauma resolution grounded in Hebbian learning and memory reconsolidation research. He trains practitioners internationally in NLP, trauma intervention, and mechanism-first change work.
ORCID iD: 0009–0009–1297–3778
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