One of the big problems in the field of therapy is we don't track outcomes. We don't have a formal way for saying "if people work with me, this is how much they change."
Which is a problem. If your suffering you want the certainty of knowing who can help you.
Which is why I'm excited for today's guest post form Leila Anderson. Leila and were pretty good friends in college, and over the years we've kept in touch. So when a few months back I heard about her treatment center's amazing outcomes, I had to reach out.
In this blog Leila breaks down the astounding outcomes her 30 day residential treatment center is seeing. And these outcomes are important not just for the field. But for the people they represent. Hurting people are going to Leila's treatment center and finding real help.
And she's got the data to prove it.
So if you're interested in what makes a top notch treatment center, this is for you.
Best,
Jordan (the counselor)
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Hello! My name is Leila Anderson, LMFT-S, LCDC, and I’m the Executive Clinical Director of a 30-day 15-bed residential dual diagnosis treatment center south of Austin, Texas called Ava Recovery Center.
We’ve been open since last June and have welcomed nearly 100 clients through our doors in that time.
Ava is special to me personally because I have had the enormous privilege of getting to watch Ava come into being from before the beginning. I developed the curriculum (a blend of DBT and IFS that I think is pretty special), built a fair share of the furniture, and brought together the staff members who were with us on day one.
Over the past 14 months, it has become clear to us that Ava is special in another way, too:
Our clients report symptom improvement unlike anything I’ve ever seen.
Why Ava Recovery is the best dual diagnosis treatment center in Austin, Texas (according to the data)
From the very beginning of Ava, we’ve used a platform called Trac9, a set of standardized assessments and predictive algorithms, to assess each client weekly across several domains:
Spirituality | Commitment to sobriety | Optimism | Quality of life |
Stress | Visual response to cravings | Verbal response to cravings | Therapist satisfaction |
Trauma | Anxiety | Depression |
Each client’s scores across these domains are set to a standard scale and combined into one master number, the Global Recovery Score.
Near our one-year mark, I pulled an overview of our data and realized that our clients’ Global Recovery Scores were improving more than 60% over the course of 5 weeks - significantly faster than the approximately 20% score improvement that Trac9 records as the national average for programs using their assessment platform.
Our clients tended to discharge with higher global recovery scores than average despite the fact that they generally admitted with lower global recovery scores:
In practice, this kind of score improvement looks like clients beginning to embrace and implement the skills they’re learning, to connect more deeply with their peers, and to report relief from distressing symptoms like cravings, nightmares, and shame-induced social anxiety.
By the end of 30 days, nearly all of our clients demonstrate sufficient improvement in symptoms to qualify for step-down to a lower level of care - meaning that they no longer require residential treatment to have a good shot at maintaining the progress they have made with the help of outpatient services.
Our percentage of successfully-discharging clients, who completed all recommended clinical work and were discharged after creating an aftercare plan with their therapist, is also about 5% higher than the national average, largely due to a 5% lower rate of clients discharging against medical/clinical advice.
This indicates that our clients generally trust our therapists and our process, allowing us to work closely with them to make sure that our program sets them up for success before they leave.
This was obviously amazing to see. It also wasn’t a complete surprise. We knew we were doing something different, and we suspected that it was going to work.
How Ava Recovery uses technology to be the best dual diagnosis treatment center in Austin, Texas
First of all, the obvious-but-often-missed: We track how things are going and make changes as needed.
I remember when I was in graduate school and my professors asked us to bring session satisfaction surveys to our clients and have them fill them out at the end of every session. It felt so awkward - sitting there watching as the client bubbled in their responses and then handed the papers back to me. It also didn’t feel like the clients had the emotional space they needed to be honest on those assessments.
Fortunately, with Trac9, this isn’t a concern. We give clients secure tablets with their weekly assessments pulled up, they complete them in privacy, and then therapists can view them from their own accounts and decide how to incorporate the data into their treatment.
Trac9 also tracks outcomes post-discharge through emailed monthly follow-up surveys (anonymized and optionally incentivized with small gift cards), so we have a good idea of which clients are staying sober, how their life satisfaction is, and whether they need more support.
Having this data isn’t required by any licensing or accrediting body, but it absolutely helps as we’re trying to negotiate insurance rates, get authorizations, or improve pieces of our clinical process.
It also gives us incredibly useful insights into how our clients are doing: If I have a client who dropped in commitment to sobriety over the past week, that means something. If their spiritual practices went up as their depression went down, that means something, too.
Trac9 doesn’t only show me the data - it also gives me feedback on what it means, sending me alerts like “Client has high levels of Stress for someone in their 2nd week of treatment.” It even alerts me when a client is at a high risk for leaving treatment against staff advice based on the particular patterns of symptoms fluctuation that have traditionally preceded unsuccessful discharge at Ava.
All of this together gives our treatment team exactly what we need to see the whole picture of what’s going on with a client and refine our treatment plans in response. And of course, if our intervention isn’t working - we know that quickly too and we can make changes.
As therapists, our ultimate goal is to facilitate positive change in our clients' lives, fostering growth, healing, and resilience. The journey toward achieving these outcomes can be challenging, both for the individuals under our care and for the dedicated staff providing support. However, what if there was a way to enhance client outcomes and staff retention simultaneously? The answer lies in the strategic integration of data tracking and deliberate practice within a residential treatment center.
How Ava Recovery trains staff to provide the best dual diagnosis treatment center in Austin, Texas
Second, the hard-to-do: We practiced. A lot.
I specialize in treating shame. One of the things that becomes clear quickly in working with shame is that combating shame with compliments doesn’t work. In fact, responding to a deep-seated sense of “not-enoughness” with a contradiction (“Um actually, you ARE enough”) can make the shame worse.
It’s much more effective to clear away the fog, look at the painful limiting beliefs, pick out the small pieces of them that have some truth so we can start making those things right, and let the rest fall away.
So as much as possible, at Ava, when we fail or imposter syndrome comes up or we need to do something different - we really look at the situation and practice improving rather than just sitting around and reassuring each other that we’re already good enough. Sometimes, our fear of not being good enough comes from a nugget of true understanding that we aren’t good enough therapists - not yet. But we can be.
What does this look like in practice?
If something goes south, we try our best to walk the fine line of being realistic about it - neither catastrophizing nor sugar-coating.
We trace back what happened, assuming, in good Dialectical Behavior Therapy fashion, that we were doing our best AND we have a responsibility to do better. Then we go through the following steps:
We look at what we want similar situations to look like in the future.
We break down which components of the situation are in our conscious control.
We plot out how we can change our procedures and our own responses and start moving. Often, these changes look like increasing training, hands-on coaching, adding or removing responsibilities based on skills fits, or adjusting language or rhetoric.
These steps don’t have start-and-end points - rather, we as a team revisit these ideas as new communities of clients come in, keeping in mind that while some skills transfer to every group of clients, others can and should be optimized based on the needs of the current community.
This process, when applied well, gives us a framework for identifying which staff members on our team are really good at certain tasks and opens doors for them to teach the rest of us how they do it and how we can do it better. This, in turn, helps each of our staff members play to their strengths on a daily basis. Ripple effects from this include increased staff retention and morale in addition to improved client outcomes.
Ava Recovery, using personal connection to become the best dual diagnosis treatment center in Austin, Texas
Finally, the magic: Everything is attachment.
The third component of our treatment is the program itself - the curriculum and the way that every staff member is trained to implement it.
Our program is based around the core assumptions and skills of Dialectical Behavior Therapy (DBT) and the internal framework of Internal Family Systems Therapy (IFS). The relational aspects of the IFS model give our staff and clients linguistic and conceptual “handles” with which they can more effectively implement the transformative skills taught by traditional DBT therapy.
This isn’t the forum to go much deeper into the details of how these fit together, but the important piece is this:
Both DBT and IFS are models that allow people to attach to themselves and others safely.
That’s what we’re going for at Ava. Safe, secure attachment.
I have read common factors research for years that has proposed therapeutic alliance as necessary for therapeutic change. I would argue, based on our experience at Ava, that therapeutic alliance (another way of saying secure attachment) is the intervention itself.
Too often, we come in hot with our interventions, believing them to be the magic. I really believe that by the time it’s time for interventions in a new therapist-client relationship, the attachment has already begun creating steady change.
As we look at the data we have at our fingertips, we consider that symptoms are just that - symptoms. They are caused by an underlying problem, and that problem is attachment-related. Trauma, shame, addiction, relationship conflicts - they all come back to attachment.
When I look at elevated depression, I’m not going to start with an assignment. I’m going to start by being present with the client, evaluating what barriers exist to their being present with themself, and coaching them through that process.
So the skill we practice more than any other is the skill of attachment. We rehearse difficult situations, talk through countertransference, and take the time and space we need for our own personal health and sanity. When we can’t sit with a client from a Core Self/secure attachment-led place, we identify what’s going on and respond to it using the exact same skills we teach our clients.
It doesn’t have to be fancy or complicated. We just have to be willing to be fully present with ourselves and with our clients, to be honest with ourselves when that’s not possible, and to practice conscious improvement in our own capacity as we move forward. When we have those skills, we also have a template for helping our clients progress down the same path.
Conclusion: Ava Recovery is about always learning more about helping clients.
As therapists, we have a profound responsibility to guide individuals toward improved mental health and well-being. The synergistic combination of data tracking and deliberate practice has redefined the landscape of therapeutic care as our focus on attachment has opened up new pathways for conscious healing within us and between us. This approach marks significant progress toward new approaches to client care that hold the promise of positive change for both clients and clinicians alike.
We have every intention of continuing to refine our processes as we move forward at Ava and are hopeful that we haven’t yet hit the cap of what’s possible for clients to accomplish in 30 days south of Austin, Texas.
In the meantime, if our approach interests you, please get in touch! Although we’ve implemented these practices for a specific context, I believe that every piece of what we’ve done can be scaled and applied to different practices just as effectively. I can be reached at leila@avarecovery.com or through my website, https://leilaanderson.dev. More information about Ava can be found at https://avarecovery.com/.
Warm regards,
Leila Anderson, LMFT-S, LCDC
Executive Clinical Director
Ava Recovery Center
-Fin-
Want to get 5 more clients??
Also, as you know, I run a small consultation firm where we teach therapists to go from 0-10k a month in about 6 months using our Numerapy model of consultation.
One of the big problems therapists have is they can't get clients.
We're giving a new training teaching therapists to use their current network to get their next 5 clients. The training is $20 (which goes to charity) and we only have 6 spots left. Registration closes Wednesday.
Learn more below!
Jordan Harris, Ph.D., LMFT-S, LPC-S, received his Doctor of Philosophy in Marriage and Family Therapy from the University of Louisiana Monroe. He is a licensed professional counselor and a licensed marriage and family therapist in the state of Arkansas, USA. In his clinical work, he enjoys working with couples. He also runs a blog on deliberate practice for therapists and counselors at Jordanthecounselor.com.