Successful Relationships - Vivian Baruch

20/07/2025

Marriage is a long conversation.

15/07/2025

In my work as a couples coach, I often hear one partner ask “Why don’t they think or feel like me? What’s wrong with them?” At the core of this confusion is the idea that your partner should think and feel the same as you.

They don’t.

Your thoughts, feelings, wants and needs are different due to many reasons – among them biological, psychological, social and cultural factors.

Successful Relationships July newsletter out now.

In my work as a couples coach, I often hear one partner ask "Why don't they think or feel like me?" Nothing's necessarily going wrong here.

16/05/2025

Here's my 48 minute interview by Juliet Austin & Clinton Power from the Mind Body Training Institute. In it I discuss the science & art of Feedback Informed Treatment (FIT), which helps coaches, counsellors, psychologists, psychotherapists & social workers track outcomes & alliance (relationship) with our behavioural health clients. https://youtu.be/lIgU-n0oEkA?t=1

You can read more about it here https://vivianbaruch.com/2025/05/18/fit-webinar-with-vivian-baruch/

My 48 minute interview by Juliet Austin & Clinton Power from the Mind Body Training Institute (MBTI). In it I discuss the science and art of Feedback Informe...

06/05/2025

Free interview by Clinton Power & Juliet Austin of the Mind Body Training Institute. Next week Clinton & Juliet will interview me on my 20-year clinical use of Feedback Informed Treatment (FIT). Their institute offers free and fee-based courses for therapists and wellness professionals on marketing and skill-building.

In 2004, I trained with Dr. Scott D. Miller, the founder of the International Center for Clinical Excellence (ICCE), in the use of Feedback Informed Treatment. FIT is an empirically supported, pantheoretical approach for evaluating and improving the quality and effectiveness of behavioral health services. FIT can be incorporated into your preferred method of doing therapy, as it’s not a model of doing therapy. It involves routinely and formally soliciting feedback from clients regarding the therapeutic alliance and outcome of care and using the resulting information to inform and tailor service delivery to each unique client. https://mindbodytraininginstitute.com/next-free-support-webinar/

06/05/2025

What a relief to have psychologist and cognitive scientist Scott Barry Kaufman add his research to the growing number of people speaking out about the possible damage of current therapeutic fashions. He shows these may be negatively impacting the emotional and psychological wellbeing of our clients, instead of helping them foster abilities to deal with life’s inevitable challenges. I particularly enjoyed the last section where he and Michael Shermer discuss mentalism, where Scott displays his skills as The Amazing Dr. Scott. I just bought his new book "Rise Above".

In this interview, Scott examines “…how popular narratives around sensitivity, self-esteem, and emotional regulation may be holding us back. He unpacks the psychological costs of coddling (vs. empowerment), the rise of risk aversion, and how modern parenting, education, and therapy shape our sense of self.”

He says: “Michael, I want to have a little bit of humility here. In one sense my book is not about trauma actually. It’s not about helping people who really have trauma. It's how we overuse that word so much, to the extent to which we're applying all these trauma techniques to people who are having normal ordinary human experiences of life. And I think I need to emphasize that point.

I think that for the large majority of people reading my book techniques like …really challenging your cognitive distortions and also emotional regulation techniques, go such a long way and are so much more helpful than immediately blaming all of your uncomfortable emotions on trauma.

But actually, learning techniques to cope with your uncomfortable emotions is a more productive way forward for the large majority of humans who are having normal human experiences. It's almost like we've reached a point in our society where we don't allow ourselves to not be happy anymore. Like the default expectation is that we should be happy. And so, in a lot of ways, it's really written for that large swathe.” https://www.youtube.com/watch?v=_tJPRE1_g9M

https://www.youtube.com/watch?v=_tJPRE1_g9M

The Michael Shermer Show # 513 It’s tempting to see ourselves as damaged or powerless—defined by past traumas, overwhelming emotions, and daily struggles. Bu...

07/04/2025

Research indicates that professional humility is associated with higher levels of clinical effectiveness.

In this 10th, and final video, Dr. Nathan Castle and couples therapist, Vivian Baruch, talk about how FIT engenders professional humility, in the process enhancing engagement and outcome.

NC - I'm hearing you talk about these cases with real people, where you get their voice (about their life & their therapy). You mostly do relationship counselling, but it could be with individuals as well. You get their voice, and it conflicts with what you might have assumed was the case. Either they don't think the therapy is as helpful, or they're not feeling as well as you think.

And it makes me think of a lot of therapists out there, and I was one of these prior to using FIT (Feedback Informed Treatment). I thought I could pick up someone who's deteriorating in my care. (The ICCE Performance Benchmarks show thar 5-10% of clients are reliably worse in treatment). I probably never thought about what percentage of the time I would pick up deterioration. But what was so humbling for me when I did the FIT training with the International Center for Clinical Excellence, we only pick up that the client is deteriorating, I hope I'm not butchering the numbers, less than 5% of the time. It's so small!

And (the online tracking systems) MyOutcomes or NovoPsych or FIT-Outcomes or any of those platforms, they can pick this up 80% of the time. So I think in some ways it's a bit of a superpower, if you’re okay with being surprised. I guess that's the key, if you're okay with being “Oh that's not what I thought!” I'd love to hear from you about how you keep that curiosity open. How do you maybe even put your ego to the side at times to be open, surprised and feeling good about being wrong, at your own assumptions?

VB - Well I just remind myself we're all wrong at times. So often what we pick up or think that we pick up is wrong. Really, I can't remember who told me this, but our clients have been doing what they're doing for many years before we meet them. So, we don't have the abilities, I think, to really understand a client just from how they're presenting.

I think what you said is great. The superpower of the FIT measurement gives us the ability for them (clients) to score themselves and how they're feeling in these four areas in their life. And (for us clinicians) to actually use that as a springboard for talking about (their scores). We can say “Tell me more about that”. “Why isn't this getting better since last time? What's your understanding about that?”

So, it's really about their voice. It's not me. I don't have the superpower to understand what's going on in their life. And it’s the same with the alliance (their view of the relationship with me). I might think “Well this felt easy for me. They laughed and they smiled, and I was able to help them emotionally regulate when they were dysregulated. OK, that's gone well”. And then they mark me low on the SRS (Session Rating Scale) and I go “Oh, tell me about that. What was a point (in our session) that could have been done differently?” Or “What happened there?”

Or if it was (a score of) five (out of ten) on (their sense of) being heard (by me or their partner), “Was there a point where it was actually worse? Was there a point where it was a four?” I think the numbers are really teaching us humility. They just keep us on track to remember that we're not “It” for the clients we see. They're the experts in their life. https://www.youtube.com/watch?v=X7sqKghIx5s

For information on the three day FIT online training in Australian time zones, go to https://www.eventbrite.ie/e/feedback-informed-treatment-fit-intensive-online-tickets-910779204117?aff=oddtdtcreator

Research indicates that professional humility is associated with higher levels of clinical effectiveness. In this 10th, and final video, Dr. Nathan Castle a...

30/03/2025

Contracts in Relationship. Contracts in relationship exist between every couple. They can be explicit and talked about, or implicit and assumed. If not talked about, they’re based on hidden assumptions. These hidden assumptions are usually wrong because they’re formed on hopes, dreams and expectations rather than on an agreed reality. Contracts create clear boundaries. Boundaries help us deal with our differences and are a very important relationship skill to develop.

Successful Relationships March newsletter out now

Contracts in relationship make us freer & transparently evolve over time. Unspoken contracts in relationship are based on hidden assumptions.

25/03/2025

Is Feedback Informed Treatment (FIT) applicable across treatment approaches?
https://www.youtube.com/watch?v=z_-7KcYkIok

In this video, Dr. Nathan Castle speaks with couples therapist, Vivian Baruch about the applicability of FIT across different therapeutic modalities.

NC – One of the things that strikes me as I'm thinking about who's going to watch this, is that we are an eclectic bunch, us psychologists. Some of us are maybe CBTers (Cognitive Behavioural Therapists), some of us psychodynamic, some of us use EMDR (Eye Movement Desensitizing & Reprocessing), or often, what's probably the most common, I think it's around 70% of us, we kind of just grab little things from everywhere. And I think that some people out there might say, well Feedback Informed Treatment (FIT) is for this model, that's for CBTers - I can see you already shaking your head. Because I actually personally, I like the other models as well, like psychodynamic. Maybe you can just speak to, in terms of your work using FIT, do you feel constrained at all to any models that you need to learn, or do you feel free to learn whatever you want? Whether it's EMDR, psychodynamic… I'd love to hear about that.

VB – Absolutely. In the article that I've written, I quote Bruce Wampold (https://www.psychotherapy.net/interview/bruce-wampold-psychotherapy-effectiveness) from one of the interviews that he gave. He said if you have two or three (bona fide treatment) models that you feel make sense to you and that you feel competent in (and you can provide your client with a rationale for its use which makes sense to the client), that's all you need. The model is something to come back to, but ultimately as Wampold says about the Dodo Bird Effect, all models work about the same. (The Dodo Bird Effect was introduced by Saul Rosenzweig in 1936, and suggests that all empirically validated psychotherapies, regardless of their specific components, produce equivalent outcomes. It draws on imagery from Lewis Carroll's Alice's Adventures in Wonderland).

You know the data has shown, when comparing (bona fide) models against models, they're all about equally effective. So, it doesn't really matter (which model we use). It's like what the TDPA says (Taxonomy of Deliberate Practice Activities in Psychotherapy https://darylchow.substack.com/p/ff184). First off, it's up to us (therapists) to provide a structure so that the client feels held in some way, whether it's CBT, EMDR, whatever. But it must be an evidence-based practice, not just waving hands or doing something that doesn't really have anything behind it. So the structure (is very important) & the other things are the art (of psychotherapy). Like hope and expectancy, the second thing, is how do you provide a little bit of hope or let them know what they can expect. (By saying something like) “Given what you're saying and what's being going on (for you), this isn't something (unusual). This is stuff I've seen before, it doesn't feel like it's going to be unfixable, if we can work well together.” So, you kind of weave that into it in some way or another.

Then (the third factor in the TDPA) you're really working on the alliance, the relationship factors between you and the client. Then you must take into account the client, that's the fourth aspect. The client factors are their context (their preferences, identity, worldview), it’s whatever you may be impacting positively or negatively in the work together. And then (fifth) looking at our factors (therapist factors), like what do we need to do to be flexible enough, and in the moment enough, with this client, in this session (to help them towards their goals, hopes and expectations).

So these are all the things that give me an immense amount of freedom (in my work), it's not constraining at all. I don't have to (follow a protocol). I've trained in so many models, I don't have to “do” this model or that model. I'm trying this and I'm checking out if this making sense (to my client). I ask them “Is this something that you want to explore more today?” (If they say no, I say) “Okay, what do you want to talk about?” and follow up with “What's worked before, where did it get stuck, what else might you know (about what you need my help with)?” So, I'm just going to pull up whatever, I'll do whatever it takes to help them (reach their goals, find their purpose or meaning). It's very freeing, it's not constraining at all.

NC – Wonderful.

VB - So it allows creativity basically.

NC – Yeah, that's absolutely what I hear from you, creativity for you and flexibility to the attunement to the client.

The early bird rate expires in five days. For booking information for the upcoming online Feedback Informed Treatment (FIT) in Australian time zone, go to https://www.eventbrite.ie/e/feedback-informed-treatment-fit-intensive-online-tickets-910779204117?aff=oddtdtcreator

In this video, Dr. Nathan Castle speaks with couples therapist, Vivian Baruch about the applicability of FIT across different therapeutic modalities.

18/03/2025

Thank you Scott & Dan! What an exciting & stimulating interview with Dr. Eric Caplan about doing WHATEVER it takes to help our clients get the outcomes they want. This includes complying with their worldview, values, preferences & identity plus forming an explicit agreement with them about the methods we & they will use both inside & outside the therapy room to reach their individualised goals. I'd sign up to do Eric Caplan's course, if that was made available. Looking forward to your next steps together with him.

Dr. Scott Miller & Dr. Dan Lewis say: “Here was a person who'd written a comprehensive and deeply provocative view about the origins of our field -- one that had profound implications for understanding the challenges our field is facing (e.g. demand exceeding supply, the dominance of the pharmaceutical industry, limitations imposed by insurance and other third-party funders. Plus, it turns out, he was about to publish a new book. It focused on a legal case few practitioners have ever heard of but which influences clinical practice to this day.”

The early bird rate for the Feedback Informed Treatment June 3rd-5th in Australian time zones expires on 31st March 2025. For registrations or enquiries, see https://www.eventbrite.ie/e/feedback-informed-treatment-fit-intensive-online-tickets-910779204117?aff=oddtdtcreator

A few years ago, my colleague Dr. Dan Lewis and I published a review of two books for an episode of our podcast, The Book Case, titled, "Psychotherapy's Orig...

12/03/2025

In this brief video, Dr. Nathan Castle and Couples therapist Vivian Baruch talk about three performance metrics that can be used to identify targets for deliberate practice.

NC: One of the processes of DP is to kind of highlight this point that I'm going to (need to) work on, as you rightly put it. With a lot of the Feedback Informed Treatment, the different apps can help you with that, with the aggregate results. Now there's going to be some people watching this (and asking) “Aggregate? What's the aggregate stuff that you're talking about?” Right? And now there's quite a few (apps out) there. But maybe you could just mention three of those results that come up that could be something that you could work on as a therapist?

VB: Well, I mean ….You know, according to the benchmarks, it (any of the apps) shows you the aggregate results. It will compare what's happening with this client (to the international benchmarks). So I use it one client at a time. Are they on track according to the benchmarks of clients around the world whose therapists have been tracking (outcome & alliance scores). If they come in with this Outcome Rating Scale (ORS) in session one, are they on track measured against all the clients around the world whose therapists have been using this (any tracking app). So that's where aggregate (ratings) come in, in that way.

Secondly, it's comparing, it helps me compare or see patterns. (For example), if I've had clients come in with these kinds of scores, in that ballpark in the Outcome Rating Scale, and they've tracked in this way, I see patterns about my own work. The aggregate (scores) compare this client with the history of the clients that I've had (to date). So that's the second thing.

But the international benchmarks just keep us on track with this. It’s what the data has been showing, the meta-analytic data for almost 25 years now. (They show) that if you have these type of scores you're going to be on track, which the app shows you is in the green zone. So you're on track with this client (in helping them reach their goals). Or they're in the yellow zone, suggesting you (need to) pay attention. They (the client) may be at risk of dropping out or not improving. Or they're in the red zone, and this isn't really progressing, so we need to keep having conversations with them (about that). Because that's what the data has been showing, over this amount of time, that doing what you're doing, in this way, if you keep doing this it's not going to get any better. So we really keep having to ask the client “What needs to be added, what needs to be changed, what else needs to happen?” (to get you on track with getting the outcomes you’re seeking). I think it's a roundabout way of answering what you've asked.

NC: It's a great answer. Thank you Vivian.

In this brief video, Dr. Nathan Castle and Couples therapist Vivian Baruch talk about three performance metrics that can be used to identify targets for deli...

04/03/2025

The Psychotherapy and Counselling Federation of Australia (PACFA) has endorsed the three day Feedback Informed Training (FIT) in Australian time zone on 3 - 5 June 2025, 9:00am to 4:00pm, AEST.

https://pacfa.org.au/portal/Events/non-pacfa-2024.aspx?EventKey=EX25TICCE1&WebsiteKey=663df354-bb4c-40db-9f44-9f1e672224ed

Take advantage of the Early Bird rate of $1,100 USD = $1768 AUD which expires on 31st March 2025. The Regular rate which starts from 1st April 2025 is $1200 USD = $1929 AUD.

This course counts towards 18 hours of category A CPD.

The topics covered are:
• What is FIT?
• Empirical foundations of FIT - research supporting outcome and alliance measures
• Creating a feedback friendly environment – using the Session Rating Scale (SRS) and the Outcome Rating Scale (ORS)
• Methods for obtaining client feedback – various outcome management tools
• Interpreting and using individual client outcome and alliance feedback data - interpret common patterns
• Interpreting and using aggregate outcome and alliance feedback data
Presenters:
Scott D. Miller PhD
Cynthia Maeschalck Director Professional Development ICCE

This three-day, online course will be delivered for the first time in Australian (AEST) time zone. If you've read the literature or taken an introductory workshop about FIT and want to deepen your understanding of the principles and practices involved, this is the training for you! The FIT intensive...

04/03/2025

How doing Feedback Informed Treatment (FIT) helps with "impostor syndrome".

Nathan Castle: There are many different reasons to do Feedback Informed Treatment, many different motivations to go to this International Center for Clinical Excellence (ICCE) training in 2025 to learn FIT. I would say when I first started my journey, I was pretty hellbent on getting more effective. And as you've been able to tell us, we can get up to 25% more effective. But when I look back, having done it for maybe five or six years now, I also noticed that what I wanted was to help with some impostor syndrome and to help to feel reassured or more confident that what I'm doing in therapy, which can be very abstract, is helpful.

And now while we have got more effectiveness, myself and my team over the years with FIT, I would say the bigger value for me is about feeling less impostor syndrome. I wonder if you can talk to that for some people that might be watching this, that are unsure of themselves, about whether they are helping, and how you know doing FIT might help them on that journey.

Scott Miller: So interesting to hear this from you and from others that there is a strong sense of feeling like “I'm an impostor in the room with clients,” and I'd like to do a bit of a reframe on that word. We know from research done by another Norwegian researcher Helene Nissen-Lie, that therapists who embody a kind of professional self-doubt actually have better outcomes. So instead of impostor syndrome, how about we reframe that as humility? And secondly, instead of trying to erase it, let's embrace it.

What we know is that when therapists attend continuing education professional development kinds of workshops, that it actually increases their level of confidence without changing their ability to help. Now that's truly being an impostor. So, what we don't need is an overabundance of confidence based on using a particular model or technique. Instead, I'd say be humble, doubt yourself, and talk to your client about that. Now at the same time, that doesn't mean that you shouldn't feel hopeful. The reason is that because clients are often quite robust, and the data say that being with us leads to a large effect size of about .80. Let me just characterize that a bit. It's the same effect size as coronary artery bypass surgery; it's four times the effect size of fluoride in the prevention of dental carries.

So, in general there isn't any reason to feel like an impostor. What we do works. However, we know the work can be messy from client to client and day to day. The best way to address that is to stay
connected to your client, to ask them for feedback. “What do you think? Are we making a difference? Are we connected with regard to what you're hoping for, using strategies and making suggestions that seem to fit for you, your values and world view? Am I doing the job that you're hiring me to do with you?” And if not, then I try to adjust. Not being committed to my model, but believing that this client can change if we just find what's right for them. And it may not be with me. Maybe it's in another program, maybe it's with another practitioner. But I believe that change is possible for you.

NC: Scott just hearing in this conversation as we talk about the client's voice in feedback, one thing that has struck me that I don't know if there is any research on, but is there any information out there on how FIT may help from a cultural awareness or cultural competency point of view. We're sitting in the room with someone who might be different to us in some way.

SM: Well, I think there are a couple of things we can look at. First, our particular tools have been translated into about 35 different languages and used in just as many different cultures. And so far, when we compare the effects overall, and by the way this is true with FIT as well as psychological care, we don't see any difference in response in the aggregate. But that doesn't mean we're not going to see differences between me and this client, and differences that I don't notice in the work that I'm doing with them. So by asking for feedback using the measures, I can aggregate data and actually test whether or not I have a differential effect with certain kinds of clients, maybe based on their cultural background, their presentation type, their s*xual orientation and a host of other variables.

And specifically it gives me a way to foster a conversation between this particular client and me because most of the studies that we do are comparing group responses. We put people in group A and people in group B which isn't very good really for addressing the question about my helpfulness with this particular client from this background that might be different than my own. It's fine in a general question like are there cultural differences between this group and that the issue. And the challenge is that in most instances, within group variability, that is the differences between people in the same group, is greater than the differences between two different groups. FIT is a way to tease that out and make sure I'm attending to this person, with that background, at this time, and that problem.

NC: One of the areas of therapy that is garnering a lot of interest Scott, and certainly in Australia it has now become a competency for psychologists, is Deliberate Practice (DP). Let's talk about that. But I first want to start with your journey, as someone who was finding this type of practice, Deliberate Practice, and really one of the forerunners in bringing it into the psychotherapy world. Tell me a bit about how you identify Deliberate Practice as a potential to help us in psychotherapy and what does it mean for those people in Australia now looking at how to be competent in this....

In this interview, Australian psychologist Dr. Nathan and the developer of feedback informed treatment, Dr. Scott D. Miller, talk about FIT can help therapis...