Tag: Distress Levels

CORE-34 Statistical Evidence shows Counselling Improves Well-being.

This article discusses how the use of a survey containing 34 questions (called “CORE-OM”) allowed me to demonstrate that counselling can improve psychological distress. Four psychological areas are measured

CORE-34 Measures Four Psychological Areas.

• Well-being
• Symptoms
• Functioning
• Risk states (eg self-harm)

History of the iCounsellor.co.uk (2009/10) CORE Survey.

The survey was taken during the period 2009-2010 and with clients’ permissions. All clients were British and between the ages of 22 and 49. Firstly, the survey was offered at the second session (rather than the first as clients are particularly more anxious than usual during the first session and this tends to skew results). Counselling commenced as it would usually. The survey was offered a second time during a session in the ending period of therapy and the information shared with the client.

The statistical information showed that psychological improvements are recorded during the period in which the person was in counselling.

What is CORE-OM?

Clinical Outcome Measure

Initial Distress Levels	→	Final Distress Levels
[Severe]	→	[Low Level]
[Modererately Severe]	→	[Mild]
[Moderate]	→	[Healthy]
[Mild]	→	[Healthy]

The table above shows that the individuals who took up counselling with Dean Richardson/iCounsellor.co.uk during 2009-2010 experienced improvements in their distress levels (data is taken anonymously from actual client data CORE forms and used with permission). CORE measures improved levels of distress in such areas as well-being, symptoms/problems, life-functioning and states of risk/harm.

The CORE Outcome Measure (CORE-OM) is a client self-report questionnaire designed to be administered before and after therapy. The client is asked to respond to 34 questions about how they have been feeling over the last week, using a 5-point scale ranging from ‘not at all’ to ‘most or all of the time’. The 34 items of the measure cover four dimensions: subjective well-being; problems/symptoms; life functioning; and risk/harm. The responses are designed to be averaged by the practitioner to produce a mean score to indicate the level of current psychological global distress (from ‘healthy’ to ‘severe’). The questionnaire is repeated after the last session of treatment; comparison of the pre- and post-therapy scores offers a measure of ‘outcome’ (i.e. whether or not the client’s level of distress has changed, and by how much).

For further information on CORE, including downloadable CORE forms, see the CORE-OM website.

How client and therapist use CORE together.

CORE-OM Scores & Severity Levels

140				Severe (85+)
130
120
110
100
90				Moderate to Severe (68-84)
80
70
60				Moderate (51-67)
50
40				Mild (34-50)
30
20				Low level (21-33)
10				Healthy (0-20)
0

Distress Severity Levels

Some therapy agencies and therapists use CORE as part of the assessment. For me, it is an optional part of my counselling procedures. A client may wish to take the CORE survey at the start & end but they do not have to participate in the survey. The survey is not offered to couples in couple counselling because couple counselling works on the relationship, not two individuals (and CORE does not measure distress levels of a relationship, only the individuals).

CORE can therefore be used as part of a “tool-kit” to complement not only the counselling experience but to give the client something visual and measurable.

CORE is not a tool for a complete diagnosis. Rather, one might think of CORE a little like a room-thermometer; the thermometer might indicate if the room could benefit from more heat being added but, in reality, it’s the people within the room who will decide if they require more warmth. CORE therefore may suggest an improvement has or has not been recorded, but it’s the client him/herself who’s opinion matters.

When used, the CORE survey takes about five minutes to complete, and is done in the counselling room. When completed, I summarise the most important details and discuss with the client about what the survey reveals to us. This can often be a useful source of topics to discuss in counselling. Near to the end of our counselling work, another survey allows us to compare how the client was in the past with how they are now.

What the iCounsellor.co.uk (2009/10) CORE survey demonstrates about Counselling.

By using CORE, clients and I were able to demonstrate statistically that a person’s psychological well-being, symptoms, life-functioning and states of harm or risk were improved during the counselling process.

For practitioners to assess meaningful improvement over the course of therapy, two measurements are important: reliable change and clinically significant change.

• Reliable change is change that exceeds that which might be expected by chance alone or measurement error, it is represented by a change of 5 or more in the clinical score.
• Clinically significant change is indicated when a client’s CORE score moves from the clinical to the non-clinical population (eg a CORE score of around 10 or below).

 

Update November 2013: I thought it important to add this note to clarify that as a counsellor working with individuals I no longer use CORE in my practice (and I never used it with couples … as CORE is unable to measure a relationship).  CORE statistics are helpful to those who are seeking to prove a position (such as seeking funding, or demonstrating an outcome of using a particular model of therapy, for instance).  For clinical work, however, I have found that it’s the relationship between client and counsellor that is far more important in discussing & determining outcome… and a reflection of a client’s state of mind using numbers can be less than helpful. 

© Article Dean Richardson 2010.