Building a Feedback-Friendly Practice: A Clinician’s Guide
This article is a reflection on why feedback in therapy can be so wonderful and tricky at the same time. More specifically, we outline several practical ideas for collecting feedback and introduce the idea of using a “third party” feedback collector! We also include some sample feedback questions at the end.
I would like to thank Shubha for a wonderful discussion that helped prompt some of the ideas for this writing.
Why Feedback Matters
Feedback can be a beautiful thing. More specifically, feedback in therapy or other clinical practice can:
Allow clinicians to understand (and potentially amplify!) what is already going well in a therapeutic relationship
Help clinicians detect early “warning signs” that a client/patient is feeling uncomfortable, confused, or just not fully supported by therapy; ideally leading to positive changes in the client’s experience
Provide clients with the chance to share anything they found hurtful, stressful, confusing, or frustrating in therapy; and potentially to receive acknowledgment or a restorative conversation from the cliniian
Offer the clinician a valuable opportunity to reflect and grow their own practice
Hidden Barriers to Feedback- Why Collecting Feedback Isn’t Always Straightforward
Tentatively, I would guess that most clinicians would consider themselves to be open to feedback, and a nontrivial portion may directly communicate to their clients that feedback is welcome. Despite this, there can still be so many hidden barriers to feedback. For example, clients may wonder:
Is it okay to give feedback at all?
Are there limits to the type of feedback (or frequency of feedback) that’s welcome?
Am I being “too sensitive” or overreacting?
If clients feel that their initial attempts to give feedback were met with a negative or dismissive reaction, they might withdraw from future attempts.
It’s also worth noting that certain types of feedback may be particularly hard to share directly — especially when they touch on things that feel irreversible, are outside the clinician’s control, or are deeply identity-related.
Example #1
A clinician has extenuating circumstances that are significantly impacting their clinical practice (e.g. their availability, their energy levels, and/or attention during session). A client may be significantly negatively impacted by these changes, but may feel bad expressing this directly to the clinician, especially if they sense the clinician is struggling.
Example #2
A client is uncertain how the clinician would react to an aspect of their identity (e.g. they’re unsure whether the therapist is LGBTQ+ inclusive or neurodiversity-affirming). They may find it difficult to give that feedback without “outing” themselves in the process.
Practical Ideas for Creating a Truly Feedback-Friendly Environment
1. Periodic Check-ins
Instead of just relying on a one-time comment (e.g. “you’re always welcome to share feedback with me”), consider having regular check-ins where clients are invited to share feedback if they would like. Ideally, this can be set up in a way such that there is no obligation to provide feedback, but where the option is clearly there.
Reasoning: Clients may struggle to figure out whether something is “important enough” to bring up, whether it’s the right time, or what type of feedback is okay. A direct invitation to share feedback can be a relief and mitigate some of that guesswork.
2. Give as Many Options as Possible
You can offer the chance to give feedback:
Conversationally, either informally or through going through a more structured list of questions together
Asynchronously through:
A feedback form – which could include different options, branching logic, and the option to share anonymously or with the client’s name
An open-ended document or unstructured form
A secure channel for a voice message or video
Directly to the clinician, or alternatively to a “third party feedback collector” (see Section 3)
In addition, there may be other ways to create a sort of “personalised feedback setting” for the client. Some additional guiding questions include:
Does the client want to be invited to give feedback at check-ins (and if so, how often)? Or would they prefer to opt out, knowing the feedback tools are always available?
How would they like you to follow up? (Would they like a conversation afterward to process the feedback, a written response to their feedback, a summary of what changes you plan to make based on their feedback, or no follow-up at all?)
Would the client like to suggest resources or training? Some clients may find it very meaningful to know that these kinds of suggestions are welcome. For example, if an autistic client feels slightly disconnected from their clinician due to a lack of familiarity on autism, it could be a relief to be able to suggest some autism-related trainings. However, others may feel uncomfortable to be asked to give suggestions or as though it is shifting responsibility for ongoing learning from the clinician to themselves.
Reasoning: The more mechanisms you give for providing feedback, the better the chance that one of these mechanisms will be accessible and comfortable for the client. For clients who benefit from structure, things like structured surveys or semi-structured interviews can provide a comforting scaffolding to their reflection.
3. Utilise an External Feedback Collector
(I’m hoping to create another post later that discusses this in depth; with a particular focus on the logistics of how this could be set up, potential risks and how to mitigate them, and legal considerations!)
For now, I’m excited to share this idea as well as some tentative benefits that an external feedback collector could offer. The role of the external feedback collector could be to meet with clients, hear their feedback and/or reflections, and (with permission) share their feedback with the clinician.
Potential benefits:
Can help filter and structure feedback in a way that is supportive of everyone involved (which may help patients/clients feel more comfortable giving raw or honest feedback)
Can potentially help anonymise feedback before it is shared with the clinician, while still allowing clients to share their detailed feedback in full with the feedback collector
Can provide support for the clinician when receiving feedback as well as an extra layer of accountability
Can reduce the risk of therapists reacting defensively or dismissively to their patients; as they have the chance to process feedback with the external feedback collector first
Reasoning: Provides further options for clients in giving feedback, may be especially helpful for feedback they are either (a) particularly hesitant to bring up to their clinician or (b) feel they haven’t been able to successfully address with their clinician.
4. Have a “Feedback Reflection” Plan
This topic deserves its own article (or several!), and I am by no means claiming to be an expert in how to perfectly process feedback.
However, I do know that it is beneficial when clinicians have put thought into what they plan to actually do with feedback. Some guiding questions include:
How will they reflect on feedback?
Who will they go to for support if they feel stuck in processing feedback?
What are their own patterns of defensiveness and how might that impact how they process different types of feedback?
Reasoning: It can be very harmful to clients if they are invited to share feedback and told that their honest feedback is deeply valuable– only to feel that their feedback is treated like a problem when they actually do share it! Likewise, while I certainly don’t think clinicians need to agree completely with every piece of feedback they receive, on average feedback can be a wonderful tool for ongoing growth and that will be most effective if a good reflection plan is in place.
Appendix: Sample feedback questions
(This is very much a work in progress, please don’t hesitate to email hello@allneurotypes.com if you have any feedback on our feedback!)
We would suggest making all questions optional and ensuring that clients know they are welcome to skip any question.
1. Overall, how well has therapy been meeting your needs/supporting you in achieving your goals? (Suggestion: use a Likert scale and open text option so people can answer in whichever way is most comfortable– or use both!)
2. Is there anything that you especially enjoy about therapy and/or that you hope continues to be part of your therapy experience?
3. Is there any part of therapy that you have found stressful, uncomfortable, frustrating, or just less effective than you hoped?
Has your therapist ever said something or responded to you in a way that felt confusing, dismissive, or otherwise not helpful?
4. Often, therapists may be very supportive or effective on certain topics or aspects of identity and less supportive or effective on other topics or aspects of identity. If you are comfortable sharing, please feel welcome to indicate:
Topics that you feel are easy to discuss with your therapist: …
Topics that have been more challenging: …
Any areas where you would suggest your therapist to seek out continuing education or training: …
Any topics that you are hesitant to bring up to your therapist because you aren’t sure how they would respond: …
5. Are there any areas of therapy that you would like to be adjusted? You’re welcome to share specific suggestions here and/or to just share your thoughts/experiences so far. Below are some common areas where people may need adjustment, and you are also welcome to use the “other” box to add anything else:
Punctuality of sessions/ease of scheduling
Amount of self-disclosure (e.g. would you prefer for your therapist to share more about their life or less? Are there specific topics that you would prefer more or less self-disclosure on?)
Degree of structure (e.g. would you like more structure, more advance notice of what to expect in session, more flexibility, anything else?)
Autonomy/compliance or other forms of discrimination (e.g. are there ways in which therapy is reinforcing – regardless of intention – compliance, masking, or stigma against aspects of one’s identity)
Style of communication (e.g. would you like the therapist to take a more directive role in sessions? A less directive role? Would you prefer for things to be communicated to you in a different way such as more detail, more concise suggestions, use of visuals or worksheets when possible, etc.)
Other
6. Is there anything that you wish your therapist understood/understood better about you? Some examples are:
Are there areas of your experiences or part of your communication that you would like them to understand better?
What are some signs that you are becoming stressed or overwhelmed by something? Are there indicators you would like your therapist to be more aware of when working with you?
How would you like your therapist to check-in with you about sessions/whether you are comfortable? (E.g. would you like a quick check-in at the end of every session, during certain activities, something else?)
7. Please select any of the following that apply to you (if you feel comfortable). Most of these items are not inherently good or bad, but they may be indications that extra care is required in therapy:
I feel high highs and low lows regarding this therapy (e.g. some moments feel extremely good while others are especially painful or confusing)
I feel deeply attached to the therapist or feel dependant on the therapist (emotionally, practically, or otherwise)
There are parts of the therapist’s approach that feel unusual, confusing, or uncomfortable to me
I find myself thinking about my therapist very often in between sessions
I feel like my relationship with the therapist goes beyond a typical therapist-client relationship (it feels special in some way or I know the therapist in another capacity or they have made exceptions for me/us, etc.)
8. Is there anything else that’s on your mind that you would like to share with me [the external feedback collector] (but that you don’t want to be shared with your therapist?). For example, maybe you had an experience that didn’t feel great, but you aren’t sure if you want to bring it up.
9. How would you like us to use the information you shared? Please select all that apply and use the open text box below to elaborate if you would like!
I would like you to read my responses, but don’t want them to be shared with my therapist at this time (except in a completely de-identified, aggregated way – e.g. adding any numerical scores to an average across all patients)
I would like you to summarise my responses and let me see the summary before it is shared with my therapist
I would like you to summarise my responses and share them directly with my therapist
I would like my responses (with the exception of question 8) to be shared directly with my therapist
I would like my therapist to follow up with me about my responses
I would like a follow up on any suggestions I made (e.g. suggested continuing education, changes to the practice overall related to accessibility, other)
Other (please specify)
