The Two Chairs Clinical Innovation and Research Team is dedicated to building mental health interventions and products that lead to meaningful improvement for our clients.
Last month, we attended the 2023 Association for Behavioral and Cognitive Therapies (ABCT) annual convention in Seattle, Washington — an eagerly awaited event for professionals interested in evidence-based mental health care. Every year, experts meet to discuss the latest science and trends in cognitive behavioral therapy (CBT) and pressing challenges in the field.
As we reflect on this year’s convention, we continue to be excited and impressed by how Two Chairs is right in stride with the latest science and innovation of the field. We are excited to share our five key takeaways from the meeting and thoughts on how Two Chairs and the technology-enabled behavioral health field more broadly are well situated to address the current challenges in mental health care.
Five takeaways on mental health care innovation — and how Two Chairs is leading
1. We’ve moved beyond “build it and they will come”
For many years, the CBT community focused on developing sophisticated, evidence-supported treatments and hoped that just “getting them out there” would lead to adoption into practice. We now know that this strategy alone does not work!
We must design interventions with the end user in mind if we ever hope to have them adopted into practice. Several sessions at the convention focused on lessons learned from efforts to implement evidence-based interventions in community settings. The main takeaway: stakeholders should be involved in every step of the process.
At Two Chairs, we know our clinicians and clients have the boots-on-the-ground experience and knowledge that we need to build meaningful products and interventions. That’s why we design in partnership with them.
Our clinicians have the opportunity to consult with us on any new initiative, from idea to implementation. Before we start any new initiative, we involve our clinical team to understand their needs. As we are developing new products or interventions, we consult the team to ensure the product is meeting their needs. Before we launch, we run pilots and beta tests in collaboration with our clinicians to ensure we are getting the intended results. As we launch, we continue to check-in with our clinicians and incorporate their feedback in future iterations of the product.
2. Clinician time is precious and should be protected
As demand for mental health care has increased to historical levels, clinicians' already difficult job has gotten even harder. There simply are not enough licensed clinicians to meet the demand.
Sessions at ABCT highlighted the importance of protecting clinician time to focus on treating clients who need care the most. This included a range of innovative approaches including task-sharing and increased use of paraprofessionals, single-session or low-intensity interventions, digital technology, and artificial intelligence (AI) to support synchronous training and documentation.
At Two Chairs, we are always looking for ways to enhance our provider experience and protect the clinical hour. In collaboration with our clinicians, we have designed intuitive platforms to help streamline their non-clinical tasks, like documentation. We are also continuously working to address known pain points and continue to find innovative ways to leverage technology to offload tasks that don’t require a licensed clinician. We’re excited about continuing to explore new ways to make our clinicians’ lives easier and increase access to high quality mental health care.
3. Therapy is more than just skills training
There has long been a debate about whether specific therapy techniques or so-called “common” factors that are present in all types of therapy are more important in driving positive clinical outcomes. Traditionally, ABCT has been very focused on the technical aspects of cognitive and behavioral therapies. So, we were surprised to see non-specific factors come up in a number of sessions.
The general consensus is that therapist characteristics like interpersonal effectiveness, empathy, warmth and therapeutic alliance are primary drivers of positive outcomes in care. Therapeutic alliance has always been a core part of the Two Chairs model. Our unique matching process is designed specifically to enhance the relationship between the therapist and client, and feedback on therapeutic alliance is a core part of our measurement-based care model.
Finding the right therapist is often the hardest part of getting started. At Two Chairs, we take the guesswork out of the process and find 98% of our clients the right therapist on the first try.
4. Diversity, equity, inclusion and belonging
Over the past few years, we have seen a much-needed increased focus on the importance of diversity, equity, inclusion and belonging (DEIB) at ABCT. It’s now clear that a one-size-fits-all approach to delivering mental health services is inadequate and does not meet the needs of all.
It is crucial to develop culturally responsive approaches to assessment and intervention and train the mental health workforce to incorporate and consider culture in everything we do.
This year, sessions at ABCT also focused on strategies for enhancing training and ongoing support for clinicians, including the use of professional consultation to help clinicians better understand their discomfort and implicit biases and address knowledge gaps when working with marginalized populations.
DEIB is top of mind at Two Chairs, particularly for our clinicians, and we strive to provide them the resources and support they need to provide quality services to all. We offer speciality consultation groups focused on providing culturally responsive care, and, this past year, we also brought on an expert in clinical psychology and DEIB to lead our efforts there. He works closely with our clinical teams to ensure that all of our clinical processes are culturally responsive, from our measurement-based care model, to the interventions we deliver, to our client-facing products and communications.
Addressing DEIB requires continuous attention and effort. At Two Chairs, we are committed to ongoing work to improve the cultural responsiveness of our care to ensure we are meeting the needs of all of our clients.
5. One-size measurement doesn’t fit all
As a field, we have accepted that measurement is an important way to evaluate the effectiveness of the care we provide. Despite this, doing measurement-based care is hard. Clients are often resistant to consistently completing measures, particularly if they don’t feel like the measures are relevant for them. And clinicians often don’t know how to effectively leverage data to inform care.
At ABCT, we sat in on conversations about the importance of tailoring and individually selecting measures to maximize their relevance to individual clients, as well as of clinicians contextualizing standardized data collection to enhance the relevance of measures that have not been individually selected.
Measurement-based care is a core part of our care model at Two Chairs. We have focused on leveraging the data to adapt care to each client’s needs and trained our clinicians to not only interpret the data alongside the client, but help the client understand how the data relate to their experiences, symptoms, and treatment goals. We are always listening to our clients and clinicians and evolving our system to better meet their needs, and are excited to continue to adapt our measurement-based care model to meet every clients’ needs.
ABCT always provides a welcome opportunity for continued learning and reflection. We have made so much progress toward improving access to high quality mental health care, but there is still a lot of work to be done.
At Two Chairs, we take our mission to build a world where everyone has access to exceptional mental health care seriously. We are committed to continuing to learn, and are encouraged that Two Chairs is a model for how industry can be at the forefront of science and innovation.