scottdm – Page 6 – Scott D.Miller

Using Feedback Informed Treatment to Improve Medication Adherence and Reduce Healthcare Costs

Medication adherence is a BIG problem. According to recent research, nearly one-third of the prescriptions written are never filled. Other data document that more than 60% of people who actually go the pharmacy and get the drug, do not take it as prescribed. What’s the problem, you may ask? Inefficiency aside, the health risks are — read more
Want to be more effective? Point North!

Sime time ago, while on a flight, I watched a program from the Discovery Channel about the North American red fox. The furry little creatures were shown hunting rodents hidden under three feet of snow. Three feet! Up in the air the foxes would hop, thrusting their noses deep into the drifts. Most of the time, — read more
The Sounds of Silence: More on Research, Researchers, and the Media

A while ago, I wrote about an article that appeared in The Guardian, one of the U.K.’s largest daily newspapers. Citing a single study published in Denmark, the authors boldly asserted, “The claim that all forms of psychotherapy are winners has been dealt a blow.” Sure enough, that one study comparing CBT to psychoanalysis, found — read more
Public Attitudes Toward Mental Health Services: A Change for the Worse

The results are not encouraging. A recent meta-analysis found that public attitudes toward psychotherapy have become progressively more negative over the last 40 years. The impact on practitioners is staggering. Between 1997 and 2007, use of psychotherapy declined by 35%. Not surprisingly, clinicians’ incomes also suffered, dropping 15-20% over the last decade. So, if not psychotherapy, what do — read more
Is Supervision Important to you?

How valuable is clinical supervision to you? In their massive, long-term international study of therapist development, researchers Orlinsky and Rønnestad (2005) found that “practitioners at all experience levels, theoretical orientations, professions, and nationalities report that supervised client experience is highly important for their current and career development” (p. 188). Despite the value most of us place on — read more
Is your therapy making your clients worse? The Guardian Strikes Again

A while ago, an article appeared in The Guardian, one of the U.K.’s largest daily newspapers. “Counselling and Therapy can be Harmful,” the headline boldly asserted, citing results of a study yet to be published. It certainly got my attention. Do some people in therapy get worse? The answer is, most assuredly, “Yes.” Research dating — read more
What’s in an Acronym? CDOI, FIT, PCOMS, ORS, SRS … all BS?

“What’s in a name?” –William Shakespeare A little over a week ago, I received an email from Anna Graham Anderson, a graduate student in psychology at Aarhus University in Denmark. “I’m writing,” she said, “in hopes of receiving some clarifications.” Without reading any further, I knew exactly where Anna was going. I’d fielded the same — read more
What can therapists learn from the CIA? Experts versus the "Wisdom of the Crowd"

What can we therapists learn from the CIA? In a phrase, “When it comes to making predictions about important future events, don’t rely on experts!” After a spate of embarrassing, high-profile intelligence failures, a recent story showed how a relatively small group of average people made better predictions about critical world events than highly-trained analysts with access to classified information. — read more
Do you know who said, "Sometimes the magic works, sometimes it doesn’t"?

Well, do you? It was Chief Dan George playing the role of Old Lodge Skins in the 1970 movie, “Little Big Man.” Whether or not you’ve seen or remember the film, if you’re a practicing therapist, you know the wisdom contained in that quote. No matter how skilled the clinician or devoted the client, “sometimes therapy works, sometimes it — read more
How not to be among the 70-95% of practitioners and agencies that fail

Our field is full of good ideas, strategies that work. Each year, practitioners and agencies devote considerable time and resources to staying current with new developments. What does the research say about such efforts? When it comes to the implementation of new, evidence-based practices, traditional training strategies routinely produce only 5% to 30% success rates. Said another way, 70-95% of training fails — read more
Dumb and Dumber: Research and the Media

“Just when I thought you couldn’t get any dumber, you go and do something like this… and totally redeem yourself!” – Harry in Dumb & Dumber A while back, my inbox suddenly began filling with emails from friends and fellow researchers around the globe. “Have you seen the article in the Guardian?” they asked. “What — read more
Are you any good as a therapist? The Legacy of Paul W. Clement

Twenty years ago, I came across an article published in the journal, Professional Psychology. It was written by a psychologist in private practice, Paul Clement. The piece caught my eye for a number of reasons. First, although we’d never met, Paul lived and worked in Pasadena, California, a short ride from my childhood home. Second, the — read more
Good News and Bad News about Psychotherapy

Have you seen this month’s issue of, “The National Psychologist?” If you do counseling or psychotherapy, you should read it. The headline screams, “Therapy: No Improvement for 40 Years.” And while I did not know the article would be published, I was not surprised by the title nor it’s contents. The author and associate editor, — read more
Do you do psychotherapy?

You know psychotherapy works. Forty years of research evidence backs up your faith in the process. And yet, between 1998 and 2007, psychotherapy use decreased by 35%. People still sought help, they just went elsewhere to get it. For instance, use of psychotropic drugs is up 40% over the last decade. A recent article in — read more
NIMH Dumps the DSM-5: The No News Big News

Some time ago, I blogged about results from field trials of the soon-to-be-released, fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Turns out, many of the diagnoses in the “new and improved” version were simply unreliable. In fact, the likelihood of two clinicians, applying the same criteria to assess the same person — read more
Evidence-based Practice is a Verb not a Noun

Evidence-based practice (EBP). What is it? Take a look at the graphic above. According to American Psychological Association and the Institute of Medicine, there are three components: (1) the best evidence; in combination with (2) individual clinical expertise; and consistent with (3) patient values and expectations. Said another way, EBP is a verb. Why then — read more
The Revolution in Swedish Mental Health Services: UPDATE on the CBT Monopoly

No blogpost I’ve ever published received the amount of attention as one back in 2012 detailing changes to Swedish Mental Health practice. At the time, I reported about research results showing that the massive investment of resources in training therapists in CBT had not translated into improved outcomes or efficiency in the treatment of people with — read more
What to Pay Attention to in Therapy?

A week or so ago, I received an email from my friend, colleague, and mentor Joe Yeager. He runs a small listserve that sends out interesting and often provocative information. The email contained pictures from a new and, dare I say, ingenious advertising campaign for Colgate brand dental floss. Before I give you any of — read more
S.A.M.S.H.A. designates Feedback-Informed Treatment an "Evidence-based Practice"

(This post is included for historical purposes. Following the 2016 election, the NREPP registry was decommissioned) February 2, 2013 Chicago, Illinois USA I am honored to announce that Feedback-Informed Treatment (FIT) has been added to SAMSHA’s official database of evidence-based practices (EBP) known as NREPP (the National Registry of Evidence-based Programs and Practices). Briefly, NREPP — read more
Curing Clinician Overconfidence: Try Darting and Frowning

Overconfidence. It’s a problem that leads to systematic errors in judgement. Long thought to arise out of hubris or the corrupting effects of the emotion, the evidence actually shows it to be built into humans’ evolved cognitive machinery. Existimo ergo certus sum (I think, therefore I am…certain). Behavioral health professionals are not immune. The first — read more
Believing is Seeing: How Wishing Makes Things So

Yesterday evening, my family and I were watching a bit of T.V. My son, Michael commented about all the ads for nutrional supplements, juicing machines, weight loss programs and devices. “Oh yeah,” I thought, then explained to him, “It’s the start of a new year.” Following “spending more time with family,” available evidence shows exercise and weight loss top — read more
Feedback in Groups: New Tools, New Evidence

Groups are an increasingly popular mode for delivering behavioral health services. Few would deny that using the same hour to treat mutliple people is more cost effective. A large body of research shows it to be as effective in general as individually delivered treatments. Now clinicians can incorporate feedback into the group therapy using a brief, scientifically validated — read more
Dealing with Scientific Objections to the Outcome and Session Rating Scales: Real and Bogus

The available evidence is clear: seeking formal feedback from consumers of behavioral health services decreases drop out and deterioration while simultanesouly improving effectiveness. When teaching practitioners how to use the ORS and SRS to elicit feedback regarding progress and the therapeutic relationship, three common and important concerns are raised: How can such simple and brief scales provide — read more
The Importance of "Whoops" in Improving Treatment Outcome

“Ring the bells that still can ring, Forget your perfect offering There is a crack in everything, That’s how the light gets in.” Leonard Cohen, Anthem Making mistakes. We all do it, in both our personal and professional lives. “To err is human…,” the old saying goes. And most of us say, if asked, that we agree — read more
What is the Real Source of Effectiveness in Smoking Cessation Treatment? New Research on Feedback Informed Treatment

When it rains, it pours! Growing interest in FIT is leading to the publication of research articles on its application in different contexts — an article on using the ORS and SRS in smoking cessation treatment, another a long-awaited article on the validity and reliability of the Group Session Rating Scale, and finally, a piece — read more
An Easy Way to Improve Our Schools (and Psychotherapy)

There is this article that appeared a while ago in the Atlantic Monthly that stuck with me. In it, Amanda Ripley detailed a simple and straightforward method for improving the performance of the public schools: have kids grade teachers. What kind of grades you ask? Not those on standardized achievement tests, and certainly not measures of — read more
Psychotherapy Training: Is it Worth the Bother?

Big bucks. That’s what training in psychotherapy costs. Take graduate school in psychology as an example. According to the US Department of Education’s National Center (NCES), a typical doctoral program takes five years to complete and costs between US$ 240,000-300,000.00. Who has that kind of money laying around after completing four years of college? The… — read more
Thomas Szasz, M.D.: Memories of a Friend and Mentor

Very early in the morning of December 9th, 2009, I received a call in my hotel room. My long time colleague and mentor, Jeffrey Zeig was on the other end. "May I ask you a favor?" he said. "Of course," I instantly replied, completely unaware of what was coming. "Tom Szasz is caught in a… — read more
Barriers to seeking mental health care

With all the challenges facing the profession, it is important to highlight people and organizations that are working hard to make a difference. On that note, tomorrow, Tuesday the 25th of September 2012 is the very first National Psychotherapy Day. Having a day of unified, active promotion of psychotherapy is the brain child… — read more
Looking for Results in All the Wrong Places: What Makes Feedback Work?

As anyone knows who reads this blog or has been to one of my workshops, I am a fan of feedback. Back in the mid-1990’s, I began using Lynn Johnson’s 10-item Session Rating Scale in my clinical work. His book, Psychotherapy in the Age of Accountability, and our long relationship, convinced me that I… — read more