-
How Deliberate Practice can Improve Your Therapeutic Effectiveness
In 2015, colleagues and I released the largest, longitudinal study of therapist effectiveness ever published. The study examined outcomes of 6500 clients treated by 170 practitioners whose results had been tracked an average of 5 years—some as long as 17 years! The result? Clinician outcomes, on average, not only did not improve, but actually slowly — read more
-
“Mind the Gap”: A Strategy for Insuring you get the Feedback you need to Improve your Game (whatever that is)
Join me in a brief “thought experiment.” Suppose you were a gifted painter or photographer and had the chance to provide an image of yourself that would endure–and perhaps be the only one people would know you by–for hundreds of years after your death. How would you proceed? What criteria would guide your work, be — read more
-
Does practice make perfect?
“Practice does not make perfect,” my friend, and award-winning magician, Michael Ammar, is fond of saying. “Rather,” he observes, “practice makes permanent.” Thus, if we are not getting better as we work, our work will simply insure our current performance stays the same. Now, before reading any further, watch a bit of the video below. — read more
-
Dodos and Dropouts: Two Chronic Problems in Psychotherapy (and what clinicians can do about them)
Last week, my inbox started filling with emails from colleagues about a new study. Working with a real world sample, researchers compared dynamic therapy to cognitive therapy and found… (drum roll please) NO DIFFERENCE IN OUTCOME! Long ago, psychologist Saul Rosenzweig dubbed the equivalence in outcome between competing brands of psychotherapy, “The Dodo Verdict.” (I’m — read more
-
Making the Impossible, Possible: The Fragile Balance
Trip-Advisor scores it # 11 out of 45 things to do Sausalito, California. No, it not’s the iconic Golden Gate Bridge or Point Bonita Lighthouse. Neither is it one of the fantastic local restaurants or bars. What’s more, in what can be a fairly pricey area, this attraction won’t cost you a penny. It’s the — read more
-
Why aren’t therapists talking about this?
Turns out, every year, for the last several years, and right around this time, I’ve done a post on the subject of deterioration in psychotherapy. In June 2014, I was responding to yet another attention-grabbing story published in The Guardian, one of the U.K.’s largest daily newspapers. “Misjudged counselling and therapy can be harmful,” the — read more
-
NERD ALERT: Determining IF, WHAT, and HOW Psychotherapy Works
OK, this post may not be for everyone. I’m hoping to “go beyond the headlines,” “dig deep,” and cover a subject essential to research on the effectiveness of psychotherapy. So, if you fit point #2 in the definition above, read on. It’s easy to forget the revolution that took place in the field of psychotherapy — read more
-
Improving the Odds: Implementing FIT in Care for Problem Gamblers and their Families
Quick Healthcare Quiz What problem in the U.S. costs the government approximately $274 per adult annually? If you guessed gambling, give yourself one point. According to the latest research, nearly 6 million Americans have a serious gaming problem—a number that is on the rise. One-third of the Nation’s adults visit a Casino every year, losing — read more
-
Do you know Norman Malone? FIT, Grit, and Grace Personified
At the tender age of 10, Norman Malone’s father attacked him and his two younger brothers with a hammer while they slept. Their mother, drugged into unconsciousness by her husband the prior evening, found the children the next morning. Each had suffered grave head wounds, but were alive. Later, all would learn the senior Malone — read more
-
Psychotherapy and the Cure for the Common Cold
What do the common cold and psychotherapy have in common? Read on, the answers may surprise you… Lost productivity costs are roughly the same for the common cold and most common mental health problems; The common cold and most common mental health problems affect an amazingly large group of people each year. In the United — read more
-
What is the essential quality of effective Feedback? New research points the way
“We should not try to design a better world,” says Owen Barder, senior fellow at the Center for Global Development, “We should make better feedback loops.” Feedback has become a bit of a buzzword in mental health. Therapists are being asked to use formal measures of progress and the quality of the relationship and use — read more
-
Are you Better? Improving Effectiveness One Therapist at a Time
Greetings from snowy Sweden. I’m in the beautiful city of Gothenburg this week, working with therapists and administrators on implementing Feedback-Informed Treatment (FIT). I’m always impressed by the dedication of those who attend the intensive workshops. More, I feel responsible for providing a training that not only results in mastery of the material, but also — read more
-
I Was Wrong: The Healing Power of Admitting Mistakes in Psychotherapy
Across modalities, the therapeutic relationship has consistently been found to be a robust predictor of treatment outcome. Most practicing clinicians understand this finding and work hard at establishing and maintaining a collaborative working alliance. Here’s a less well known, but sobering statistic: clients report tensions or actual breakdowns in the therapeutic relationship in 19% to — read more
-
The Benefits of Doubt: New Research Sheds Light on Becoming a More Effective Therapist
These are exciting times for clinicians. The pieces of the puzzle are falling into place. Researchers are finally beginning to understand what it takes to improve the effectiveness of psychotherapy. Shifting away from the failed, decades-long focus on methods and diagnosis, attention has now turned to the individual practitioner. Such efforts have already shown a — read more
-
Swedish National Audit Office concludes: When all you have is CBT, mental health suffers
“The One-Sided Focus on CBT is Damaging Swedish Mental Health” That’s the headline from one of Sweden’s largest daily newspapers for Monday, November 9th. Professor Gunnar Bohman, together with colleagues and psychotherapists, Eva Mari Eneroth Säll and Marie-Louise Ögren, were responding to a report released last week by the Swedish National Audit Office (NAO). In a prior — read more
-
Recent study documents the effectiveness of psychotherapy has been overstated: An example of an RFTM and PEBKAC problem
Not being a computer nerd, I’d never come across these expressions. My 14-year-old son was the first person I heard use the terms. He was referring to a problem I was having with my desktop computer. To be sure, I’m no Luddite. Still, “computer” will always be a second language for me. With a restart — read more
-
The Verdict is “In”: Feedback is NOT enough to Improve Outcome
Years have passed since I blogged about claims being made about the impact of routine outcome monitoring (ROM) on the quality and outcome of mental health services. While a small number of studies showed promise, others results indicated that therapists did not learn from nor become more effective over time as a result of being exposed — read more
-
Intake: A Mistake
Available evidence leaves little doubt. As I’ve blogged about previously, separating intake from treatment results in: • Higher dropout rates; • Poorer outcomes; • Longer treatment duration; and • Higher costs And yet, in many public behavioral health agencies, the practice is commonplace. What else can we expect? Chronically underfunded, and — read more
-
What’s happening to CBT? And why all the hoopla misses the point
Previously, I’ve blogged about results from a Swedish study examining the impact of psychotherapy’s “favorite son”–cognitive behavioral therapy–on the outcome of people disabled by depression and anxiety. Like many other Western countries, the percentage of people in Sweden disabled by mental health problems was growing dramatically. Costs were skyrocketing. Even with treatment, far too many left the — read more
-
Love, Mercy, & Adverse Events in Psychotherapy
Just over a year ago, I blogged about an article that appeared in one of the U.K.’s largest daily newspapers, The Guardian. Below a picture of an attractive, yet dejected looking woman (reclined on a couch), the caption read, “Major new study reveals incorrect … care can do more harm than good.” I was interested. As — read more
-
Time to Rethink Burnout: Lessons from Supershrinks
The world seems to be in the midst of a pandemic of burnout, spread across all age groups, genders, professions, and cultures. Research specific to mental health providers finds that between 21 and 67 percent may be experiencing high levels. Other related “conditions” have been identified, including compassion fatigue (CF), vicarious traumatization (VT), and secondary traumatic — read more
-
What is the difference between a therapist and a compassionate friend?
What’s the difference between a trained therapist and a compassionate friend? Look at outcomes and you are likely to be disappointed. For example, meta-analyses of studies comparing professionals to paraprofessionals (or students) either find that the latter group achieve significantly better results or, at worst, the same! A clearer difference can be found in area — read more
-
The Failure Rate of Psychotherapy: What it is and what we can do?
You are not going to believe me when I say it. Fifty percent. It’s true. Even in studies where carefully selected therapists who receive copious amounts of training, support, and supervision, and treat clients with a single diagnosis or problem, between 5 and 10% get worse and 35-40% experience no benefit whatsoever! That’s half, or — read more
-
Becoming a more effective therapist: Three evidence-based clues from research on the field’s most effective practitioners
It’s one of those secrets everyone knows, but few talk openly about: some therapists are more effective than others. Available evidence indicates that clients seen by these practitioners experience 50% more improvement, 50% less drop out, have shorter lengths of stay, and are significantly less likely to deteriorate while in care. So, how do these — read more
-
Implementing Feedback Informed Treatment
What do the Sydney Opera House, Boston Central Artery Tunnel, and Eurozone Typhoon Defense Project all have in common? In each case, their developers suffered from, “The Planning Fallacy” (PF). First recognized in 1979 by Nobel Prize winning psychologists Daniel Kahneman and Amos Tversky, the planning fallacy is the all too human tendency to underestimate — read more
-
What do clinicians want anyway?
What topics are practitioners interested in learning about? If you read a research journal, attend a continuing education event, or examine the syllabus from any graduate school course, you’re likely to conclude: (1) diagnosis; (2) treatment methods; and perhaps (3) the brain. As I’ve written previously about, the brain is currently a hot topic in — read more
-
Therapist Wanted: Dead or Alive
Do you get those letters about the top healthcare providers in your area? At the beginning of the new year, our city’s local magazine publishes a list of the top healthcare providers. It’s a big deal. Organized by location and specialty, the issue contains full-page photos, glossy spreads, and breezy write-ups. Impressive stuff with a — read more
-
Dinner with Paul McCartney (and others)
Growing up, my family had a game we frequently played around the dining room table. “If you could invite anyone to dinner,” it always started,”who would it be?” Invariably, my father chose historical figures: Abraham Lincoln, Mark Twain, Leonardo Da Vinci. My mom was more inclined toward the living: Jackie O., J.D. Salinger, Lucille Ball. — read more
-
Is Documentation Helping or Hindering Mental Health Care? Please Let me know.
So, how much time do you spend doing paperwork? Assessments, progress notes, treatment plans, billing, updates, etc.–the lot? When I asked the director of the agency I was working at last week, it took him no time to respond. “Fifty percent,” he said, then added without the slightest bit of irony, “It’s a clinic-wide goal, — read more