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The Growing Inaccessibility of Science
It’s a complaint I’ve heard from the earliest days of my career. Therapists do not read the research. I often mentioned it when teaching workshops around the globe. “How do we know?” I would jokingly ask, and then quickly answer, “Research, of course!” Like people living before the development of the printing press who were — read more
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Reducing Dropout and Unplanned Terminations in Mental Health Services
Being a mental health professional is a lot like being a parent. Please read that last statement carefully before drawing any conclusions! I did not say mental health services are similar to parenting. Rather, despite their best efforts, therapists, like parents, routinely feel they fall short of their hopes and objectives. To be sure, research — read more
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Do We Learn from Our Clients? Yes, No, Maybe So …
When it comes to professional development, we therapists are remarkably consistent in opinion about what matters. Regardless of experience level, theoretical preference, professional discipline, or gender identity, large, longitudinal studies show “learning from clients” is considered the most important and influential contributor (1, 2). Said another way, we believe clinical experience leads to better, increasingly — read more
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“My Mother Made Me Do It”: An Interview with Don Meichenbaum on the Origins of CBT (Plus: Tips for Surviving COVID-19)
Imagine having the distinction of being voted one of the top 10 most influential psychotherapists of the 20th Century. Psychologist Don Meichenbaum is that person. In his spare time, together with Arron Beck and Marvin Goldfried, he created the most popular and researched method of psychotherapy in use today: cognitive-behavior therapy (CBT). I got to — read more
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It’s Time to Abandon the “Mean” in Psychotherapy Practice and Research
Recognize this? Yours will likely look at bit different. If you drive an expensive car, it may be motorized, with buttons automatically set to your preferences. All, however, serve the same purpose. Got it? It’s the lever for adjusting your car seat. I’m betting you’re not impressed. Believe it or not though, this little device — read more
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Feedback is NOT Enough: A Brief Update about the Empirical Evidence
The use of routine outcome monitoring (ROM) is on the rise. In the United States and abroad, regulatory bodies are actually mandating the gathering of outcome data as the new “standard of care.” As agencies rush to implement–often at great cost in terms of time and money–the question remains: just how much does ROM contribute — read more
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Finding Meaning in Psychotherapy Amidst the Trivia and Trivial
I don’t know if you feel the same way I do. Looking back, I’m pretty sure its been going on for a while, but somehow I didn’t notice. Professional books and journals fill my bookshelves and are stacked around my desk. I am, and always have been, a voracious–even compulsive–reader. In the last couple of years, the volume — read more
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Symptom Reduction or Well-being: What Outcome should Matter Most in Psychotherapy
So, what contributes to a living a long, healthy life? Clean Air? Being lean versus overweight? The absence of depression or anxiety? Exercising regularly? Getting a flu vaccine? Abstaining from smoking? Minimizing alcohol intake? Personal sense of meaning? Close interpersonal relationships? Social integration? OK, I’ll come clean: all contribute–but not equally. Far from it. Some are more important than others. So, what contributes — read more
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Ho, Ho, Oh No! Science, politics, and the demise of the National Registry of Evidence-based Programs and Practices
While you were celebrating the Holidays–shopping and spending time with family–government officials were busy at work. On December 28th, the Substance Abuse and Mental Health Services (SAMHSA) sent a formal termination notice to the National Registry of Evidence-based Programs and Practices (NREPP). Ho, ho, oh no…! Briefly, NREPP is “an evidence-based repository and review system designed to provide the public — read more
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Better Results through Deliberate Practice
The legendary cellist Pablo Casals was once interviewed by comedian George Carlin. When asked why, at age 93, he continued to practice three hours a day, Casals replied, “I’m beginning to show some improvement!” Hard not to feel inspired and humbled by such dedication, eh? And while humorous, Casals was not joking. Across a wide variety — read more
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That’s it. I’m done. It’s time for me to say goodbye.
Ending psychotherapy. Whether formal or informal, planned or unplanned, it’s going to happen every time treatment is initiated. What do we know about the subject? Nearly 50% of people who start, discontinue without warning. At the time they end, half have experienced no meaningful improvement in their functioning or well-being. On the other hand, of those who — read more
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Something BIG is Happening: The Demand for Routine Outcome Measurement from Funders
Something is happening. Something big. Downloads of the Outcome and Session Rating Scales have skyrocketed. The number of emails I receive has been steadily increasing. The subject? Routine outcome measurement. The questions: Where can I get copies of your measures? Paper and pencil versions are available on my website. What is the cost? Individual practitioners — read more
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The Illness and the Cure: Two Free, Evidence-based Resources for What Ails and Can Heal Serious Psychological Distress
Findings from several recent studies are sobering. Depression is now the leading cause of ill-health and disability worldwide–more than cancer, heart disease, respiratory problems, and accidents. Yesterday, researchers reported that serious psychological distress is at an all-time high, significantly affecting not only quality but actual life expectancy. And who has not heard about the opioid — read more
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The Missing Link: Why 80% of People who could benefit will never see a Therapist
The facts are startling. Despite being on the scene for close to 150 years, the field of mental health–and psychotherapy in particular–does not, and never has had mass appeal. Epidemiological studies consistently show, for example, the majority of people who could benefit from seeing a therapist, do not go. And nowadays, fewer and fewer are — read more
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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