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Agape
Over the last several months, I’ve been writing a series of short, but true stories from my life and work. I’ve been surprised by and am grateful for the positive response. All of the stories can be found on my substack account, called “Snippets.” Here’s one from early on in my career, a lesson about — read more
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A not so helpful, helping hand
“Your reach should exceed your grasp,” was one of my dad’s favorite sayings. Smile on his face, he would often add, “be prepared to end up empty handed” – which reminds me of a memory. I was seated on the right side of the room, in the aisle seat, second row from the front. As — read more
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Alas, it seems everyone comes from Lake Wobegon
You’ve heard of it, right? Lake Wobegon? The fictional town in Minnesota made famous by master story-teller, Garrison Keller. The place where, “all the people are strong, good-looking, and above average?” Turns out, if the city were “Psychotherapy,” it would not be a fictional place. Since 2012 when the first study appeared in the literature, — 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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Is THAT true? Judging Evidence by How Often its Repeated
I’m sure you’ve heard it repeated many times: The term, “evidence-based practice” refers to specific treatment approaches which have been tested in research and found to be effective; CBT is the most effective form of psychotherapy for anxiety and depression; Neuroscience has added valuable insights to the practice of psychotherapy in addition to establishing the — read more
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“What works” with eating disorders (and how long will it take the field to swallow these results)?
What works in the treatment of people with eating disorders? Search around a bit on the internet, or consult official treatment guidelines, and you’ll find cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) listed as the “best-supported” or “preferred” psychological approaches for bulimia, anorexia, and binge eating. Such recommendations strongly imply such approaches contain ingredients specifically — 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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Clinical Practice Guidelines: Beneficial Development or Bad Therapy?
A couple of weeks ago, the American Psychological Association (APA) released clinical practice guidelines for the treatment of people diagnosed with post-traumatic stress disorder (PTSD). “Developed over four years using a rigorous process,” according to an article in the APA Monitor, these are the first of many additional recommendations of specific treatment methods for particular psychiatric diagnoses to be published — 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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“What about the Liars and Deniers?” Working Effectively with Mandated and Incarcerated Clients and People who Sexually Abuse
It was just a little over a month ago. I was doing a workshop somewhere in the States. My topic? Using formal client feedback to guide and improve the quality and outcome of psychotherapy– our SAMHSA-approved, NREPP listed evidence-based practice. At the first break, I was approached by one of the attendees. “I’m really enjoying — read more
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“I can’t let others know…”: Shame as a Barrier to Professional Development
Shame (noun \ˈshām\): Consciousness of shortcoming, guilt, or impropriety. Turns out, for many therapists, this powerful and painful emotion is a significant barrier to professional development. Doing psychotherapy is challenging in the best of circumstances. As many as 25% of clients drop out before experiencing a measureable improvement in their functioning. Of those who — read more
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“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
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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
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Obesity Redux: The RFL Results and complex Nature of Truth and Science
Back in April, I blogged about research published by Ryan Sorrell on the use of feedback-informed treatment in a telephonically-divered weight management program. The study, which appeared in the journal Disease Management*, not only found that the program and feedback led to weight loss, but also significant improvements in distress, health eating behaviors (70%), exercise (65%), and presenteeism on… — read more
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A Lotta Help from One’s Friends: The Role of Community in the Pursuit of Excellence
Dateline: Chicago, IL USA Hard not to be impressed with the USA Women’s Gymnastic team. What skill, percision, expertise, and excellence. By now, I’m sure you’ve seen the interviews. In all instances, each and every one has focused on the team. Despite some in the media attempting to make stars out of the individual members,… — read more
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A Progress Report on the Science (and Art ) of Psychotherapy: The Psychotherapy Networker 30th Anniversary Edition
The 30th Anniversary Edition of the Psychotherapy Networker has hit newsstands. In it, is an article by Diane Cole taking the measure of psychotherapy. Her question? Has the field gotten any better over the last three decades? The entire issue is a "must read," starting with editor Rich Simon’s lengthy and thought provoking editorial, "Still… — read more
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Achieving Clinical Excellence Conference 2013: CALL FOR PAPERS
Horsholm, Denmark Spent the weekend with the planning committe for the 2013 Achieving Clinical Excellence Conference. Committee members came in from all over the world–the USA, Romania, Holland, the UK, and Denmark–to finalize speakers, the conference venue, and mock up the logo for the conference brochure and advertizing. Like last time, we are not only bringing in the… — read more
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Am-ACE-ing Events in Kansas City: The First International Achieving Clinical Excellence Conference
Here’s a riddle for you: What do therapists, researchers, case managers, magicians, surgeons, award winning musicians, counselors, jugglers, behavioral health agency directors, and balloon twisting artists have in common? Answer: They all participated in the first "Achieving Clinical Excellence" held last week in Kansas City, Missouri. It’s true. The "motley" crew of presenters, entertainers, and attendees came to Kansas… — read more
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The Effects of Feedback on Medication Compliance and Outcome: Follow Up on The University of Pittsburgh Study
Late last year, I blogged about a study being conducted at the University of Pittsburgh by Dr. Jan Pringle, the director of the Program Evalutation Research Unit in the School of Pharmacology and her colleague, Dr. Michael Melczak. You’ll recall, there were two conditions in the study. In the first, pharmacists–the practitioner most likely to interact… — read more
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After the Thrill is Gone: Sustaining a Commitment to Routinely Seeking Feedback
Helsingor Castle (the setting for Shakespeare’s Hamlet) Dateline: May 8th, 2010, Helsingor, Denmark This weekend I’m in Denmark doing a two-day workshop on "Supershrinks" sponsored by Danish psychologist and ICCE Senior Associate and Trainer Susanne Bargmann. Just finished the first day with a group of 30 talented clinicians working diligently to achieve their personal best. The… — read more
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"What Works" in Holland: The Cenzo Experience
When it comes to healthcare, it can be said without risk of exaggeration that "revolution is in the air." The most sweeping legislation in history has just been passed in the United States. Elsewhere, as I’ve been documenting in my blogs, countries, states, provinces, and municipalities are struggling to maintain quality while containing costs of… — read more
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"What Works" in Norway
Dateline: Tromsø, Norway Place: Rica Ishavshotel For the last two days, I’ve had the privilege of working with 125+ clinicians (psychotherapists, psychologists, social workers, psychiatrists, and addiction treatment professionals) in far northern Norway. The focus of the two-day training was on "What Works" in treatment, in particular examining what constitutes "evidence-based practice" and how to… — read more
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Are all treatments approaches equally effective?
Bruce Wampold, Ph.D. Late yesterday, I blogged about a soon-to-be published article in Clinical Psychology Review in which the authors argue that the finding by Benish, Imel, & Wampold (2008) of equivalence in outcomes among treatments for PTSD was due to, "bias, overgeneralization, lack of transparency, and poor judgement." Which interpretation of the evidence is correct? Are there… — read more
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Holidays and Suicide: Tis’ the Season NOT!
The notion that suicides increase during the holiday season is as traditional as "Santa Claus"–and, according to statistics dating back at least a decade, just as illusory. In fact, research actually shows suicide rates to be the lowest in December! According to Dan Romer, a researcher at the Annenberb Public Policy Center at the University… — read more