Deliberate Practice and Top Performance – Scott D.Miller

Seeing What Others Miss

It’s one of my favorite lines from one of my all time favorite films. Civilian Ellen Ripley (Sigourney Weaver) accompanies a troop of “colonial marines” to LV-426. Contact with the people living and working on the distant exomoon has been lost. A formidable life form is suspected. The Alien. Ripley is on board as an advisor. The only — read more
Two Resources for Using Deliberate Practice to Improve your Therapeutic Effectiveness

The idea that improvement in a given skill or performance domain depends on practice is hardly new. Indeed, references to enhancing a person’s abilities through focused concentration and effort date back more than two millennia (1). Though the term, deliberate practice, includes the word, “practice,” it is altogether different. The goal is neither proficiency nor — read more
Getting in the Deliberate Practice HABIT

Type the words, “Old habits …” into Google, and the search engine quickly adds, “die hard” and “are hard to break.” When I did it just now, these were followed by two song titles — one by Hank Williams Jr., the other by Mick Jagger — both dealing with letting go of past relationships. Alas, in love — read more
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
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
Making Sense of Client Feedback

I have a guilty confession to make. I really like Kitchen Nightmares. Even though the show finished its run six L O N G years ago, I still watch it in re-runs. The concept was simple. Send one of the world’s best known chefs to save a failing restaurant. Each week a new disaster establishment was featured. A — read more
Getting Beyond the “Good Idea” Phase in Evidence-based Practice

The year is 1846. Hungarian-born physician Ignaz Semmelweis is in his first month of employment at Vienna General hospital when he notices a troublingly high death rate among women giving birth in the obstetrics ward. Medical science at the time attributes the problem to “miasma,” an invisible, poison gas believed responsible for a variety of illnesses. — read more
The Expert on Expertise: An Interview with K. Anders Ericsson

I can remember exactly where I was when I first “met” Swedish psychologist, K. Anders Ericsson. Several hours into a long, overseas flight, I discovered someone had left a magazine in the seat pocket. I never would have even given the periodical a second thought had I not seen all the movies onboard — many — read more
“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
Questions and Answers about Feedback Informed Treatment and Deliberate Practice: Another COVID-19 Resource

Since they were developed and tested back in the late 90’s, the Outcome and Session Rating Scales have been downloaded by practitioners more than 100,000 times! Judging by the number of cases entered into the three authorized software applications, the tools have been used inform service delivery for millions of clients seeking care for different — read more
Supervision: Time for a New Way or to Dump the Practice Altogether?

Therapists value supervision. How do we know? Research. In their massive, long-term international study of therapist development, for example, Orlinsky and Rønnestad (2005) found, “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). Regulatory boards deem supervision essential, in most jurisdictions — read more
The Baader-Meinhof Effect in Trauma and Psychotherapy

Have you heard of the “Baader-Meinhof” effect? If not, I’m positive you’ll soon be seeing evidence of it everywhere. That’s what “it” is, by the way — that curious experience of seeing something you’ve just noticed, been told of, or thought about, cropping up all around you. So … You buy a car and suddenly it’s — read more
Responsiveness is “Job One” in Becoming a More Effective Therapist

Look at the picture to the left. What do you see? In no time at all, most report a large face with deep set eyes and slight frown. Actually, once seen, it’s difficult, if not impossible to unsee. Try it. Look away momentarily then back again. Once set in motion, the process tends to take — read more
Learning Charisma

I entered university an accounting major. My first year, I took all the recommended courses: accounting theory, fundamentals of financial and managerial accounting, and so on. I’d likely be sitting in an office balancing company ledgers or completing tax documents had I never met Hal Miller. A Harvard-educated professor, Dr. Miller taught multiple sections of — read more
Mountains and Molehills, or What the JFK Assasination and the Therapeutic Relationship have in Common?

Over the last 10 days or so, I’ve been digesting a recently published article on the therapeutic alliance — reading, highlighting, tracking down references, rereading, and then discussing the reported findings with colleagues and a peer group of fellow researchers. It’s what I do. The particular study has been on my “to be read” pile — read more
Routine Outcome Monitoring and Deliberate Practice: Fad or Phenomenon?

Would you believe me if I told you there was a way you could more than double the chances of helping your clients? Probably not, eh? As I’ve documented previously, claims abound regaring new methods for improving the outcome of psychotherapy. It’s easy to grow cynical. And yet, findings from a recent study document when clinicians add — read more
Time for a New Paradigm? Psychotherapy Outcomes Stagnant for 40 years

You’ve heard it said before. Flying is the safest form of transportation. Facts back up the claim. In fact, it’s not even close. In terms of distance traveled, the fatality rate per billion kilometers is .003, improving dramatically over the years. Cars, by contrast, are almost 1,000 times more dangerous. Still, since 1923, the fatality rate in — read more
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
Science is Real (confusing)

The graphic above is a small sample of the many posts I encountered on social media last week. Obviously, science has a great deal of currency in public discourse. Now, look at the bottom row. On the far left, we are told that drinking wine will help you live a longer life. On the right, the exact opposite — read more
Just how good are our theories about the causes and alleviation of mental and emotional suffering?

Does the name Barry Marshall ring a bell? Probably not if you are a mental health professional. For decades, the Australian physician was persona non grata in the field of medicine — or perhaps stated more accurately, persona sciocca, a fool. Beginning in the early 1980’s, Marshall, together with colleague Robin Warren, advanced the hypothesis that the bacteria — read more
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
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
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
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
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
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
Would you rather . . . be approved or improved?

Some time ago, my son had a minor obsession. Whether at the dinner table, in the car, or out for a walk, he was constantly peppering us with, “would you rather” questions? You know the ones I mean, where you are forced to choose between two equally bizarre or unpleasant alternatives? “Would you rather always — read more
“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
The Asch Effect: The Impact of Conformity, Rebelliousness, and Ignorance in Research on Psychology and Psychotherapy

Consider the photo above. If you ever took Psych 101, it should be familiar. The year is 1951. The balding man on the right is psychologist, Solomon Asch. Gathered around the table are a bunch of undergraduates at Swarthmore College participating in a vision test. Briefly, the procedure began with a cardboard printout displaying three — read more
The Replication Crisis in Psychology: What is and is NOT being talked about

Psychology has been in the headlines a fair bit of late—and the news is not positive. I blogged about this last year, when a study appeared documenting that the effectiveness of CBT was declining–50% over the last four decades. The problem is serious. Between 2012 and 2014, for example, a team of researchers working together — read more