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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
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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
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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
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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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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
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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
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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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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
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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
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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
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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
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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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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
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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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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
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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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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
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The Cryptonite of Behavioral Health: Making Mistakes
Most people readily agree that its important to "learn from mistakes." In truth, however, few actually believe it. Mistakes are like cryptonite, making us feel and, more importantly, look stupid and weak. As a result, despite what we might advise others, we do our best to avoid making and admitting them. Such avoidance comes with… — read more
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Connecting, Learning, and Sharing: The ICCE at One Year
September 7, 2010 Chicago, Illinois USA I can’t believe it. Summer is over. Kids are back in school. And the International Center for Clinical Excellence (ICCE) is celebrating its one year anniversary! Time passes so quickly. On August 24th, 2009, I blogged about the creation of a web-based community of clinicians using the latest Web2.0 technology where… — read more
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Error-centric Practice: How Getting it Wrong can Help you Get it Right
It’s an idea that makes intuitive sense but is simultanesouly unappealing to most people. I, for one, don’t like it. What’s more, it flies in the face of the "self-esteem" orientation that has dominated much of educational theory and practice over the last several decades. And yet, research summarized in a recent issue of Scientific American… — read more
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So you want to be a better therapist? Take a hike!
How best to improve your performance as a clinician? Take the continuing education mutliple-choice quiz: a. Attend a two-day training; b. Have an hour of supervision from a recognized expert in a particular treatment approach; c. Read a professional book, article, or research study; d. Take a walk or nap. If you chose a, b,… — read more
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The Road to Clinical Excellence is Paved with Practice, Mistakes, & Hard Work
Last week, I received an email from friend and ICCE member David Claud. I’ve known Dave for the better part of a decade, having met–I believe–at a Ericksonian conference in Florida where he lives and works. He and the crew at the Center for Family Service in Palm Beach County figure prominently in the history… — read more
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Learning, Mastery, and Achieving One’s Personal Best
Dateline: Sunday, April 25th, 2010 Chicago, IL There’s a feeling I get whenever I’m learning something new. It’s a combination of wonder and possibility. Even though I’ve been traveling and teaching full time for over 18 years, I still feel that get that feeling of excitement whenever I step on a plane: What will I see? Who will… — read more
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Deliberate Practice, Expertise, & Excellence
Later today, I board United flight 908 on my way to workshops scheduled in Holland and Belgium. My routine in the days leading up to an international trip is always the same. I slowly gather together the items I’ll need while away: computer (check); european electric adapter (check); presentation materials (check); clothes (check). And, oh yeah, two decks of playing cards… — read more
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International "Achieving Clinical Excellence" Conference
Mark your calendars! The International Center for Clinical Excellence is pleased to announce the “Achieving Clinical Excellence” (ACE) conference to be held at the Westin Hotel in Kansas City, Missouri on October 20-22nd, 2010. K. Anders Erickson, Ph.D., the editor of The Cambridge Handbook of Expertise and Expert Performance and recognized “expert on experts,” will keynote… — read more
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Excellence in Behavioral Health in Arizona
For those of you following me on Twitter (and if you’re not already, please do as it’s a blast), you know I was teaching at the 41st Annual Southwestern School for Behavioral Health Studies. First, let me express my appreciation to the Board and Michelle Brown for bringing me to Tucson to present on “Achieving… — read more