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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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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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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
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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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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
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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
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What does losing your keys have in common with the treatment of trauma?
Last week, I was preparing to leave the house and could not locate my keys. Trust me when I say, it’s embarrassing to admit this is not an infrequent occurrence. Logic and reason are always my first problem solving choices. That’s why I paused after looking in the kitchen drawer where I am supposed to… — read more
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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
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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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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
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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
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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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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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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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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 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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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
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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
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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