Feedback Informed Treatment – FIT – Page 4 – Scott D.Miller

Aren’t You the Anti-Evidence-Based Practice Guy? My Socks. And Other Crazy Questions.

It’s just two weeks ago. I was on a call with movers and shakers from a western state. They were looking to implement Feedback Informed Treatment (FIT)–that is, using measures of progress and the therapeutic relationship to monitor and improve the quality and outcome of mental health services. I was in the middle of reviewing — read more
What Works in Psychotherapy? Valuing “What Works” rather than Working with What We Value

Most clinicians agree, the therapeutic relationship is an important ingredient in effective psychotherapy. However, ask them the last time they: (1) read a study on the subject; (2) attended a postgraduate training specifically aimed at improving their skills in this area; or simply to (3) identify and define the factors contributing to an effective relationship, — read more
“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
What heals trauma?

“Exposure!” a choir of professional voices sings, “its the only proven way.” “No, no,” others insist, “You can tap yourself to emotional freedom.” “Poppycock!” another group jumps in, “Horizontal saccadic eye movements are the ticket!” “Beware the dominant discourse,” a few, particularly literate warn, “focusing on what was done to the person can retraumatize, help them — 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
Psychotherapy’s Most Closely Held Secret: Some Practitioners are more Effective than Others

Take a good look at the picture below. Do you recognize this person? Let me give you a hint. In 1974, he published the first empirical study documenting one of psychotherapy’s most closely held secrets: some therapists are more effective than others. It’s true. You know it. I know it. Everyone knows it. We just don’t — 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
I have some magic beans for sale…you want them?

So, you’re out for a walk. It’s a beautiful day but you’re caught up in your thoughts, feeling a bit discouraged and concerned. For whatever reason, some of the people you are working with aren’t improving. You’re no novice clinician. You know impasses are a common feature of therapeutic work. Still, this time your knowledge — read more
Implementation: The KEY to Improving the Effectiveness of Psychotherapy

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Who cares about you anyway? The Role of the Psychotherapist in the Era of Evidence-based Practice

Which of the following are bad for health and longevity? A. Smoking; B. Consuming too much alcohol; C. Being overweight; D. Not flossing regularly. If you answered “yes” to any or all of the items, you are WRONG–that is, at least, if you are determined to rely on evidence derived from randomized controlled trials (RCT’s) — read more
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
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
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
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
We Need MORE Drugs, Right?

Being human means being conscious. Being conscious means knowing, “reality bites.” Little wonder evidence shows people have sought to alter their consciousness since the Stone Age. Whether its music, dance, the ingestion of psychoactive plants, or the modern pharmaceuticals, humans evince a strong desire to move beyond their present reality–to transcend it, even if only — 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
Brave or Foolhardy? Dramatic Implications of a New Psychotherapy Outcome Study

Does diagnosis matter? What about the treatment approach? Applying particular therapeutic methods to specific psychiatric diagnoses is the considered by many a “best practice”–the core of what some label, “empirically-supported” (EST) or “evidence-based psychological treatments” (EBPT). Now, imagine a place where diagnosis and prescriptive protocols are not required or even considered essential to clinical practice. — read more
“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
From Evidence-based Practice to Cultural Change: Steps to Successful Implementation

Chances are your are carrying a smartphone–maybe you’re even reading this post on your Android or Iphone! One thing I’m almost certain of is that the device you own–can’t live without–is not a Nokia. The nearly complete absence of the brand is strange. Not long ago, the company dominated the mobile phone market. At one time, — 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
Improving Individual Therapist Effectiveness

Take a look at the figure to the right. It’s data taken from the largest study conducted in the history of psychotherapy research examining the relationship between experience and effectiveness. Each of the smaller lines represents the outcomes of an individual practitioner followed, in some cases, over a 17-year period. The single, thicker, dashed-line plots the — 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
How Deliberate Practice can Improve Your Therapeutic Effectiveness

In 2015, colleagues and I released the largest, longitudinal study of therapist effectiveness ever published. The study examined outcomes of 6500 clients treated by 170 practitioners whose results had been tracked an average of 5 years—some as long as 17 years! The result? Clinician outcomes, on average, not only did not improve, but actually slowly — read more
“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
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