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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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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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Please, don’t use my scales…
Or, at least that’s what I said in response to his question. The look on his face made clear my words caused more confusion than clarity. “But then, how will I found out which of the therapists at my agency are effective?” he asked. “The purpose of FIT,” I replied, “is not to profile, but rather… — 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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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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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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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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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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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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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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“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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What is the essential quality of effective Feedback? New research points the way
“We should not try to design a better world,” says Owen Barder, senior fellow at the Center for Global Development, “We should make better feedback loops.” Feedback has become a bit of a buzzword in mental health. Therapists are being asked to use formal measures of progress and the quality of the relationship and use… — 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
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Implementing Feedback Informed Treatment
What do the Sydney Opera House, Boston Central Artery Tunnel, and Eurozone Typhoon Defense Project all have in common? In each case, their developers suffered from, “The Planning Fallacy” (PF). First recognized in 1979 by Nobel Prize winning psychologists Daniel Kahneman and Amos Tversky, the planning fallacy is the all too human tendency to underestimate… — read more
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Is Documentation Helping or Hindering Mental Health Care? Please Let me know.
So, how much time do you spend doing paperwork? Assessments, progress notes, treatment plans, billing, updates, etc.–the lot? When I asked the director of the agency I was working at last week, it took him no time to respond. “Fifty percent,” he said, then added without the slightest bit of irony, “It’s a clinic-wide goal,… — read more
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What can therapists learn from the CIA? Experts versus the "Wisdom of the Crowd"
What can we therapists learn from the CIA? In a phrase, “When it comes to making predictions about important future events, don’t rely on experts!” After a spate of embarrassing, high-profile intelligence failures, a recent story showed how a relatively small group of average people made better predictions about critical world events than highly-trained analysts with access to classified information. … — read more
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Cutting Edge Feedback
Earth | Time Lapse View from Space, Fly Over | NASA, ISS Using feedback to guide and improve the quality and outcome of behavioral health services is growing in popularity. The number of systems available for measuring, aggregating, and interpreting the feedback provided by consumers is increasing. The question, of course, is, "which is best?" … — read more
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Changing Home-Based Mental Health Care for Good: Using Feedback Informed Treatment
Modified Arnold Woodruff & Kathy Levenston Some teach. Some write. Some publish research. Arnold Woodruff and Kathy Levenston work for a living! Kathy Levenston specializes in working with foster and adopted children. Arnold Woodruff developed the first intensive in-home program run by a community services board in Virginia. He has over 30 years of experience, and has served as… — read more
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Getting FIT in the New Year: The Latest Evidence
John Norcross, Ph.D. is without a doubt the researcher that has done the most to highlight the evidence-base supporting the importance of the relationship between clinician and consumer in successful behavioral healthcare. The second edition of his book, Psychotherapy Relationships that Work, is about to be released. Like the last edition, this volume is a virtual… — read more
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The Impact of Mentors
Brendan Madden Scott D. Miller Jeffrey K. Zeig A little over month ago, I blogged about how the outcome and session rating scales were originally conceived of and developed. A few days prior to that, I wrote about where the whole idea of using measures to solicit feedback had started. In both instances, my teachers and supervisors played a… — read more
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Why ongoing, formal feedback is critical for improving outcomes in healthcare
Not long ago, I had a rather lengthy email exchange with a well-known, high profile psychotherapist in the United States. Feedback was the topic. We both agreed that feedback was central to successful psychotherapy. We differed, however, in terms of method. I argued for the use of simple, standardized measures of progress and alliance (e.g., ORS and SRS). In support… — read more