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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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Session Frequency and Outcome: What is the “Right Dose” for Effective Psychotherapy?
The last two years have been difficult. Whether through illness, death of loved ones, job loss, economic insecurity, or social isolation, few have escaped the consequences of the worldwide pandemic. While government and media attention has been focused on physical health, rates of anxiety and depression have soared (1). Younger people have been particularly impacted. … — 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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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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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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Far from Normal: More Resources for Feedback Informed Treatment in the Time of COVID-19
I hope this post finds you, your loved ones, and colleagues, safe and healthy. What an amazing few weeks this has been. Daily life, as most of us know it, has been turned upside down. The clinicians I’ve spoken with are working frantically to adjust to the new reality, including staying abreast of rapidly evolving… — 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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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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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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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 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
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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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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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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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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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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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What do clinicians want anyway?
What topics are practitioners interested in learning about? If you read a research journal, attend a continuing education event, or examine the syllabus from any graduate school course, you’re likely to conclude: (1) diagnosis; (2) treatment methods; and perhaps (3) the brain. As I’ve written previously about, the brain is currently a hot topic in… — read more
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Therapist Wanted: Dead or Alive
Do you get those letters about the top healthcare providers in your area? At the beginning of the new year, our city’s local magazine publishes a list of the top healthcare providers. It’s a big deal. Organized by location and specialty, the issue contains full-page photos, glossy spreads, and breezy write-ups. Impressive stuff with a… — read more
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Feedback Informed Treatment: Update
Chicago, IL (USA) The last two weeks have been a whirlwind of activity here in Chicago. First, the "Advanced Intensive." Next came the annual "Training of Trainers." Each week, the room was filled to capacity with practitioners, researchers, supervisors, and agency directors from around the globe receiving in-depth training in feedback-informed practice. It was a… — read more
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Ohio Update: Use of CDOI improves outcome, retention, and decreases "board-level" complaints
A few days ago, I received an email from Shirley Galdys, the Associate Director of the Crawford-Marion Alcohol and Drug/Mental Health Services Board in Marion, Ohio. Back in January, I blogged about the steps the group had taken to deal with the cutbacks, shortfalls, and all around tough economic circumstances facing agencies in Ohio. At… — read more