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Agape
Over the last several months, I’ve been writing a series of short, but true stories from my life and work. I’ve been surprised by and am grateful for the positive response. All of the stories can be found on my substack account, called “Snippets.” Here’s one from early on in my career, a lesson about — read more
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A not so helpful, helping hand
“Your reach should exceed your grasp,” was one of my dad’s favorite sayings. Smile on his face, he would often add, “be prepared to end up empty handed” – which reminds me of a memory. I was seated on the right side of the room, in the aisle seat, second row from the front. As — read more
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Alas, it seems everyone comes from Lake Wobegon
You’ve heard of it, right? Lake Wobegon? The fictional town in Minnesota made famous by master story-teller, Garrison Keller. The place where, “all the people are strong, good-looking, and above average?” Turns out, if the city were “Psychotherapy,” it would not be a fictional place. Since 2012 when the first study appeared in the literature, — 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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“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
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“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
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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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“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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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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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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An Easy Way to Improve Our Schools (and Psychotherapy)
There is this article that appeared a while ago in the Atlantic Monthly that stuck with me. In it, Amanda Ripley detailed a simple and straightforward method for improving the performance of the public schools: have kids grade teachers. What kind of grades you ask? Not those on standardized achievement tests, and certainly not measures of — read more
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The Revolution in Sweden: More Evidence and A Brief Follow Up
On May 13th, I blogged about a change in guidelines for clinical practice in Sweden. As in many other countries, CBT enjoyed near exclusive status as "evidence-based" on most official lists of approved treatments. Billions of Swedish crowns were spent on the approach that ultimately had no effect on the outcome of people treated… — read more
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A Lotta Help from One’s Friends: The Role of Community in the Pursuit of Excellence
Dateline: Chicago, IL USA Hard not to be impressed with the USA Women’s Gymnastic team. What skill, percision, expertise, and excellence. By now, I’m sure you’ve seen the interviews. In all instances, each and every one has focused on the team. Despite some in the media attempting to make stars out of the individual members,… — read more
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The International Center for Clinical Excellence: Using Social Networks for "Real Time" Research
The International Center for Clinical Excellence was officially lauched at the Evolution of Psychotherapy Conference in December 2009. Since that time, membership has grown steadily. With over 3800 members, the ICCE is the largest, web-based community of behavioral health professionals dedicated to improving the quality and outcome of service delivery. The site features nearly… — read more
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Mental Health Practice in a Global Economy
Did you feel it? The seismic shift that occurred in field of mental health just a little over a month ago? No? Nothing? Well, in truth, it wasn’t so much a rip in the space-time continuum as a run. That "run," however, promises to forever alter the fabric of clinical practice–in particular how clinicians earn… — read more
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A Progress Report on the Science (and Art ) of Psychotherapy: The Psychotherapy Networker 30th Anniversary Edition
The 30th Anniversary Edition of the Psychotherapy Networker has hit newsstands. In it, is an article by Diane Cole taking the measure of psychotherapy. Her question? Has the field gotten any better over the last three decades? The entire issue is a "must read," starting with editor Rich Simon’s lengthy and thought provoking editorial, "Still… — read more
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Optum Health and the ICCE: Partnering to Achieve Excellence in Behavioral Health
Monday, November 28th, 2011 Chicago, IL & Goldern Valley, MN The members, associaties, and directors of the International Center for Clinical Excellence are proud to announce a partnership with Optum Health’s Campaign for Excellence. Optum Health works with employers, payers, and providers serving nearly 60,000,000 people. Their "Campaign for Excellence (CFE)" was specifically designed to… — read more
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Feedback-Informed Treatment as Evidence-based Practice: APA, SAMSHA, and NREPP
What is evidence-based practice? Visit the UK-based NICE website, or talk to proponents of particular theoretical schools or therapeutic models, and they will tell you that being "evidence-based" means using the approach research has deemed effective for a particular diagnosis (e.g., CBT for depression, EMDR for trauma). Over the last two decades, numerous organizations and… — read more
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Achieving Clinical Excellence Conference 2013: CALL FOR PAPERS
Horsholm, Denmark Spent the weekend with the planning committe for the 2013 Achieving Clinical Excellence Conference. Committee members came in from all over the world–the USA, Romania, Holland, the UK, and Denmark–to finalize speakers, the conference venue, and mock up the logo for the conference brochure and advertizing. Like last time, we are not only bringing in the… — 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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Becoming FIT: Simple but not Easy
Becoming FIT (feedback informed in treatment). Ask any experienced practitioner and they will tell you, "it’s such a simple idea, but it’s not easy." In addition to the time it takes to master the administration and interpretation of formal feedback, special skills are required for using the information to guide service delivery. Implementation in agencies… — read more
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Growing by Leaps and Bounds: ICCE Membership Nearing 2000!
In December 2009, the International Center for Clinical Excellence was officially launched. From our booth at the Evolution of Psychotherapy conference, the international web-based community "went live," adding hundreds of members in a few days. By April, as I reported in my blog, over 1000 clinicians, researchers, policy makers, and adminsitrators had joined the site, making… — read more
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Am-ACE-ing Events in Kansas City: The First International Achieving Clinical Excellence Conference
Here’s a riddle for you: What do therapists, researchers, case managers, magicians, surgeons, award winning musicians, counselors, jugglers, behavioral health agency directors, and balloon twisting artists have in common? Answer: They all participated in the first "Achieving Clinical Excellence" held last week in Kansas City, Missouri. It’s true. The "motley" crew of presenters, entertainers, and attendees came to Kansas… — read more
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What is "Best Practice?"
You have to admit the phrase “best practice” is the buzzword of late. Graduate school training programs, professional continuing education events, policy and practice guidelines, and funding decisions are tied in some form or another to the concept. So, what exactly is it? At the State and Federal level, lists of so-called “evidence-based” interventions have been assembled and… — read more
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No Therapist Left Behind: Improving the Quality and Outcome of Behavioral Health Services One Practitioner at a Time
Staying “up-to-date” isn’t easy in today’s practice environment. In these lean economic times, training budgets are often the first to be cut. On the other hand, trying to separate the “important” from “irrelevant” in our information-rich age can be, as Mitchell Kapor once observed, “a bit like trying to get a drink from a fire hydrant.” … — read more
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Implementing Consumer-Driven, Outcome-Informed (CDOI) Behavioral Health Services: The ICCE and 2010 Training of Trainers Event
This week I’m in Calgary, Canada. Last week, I was in Charleston, South Carolina. Next week, I’ll be in Marion, Ohio and Bay city, Michigan. In each instance, I’m working with the management and staff of public behavioral health agencies that are busy implementing consumer-driven, outcome-informed clinical work. Some of the groups are just beginning… — read more