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Reducing Dropout and Unplanned Terminations in Mental Health Services
Being a mental health professional is a lot like being a parent. Please read that last statement carefully before drawing any conclusions! I did not say mental health services are similar to parenting. Rather, despite their best efforts, therapists, like parents, routinely feel they fall short of their hopes and objectives. To be sure, research… — 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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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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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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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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Becoming a more effective therapist: Three evidence-based clues from research on the field’s most effective practitioners
It’s one of those secrets everyone knows, but few talk openly about: some therapists are more effective than others. Available evidence indicates that clients seen by these practitioners experience 50% more improvement, 50% less drop out, have shorter lengths of stay, and are significantly less likely to deteriorate while in care. So, how do these… — 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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The Sounds of Silence: More on Research, Researchers, and the Media
A while ago, I wrote about an article that appeared in The Guardian, one of the U.K.’s largest daily newspapers. Citing a single study published in Denmark, the authors boldly asserted, “The claim that all forms of psychotherapy are winners has been dealt a blow.” Sure enough, that one study comparing CBT to psychoanalysis, found… — read more
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Evidence-based Practice is a Verb not a Noun
Evidence-based practice (EBP). What is it? Take a look at the graphic above. According to American Psychological Association and the Institute of Medicine, there are three components: (1) the best evidence; in combination with (2) individual clinical expertise; and consistent with (3) patient values and expectations. Said another way, EBP is a verb. Why then… — read more
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National Psychotherapy Day: A Recognition, Celebration, and Call for Action
With all the challenges facing the profession, it is important to highlight people and organizations that are working hard to make a difference. On that note, tomorrow, Tuesday the 25th of September 2012 is the very first National Psychotherapy Day. Having a day of unified, active promotion of psychotherapy is the brain child… — read more
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Is the "Summer of Love" Over? Positive Publication Bias Plagues Pharmaceutical Research
Evidence-based practice is only as good as the available "evidence"–and on this subject, research points to a continuing problem with both the methodology and type of studies that make it into the professional literature. Last week, PloS Medicine, a peer-reviewed, open access journal of the Public Library of Science, published a study showing a positive… — read more
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Goodbye Mr. & Ms. Know-it-All: Redefining Competence in the Era of Increasing Complexity
Every day behavioral health professionals make hundreds of decisions. As experts in the field, they meet and work successfully with diverse clients presenting an array of different difficulties. Available evidence indicates that the average person who receives care is better off than 80% of those with similar problems that do not. Outcomes in mental… — read more
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Pushing the Research Envelope: Getting Researchers to Conduct Clinically Meaningful Research
At the recent ACE conference, I had the pleasure of learning from the world’s leading experts on expertise and top performance. Equally stimulating were conversations in the hallways between presentations with clinicians, policy makers, and researchers attending the event. One of those was Bill Andrews, the director of the HGI Practice Research Network in the UK who… — 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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What Works in the Treatment of Post Traumatic Stress Disorder? The Definitive Study
What works in the treatment of people with post-traumatic stress? The influential Cochrane Collaboration–an "independent network of people" whose self-professed mission is to help "healthcare providers, policy makers, patients, their advocates and carers, make well-informed decisions, concludes that, "non trauma-focused psychological treatments [do] not reduce PTSD symptoms as significantly…as individual trauma focused cognitive-behavioral therapy (TFCBT), eye… — read more
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Error-centric Practice: How Getting it Wrong can Help you Get it Right
It’s an idea that makes intuitive sense but is simultanesouly unappealing to most people. I, for one, don’t like it. What’s more, it flies in the face of the "self-esteem" orientation that has dominated much of educational theory and practice over the last several decades. And yet, research summarized in a recent issue of Scientific American… — read more
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Eruptions in Europe and in Research
Dateline: 11:20 am, April 18th, 2010 Today I was supposed to fly from Stockholm, Sweden to the far northern town of Skelleftea–a flight that takes a little over an hour. Instead, I’m sitting on a train headed for Sundsvall, the first leg of a 12 hour trip that will include a 6 hour bus ride… — read more
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Problems in Evidence-Based Land: Questioning the Wisdom of "Preferred Treatments"
This last week, Jeremy Laurance, Health Editor for the U.K. Independent published an article entitled, “The big question: Does cognitive therapy work? And should the NHS (National Health Service) provide more of it?” Usually such questions are limited to professional journals and trade magazines. Instead, it ran in the “Life and Style” section of one of Britain’s… — read more
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Are all treatments approaches equally effective?
Bruce Wampold, Ph.D. Late yesterday, I blogged about a soon-to-be published article in Clinical Psychology Review in which the authors argue that the finding by Benish, Imel, & Wampold (2008) of equivalence in outcomes among treatments for PTSD was due to, "bias, overgeneralization, lack of transparency, and poor judgement." Which interpretation of the evidence is correct? Are there… — read more