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The Most Important Psychotherapy Book
Late last year, I began a project I’d been putting off for a long while: culling my professional books. I had thousands. They filled the shelves in both my office and home. To be sure, I did not collect for the sake of collecting. Each had been important to me at some time, served some — read more
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How not to be among the 70-95% of practitioners and agencies that fail
Our field is full of good ideas, strategies that work. Each year, practitioners and agencies devote considerable time and resources to staying current with new developments. What does the research say about such efforts? When it comes to the implementation of new, evidence-based practices, traditional training strategies routinely produce only 5% to 30% success rates. Said another way, 70-95% of training fails — read more
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What to Pay Attention to in Therapy?
A week or so ago, I received an email from my friend, colleague, and mentor Joe Yeager. He runs a small listserve that sends out interesting and often provocative information. The email contained pictures from a new and, dare I say, ingenious advertising campaign for Colgate brand dental floss. Before I give you any of — read more
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Curing Clinician Overconfidence: Try Darting and Frowning
Overconfidence. It’s a problem that leads to systematic errors in judgement. Long thought to arise out of hubris or the corrupting effects of the emotion, the evidence actually shows it to be built into humans’ evolved cognitive machinery. Existimo ergo certus sum (I think, therefore I am…certain). Behavioral health professionals are not immune. The first — read more
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Dealing with Scientific Objections to the Outcome and Session Rating Scales: Real and Bogus
The available evidence is clear: seeking formal feedback from consumers of behavioral health services decreases drop out and deterioration while simultanesouly improving effectiveness. When teaching practitioners how to use the ORS and SRS to elicit feedback regarding progress and the therapeutic relationship, three common and important concerns are raised: How can such simple and brief scales provide — read more
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The Importance of "Whoops" in Improving Treatment Outcome
“Ring the bells that still can ring, Forget your perfect offering There is a crack in everything, That’s how the light gets in.” Leonard Cohen, Anthem Making mistakes. We all do it, in both our personal and professional lives. “To err is human…,” the old saying goes. And most of us say, if asked, that we agree — read more
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What is the Real Source of Effectiveness in Smoking Cessation Treatment? New Research on Feedback Informed Treatment
When it rains, it pours! Growing interest in FIT is leading to the publication of research articles on its application in different contexts — an article on using the ORS and SRS in smoking cessation treatment, another a long-awaited article on the validity and reliability of the Group Session Rating Scale, and finally, a piece — 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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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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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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The World Did Not End: What it a Bad Thing?
May 25th, 2011 Chicago, Illinois On Saturday the 21st of May, 2011 the world was supposed to come to an end. It did not. My question: was that a bad thing? Would it have been better if, as the now twice wrong Prophet Harold Camping predicted, the world had ended. In the world of public… — 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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The Effects of Feedback on Medication Compliance and Outcome: Follow Up on The University of Pittsburgh Study
Late last year, I blogged about a study being conducted at the University of Pittsburgh by Dr. Jan Pringle, the director of the Program Evalutation Research Unit in the School of Pharmacology and her colleague, Dr. Michael Melczak. You’ll recall, there were two conditions in the study. In the first, pharmacists–the practitioner most likely to interact… — 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
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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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Feedback Informed Treatment (FIT): A Worldwide Trend in Behavioral Health
In my prior blogpost, I reviewed exciting developments taking place throughout Canada regarding "feedback-informed treatment" (FIT). For those following me on Twitter–and if you’re not, please do so by clicking on the link–you already know that last week I was in Tunbridge, England for a two day training sponsored by the Kent-Medway National Healthcare Trust on "Supershrinks: Learning from the Fields… — read more
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After the Thrill is Gone: Sustaining a Commitment to Routinely Seeking Feedback
Helsingor Castle (the setting for Shakespeare’s Hamlet) Dateline: May 8th, 2010, Helsingor, Denmark This weekend I’m in Denmark doing a two-day workshop on "Supershrinks" sponsored by Danish psychologist and ICCE Senior Associate and Trainer Susanne Bargmann. Just finished the first day with a group of 30 talented clinicians working diligently to achieve their personal best. The… — read more
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Feedback, Friends, and Outcome in Behavioral Health
My first year in college, my declared major was accounting. What can I say? My family didn’t have much money and my mother–who chose my major for me–thought that the next best thing to wealth was being close to money. Much to her disappointment I switched from accounting to psychology in my softmore year. That’s when I first met Dr. Michael Lambert.… — read more
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ICCE Membership Hits 1000!
Just yesterday, the membership of the International Center for Clinical Excellence burst through the 1000 mark, making it the largest community of behavioral health professionals dedicated to excellence and consumer-driven, outcome-informed clinical practice (CDOI). And there’s more news…click on the video below. — 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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"What Works" in Holland: The Cenzo Experience
When it comes to healthcare, it can be said without risk of exaggeration that "revolution is in the air." The most sweeping legislation in history has just been passed in the United States. Elsewhere, as I’ve been documenting in my blogs, countries, states, provinces, and municipalities are struggling to maintain quality while containing costs of… — read more
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Is Professional Training a Waste of Time?
Every year, thousands of students graduate from professional programs with degrees enabling them to work in the field of behavioral health. Many more who have already graduated and are working as a social worker, psychologist, counselor, or marriage and family therapist attend—often by legal mandate—continuing education events. The costs of such training in terms of time and… — read more