evidence based practice – Scott D.Miller

Want to be more effective? Point North!

Sime time ago, while on a flight, I watched a program from the Discovery Channel about the North American red fox. The furry little creatures were shown hunting rodents hidden under three feet of snow. Three feet! Up in the air the foxes would hop, thrusting their noses deep into the drifts. Most of the time, — read more
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
What’s in an Acronym? CDOI, FIT, PCOMS, ORS, SRS … all BS?

“What’s in a name?” –William Shakespeare A little over a week ago, I received an email from Anna Graham Anderson, a graduate student in psychology at Aarhus University in Denmark. “I’m writing,” she said, “in hopes of receiving some clarifications.” Without reading any further, I knew exactly where Anna was going. I’d fielded the same — read more
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
Good News and Bad News about Psychotherapy

Have you seen this month’s issue of, “The National Psychologist?” If you do counseling or psychotherapy, you should read it. The headline screams, “Therapy: No Improvement for 40 Years.” And while I did not know the article would be published, I was not surprised by the title nor it’s contents. The author and associate editor, — read more
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
The Revolution in Swedish Mental Health Services: UPDATE on the CBT Monopoly

No blogpost I’ve ever published received the amount of attention as one back in 2012 detailing changes to Swedish Mental Health practice. At the time, I reported about research results showing that the massive investment of resources in training therapists in CBT had not translated into improved outcomes or efficiency in the treatment of people with — read more
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
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
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
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
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
Psychotherapy Training: Is it Worth the Bother?

Big bucks. That’s what training in psychotherapy costs. Take graduate school in psychology as an example. According to the US Department of Education’s National Center (NCES), a typical doctoral program takes five years to complete and costs between US$ 240,000-300,000.00. Who has that kind of money laying around after completing four years of college? The… — read more
Obesity Redux: The RFL Results and complex Nature of Truth and Science

Back in April, I blogged about research published by Ryan Sorrell on the use of feedback-informed treatment in a telephonically-divered weight management program. The study, which appeared in the journal Disease Management*, not only found that the program and feedback led to weight loss, but also significant improvements in distress, health eating behaviors (70%), exercise (65%), and presenteeism on… — read more
Feedback Informed Treatment as Evidence-Based Practice

Back in November, I blogged about the ICCE application to SAMSHA’s National Registry for consideration of FIT as an official evidence-based approach (EBP). Given the definition of EBP by the Institute of Medicine and the American Psychological Association, Feedback Informed Treatment seems a perfect, well, FIT. According to the IOM and APA, evidence-based practice means… — read more
Revolution in Swedish Mental Health Care: Brief Update

In April 2010, I blogged about Jan Larsson, a Swedish clinician who works with people on the margins of the mental health system. Jan was dedicated to seeking feedback, using the ORS and SRS to tailor services to the individuals he met. It wasn’t easy. Unilke most, he did not meet his clients in an… — read more
Revolution in Swedish Mental Health Practice: The Cognitive Behavioral Therapy Monopoly Gives Way

Sunday, May 13th, 2012 Arlanda Airport, Sweden Over the last decade, Sweden, like most Western countries, embraced the call for “evidence-based practice.” Socialstyrelsen, the country’s National Board of Health and Welfare, developed and disseminated a set of guidelines (“riktlinger”) for mental health practice. Topping the list of methods was, not surprisingly, cognitive-behavioral therapy. The Swedish… — read more
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
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
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
Psychologist Alan Kazdin Needs Help: Please Give

Look at this picture. This man needs help. He is psychologist, Alan Kazdin, former president of the American Psychological Association, and current Professor of Psychology at Yale University. A little over a week ago, to the surprise and shock of many in the field, he disclosed a problem in his professional life. In an interview… — read more
The ICCE Feedback-Informed Treatment Manuals

September 12, 2011 Copenhagen, Denmark Fall is in the air. For me, that means the start of the travel season. For the next two weeks, I’ll be traveling throughout Scandanavia–this week in Denmark and Norway. It’s great to be back on the road meeting clinicians and consulting with agencies about feedback-informed treatment (FIT). On… — read more
Becoming FIT: The 2011 Training of Trainers

August 10th, 2011 Chicago, IL The first week of August was one of the hottest weeks on record in Chicago. It was also the location of the hottest training on "feedback-informed treatment" (FIT)–the 5th Annual "Training of Trainers" weeklong intensive training. We worked intensively over 5 days preparing an international group of administrators, supervisors, researchers, and… — read more
Yes, More Evidence: Spanish version of the ORS Validated by Chilean Researchers

Last week, Chile. This week, Perth, Australia. Yesterday, I landed in Sydney following a 30 hour flight from the United States. I managed to catch the last flight out to Perth before all air travel was grounded due to another ash clound–this time coming from Chile! I say "another" as just over a year ago,… — read more
How Much More Evidence Is Needed? A New Meta-Analysis on Feedback-Informed Treatment

Received an email from friend and colleague John Norcross, Ph.D. Attached were the results of a meta-analysis completed by Michael Lambert and Kenichi Shimokawa on Feedback-Informed Treatment (FIT) which will appear in the second edition of his book, Psychotherapy Relationships that Work (Oxford University Press). For those who cannot wait, you can access the same results… — read more
The Mystery of Mastery: Excellence Takes Center Stage in the Psychotherapy Networker

The Psychotherapy Networker has long been the most popular periodical among practicing clinicians. Rumor has it that the magazine has 80,000+ subscribers and sells over 120,000 copies of each issue. If you want to know what therapists are thinking and talking about, the Networker magazine is the place to look. And in the May/June issue,… — read more
The Cryptonite of Behavioral Health: Making Mistakes

Most people readily agree that its important to "learn from mistakes." In truth, however, few actually believe it. Mistakes are like cryptonite, making us feel and, more importantly, look stupid and weak. As a result, despite what we might advise others, we do our best to avoid making and admitting them. Such avoidance comes with… — read more
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
The Growing Evidence Base for Feedback-Informed Treatment (FIT)

Dateline: February 2, 2011 Location: Anchorage, AK Greetings from Anchorage, Alaska where I’ve been traveling and teaching about feedback-informed treatment (FIT). On Monday, I worked with dedicated behavioral health professionals living and working in Barrow–the northern most point in the United States. FIT has literally reached the "top of the world." How incredible is that? Here… — read more
The War on Unhappiness Heats Up

Back in September, I blogged about an article by Gary Greenberg published in the August issue of Harper’s magazine that took aim at the "helping profession." He cast a critical eye on the history of the field, it’s colorful characters, constantly shifting theoretical landscape, and claims and counterclaims regarding "best practice." Several paragraphs were devoted to my own work; specifically, research documenting the relatively inconsequential role that particular treatment approaches play… — read more