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Do Psychotherapists Improve with Time and Experience?
The practice known as “routine outcome measurement,” or ROM, is resulting in the publication of some of the biggest and most clinically relevant psychotherapy studies in history. Freed from the limits of the randomized clinical trial, and accompanying obsession with manuals and methods, researchers are finally able to examine what happens in real world clinical — read more
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Using Feedback Informed Treatment to Improve Medication Adherence and Reduce Healthcare Costs
Medication adherence is a BIG problem. According to recent research, nearly one-third of the prescriptions written are never filled. Other data document that more than 60% of people who actually go the pharmacy and get the drug, do not take it as prescribed. What’s the problem, you may ask? Inefficiency aside, the health risks are — read more
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Public Attitudes Toward Mental Health Services: A Change for the Worse
The results are not encouraging. A recent meta-analysis found that public attitudes toward psychotherapy have become progressively more negative over the last 40 years. The impact on practitioners is staggering. Between 1997 and 2007, use of psychotherapy declined by 35%. Not surprisingly, clinicians’ incomes also suffered, dropping 15-20% over the last decade. So, if not psychotherapy, what do — read more
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Is Supervision Important to you?
How valuable is clinical supervision to you? In their massive, long-term international study of therapist development, researchers Orlinsky and Rønnestad (2005) found that “practitioners at all experience levels, theoretical orientations, professions, and nationalities report that supervised client experience is highly important for their current and career development” (p. 188). Despite the value most of us place on — read more
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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
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Are you any good as a therapist? The Legacy of Paul W. Clement
Twenty years ago, I came across an article published in the journal, Professional Psychology. It was written by a psychologist in private practice, Paul Clement. The piece caught my eye for a number of reasons. First, although we’d never met, Paul lived and worked in Pasadena, California, a short ride from my childhood home. Second, the — read more
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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
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Feedback in Groups: New Tools, New Evidence
Groups are an increasingly popular mode for delivering behavioral health services. Few would deny that using the same hour to treat mutliple people is more cost effective. A large body of research shows it to be as effective in general as individually delivered treatments. Now clinicians can incorporate feedback into the group therapy using a brief, scientifically validated — read more
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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
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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
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A Handy "Little Helper" for the Outcome Rating Scale: A Freebie from the ACE Conference Committee
This last week the planning committee for the upcoming Achieving Clinical Excellence (ACE) conference meet once again in Horsholm, Denmark. In the picture from left to right: Liz Plutt, Bill Andrews, myself, Rick Plutt (Conference Chair), and Bogdan Ion. Taking the photo was Susanne Bargmann. The agenda for the three day event is now set: — read more
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The Outcome and Session Rating Scales: Support Tools
Japan, Sweden, Norway, Denmark, Germany, France, Israel, Poland, Chile, Guam, Finland, Hungary, Mexico, Australia, China, the United States…and many, many more. What do all these countries have in common? In each, clinicians and agencies are using the ORS and SRS scales to inform and improve behavioral health services. Some are using web-based systems for administration, — read more
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Looking Back, Looking Forward
Bidding goodbye to last year and welcoming the new always puts me in a reflective frame of mind. How did my life, work, and relationships go? What are my hopes for the future? Just two short years ago, together with colleagues from around the world, the International Center for Clinical Excellence (ICCE) was launched. Today,… — read more
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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
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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
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Getting FIT: The Advanced Intensive Training
Dateline: January 19, 2011 Buffalo, New York The New Year is here and travel/training season is in full swing. Last week, I was in Ohio and Virginia. This week New York and Idaho (keep your weather fingers crossed, it’s going to be dicey getting from here to there and home again). Interest in "Feedback Informed… — read more
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Finding Feasible Measures for Practice-Based Evidence
Let’s face it. Clinicians are tired. Tired of paperwork (electronic or othrwise). When I’m out and about training–which is every week by the way–and encouraging therapists to monitor and measure outcomes in their daily work few disagree in principle. The pain is readily apparent however, the minute the paper version of the Outcome Rating Scale flashes on the… — read more
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Bringing up Baseline: The Effect of Alliance and Outcome Feedback on Clinical Performance
Not long ago, my friend and colleague Dr. Rick Kamins was on vacation in Hawaii. He was walking along the streets of a small village, enjoying the warm weather and tropical breezes, when the sign on a storefront caught his eye. Healing Arts Alliance, it read. The proprieter? None other than, "Scott Miller, Master of… — read more
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Where Necessity is the Mother of Invention: Forming Alliances with Consumers on the Margins
Spring of last year, I traveled to Gothenburg, Sweden to provide training GCK–an top notch organization led by Ulla Hansson and Ulla Westling-Missios providing cutting-edge training on “what works” in psychotherapy. I’ll be back this week again doing an open workshop and an advanced training for the group. While I’m always excited to be out and about traveling… — read more
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Improving Outcomes in the Treatment of Obesity via Practice-Based Evidence: Weight Loss, Nutrition, and Work Productivity
Obesity is a large and growing problem in the United States and elswhere. Data gathered by the National Center for Health Statistics indicate that 33% Americans are obese. When overweight people are added to the mix, the figure climbs to a staggering 66%! The problem is not likely to go away soon or on its own as the same figures apply… — read more
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Behavioral Healthcare in Holland: The Turn Away from the Single-payer, Government-Based Reimbursement System
Several years ago I was contacted by a group of practitioners located in the largest city in the north of the Netherlands–actually the capital of the province known as Groningen. The "Platform," as they are known, were wondering if I’d be willing to come and speak at one of their upcoming conferences. The practice environment was undergoing dramatic change,… — read more
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Accountability in Behavioral Health: Steps for Dealing with Cutbacks, Shortfalls, and Tough Economic Conditions
As anyone who follows me on Twitter knows, I get around. In the past few months, I visited Australia, Norway, Sweden, Denmark (to name but a few countries) as well as criss-crossed the United States. If I were asked to sum up the state of public behavioral health agencies in a single word, the word–with very… — read more
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Research on the Outcome Rating Scale, Session Rating Scale & Feedback
"How valid and reliable are the ORS and SRS?" "What do the data say about the impact of routine measurement and feedback on outcome and retention in behavioral health?" "Are the ORS and SRS ‘evidence-based?’" These and other questions regarding the evidentiary support for the ORS, SRS, and feedback are becoming increasingly common in the workshops… — read more
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New Year’s Resolutions: Progress Report and Future Plans
One year ago today, I blogged about my New Year’s resolution to "take up the study of expertise and expert performance." The promise marked a significant departure from my work up to that point in time and was not without controversy. "Was I no longer interested in psychotherapy?" "Had I given up on the common factors? The… — read more
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The Study of Excellence: A Radically New Approach to Understanding "What Works" in Behavioral Health
"What works" in therapy? Believe it or not, that question–as simple as it is–has and continues to spark considerable debate. For decades, the field has been divided. On one side are those who argue that the efficacy of psychological treatments is due to specific factors (e.g., changing negative thinking patterns) inherent in the model of… — read more
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The Effects of Feedback on Medication Compliance and Outcome: The University of Pittsburgh Study
A number of years ago, I was conducting a workshop in Pittsburgh. At some point during the training, I met Dr. Jan Pringle, the director of the Program Evalutation Research Unit in the School of Pharmacy at the University of Pittsburgh. Jan had an idea: use outcome feedback to improve pharmacy practice and outcome. Every… — read more
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Climate Change in Denmark
Hans Christian Andersen, the author of such classic stories as The Ugly Duckling and the Emperor’s New Clothes, once wrote, "Life iteself is the most wonderful fairytale of all." That sentiment is certainly true of my own life. For the last 16 years, I’ve been privileged to travel around the world conducting trainings and providing consultation. Each year, I meet… — read more
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Where is Scott Miller going? The Continuing Evolution
I’ve just returned from a week in Denmark providing training for two important groups. On Wednesday and Thursday, I worked with close to 100 mental health professionals presenting the latest information on "What Works" in Therapy at the Kulturkuset in downtown Copenhagen. The training was sponsored by Solutions, an organization directed by Henrik and Mette Pedersen that… — read more
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Leading Outcomes in Vermont: The Brattleboro Retreat and Primarilink Project
For the last 7 years, I’ve been traveling to the small, picturesque village of Brattleboro, Vermont to work with clinicians, agency managers, and various state officials on integrating outcomes into behavioral health services. Peter Albert, the director of Governmental Affairs and PrimariLink at the Brattleboro Retreat, has tirelessly criss-crossed the state, promoting outcome-informed clinical work and organizing… — read more
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Outcomes in Ohio: The Ohio Council of Behavioral Health & Family Service Providers
Ohio is experiencing the same challenges faced by other states when it comes to behavioral health services: staff and financial cutbacks, increasing oversight and regulation, rising caseloads, unrelenting paperwork, and demands for accountability. Into the breach, the Ohio Council of Behavioral Health & Family Service Providers organized their 30th annual conference, focused entirely on helping… — read more