The Skill that Heals, or Kills…

October 2, 2019 By scottdm 1 Comment

Imagine a power so great that those who possess it are able to heal the sick, and those without it, cause death. By definition, it would qualify as a superpower — and, in fact, one Marvel comic character has claimed this one for their own.

More than seven dozen studies have investigated the impact of this “power” on the outcome of psychotherapy, finding that it contributes nine times more to success than whatever treatment method is employed (1 [see table, p. 258]). And now, a population-based study out of the UK has shown that diabetic patients whose physicians wield this special power have a lower risk of cardiovascular events and mortality.

Strangely, while the evidence shows this ability can be greatly enhanced with proper instruction (1), little time is spent in graduate or medical schools helping students acquire or refine it. The trend continues after formal training. For example, search the web for continuing education on the subject and the offerings are few and far between. And finally, if you think clinical experience contributes to the development of the skill, think again. Despite widespread belief to the contrary, time is not a good teacher, with studies showing no correlation between the strength of the power and the number of years a practitioner has been in the field.

So, what exactly is the “it” we are talking about?

Notice your reaction when I tell you…

EMPATHY

Skeptical? Surprised? Bemused? Knew it all along?

Whatever your response, the documented power of empathy to heal (or harm) makes clear more attention to the skill is warranted in our professional development efforts. What steps can clinicians take in this regard? A recent meta-analysis containing every study on the subject to date concludes, since “clients’ reports of therapist empathy best predict eventual treatment outcome, … regularly assessing … the client’s experience of empathy, instead of trying to intuit whether therapist behavior is empathic or not” is key.

Regularly assessing the client’s experience instead of trying to intuit.

Two decades ago, my colleagues and I developed a brief tool to do just that. Known as the Session Rating Scale, or SRS, it’s been vetted in numerous clinical trials and shown to be a valid and reliable way for clinicians to solicit feedback from clients regarding the quality of the therapeutic relationship (including empathy).

If you don’t already have a copy, you can get yours free by clicking here. Several web-based systems exist for administering and interpreting the data you gather, all of which offer free trials. More, a brand new book, and series of “how-to” manuals are available which provide step-by-step directions for using the scale in diverse settings and populations. Finally, registration for two training workshops is now open where you can get hands on training on using the measure to improve your therapeutic effectiveness. Each year, these events fill up months advance. Click here for more information.

That’s it for now!

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

P.S.: The photo at the outset of this post displays two cards from the Thoth Tarot: (1) The Lovers; and (2) Death. The first is about the possibilities inherent in uniting through love and acceptance. The second, about transformation. Sounds like psychotherapy, eh?

Very Bad Therapy (And how it can make you a more effective therapist)

September 18, 2019 By scottdm 4 Comments

Plug “psychotherapy” into the Amazon search engine and you get 60,000 hits for books, manuals, worksheets, and videos. Clearly, when it comes to “how to do it,” our field is rich with resources.

However, if you enter the words, “failure in psychotherapy” the number drops to 75, less than 20 of which are actually on topic.

TWENTY.

How to interpret such results when research shows 50% of people who enter treatment fail to benefit in any meaningful way? The numbers being what they are, it’s hard to come to any other conclusion than we avoid the subject.

Contrast our field’s relative indifference with the approach of the aviation industry. Where we avoid the subject, they embrace it, using each instance to learn and improve. The result? The safety of air travel has improved dramatically, with fatalities dropping from around 40 per million departures in the late 50’s and early 60’s, to near zero in recent years. By contrast, during the same span of time, retention and outcome rates in psychotherapy have not improved a single percentage point.

Thankfully, recent developments are challenging the status quo, putting failure center stage in a renewed effort to facilitate professional development. One of these is a new and deeply moving podcast series, “Very Bad Therapy,” run by two graduate students, Ben Fineman and Carrie Wiita. Each installment features a different client sharing a, “You would not believe what happened with my therapist” story.

Ben and Carrie are skillful and entertaining interviewers, teasing out nuances and helping reveal the rich learnings hidden in the worst moments of our work as therapists. Consider this, already they’ve published more episodes than there are books on the subject at Amazon!

Check it out. And while you’re there, listen to Episode #18, their most recent. Once again, the subject is failure and professional growth. This time, the person being interviewed is me!

Until next time,

Scott

Director, International Center for Clinical Excellence

P.S.: Registration for the Spring intensives on Feedback Informed Treatment (FIT) is open! Each year, we sell out months in advance. Click here for more information or to reserve your spot.

The Baader-Meinhof Effect in Trauma and Psychotherapy

August 28, 2019 By scottdm 25 Comments

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 everywhere. That outfit you thought was so unique? Boom! Everyone is sporting it. How about the conversation you just had with your friend? You know, the one that was so stimulating and interesting? Now the subject is on everyone’s lips.

Depending on your level of self-esteem or degree of narcissism, Baader-Meinhof either leaves you feeling on the “cutting edge” of cultural trends or constantly lagging behind others. For me, it’s generally the latter. And recently, its a feeling that has been dogging me a fair bit.

The subject? Trauma.

Whether simple or complex, ongoing or one-off, experienced as a child or adult, trauma is the topic de jour — a cause célèbre linked to an ever-growing list of problems, including depression, anxiety, dissociation, insomnia, headaches, stomachaches, asthma, stroke, diabetes, and most recently, ADHD.

Then, of course, there are the offers for training. Is it just me or is trauma the subject of every other email solicitation, podcast announcement, and printed flyer?

The truth is our field has been here many times before. Over the last 25 years, depression, multiple personality disorder, rapid cycling bipolar disorder II, attention deficit disorder, and borderline personality disorder have all burst on the scene, enjoyed a period of intense professional interest, and then receded into the background.

Available evidence makes clear this pattern — aha, whoa, and hmm what’s next? — is far from benign. While identifying who is suffering and why is an important and noble endeavor, outcomes of mental healthcare have not improved over the last 40 years. What’s more, no evidence exists that training in treatment modalities specific to any particular diagnosis — the popularly-termed, “evidence-based” practices — improves effectiveness. Problematically, studies do show undergoing such training increases practitioner perception of enhanced competence (Neimeyer, Taylor, & Cox, 2012) .

On more than one occasion, I’ve witnessed advocates of particular treatment methods claim it’s unethical for a therapist to work with people who’ve experienced a trauma if they haven’t been trained in a specific “trauma-focused” approach. It’s a curious statement — one which, given the evidence, can only be meant to bully and shame practitioners into going along with the crowd. Data on the subject are clear and date back over a decade (1, 2, 3). In case of any doubt, a brand new review of the research, published in the journal Psychotherapy, concludes, “There are no clinically meaningful differences between … treatment methods for trauma … [including those] designed intentionally to omit components [believed essential to] effective treatments (viz., exposure, cognitive restructuring, and focus on trauma)” (p. 393).

If you find the results reported in the preceding paragraph confusing or unbelievable, recalling the “Baader-Meinhof” effect can be help. It reminds us that despite its current popularity in professional discourse, trauma and its treatment is nothing new. Truth is, therapists have always been helping those who’ve suffered its effects. More, while the field’s outcomes have not improved over time, studies of real world practitioners show they generally achieve results on par with those obtained in studies of so-called evidence-based treatments 1, 2, 3).

Of course, none of the foregoing means nothing can be done to improve our effectiveness. As my Swedish grandmother Stena used to say, “The room for improvement is the biggest one in our house!”

To get started, or fine tune your professional development efforts, listen in to an interview I did recently with Elizabeth Irias from Clearly Clinical (an approved provider of CEU’s for APA, NBCC, NAADAC, CCAPP, and CAMFT). Available here: What Every Therapist Needs To Know: Lessons From The Research, Ep. 61.

In it, I lay out several, concrete, evidence-based steps, practitioners can take to improve their therapeutic effectiveness. It’s FREE, plus you can earn a FREE hour of CE credit. Additionally, if follow them on Instagram and leave a comment on this post, you’ll be automatically entered into a contest for one year of free, unlimited continuing education — the winner to be announced on October 31st, 2019.

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

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