Far from Normal: More Resources for Feedback Informed Treatment in the Time of COVID-19

March 31, 2020 By scottdm 3 Comments

I hope this post finds you, your loved ones, and colleagues, safe and healthy.

What an amazing few weeks this has been. Daily life, as most of us know it, has been turned upside down. The clinicians I’ve spoken with are working frantically to adjust to the new reality, including staying abreast of rapidly evolving healthcare regulation and learning how to provide services online.

I cannot think of a time in recent memory when the need to adapt has more pressing. As everyone knows, feedback plays a crucial role in this process.

Last week, I reported a surge in downloads of the Outcome and Session Rating Scales (ORS & SRS), up 21% over the preceding three months. Independent, randomized controlled trials document clients are two and a half times more likely to benefit from therapy when their feedback is solicited via the measures and used to inform care. Good news, eh? Practitioners are looking for methods to enhance their work in these new and challenging circumstances. Only problem is the same research shows it takes time to learn to use the measures effectively — and that’s under the best or, at least, most normal of circumstances!

Given that we are far from normal, the team at the International Center for Clinical Excellence, in combination with longtime technology and continuing education partners, have been working to provide the resources necessary for practitioners to make the leap to online services. In my prior post, a number of tips were shared, including empirically-validating scripts for oral administration of the ORS and SRS as well as instructional videos for texting, email, and online use via the three, authorized FIT software platforms.

We are not done. Below, you will find two, new instructional videos from ICCE Certified Trainers, Stacy Bancroft and Brooke Mathewes. They provide step-by-step instructions and examples of how to administer the measures orally — a useful skill if you are providing services online or via the telephone.

Two additional resources:

On April 15th at 5:00 p.m. CENTRAL time, I will be hosting a second, free online discussion for practitioners interested in feedback informed treatment and deliberate practice. Although all are welcome to join, the particular time has been chosen to accommodate colleagues in Australia, New Zealand, and Asia. To join, you must register. Here’s the link: https://zoom.us/webinar/register/WN_c5eousjqQRChSSQSj3AQZg.
My dear colleague, Elizabeth Irias at Clearly Clinical, has made a series of podcasts about the COVID-19 pandemic available for free (including CE’s). What could be better than “earning while you are learning,” with courses about transitioning to online services and understanding the latest research on the psychological impact of the virus on clients.

OK, that’s it for now.

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellenc e

Feedback Informed Treatment in the Time of COVID-19

March 23, 2020 By scottdm 4 Comments

You’ve been busy! Stocking up on food. Telecommuting. Home schooling your kids. And figuring out how you are going to pay bills while not drawing a paycheck or being able to meet with clients face to face.

Many clinicians I know are rapidly transitioning to providing services online. As you might imagine, many of those work feedback-informed, using the ORS and SRS at each visit to guide and inform treatment decisions. In fact, I’ve noticed something curious since the COVID-19 crisis began: downloads of the measures from my website are up, significantly — 21% more compared to the prior three month period.

All good but, how to employ the measures online?

Thanks to ICCE Certified Trainer, Stacy Bancroft for pulling together these tips:

Use the standardized oral scripting to administer the tools. It’s available in the download file.
Share your screen. Display the ORS and SRS and then use your finger, moving slowly along each item until they tell you to stop.
Use one of the three, authorized software systems. Each, in slightly different ways, make it possible to email, text or send links to the forms and have them completed either manually or electronically. Below, you will find several brief, how-to videos for the various systems.
Finally, connect with the members of the International Center for Clinical Excellence clinical community. It’s free to join. Just click the link below my name.

Until next time, in these uncertain times, I wish you health, safety, and peace.

Scott

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

For FIT-OUTCOMES.COM Users:

For MYOUTCOMES.COM Users:

For OpenFIT Users:

Better Results: Using Deliberate Practice to Improve Your Therapeutic Effectiveness

March 9, 2020 By scottdm 3 Comments

In 2007, my colleagues and I published an article entitled, Supershrinks: What’s the Secret of their Success? In it, we reported on the status of our then decade long effort to understand why some psychotherapists were consistently more effective than others. Although the phenomenon had first been reported in the mid-1970’s by psychologist David F. Ricks, accounting for the superior effectiveness of these clinicians had eluded scholarly explanation. Our objective was as simple: figure out what the best were doing so that the rest of us could copy it and improve our results.

After many false starts and empirical dead ends, it turned out the key was “the best of the best simply work harder at improving their performance than others do” (p. 30). Known in the expert and expertise literature as “deliberate practice,” their efforts to improve were not merely about putting in hours, but rather spending time reaching for performance objectives just beyond their level of proficiency. Decades of research had documented the impact of deliberate practice across a wide range of human endeavors including sports, music, surgery, teaching, computer programming, and chess. Surprisingly, despite this extensive evidence base, until the publication of our article, the term, much less the empirically-based process, had never appeared in any study or publication about psychotherapy.

Four years passed before the next publication on the subject appeared. In The Road to Mastery, we provided an update about our research, focusing this time on the important role environment played in successful deliberate practice. In a number of practical applications around the world, we’d discovered that, without a supportive community, the majority failed to sustain their efforts. Turns out, deliberate practice is hard. In the article, we described the type of, and even places where, clinicians could get the backing they needed to persevere.

In 2015, we published the very first empirical research in a peer reviewed journal on the role of deliberate practice in psychotherapy. During the six long years the study was being conducted, we had no idea whether our earlier work would be confirmed or discredited. Needless to say, we were pleased and relieved when the analysis of the data revealed the most effective practitioners devoted 2.5 times more hours to deliberate practice than clinicians with average outcomes. Further analysis showed factors long thought to influence the therapist effectiveness were shown to contribute nothing, including years of experience, gender, age, professional discipline, caseload, and theoretical orientation.

By this point, many other projects were underway.

A review of 40 years of outcome research seeking to determine whether the overall effectiveness of psychotherapy was stagnant, improving, or declining;
A study of the impact of therapist experience on effectiveness;
A meta-analysis comparing the impact of deliberate practice versus “mere time spent” engaged in a particular activity;
A study investigating whether average therapists could improve their results by engaging in deliberate practice; and
A randomized controlled trial investigating the impact of a specific deliberate practice activity on therapist relationship skills.

The results have challenged many long held beliefs. More importantly, however, they’ve provided the first concrete evidence of a pathway for accomplishing what had long eluded the field — reliably improving the outcomes of individual therapists.

Taking each in order, here’s what we’ve found:

Despite the proliferation of treatment models, the overall outcome of psychotherapy has not improved in four decades;
Contrary to tradition and belief, therapist effectiveness actually declines as experience in the field increases;
The impact of deliberate practice on performance is twice that of “mere time spent”;
Engaging in deliberate practice slowly, steadily and significantly improves therapist effectiveness; and
Targeted deliberate practice training significantly improves the acquisition and generalization of fundamental relationship skills.

For those interested in the details, click here. Complete the form (just your name and email) and I’ll send you the eight studies referenced above! I’ll also put you on a list to be notified when our new book, Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness, is released from the American Psychological Association. It not only summarizes the research, but lays out in step-by-step fashion how to apply the findings in your professional development efforts.

OK, that’s it for now. Until next time,

Scott

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