“I can’t let others know…”: Shame as a Barrier to Professional Development

January 21, 2017 By scottdm 12 Comments

Shame (noun \ˈshām\): Consciousness of shortcoming, guilt, or impropriety.

Turns out, for many therapists, this powerful and painful emotion is a significant barrier to professional development.

Doing psychotherapy is challenging in the best of circumstances. As many as 25% of clients drop out before experiencing a measureable improvement in their functioning. Of those who do continue, between 40 to 50% will end no different than when they started. And finally, 8 to 10% deteriorate while in care.

Faced with the realities of clinical practice, it’s easy for practitioners to feel they are forever falling short of their own and others hopes and expectations. Some respond with self-serving resignation: “It’s just not possible to help some people.” Others, research indicates, deceive themselves, either seeing progress where there is none or overestimating their effectiveness. Most, it is clear, struggle with the deep sense of responsibility they have assumed for relieving mental and emotional suffering.

As just one example, consider psychologist Tony Rousmaniere. Early on in his career, Tony started using a couple of simple tools to track the quality and outcome of his work. The data he gathered shook him to the core, “I was helping far fewer people than I’d thought–50% fewer!” And while his results were no different than the outcome of most, he recalls instantly thinking, “I can’t let anyone know this!”

“If you want to improve,” Tony says, “You have to embrace the facts. It’s not about humiliation, but rather humility. Simply put, we are not as effective as we think we are. Even the most effective among us, fail about a third of the time. But, in those failures lies the key to success.”

In his new book, Deliberate Practice for Therapists, Tony describes, in deeply personal and moving terms, his efforts to become a more effective therapist. He draws on the latest research on expertise and expert performance, providing a blueprint all clinicians can use to improve and fine-tune their performance via deliberate practice.

Earlier this month, I interviewed Tony about his journey and the new book. His honesty, transparency, and sage advice are inspiring. You’ll find the video below.

In the meantime, get hands on experience with deliberate practice this summer by signing up for the FIT Professional Development Intensive. For more information or to register, simply click the icon under my name. Hope to see you there!

Until then, best wishes,

Scott

Director, The International Center for Clinical Excellence

The Replication Crisis in Psychology: What is and is NOT being talked about

November 7, 2016 By scottdm 8 Comments

Psychology has been in the headlines a fair bit of late—and the news is not positive. I blogged about this last year, when a study appeared documenting that the effectiveness of CBT was declining–50% over the last four decades.

The problem is serious. Between 2012 and 2014, for example, a team of researchers working together on their free time tried to replicate 100 published psychology experiments and succeeded only a third of the time! As one might expect, such findings sent shock waves through academia.

Now, this week, The British Psychological Society’s Research Digest piled on, reviewing 10 “famous” findings that researchers have been unable to replicate—despite the popularity and common sense appeal of each. Among others, these include:

Power posing does not make you more powerful;
Smiling does not make you happier;
Exposing you to words (known as “priming”) related to ageing does not cause you to walk like an old person;
Having a mental image of a college professor in mind does not make you perform more intelligently (another priming study);
Being primed to think of money will not cause make you act more selfishly; and
Despite being reported in nearly every basic psychology text, babies are not born with the power to imitate.

Clearly, replication is a problem. sand-castle The bottom line? Much of psychology’s evidence-base is built on a foundation of sand.

Amidst all the controversy, I couldn’t help thinking of psychotherapy. In this area, I believe, the problem with the available research is not so much the failure to replicate, but rather an unwillingness to accept what has been replicated repeatedly. Contrary to hope and popular belief, one—if not the most—replicated finding is the lack of difference in outcome between psychotherapeutic approaches.

It’s not for lack of trying. Massive amounts of time and resources have been spent comparing treatment methods. With few exceptions, either no or inconsequential differences are found.

Consider, for example, the U.S. Government spent same $33,000,000 studying different approaches for problem drinking only to find what we already know: all worked equally well. A decade later, the British officials spent millions of pounds on the same subject with similar results.

Just this week, a study was released comparing the hugely popular method called DBT to usual care in the treatment of “high risk suicidal veterans.” Need I tell you what they found?

groundhog

As the Ground-Hog-Day-like quest continues, another often replicated finding is ignored. One of the best predictors of the outcome of psychotherapy is the quality of the therapeutic relationship between the provider and recipient of care. That was one of the chief findings, for example, in both of the studies on alcohol treatment cited above (1, 2). Put simply, better relationship = improved engagement and effectiveness.

Sadly, but not surprisingly, research, writing, and educational opportunities focused on the alliance lags model and techniques. Consider this: slightly more than 55,000 books are in print on the latter subject, compared to a paltry 193 on the former. It’s mind-boggling, really. How could one of the most robust and replicated findings in psychotherapy be so widely ignored?

My colleague Daryl Chow is working hard to get beyond the “lip service” frequently paid to the therapeutic relationship. At the ICCE Professional Development training this last August, he presented findings from an ongoing series of studies aimed at helping clinicians improve their ability to engage, retain, and help people in psychotherapy by targeting training to the individual practitioners strengths and weaknesses. Not surprisingly, the results show slow and steady improvement in connecting with a broader, more diverse, and challenging group of clinical scenarios! Those in attendance learned how to build these skills into an individualized, professional development plan.

Trust me when I say, we won’t be ignoring this and other robust findings related to improving effectiveness at the upcoming ICCE intensive trainings in Chicago. Registration is open for both the Advanced and Supervision Intensives. Join us and colleagues from around the world.

Until next time,

Scott

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

The Cryptonite of Behavioral Health: Making Mistakes

May 7, 2011 By scottdm Leave a Comment

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 a big cost: personal and professional growth stalls and even atrophies. We take on less challenging tasks, avoid taking risks, and give up more easily when confronted with situations that might expose our weaknesses. Far all that, falling a bit on “error-phobic” side of life is hardly an instance of irrationality. As Alina Tugend, author of Better by Mistake points out, “As much as people hate to make mistakes, they love pointing out the ones others have made.” Indeed, for most of us, the glee others take in pointing out our shortcomings only serves to compound our avoidance and deepen our public denial. And that’s what makes Tony Rousmaniere’s recent blogpost so unusual.

Briefly, Tony is a psychologist in private practice in San Francisco and Palo Alto. As he tells the story, he was riding in his car, listening to a recording of my presentation at the 2009 Evolution of Psychotherapy conference. The subject was “Achieving Clinical Excellence.” The message: routinely seeking feedback from clients about our mistakes decreases dropout rates and improves outcomes in psychotherapy. Tony took the message to heart. Unlike many of our peers who say they routinely ask clients for feedback, Tony actually downloaded the outcome and session rating scales and began formally asking his clients for feedback.

The story he relates makes for compelling reading, most of all because the feedback he received was not always easy to hear. And yet, he persisted, not only asking clients, but recording his work and then seeking input from colleagues. In the article, he gives step-by-step instructions for making use of the painful and sometimes confusing and contradictory feedback one receives.

Tony’s willingness to share his experience makes it tempting to say he is one brave soul. In actuality, he’s pragmatic. He placed outcomes over image. As he reports in the article, his dropout rate has plummeted and his outcomes improved. I say, “Bravo!”
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Addendum

If you are thinking of writing to tell me that I misspelled the word, “cyptonite” (the accepted spelling is kryptonite), don’t bother. I know. I did it on purpose. See what I mean?!