It’s true. Adding to a growing literature showing that the person of the therapist is more important than theoretical orientation, years of experience, or discipline, a new study documents that clients are sensitive to the quality of their therapist’s life outside of treament. In short, they can tell when you are happy or not. Despite our best efforts to conceal it, they see it in how we interact with them in therapy. By contrast, therapists’ judgements regarding the quality of the therapy are biased by their own sense of personal well-being. The solution? Short of being happy, it means we need to check in with our clients on a regular basis regarding the quality of the therapeutic relationship. Multiple randomized clinical trials show that formally soliciting feedback regarding progress and the alliance improves outcome and continued engagement in treatment. One approach, “Feedback-Informed Treatment” is now listed on SAMHSA’s National Registry of Evidence-Based Programs and Practices. Step-by-step instructions and videos for getting started are available on a new website: www.pcomsinternational.com. Seeking feedback from clients not only helps to identify and correct potential problems in therapy, but is also the first step in pushing one’s effectiveness to the next level. In case you didn’t see it, I review the research and steps for improving performance as a therapist in an article/interview on the Psychotherapy.net website. It’s sure to make you happy!
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, the ICCE is the largest, global, web-based community of providers, educators, researchers, and policy makers dedicated to improving the quality and outcome of behavioral health services. Clinicians can choose to participate in any of the 100-plus forums, create their own discussion group, immerse themselves in a library of documents and how-to videos, and consult directly with peers. Membership costs nothing and the site is free of the advertising. With just a few clicks, practitioners are able to plug into a group of like-minded clinicians whose sole reason for being on the site is to raise everyone’s performance level. I have many people to thank for the success of ICCE: senior associates and trainers, our community manager Susanne Bargmann, director of training Julie Tilsen, and our tech wizard Enda Madden.
As membership in ICCE has grown from a few hundred to well over 3000, many in the community have worked together to translate research on excellence into standards for improving clinical practice. Routine outcome monitoring (ROM) has grown in popularity around the world. As a result, new measures and trainings have proliferated. In order to insure quality and consistency, a task force was convened within ICCE in 2010 to develop a list of “Core Competencies”—a document establishing the empirical and practice foundations for outcome-informed clinical work. In 2011, the ICCE Core Competencies were used to develop and standardize the curricula for the “Advanced Intensive” and “Training-of-Trainers” workshops as well as the exam all attendees must pass to achieve certification as an ICCE Trainer. As if these accomplishments were not enough, a small cadre of ICCE associates banded together to compose the Feedback Informed Treatment and Training Manuals—six practical, “how-to”volumes covering everything from empirical foundations to implementation. None of this would have been possible without the tireless contributions of Bob Bertolino, Jason Seidel, Cynthia Maeschalck, Rob Axsen, Susanne Bargmann, Bill Robinson, Robbie Wagner, and Julie Tilsen.
Looking back, I feel tremendous gratitude–both for the members, associates, and trainers of ICCE as well as the many people who have supported my professional journey. This year, two of those mentors passed away: Dick Fisch and James Hillman. During my graduate school years, I read James Hillman’s book, Suicide and the Soul. Many years later, I had the opportunity to present alongside him at the “Evolution of Psychotherapy” conference. Dick, together with his colleagues from MRI, had a great influence on my work, especially during the early years when I was in Milwaukee with Insoo Berg and Steve de Shazer in Milwaukee doing research and writing about brief therapy. Thinking about Dick reminded me of two other teachers and mentors from that period in my life; namely, John Weakland and Jay Haley.
Looking forward, I am filled with hope and high expectations. The “Advanced Intensive” training scheduled for March 19-22nd is booked to capacity—not a single spot left. Registrations for this summer’s “Training of Trainers” course are coming in at a record pace (don’t wait if you are thinking about joining me, Cynthia and Rob). Currently, I am awaiting word from the National Registry of Evidence Based Programs and Practices (NREPP) formally recognizing “Feedback Informed Treatment” (FIT) as an evidence-based approach. The application process has been both rigorous and time-consuming. It’s worth it though. Approval by this department within the federal government would instantly raise awareness about as well as increased access to funding for implementing FIT. Keep your fingers crossed!
There’s so much more:
- Professor Jan Blomqvist, a researcher at the Center for Alcohol and Drug Research at Stockholm University (SoRAD) launched what will be the largest, independent evaluation of feedback informed treatment to date, involving 80+ clinicians and 100’s of clients located throughout Sweden. I provided the initial training to clinicians in October of last year. ICCE Certified Trainers Gunnar Lindfeldt and Magnus Johansson are providing ongoing logistic and supervisory support.
- The most sophisticated and empirically robust interpretive algorithms for the Outcome Rating Scale (based on a sample of 427,744 administrations of the ORS, in 95,478 unique episodes of care, provided by 2,354 different clinicians) have been developed and are now available for integration into software and web based applications. Unlike the prior formulas–which plotted the average progress of all consumers successful and not–the new equations provide benchmarks for comparing individual consumer progress to both successful and unsuccessful treatment episodes.
- The keynote speakers and venue for the Second Achieving Clinical Excellence Conference have been secured. We’ll be meeting at one of the nicest hotels in Amsterdam, Holland, May 16-18=9th, 2013. Thanks go to the planning committee: Bill Andrews, Susanne Bargmann, Liz Plutt, Rick Plutt, Tony Jordan, and Bogdan Ion. Please visit the conference website and submit a proposal for a workshop or presentation.
- Finally, I’ve been asked to deliver the lunchtime keynote at the upcoming Psychotherapy Networker Conference scheduled on March 23, 2012. The topic? Achieving excellence as a behavioral health practitioner. Last year, my colleague Mark Hubble and I published the lead article in the May-June issue of the magazine, describing the latest research on top performing clinicians. I’m deeply honored by the opportunity to speak at this prestigious event.
More coming in the weeks ahead. Until then, look forward to connecting on ICCE.
August 10th, 2011
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 clinicians to train others in the principles and practices of FIT. We also played hard: dinners, music, magic, and more. Here’s what attendee’s said about this years event:
Be sure and join us for the 4-day “Advanced Intensive” scheduled in March. More information can be found at: scottdmiller.com.