The Revolution in Swedish Mental Health Services: UPDATE on the CBT Monopoly

April 5, 2013 By scottdm Leave a Comment

No blogpost I’ve ever published received the amount of attention as the one on May 13th, 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 depression and anxiety. In short, the public experiment of limiting training and treatment to so called, “evidence-based methods” had failed to produce tangible results. The findings generated publications in Swedish journals as merited commentary in Swedish newspapers and on the radio.

I promised to keep people updated if and when research became available in languages other than Swedish. This week, the journal Psychotherapy, published an article comparing outcomes of three different treatment approaches, including CBT, psychodynamic, and integrative-eclectic psychotherapy. Spanning a three year period, the results gathered at 13 outpatient clinics, found that psychotherapy was remarkably effective regardless of the type of treatment offered! Read the study yourself and then ask yourself: when will a simpler, less expensive, and more client-centered approach to insuring effective and efficient behavioral health services be adopted? Routinely seeking feedback from consumers regarding the process and outcome of care provides such an alternative. The failure to find evidence that adopting specific models for specific disorders improves outcomes indicates the time has come. You can learn more about feedback-informed treatment (FIT), a practice recently designed “evidence-based” by the Substance Abuse and Mental Health Services Administration (SAMHSA), by visiting the International Center for Clinical Excellence web-based community or attending an upcoming training with me in Chicago or on the road.

Learn more about what is going on in Sweden by reading:

Everyday evidence outcomes of psychotherapies in swedish public health services (psychotherapy werbart et al 2013)

Here’s one additional reference for those of you who read Swedish. It’s the official summary of the results from the study that started this entire thread:

Delrapport ii slutversion

Resources on Feedback-Informed Treatment, Training, & Research

January 24, 2013 By scottdm Leave a Comment

Last week, I spent a day in London working with the clinical staff of the Hertfordshire Partnership NHS Foundation Trust. The subject? Feedback, of course! As soon as I stepped off my transcontinental flight, I knew it was going to be a fun day. Every way I turned at the Heathrow airport I was greeted by a machine asking for feedback about my experience: after exiting customs, at the baggage claim area, at the duty free shops. Amazing!

The process was as engaging as it was efficient. Tell us about your experience…by pressing a button bearing one of four different faces. The similarity to the ICCE Young Child Outcome Rating Scale was striking (to say the least). I felt compelled to register my feedback at every opportunity.

From London, I travelled to Gotheburg, Sweden for the first Scandanavian Advanced Intensive Training in Feedack Informed Treatment. The event, organized by GCK, Gothenburg’s Center for Competence Development, sold out in a week with participants coming from all over Scandanavia. I taught the course together with ICCE Senior Associate Susanne Bargmann using a curriculum based on the FIT Treatment and Training Manuals. The series was developed to support, in part, ICCE’s application to the US Substance Abuse and Mental Health Services Administration (SAMSHA) for designation of FIT as an evidence-based practice. Together with the Training of Trainers (TOT) and Supervision Intensive workshops, the manuals and Advanced Intensive training provides participants with the latest, cutting-edge, evidence-based information and skills in FIT.

Back in October, I blogged about an article that reviewed the evidence regarding psychotherapy training. In it, the author John Malouff concluded, “There appears to be no evidence that coursework and research completion…have any value to future psychotherapy clients…”. He continued, “Training programs…carry the responsibility to show that the training they provide have positive benefits for future clients.”

Well…on that score, learning FIT, available evidence shows, leads to direct benefits to consumers of behavioral health services. Together with New Zealand based psychologist and ICCE Senior Associate Eeuwe Schuckard, I’ve updated the review of the research supporting FIT practice (click here).

Don’t wait to learn about or deepen your understanding of and skills in feedback informed treatment. The Advanced Intensive scheduled for March 18-321st has a few spots left. You can register online by clicking here.

By the way, shortly after the publication of Malouff’s review in Psychotherapy in Australia, I wrote to the editor, Liz Sheehan, and asked for permission to reprint the article. Click here to read it.

Is Psychotherapy Getting Better?

October 11, 2012 By scottdm Leave a Comment

This last month, I spent a significant amount of time traveling around Europe and Scandanavia (Germany, Sweden, Denmark, the Netherlands) working with clinicians and mental health agencies implementing Feedback-Informed Treatment. Not infrequently, people ask me, “doesn’t all the travel wear you out?” My pat response is, “No, not at all! The worst part is being away from my family. But, meeting with practitioners and agency managers always buoys my spirits.” I mean it. I miss my family and the airlines (and airport food) are a real drag. Practitioners are, on the other hand, a different story. Despite the numerous challenges (funding, documentation, regulatory demands, etc.), they persist, working to improve their skills and provide effective help to their clients.

As happened a few months ago, I was in the SAS lounge at the Copenhagen airport, waiting for a flight, enjoying a cup of coffee, and catching up on the news, when I ran across another article by Thomas Friedman that caught my eye. “The plan,” he said, “to work hard and play by the rules to get ahead is now outdated. It takes much more than that.”

Wow, I thought, he’s so right–especially when it comes to the field of mental health. I was raised in an era when “working hard at your job” was the formula for success, the pathway to a fruitful and enjoyable career. As I travel the world, however, I see just how little reason there is to believe in this ideal any longer. The rules have changed. The world, observed Friedman, “is now a more open system. Technology and globalization are wiping out lower-skilled jobs faster, while raising the skill level required for new jobs. More than ever now, lifelong learning is the key to getting into and staying in the middle class.”

As I said earlier, the therapists I meet are working very hard–harder than either I or they ever anticipated. They are putting in more hours and, in many cases, making less money than they did a few years earlier. It’s true! Did you know, psychologists incomes are down 17% in the last decade? Simply put, working hard is a recipe for…eventual failure. If we are to survive and thrive, a change of order–not magnitude–is required.

Recently, Diane Cole addressed the challenges facing practitioners in a special issue of the Psychotherapy Networker. It’s worth a read (click here). Importantly, she doesn’t just bemoan the problems currently facing the field, but provides crucial information for helping each and every one of us take charge of our fate.