You’ve heard it said before. Flying is the safest form of transportation.
Facts back up the claim. In fact, it’s not even close. In terms of distance traveled, the fatality rate per billion kilometers is .003, improving dramatically over the years. Cars, by contrast, are almost 1,000 times more dangerous. Still, since 1923, the fatality rate in motor vehicle accidents has declined an eye-popping 93%.
How about psychotherapy? Have outcomes improved? Judging by the size of the Diagnostic and Statistical Manual and growth in the number of treatment approaches, one would expect success rates to have climbed significantly, if not exponentially. Not so, as I first presented at the Evolution of Psychotherapy Conference five years ago, and later on this blog, the empirical evidence clearly shows NO improvement.
And now a new study, this time reviewing the evidence regarding treatments for children and adolescents. Using sophisticated statistical analyses, the researchers examined 453 RCT’s spanning 53 years, involving nearly 32,000 kids treated for anxiety, depression, attention deficit/hyperactivity, and conduct problems. With the rising popularity of “evidence-based practice,” those conducting the study wanted to know whether “… our methods of developing and testing youth psychological therapies [are] producing improvement” (p. 2).
Can you guess what they found?
Outcomes have not changed (much less improved) over the last five decades–that’s 351 in dog years!
Can you imagine the outcry had similar results been published about automobiles or planes? You would fully expect hearings to be held, and leaders to be called called to account. The lives of children are on the line.
Nope. Instead, facing the supersized differences between promises made every year about “advances” in psychotherapy, and the results realized and reported in research studies, the authors meekly call for, “new approaches to treatment design and intervention science” (p. 1).
Really? Is that what’s required? Researchers going back to the drawing board of “treatment and intervention?”
No, what’s needed is an entirely different view of what clinicians actually do — and it starts by giving up the idea that psychotherapy is a form of treatment similar to antibiotics or angioplasty. Let’s face it. Psychotherapy is no more a medical treatment than are the facials, salt glows and body wraps one receives at the local spa. Which is not to say, it doesn’t work.
Outside the halls of academia, millions of therapists worldwide are helping people on a daily basis to live happier, more meaningful and functional lives. Dozens of studies of real world practitioners document outcomes that meet or exceed benchmarks established in tightly controlled, model-driven, randomized trials — all without following a particular, “evidence-based” protocol (see 1, 2, 3,4).
So, how best to conceptualize the effective work clinicians do? And, importantly, what could researchers offer that would be of real help to therapists?
That psychotherapy works, says more about humans and our need for connection, meaning, and purpose, than it does about the particulars of any given model or approach. And that our methods focus on thoughts, feelings, behaviors, and brain chemistry, says more about our Western values and beliefs, than about the ingredients necessary for successful healing.
Simply put, the field does not need to, as the authors of the study argue, “intensify the search for mechanisms of change [and] transdiagnostic … treatments” (p. 1). Doing so is merely a recipe for “more of the same.” Rather, to move forward, it should abandon the medical paradigm that has long had a stranglehold on our research and professional discourse, choosing instead to reconnect with the larger, worldwide family of healers, one that has existed since the dawn of history and which, from the outset, has been deeply engaged in the values and beliefs of those they treat, using whatever means necessary, consistent with the culture, to engender change.
What might that look like in practice?
As already documented, practicing clinicians already do a pretty darn good job helping their clients. There’s nothing wrong with our Westernized approaches when they work. At the same time, we don’t succeed with everyone. The problem, studies show, is we’re not particularly good at knowing when we’re not being helpful, when clients are at risk for dropping out or are actually deteriorating while in our care (1, 2). On this score, research has already provided a solution. Dozens of studies document, for example, using simple measures at the beginning and end of each visit not only provides clinicians with an opportunity to intervene more successfully with “at risk” clients, but also helps identify opportunities for their own growth and development (1, 2). If you’re not routinely and formally measuring the quality and outcome of your work, you can get started by accessing two simple tools here.
With outcome as our guide, all that remains is being willing to look outside the profession for possibilities for healing and change unbound by convention and the medical view. That’s happening already, by the way, in the world’s two most populous countries, India and China, with professionals learning the ways of indigenous healers and government officials tapping local shaman to meet citizen’s mental health and well being needs.
So, what about you? What you are doing to extend your healing reach?
And, in case you haven’t seen it, the video below is from the most recent Evolution of Psychotherapy conference, where I talk about new research documenting psychics achieving the same or better results as psychotherapists.
Until next time,
Scott
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
P.S.: Want to learn more about using outcome to inform and improve your effectiveness? Join me and an international group of teachers and researchers in Chicago for our Summer Intensives. For detailed information and to register, click on the banners below.
That was a great speech Scott – well done. Cognitive science is now embracing radical enactivism – and with it comes a whole new science – as we recognise our interdependence as the primary reality. It takes us into domains traditionally explored by psychics and mystics – but thru the philosophy of Wittgenstein and others we enter this world, or recognise our interconnectedness (we’ve always been in it); a tradition that has its roots in Vico and Goethe. It gives rise to a participatory science or intellectual discipline, not one in which we stand apart as “objective observers”. Current thought leaders include Dan Hutto, Moyal-Sharrock, John Shotter, and papers are starting to appear in the psychotherapy literature – this will facilitate a science here.
I wholeheartedly resonate with you Scott. It’s really relieving, this is an open-minded, hope-giving view about our field. Thanks.
Adriano
I’ve been a licensed clinician since 1982, and in private practice since 1992…the more I do and see and listen, the more I learn…and what I’ve noticed is that every 10-15 years someone discovers a new approach that seems to borrow from what others were already doing!
It’s all about the relationship and helping others self-educate and adapt to their reality in healthiest ways possible!
Very well done, Scott! You brilliantly connect history to the present and in doing so show us how the idea of the relationship isn’t new at all. You are never afraid to go where the facts take you. I am particularly intriguing about the data on the effectiveness of psychics. I enjoyed listening and always learn something new when I hear you speak. Thank you
I enjoyed watching your presentation. You are getting more snarky as you age. I love it. I am a Christian Minister and retired Counselor that integrates Psych and theology/prayer primarily when I train Peer Helpers and Coaches and Mentors and Befrienders. (All the same). I think World View and Values are key to receiving direct input but deep listening is crucial to discovering Worldview first. At our church healing service a lady told me of her deepest fears and how prayer with Bible study helped her. She added, “I would never tell my Psychiatrist. He would lock me up.”
At a Psych conference in Chicago I chatted with a TX that proudly announced that he told a Client to stay away from her Pastor. When I asked who she trusted more he was stunned to think she spent 5 times as much energy and time at church, Bible study, and prayer as she did with him.
I run a large Psych Clinic in Cincinnati but think the Peer Helpers I train are more successful at healing than most of the Pro TX. Believers that take Isaiah 61 seriously still try to “Heal the broken hearted and set the captives free”.
Hey Gary,
Like what you had to say about worldviews and I found it fascinating to listen to Scott talk about worldviews and how it’s about connecting with the client’s perspective. Considering our current Western culture and the post-postmodern thinking are we just trying to create a virtual utopia?
Paul
Thank you very much Scott, i am glad to comment about our westernized thinking linking every problem to scientific causes. As a medical practitioner, i have come to accept the hard facts that indeed the medical model of health cannot comprehensively help all our clients. The sociological and anthropological perspectives (indigenous knowledge) is part and partial of the treatment.
Tacit knowledge has helped me understand that there two causes of illness, that is physical causes (bacteria, viruses, protozoa e.t.c) and spiritual causes of disease. I have realized that medical science cannot help spiritually induced ailments as indigenous healers cannot treat bacteria or viruses.
In Uganda, there have been efforts to harmonize activities by medical workers and spiritual workers that is the traditional healers and church priests and pastors. However, the two groups have failed to come to a smooth consensus about the role of each. This is so because either parties sometimes fail to recognize their limits. this stems from the fact that physical illnesses affect the spirit and spiritual illnesses affect the body.
Time for a New Paradigm? Psychotherapy Outcomes Stagnant for 40 years.
Do we really need a paradigm Shift? I do not think so. It is the Radical scientists thinking that for anything to matter should be empirically derived and must be replicable. Psychics and all spiritualists have a natural endowments and sensation that most people only dream of.
In conclusion, as Albert Einstein the theoretical physicist put it, not everything that is countable counts, and not everything that is countable counts.
Thank you.
Agnes
Addendum;
Not everything that counts is countable and not everything that is countable counts!
Such a breath of fresh air. I have been following the work of Nick Drury, Thomas Szasz, and Peter Hacker to name but a few. My mentor was the late Henri Bortoft. And I am a lecturer in Goethean science.