Symptom Reduction or Well-being: What Outcome should Matter Most in Psychotherapy
So, what contributes to a living a long, healthy life? Clean Air? Being lean versus overweight? The absence of depression or anxiety? Exercising regularly? Getting a flu vaccine? Abstaining from smoking? Minimizing alcohol intake? Personal sense of meaning? Close interpersonal relationships? Social integration? OK, I'll come clean: all contribute--but not equally. Far from it. Some are more important ...
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Ho, Ho, Oh No! Science, politics, and the demise of the National Registry of Evidence-based Programs and Practices
While you were celebrating the Holidays--shopping and spending time with family--government officials were busy at work. On December 28th, the Substance Abuse and Mental Health Services (SAMHSA) sent a formal termination notice to the National Registry of Evidence-based Programs and Practices (NREPP). Ho, ho, oh no...! Briefly, NREPP is "an evidence-based repository and review system ...
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Joint Commission and SAMHSA Set New Standard of Care for Measurement Based Care
The Joint Commission has recently revised their standards of care. To maintain accreditation, organizations are now required to assess outcomes with a standardized measurement tool. The Substance Abuse and Mental Health Services Administration is moving in the same direction. Two scales I developed met the new standard. Both are ...
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Better Results through Deliberate Practice
The legendary cellist Pablo Casals was once interviewed by comedian George Carlin. When asked why, at age 93, he continued to practice three hours a day, Casals replied, "I'm beginning to show some improvement!" Hard not to feel inspired and humbled by such dedication, eh? And while humorous, Casals was ...
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We Need MORE Drugs, Right?
Being human means being conscious. Being conscious means knowing, "reality bites." Little wonder evidence shows people have sought to alter their consciousness since the Stone Age. Whether its music, dance, the ingestion of psychoactive plants, or the modern pharmaceuticals, humans evince a strong desire to move beyond their present reality--to ...
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Clinical Practice Guidelines: Beneficial Development or Bad Therapy?
A couple of weeks ago, the American Psychological Association (APA) released clinical practice guidelines for the treatment of people diagnosed with post-traumatic stress disorder (PTSD). "Developed over four years using a rigorous process," according to an article in the APA Monitor, these are the first of many additional recommendations of specific treatment methods for particular ...
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That’s it. I’m done. It’s time for me to say goodbye.
Ending psychotherapy. Whether formal or informal, planned or unplanned, it's going to happen every time treatment is initiated. What do we know about the subject? Nearly 50% of people who start, discontinue without warning. At the time they end, half have experienced no meaningful improvement in their functioning or well-being. On the ...
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Something BIG is Happening: The Demand for Routine Outcome Measurement from Funders
Something is happening. Something big. Downloads of the Outcome and Session Rating Scales have skyrocketed. The number of emails I receive has been steadily increasing. The subject? Routine outcome measurement. The questions: Paper and pencil versions are available on ...
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Brave or Foolhardy? Dramatic Implications of a New Psychotherapy Outcome Study
Does diagnosis matter? What about the treatment approach? Applying particular therapeutic methods to specific psychiatric diagnoses is the considered by many a "best practice"--the core of what some label, "empirically-supported" (EST) or "evidence-based psychological treatments" (EBPT). Now, imagine a place where diagnosis and prescriptive protocols are not required or even ...
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“What about the Liars and Deniers?” Working Effectively with Mandated and Incarcerated Clients and People who Sexually Abuse
It was just a little over a month ago. I was doing a workshop somewhere in the States. My topic? Using formal client feedback to guide and improve the quality and outcome of psychotherapy-- our SAMHSA-approved, NREPP listed evidence-based practice. At the first break, I was approached by one of ...
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From Evidence-based Practice to Cultural Change: Steps to Successful Implementation
Chances are your are carrying a smartphone--maybe you're even reading this post on your Android or Iphone! One thing I'm almost certain of is that the device you own--can't live without--is not a Nokia. The nearly complete absence of the brand is strange. Not long ago, the company dominated the mobile ...
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More Deliberate Practice Resources…
Last week, I blogged about a free, online resource aimed at helping therapists improve their outcomes via deliberate practice. As the web-based system was doubling as a randomized controlled trial (RCT), participants would not only be accessing a cutting-edge, evidence-based protocol but also contributing to the field's growing knowledge in ...
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Can you tell me what I’m supposed to do? A free deliberate practice resource
You've read the studies. Maybe you've even attended a training. Deliberate practice is the key to improving your effectiveness as a psychotherapist. Top performing therapists devote twice as much time to the process. More, when employed purposefully and mindfully, the outcomes of average practitioners steadily rise over time. But what ...
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The Illness and the Cure: Two Free, Evidence-based Resources for What Ails and Can Heal Serious Psychological Distress
Findings from several recent studies are sobering. Depression is now the leading cause of ill-health and disability worldwide--more than cancer, heart disease, respiratory problems, and accidents. Yesterday, researchers reported that serious psychological distress is at an all-time high, significantly affecting not only quality but actual life expectancy. And who has ...
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The Missing Link: Why 80% of People who could benefit will never see a Therapist
The facts are startling. Despite being on the scene for close to 150 years, the field of mental health--and psychotherapy in particular--does not, and never has had mass appeal. Epidemiological studies consistently show, for example, the majority of people who could benefit from seeing a therapist, do not go. ...
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Would you rather . . . be approved or improved?
Some time ago, my son had a minor obsession. Whether at the dinner table, in the car, or out for a walk, he was constantly peppering us with, "would you rather" questions? You know the ones I mean, where you are forced to choose between two equally bizarre or unpleasant ...
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