Bad therapy.
Are you guilty of it? A quick internet search turned up only 15 books on the subject. It’s strange, especially when you consider that between 5 and 10% of clients are actually worse off following treatment and an additional 35-40% experience no benefit whatsoever! (Yep, that’s nearly 50%)
And what about those numerous “micro-failures.” You know the ones I’m talking about? Those miniature ruptures, empathic missteps, and outright gaffs committed during the therapy hour. For example, seated opposite your client, empathic look glued to your face and suddenly you cannot remember your client’s name? Or worse, you call them by someone else’s. The point is, there’s a lot of bad therapy.
Why don’t we therapists talk about these experiences more often? Could it possibly be that we don’t know? Four years on, I can still remember the surprise I felt when Norwegian researcher, Jorgen Flor, found most therapists had a hard time recalling any clients they hadn’t helped.
One group does know — and recently, they’ve been talking their experiences! The Very Bad Therapy podcast is one of my favorites. After listening to sixty-some-odd episodes of clients exposing our shortcomings, I reached out to the podcast’s two fearless interviewers, clinicians Ben Fineman and Carrie Wiita, to learn what had motivated them to start the series in the first place and what, if anything, they’d learned along the way. Here’s what I promise: they have no shame (and its a good thing for us they don’t)!
OK, that’s it for now. Until next time, all the best,
Scott
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
P.S.: For the first time ever, we’re offering the FIT Implementation Intensive Online. It’s one of the four courses required for certification as an ICCE FIT Trainer. As with our “in-person” events, we have an international faculty and strictly limit the number of participants to 40 to ensure the highest quality experience. Click here for more information or to register.
I heard you on Daniel Rosen’s podcast.
I write about listening and I’d like to share some thoughts on the fundamental dynamics of listening with you. First, a quick story:
Meghan watches as her mother finishes a telephone call.
“Mommy, why are you crying?” she asks gently.
“I’m okay,” mommy sighs, “I’m okay.”
Meghan leaves the room and comes back moments later.
“When I’m sad, I hold on to Mr. Brown,” she says, handing over a teddy bear to her mother.
To me, a great listener finds a way to graciously share their best with a speaker, while respecting the speaker’s story the entire time. There is no “teddy bear” technique. They offer their best so the speaker can think, feel, and speak outside their comfort zone, so they can tell a “better” story, and create a “better” future.
Many things can of course go wrong in this process. The listener may not know how to share their best. The listener may not have the appropriate experiences to share. It can take a long time to discover what a speaker needs. The speaker may simply not like teddy bears. The listener can slip and make mistakes.
In addition, a listener has to constantly improve. How? By feeling and experiencing, and then abstracting those feelings and experiences, and deriving personal and universal meanings. Great listeners think about things as they appear, and search for underlying interconnections and significance. They realize that sadness doesn’t have to be permanent or crippling, that happiness and success aren’t guaranteed. They’ve developed ways to deal with life, and can even graciously share those with others (eg. offering someone a teddy bear).
I believe a clear example of the fundamental dynamics can serve as a overall guiding principle, and also help explain why things succeed or fail in practice.
I hope you find this interesting.
That’s the trouble with using measures. If you test, you’re going to find problems. I have to admit there have been times when my measuring lapsed. I didn’t like seeing evidence of my inadequacy. I can empathize with the impulse to do less testing. Nevertheless, measuring doesn’t create problems, it creates awareness of problems.
Thanks for sharing this important message.
I wish there was a podcast entitled, “Very good therapy.”
Will you be following up, Scott, with a post on the supershrinks? What do they do that makes their performance better than the average?
Listen to the Very Bad Therapy podcast and they do give you the answers to this!
Feedback-informed treatment
Use of outcome measures
Deliberate Practice