Responsiveness is “Job One” in Becoming a More Effective Therapist

June 28, 2019 By scottdm 1 Comment

Look at the picture to the left. What do you see?

In no time at all, most report a large face with deep set eyes and slight frown.

Actually, once seen, it’s difficult, if not impossible to unsee. Try it. Look away momentarily then back again.

Once set in motion, the process tends to take on a life of its own, with many other items coming into focus.

Do you see the ghostly hand? Skeletonized spine and rib cage? Other eyes and faces? A clown hat?

From an evolutionary perspective, the tendency to find patterns — be it in clouds, polished marble surfaces, burn marks on toast, or tea leaves in a cup — is easy to understand. For our earliest ancestors, seeing eyes in the underbrush, whether real or illusory, had obvious survival value. Whether or not the perceptions or predictions were accurate mattered less than the consequences of being wrong.

In short, we are hardwired to look for and find patterns. And, as researchers Foster and Kokko (2008) point out, “natural selection … favour[s] strategies that make many incorrect causal associations in order to establish those that are essential for survival …” (p. 36).

As proof of the tendency to draw incorrect causal associations, one need only look at the field’s most popular beliefs and practices, many of which, the evidence shows, have little or no relationship to outcome. These include:

Alas, all of the above, and more, are mere “faces in the clouds” — compelling to be sure, but more accurately seen as indicators of our desire to improve than reliable pathways to better results. They are not.

So, what, if anything, can we do to improve our effectiveness?

According to researchers Stiles and Horvath (2017), “Certain therapists are more effective than others … because [they are] appropriately responsive … providing each client with a different, individually tailored treatment” (p. 71).

Sounds good, right? The recommendation that one should “fit the therapy to the person” is as old as the profession. The challenge, of course, is knowing when to respond as well as whether any of the myriad “in-the-moment” adjustments we make in a given therapy hour actually help.

That is until now.

Consider a new study involving 100’s real world therapists and more than 10,000 of their clients (Brown and Cazauvielh, 2019). Intriguingly, the researchers found, therapists who were more “engaged” in formally seeking and utilizing feedback from their clients regarding progress and quality of care — as measured by the frequency with which they logged in to a computerized outcome management system to check their results — were significantly more effective.

How much, you ask?

Look at the graph above. With an effect size difference of .4 σ, the feedback-informed practitioners (green curve) were on average more effective than 70% of their less engaged, less responsive peers (the red).

Such findings confirm and extend results from another study I blogged about back in May documenting that feedback-informed treatment, or FIT, led to significant improvements in the quality and strength of the therapeutic alliance.

Why some choose to actively utilize feedback to inform and improve the quality and outcome of care, while others dutifully administer measurement scales but ignore the results is currently unknown — that is, scientifically. Could it really be that mysterious, however? Many of us have exercise equipment stuffed into closets bought in the moment but never used. In time, I suspect research will eventually point to the same factors responsible for implementation failures in other areas of life, both personal and professional (e.g., habit, lack of support, contextual barriers, etc.).

Until then, one thing we know helps is community. Having like-minded to interact with and share experiences makes a difference when it comes to staying on track. The International Center for Clinical Excellence is a free, social network with thousands of members around the world. Every day, practitioners, managers, and supervisors meet to address questions and provide support to one another in their efforts to implement feedback-informed treatment. Click on the link to connect today.

Still wanting more? Listen to my interview with Gay Barfield, Ph.D., a colleague of Carl Rogers, with whom she co-directed the Carl Rogers Institute for Peace –an organization that applied person-centered principles to real and potential international crisis situations, and for which Dr. Rogers was nominated for the Nobel Peace Prize in 1987. I know her words and being will inspire you to seek and use client feedback on a more regular basis…

OK, done for now,

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

P.S.: Registration for the Spring 2020 Advanced and Supervision Intensives is open! Both events sold out months in advance this year. Click on the icons below for more information or to register.
ICCE Fit Supervision Intensive 2020 Scott D Miller

Learning Charisma

June 11, 2019 By scottdm Leave a Comment

I entered university an accounting major.

My first year, I took all the recommended courses: accounting theory, fundamentals of financial and managerial accounting, and so on.

I’d likely be sitting in an office balancing company ledgers or completing tax documents had I never met Hal Miller. A Harvard-educated professor, Dr. Miller taught multiple sections of the Psychology 111 course students could take as part of the required “general education” curriculum.

Decades have now passed since I first met him. Still, I remember that first class as if it were yesterday. When I arrived, every seat in the large, theater-style classroom was already taken, students overflowing into the hallway outside. In time, I’d learn many were not officially registered for the class. They were there because they wanted to hear him speak.

Within weeks, I’d changed my major to psychology. I’m not sure how interested I was in the subject at the time. Rather, I wanted to be like Hal Miller. He loved what he was doing, was devoted to learning, and, most importantly, made me want to study. He was, in a word, charismatic.

“Charisma,” researchers Antonakis, Fenley, and Liechti report, “is rooted in values and feelings. It’s influence born of the alchemy that Aristotle called, the logos, the ethos, and the pathos.”

LOGOS = WORDS, LOGIC, FACTS

ETHOS = ETHICS, CREDIBILITY, EXPERTISE

PATHOS = EMOTIONS, CONNECTION, LIKE-MINDEDNESS

Hal Miller embodied all three qualities. His ability to engage, communicate, and inform, literally changed my life. I’m sure you can identify people who’ve had a similar impact on you.

But how did he do what he did? Did he learn it? Was it in his genes?

It turns out, the word, charisma, comes from the Greek χάρισμα, meaning “gift of grace” — a view widely held even today. You either “got it or you ain’t.”

Curiously, while one study in psychotherapy found it to be both relationally and therapeutically helpful, most of the serious research on the subject comes from other fields where social influence is critical to success (e.g., leadership, training, management). There, the evidence is clear: charisma is, “a learnable skill or, rather, a set of skills,” the potency of which can be dramatically improved with practice.

What exactly does that entail?

As a person whose spent his entire professional career providing continuing education workshops to therapists, I can tell you the absence of specific training means its mostly trial and error. A few have the good fortune to work closely with a gifted practitioner or presenter. I had the opportunity, or example, to work closely with Insoo Berg — a person who exuded warmth and charisma both in the therapy room and on the lecture circuit. And yet, rarely are students of charismatic individuals are as successful or magnetic as their mentors.

So, what does it take?

As hackneyed as it may sound at first, the key is “being yourself.” While its tempting to copy the content, style, and mannerisms of the Hal Millers and Insoo Bergs in our lives, doing so, everyone quickly recognizes, is mere tribute. Success means putting the principles of charisma — logos, ethos, pathos — into practice in a way that is congruent with who you are, your own style, persona and, critically, message.

Below, you’ll find a TedTalk by Professor John Antonakis, one of the leading researchers on charisma. It’s worth a listen. The first 5 minutes is interesting and provocative, but you must listen longer to learn about the evidence documenting that you can dramatically improve your ability to communicate with impact.

If you still are looking for something more practical and skill-based, and specific to psychotherapy, then join my colleagues and I for the upcoming “Training of Trainers” workshop, held the first week of August in downtown Chicago. Together with an international faculty, and participants from around the world, we’ll work on helping you become the most effective version of you, either in your role as a therapist or trainer/presenter. For more information or to register, click here.

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

Do you know Dr. Myron Fox?

June 4, 2019 By scottdm 3 Comments

Take a good look at the photo to the left.

Do you know this person?

His name is Myron L. Fox, M.D., a graduate of the Albert Einstein School of Medicine.

Still doesn’t ring a bell?

At one point, he was the one of the highest rated presenters on the continuing education circuit for physicians, psychologists, social workers, and educators. He delivered hour long lectures followed by 30 minutes of Q & A at major universities. Among other topics, he spoke about the biochemistry of memory. Those in attendance routinely described his lectures as “outstanding,” “stimulating,” “thought provoking,” and “clear and well organized.”

Only one wrinkle. Dr. Fox was not a physician. He wasn’t a doctor of any kind. Neither was his name Myron Fox. In fact, he really knew nothing about the subjects on which he spoke. Rather, the man in the photo was a paid actor coached by a group of experimenters to present a lecture full of “double-talk, neologisms, non sequiturs, and contradictory statements” in one of two ways: straightforward or entertaining.

No surprise, in the first instance, the participants learned less and performed more poorly on a subsequent test than those who attended a similar lecture delivered by a real scientist. However, when “Dr. Fox” adopted a lively demeanor, used humor, and displayed warmth toward and interest in his audience, any correlation between the content covered and audience ratings of the experience disappeared. Indeed, so potent was his style, it masked a completely “meaningless, jargon-filled, and confused presentation” (Merritt, 2008).

The study has been replicated many times with similar results. Even when participants are warned ahead of time to be on guard, the “Dr. Fox Effect” — as it has come to be known — remains in force. Over the years, the findings have been cited as evidence against using speaker and student ratings to evaluate teachers and lecturers. By contrast, I’ve always thought the study showed how important engagement was to effective teaching. After all, in all versions of the study, participants exposed to entertaining versions of lectures scored more highly on subsequent knowledge tests than those hearing material presented in a “straightforward” manner.

It’s why the International Center for Clinical Excellence is offering the “Training of Trainers” course this summer. Knowing that WHO you present is just as critical as WHAT, this three-day, evidence-based, bootcamp style workshop is specifically designed to help you become a better presenter/trainer, one that builds on your style and persona. Click here for more information or to register.

All the best,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
iccexcellence.com