The Debate of the Century

August 27, 2009 By scottdm

What causes change in psychotherapy? Specific treatments applied to specific disorders? Those in the “evidence-based” say so and have had a huge influence on behavioral healthcare policy and reimbursement. Over the last 10 years, my colleagues and I have written extensively and traveled the world offering a different perspective: by and large, the effectiveness of care is due to a shared group of factors common to all treatment approaches.

In place of “evidence-based” practice, we’ve argued for “practice-based”evidence. Said another way, what really matters in the debate is whether clients benefit–not the particular treatment approach. Here on my website, clinicians can download absolutely free measures that can be used to monitor and improve outcome and retention (click Performance Metrics).

Anyway, the message is finally getting through. Recently, uber-statistician and all around good guy Bruce Wampold, Ph.D. debated prominent EBP proponent Steve Hollon. Following the exchange, a vote was taken. Bruce won handily: more than 15:1.

Scroll down to “Closing Debate” (Thursday)

Announcement: Evolving in a new direction

August 25, 2009 By scottdm Leave a Comment

As those of you who have followed my work and blog know, my perspective is evolving. The direction I’m heading builds on all of the work done to date including the common factors, measurement of outcome and alliance, and feedback. Crucially, however, it goes one step further; bridging the common and specific factors divide that has long dominated and splintered the field, and identifying the concrete steps that diverse providers can take to improve their effectiveness and the services they offer consumers.

For the past 10 years much of my work has been available through the Institute for the Study of Therapeutic Change (ISTC) and featured on its website. In line with the evolution in my perspective my work is now increasingly centered on a new organization, the International Center for Clinical Excellence (ICCE), an international consortium of researchers, educators, and clinicians dedicated to understanding and promoting excellence in behavior healthcare. My colleague Barry Duncan, co-founder of the ISTC, is also developing his work in new directions and we have therefore decided that the time is now right to dissolve our long-term partnership in the ISTC. I recognise that for many of you, who have followed my work over the years, that this may come as a surprising development and I am hoping that this post and others to follow will provide guidance, reassurance and most importantly continuity.

Central to the mission of the International Center for Clinical Excellence (ICCE) is the creation of a web-based community of clinicians using the latest Web 2.0 technology where participants can learn from and share with each other. Based on the principles of Clinical Community Social Software (CCSS) it is specifically designed to support clinical excellence through creating virtual clinical networks, groups and clinical communities where clinicians can be supported in the key behavior changes required for developing clinical excellence. Participants can, using a variety of social networking and collaborative tools, share clinical insights through discussion forums and video posts as well as improve client outcomes through learning the skills of clinical excellence.

We have finished our first round of beta-testing for the site and you can go to the website at: www.centerforclinicalexcellence.com to register to become a member (its free and you’ll be notified the minute the entire site is live)!

For those of you new to the tremendous opportunities for web-based collaborative social software, let me reassure you that the site will permit access and use at whatever level you desire (everything from the familiar email, to online posts and discussions in real time). It will provide lots of help to learn how to explore the information and resources on offer as well as the support of colleagues in the community. I am very excited by this opportunity to interact with behavioral health professionals all over the world in this way. Over the next few days, I’ll be posting more information about the ICCE and our first International Conference on Excellence in Behavioral Health on my blog at www.scottdmiller.com. I encourage you to follow the updates on my blog and post any questions or comments.

Expertise and Excellence: What it Takes to Improve Therapeutic Effectiveness

April 2, 2009 By scottdm 1 Comment

If you’ve been following my website and the Top Performance Blog you know that my professional interests over the last couples of years have been shifting, away from psychotherapy, the common factors, and feedback and toward the study of expertise and excellence.

Studying this literature (click here for an interesting summary), makes clear that the factors responsible for superior performance are the same regardless of the specific endeavor one sets out to master. The chief principle will come as no surprise: You have to work harder than everyone else at whatever you want to be best at.

In other words, you have to practice.

Hard work is not enough, however. Research shows that few attain international status as superior performers without access to high levels of support and detailed instruction from exceptional teachers over sustained periods of time. In the massive “Cambridge Handbook of Expertise and Expert Performance,” Feltovich et al. note, “Research on what enabled some individuals to reach expert performance, rather than mediocre achievement, revealed that expert and elite performers seek out teachers and engage in specifically designed training activities…that provide feedback on performance, as well as opportunities for repetition and gradual refinement” (p. 61).

What makes for a “good” teacher? Well, in essence, that is what the “Top Performance” blog is all about. I’m going on a journey, a quest really. I’ve decided to take up two hoppies–activities I’ve always had a interest in but never had to the time to study seriously–magic and the ukelele.

Practicing is already proving challenging. Indeed, the process reminds me a lot of when I started out in the field of psychology. In a word, its daunting. There are literally thousands of “tricks” and “songs,” (as there are 100’s of treatment models), millions of how-to books, videos, and other instructional media (just as in the therapy world), as well as experts (who, similar to the field of psychotherapy, offer a wide and bewildering array of different and oftentimes contractory opinions).

By starting completely over with subjects I know nothing about, I hope to put into practice the insights gleaned from our study of expertise and expert performance, along the way reporting the challenges, triumphs and failures associated with learning to master new skills. I’ll review performances, instructional media (live, printed, DVD, etc), and the teachers I met. Stay tuned.