Does Teletherapy Work?

July 22, 2020 By scottdm Leave a Comment

With the outbreak of the coronavirus, much of mental health service delivery shifted online. Regulations regarding payment and confidentiality were scaled back in an effort to deal with the unprecedented circumstances, allowing clinicians and their clients to meet virtually in order to reduce the spread of the illness.

But is teletherapy helpful?

Listening to discussions among therapists on social media, the assessment is decidedly mixed. Almost all are grateful for the opportunity online platforms provide to meet with clients. On the other hand, many question its effectiveness relative to in person services. At a minimum, challenges exist.

So, what does the research indicate?

Drum roll please …

no difference in outcome for adults, adolescents and children being treated for the most common concerns addressed in psychotherapy (e.g., depression, anxiety, trauma, eating problems, substance abuse). What’s more, online services are associated with greater utilization of and less dropout from mental health care.

That said, challenges are evident. For most clinicians and clients, teletherapy is an entirely new enterprise requiring a period of learning and adjustment. Critically, the sensory input clinicians rely upon to make clinical judgments is also restricted — all the more reason to make “Feedback-Informed Treatment (FIT) a routine part of the services you provide. Even if you’re regularly seeking feedback from clients using standardized measures like the Outcome and Session Rating Scales, doing so virtually will be new for most.

It’s why many of my posts since mid-March have provided detailed information using the measures online (read them by clicking: 1, 2, 3, 4, 5, 6, 7, 8, 9). Below you’ll finds links to all the “how-to” videos FIT Certified Trainers created over the last four months. No need to re-invent the wheel –and, no, if you’ve downloaded paper and pencil copies, digitizing the measures is not allowed — but there’s really no need. Three authorized systems are available that administer, score, and most importantly, provide access to real time feedback and a series of evidence-based metrics for assessing your performance and developing deliberate practice objectives.

Getting Beyond the “Good Idea” Phase in Evidence-based Practice

July 9, 2020 By scottdm Leave a Comment

The year is 1846. Hungarian-born physician Ignaz Semmelweis is in his first month of employment at Vienna General hospital when he notices a troublingly high death rate among women giving birth in the obstetrics ward. Medical science at the time attributes the problem to “miasma,” an invisible, poison gas believed responsible for a variety of illnesses.

Semmelweis has a different idea. Having noticed midwives at the hospital have a death rate six times lower than physicians, he concludes the prevailing theory cannot possibly be correct. The final breakthrough comes when a male colleague dies after puncturing his finger while performing an autopsy. Reasoning that contact with corpses is somehow implicated in the higher death rate among physicians, he orders all to wash their hands prior to interacting with patients. The rest is, as they say, history. In no time, the mortality rate on the maternity ward plummets, dropping to the same level as that of midwives.

Nowadays, of course, handwashing is considered a “best practice.” Decades of research show it to be the single most effective way to prevent the spread of infections. And yet, nearly 200 years after Semmewies’s life-saving discovery, compliance with hand hygiene among healthcare professionals remains shockingly low, with figures consistently ranging between 40 and 60% (1, 2). Bottom line: a vast gulf exists between sound scientific practices and their implementation in real world settings. Indeed, the evidence shows 70 to 95% of attempts to implement evidence-based strategies fail.

To the surprise of many, successful implementation depends less on disseminating “how to” information to practitioners than on establishing a culture supportive of new practices. In one study of hand washing, for example, when Johns Hopkins Hospital administrators put policies and structures in place facilitating an open, collaborative, and transparent culture among healthcare staff (e.g., nurses, physicians, assistants), compliance rates soared and infections dropped to zero!

Feedback Informed Treatment (FIT) — soliciting and using formal client feedback to guide mental health service delivery — is another sound scientific practice. Scores of randomized clinical trials and naturalistic studies show it improves outcomes while simultaneously reducing drop out and deterioration rates. And while literally hundreds of thousands of practitioners and agencies have downloaded the Outcome and Session Rating Scales — my two, brief, feedback tools — since they were developed nearly 20 years ago, I know most will struggle to put them into practice in a consistent and effective way.

To be clear, the problem has nothing to do with motivation or training. Most are enthusiastic to start. Many invest significant time and money in training. Rather, just as with hand washing, the real challenge is creating the open, collaborative, and transparent workplace culture necessary to sustain FIT in daily practice. What exactly does such a culture look like and what actions can practitioners, supervisors, and managers take to facilitate its development? That’s the subject of our latest “how to” video by ICCE Certified Trainer, Stacy Bancroft. It’s packed with practical strategies tested in real world clinical settings.

By the way, want to interact with FIT Practitioners around the world? Join the conversation here.

Forgiveness

July 1, 2020 By scottdm Leave a Comment

One warm, summer June day, Marietta Jaeger, her husband Bill, and their five children packed into their borrowed R.V. for a cross-country road trip touring the American west. “This was going to be the adventure of a lifetime, a grand family vacation, the one we were going to talk about for the rest of our lives,” Marietta observes some four decades later, “and it certainly has been.”

On the third night of their stay, camped at the headwaters of the Missouri river, the family’s youngest child — 7-year old Susie Jaeger — was kidnapped. A slit made with surgical precision in the canvas of the tent in which she slept with her brothers and sisters was the only clue to what had happened.

Hours, days, and weeks passed while local, state, and federal authorities searched. Although increasingly desperate, Marietta maintained her focus and composure, attending to her other children while constantly juggling interactions with law enforcement and the media. Then, “A day came,” she recalls, “where I began to get angry.” By this time, the family had been camped out at the river’s edge for over a month. “By the time I got into bed,” she continues, “I was just ravaged with hatred and a desire for revenge.” Her eyes narrowing in anger, she confesses, “I wanted this guy to swing,” adding, “I could have killed him for what he had done with my bare hands and a smile on my face.”

No one I know would fault Marietta for her feelings. Some experts might even suggest her reaction was a necessary, even helpful part of recovering from such a traumatic event. In the end, however, it was not the path she chose to stay on. Quite the contrary. Rather, before daylight broke the next day, and years before she would learn what actually happened to her daughter, Marietta made the decision to forgive the person who had taken Susie.

Believe me when I say, her decision was no mere contrivance or symbolic gesture. Her behavior followed suit — acts of grace, understanding, and empathy most would find exceptionally difficult to emulate — for example, expressing genuine care and concern for the kidnapper when he called to taunt the family one year later on the date and exact hour he’d absconded with Susie.

I won’t tell you here what happened. You can watch for yourself in the link to the 20/20 episode below. What I will say is that Marietta Jaeger’s ability to forgive proved to be the key to solving the kidnapping of her daughter.

Research documents the healing effects of forgiveness on individuals and groups (1, 2, 3, 4, 5). Other data indicate people, particularly those seeking psychotherapy, want to forgive. But how? What exactly are the steps?

I had the opportunity to speak with Marietta Jaeger last week. During the time we spent together, she told me how she did it. I experienced a wide range of emotions: anger, discouragement, frustration, bafflement, sadness, and peace.