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Fasten your seatbelt

September 3, 2024 By scottdm 4 Comments

“History” has a way of feeling as though it happened long ago.  Selfies are such a ubiquitous part of our culture it’s hard to believe the technology that gave rise to them appeared only 15 years ago.

One more example.  Seatbelts.  On entering the car, my kids and grandkids fasten theirs without thinking.  Amazing given that the first law mandating their use did not appear until 1984!

1984. 

I’m sure that date seemed far off in the future to George Orwell.  Truth is, however, it’s not so long ago.  I was a graduate student at the time doing a practicum on the psychiatric ward of a local hospital – and it was full to capacity with patients diagnosed with what previously had been considered an exceptionally rare disorder, multiple personality. 

That same year, in what at first seemed an unrelated development, news broke about a child pornography and sexual abuse ring operating at a preschool in Southern California.  Interviews of the children by therapists revealed even more sinister details – ritualistic abuse, animal mutilation, sacrificial murder.  It didn’t stop there.  Other daycare centers were soon implicated, beginning nearby and eventually spreading across the country, exposing a heretofore unknown network of satanic cults.

One day, while working on the unit, I noticed something peculiar.  Amidst the changing names, dress, and interactional styles, several of the patients had multiple sets of eyewear.  I’m not talking about Ray-Ban’s versus Maui Jim, but rather prescription glasses.  More, the pair they wore seemed to vary depending on which of their many personalities was dominant at the time.

And that’s when my dissertation project was born.  Over the next year-and-a-half, I ferried patients from the unit to the office of an ophthalmologist who had volunteered to run the tests for the study.  Three alters per person had their eyes refracted, retina and vascular structure examined, and intraocular pressure measured.  The same tests were completed on an equal number of people who had been trained to feign the disorder during the examination.    

During this time, allegations of sexual abuse by organized groups of devil worshipping pedophiles continued to emerge. I’m not sure where I was when a connection was suggested between satanic ritual abuse and the development of multiple personality disorder.    In truth, it wasn’t a big leap.  A decade earlier, the book, Sybil, and later television mini-series starring Sally Fields, made the public aware of the link between sexual abuse and splintering of personality.  

I do remember where I was when I heard that expressions of doubt about the validity of reports regarding widespread satanic abuse could be evidence of complicity.  I was at a national conference.  Even more mind-bending were the rumors about who was behind the global conspiracy and their true intentions.  Can you guess?

By the time I’d finished my dissertation and published a larger, follow-up study, much had changed.  My own research challenged the view of the diagnosis popular at the time; namely, that the chief characteristic of the disorder was the existence of separate and distinct alter personalities.  Turns out, the visual functioning of people with the diagnosis was indeed highly variable, but not reliably so.

On the legal front, despite spending seven years and fifteen million dollars, the prosecution of the teachers or owners of the original daycare facility resulted in no convictions for any crime.  Excavations of an adjacent lot found no evidence of the “secret underground rooms” reportedly used for photographing and abusing children.  Despite extensive investigations by the FBI and National Center on Child Abuse and Neglect, none of the twelve thousand accusations of cult led sexual abuse were substantiated.  It would take decades in some instances, but all who were convicted were eventually released, including a man whose daughters’ recovered memories of sexual abuse and human sacrifice led to his conviction and twenty-year prison sentence.  In time, even Shirley Mason, the real Sybil, recanted, admitting in a letter to her psychiatrist that she’d fabricated the entire story. 

And then, just as quickly as it all had started, public and professional interest came to an end.  Media stories all but disappeared.  Incidence of the diagnosis in hospitals and clinical practice declined precipitously.  Specialized treatment centers closed, and professional associations disbanded.

Progress, it seems, was to be had elsewhere.  The “decade of the brain” was underway, and the field was moving on.   Remember that?  It wasn’t that long ago.

Filed Under: Feedback Informed Treatment - FIT

A not so helpful, helping hand

August 28, 2024 By scottdm 2 Comments

“Your reach should exceed your grasp,” was one of my dad’s favorite sayings.  Smile on his face, he would often add, “be prepared to end up empty handed” – which reminds me of a memory.

I was seated on the right side of the room, in the aisle seat, second row from the front.  As far as venues go, it was nothing special.  The workshop was another story.  I’d been looking forward to attending for several months.  I wasn’t alone.  Every seat was taken – many of the participants familiar to me, although older and much more experienced. 

I’m sure I was the only grad student in attendance.  It wasn’t for lack of interest.  The cost was simply too high.  I’d only managed to secure a spot by agreeing to help out the organizers.      

Day two began with a video featuring the second meeting with a couple.  We’d seen the first session the day before.   And while the details of the discussion between the couple and therapist are lost to time, I remember with absolute clarity how their visit concluded.   The therapist told the couple to shave their heads and bury the clippings in a hole in their back yard prior to the next visit. 

My reaction was instantaneous.  I started laughing.  I couldn’t control myself.  Neither could the other attendees.  The “intervention” – as the homework task was termed – was just so surprising.  At the same time, it fit the situation.  Like the answers to classic Zen koans, a perfect combination of absurdity, recognition and truth.  You know, “What is the sound of one hand clapping?”  (The answer can be found in the parenthesis below) 

Anyway, when someone in the audience shouted, “Did they come back?” the presenter responded in true cliff-hanger fashion, “You will have to come back tomorrow to find out.”

And there we sat, the room strangely quiet for so early in the morning. 

I didn’t know what to expect.  As the video began playing, the audible gasps of those around me suggested my fellow attendees didn’t either.  But there the couple was, center screen, seated in adjoining chairs, both as bald as Winston Churchill.  According to their statements, engaging in the task had been transformative.  The problems that had proven so intractable to their own and prior professionals’ attempts to help had largely resolved.

Had I not seen it with my own eyes, I would not have believed it.  I listened ever more attentively the rest of the day, taking careful notes and mulling over the answers given to participants questions.  At the end, I bought the presenter’s latest book.  “To Scott,” the personal inscription read, “Use it or lose it.”

I still have the book on my shelf in my office. What I don’t have is a picture of my supervisor’s face when I related the story at our next meeting – not about the video of the couple, mind you, but rather what happened when I instructed my one practicum client to shave their head.  With a roll of their eyes, they’d stood and left the session.  My supervisor?  Kind of like the sound of one hand clapping, silence (in this instance, I believe, the stunned variety).

So, has your reach ever exceeded your grasp in this way? Left you empty handed or worse, with an empty seat in your office? What happened for you? Your client? What, if anything changed in your understanding of the work? Finally, what advise would you offer a person just entering the field given the abundance of therapeutic options and choices?

If you’re interested, more such stories are available on my Substack page.

OK, until next time, I wish you the best,

Scott

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

P.S.: Registration is open for the next, Feedback Informed Treatment Supervision/Consultation Intensive. Click here or the icon below for more information or to secure your spot.

(Shame on you.  Go back and finish the story)

Filed Under: Feedback Informed Treatment - FIT

Alas, it seems everyone comes from Lake Wobegon

August 21, 2024 By scottdm 2 Comments

You’ve heard of it, right? Lake Wobegon? The fictional town in Minnesota made famous by master story-teller, Garrison Keller. The place where, “all the people are strong, good-looking, and above average?”

Turns out, if the city were “Psychotherapy,” it would not be a fictional place. Since 2012 when the first study appeared in the literature, others have been published documenting the tendency of practitioners to overestimate their effectiveness — on average, by 65% (1, 2). The impact on professional development could not be greater. Again, multiple studies show, for example, therapists do not improve with time or experience despite obtaining regular supervision or attending the latest continuing education workshops (3).

If you are like most therapists, you’re likely feeling skeptical about such findings — and there are some exceptions. More on that in a moment.

In the meantime, consider the results of a study my colleagues and I just published in Practice Innovations. We knew that research to date had relied exclusively on therapists in Western cultures and wanted to explore whether The Lake Wobegon Effect would be observable in other cultures — particularly, those valuing humility and modesty. Turns out, similar to therapists from the US, Canada, Australia and Europe, Chinese psychotherapists (N = 223) rated themselves as above average (the mean percentile rank being statistically indistinguishable).

So, who are the exceptions? In the studies documenting that most therapists become more confident while remaining average or achieving poorer outcomes, some — between 15 and 25% — defy the trend and actually improve with time and experience.

What is it that they do? Returning to Lake Wobegon, they neither express nor rely on feelings of humility. Rather, they engage in activities that engender the self-doubt required for making changes in how they work. One example is measuring their performance. Indeed, the only study ever published to document improved outcomes at the individual practitioner level involved therapists routinely measuring client progress, identifying those at risk of dropout or a negative or null outcome, and obtaining feedback targeted to their specific clinical errors and performance deficits (4).

Whether you are an experienced practitioner or new to the field, have been measuring your results for years or wanting to get started, the upcoming Feedback Informed Treatment Intensive will help you put Lake Wobegon in the rearview mirror. Three days, online, and ongoing support from a worldwide community of helping professionals dedicated to improving the outcome of behavioral health services. Click the icon below for more information or to register. As always, feel free to reach out with any questions.

Until next time,

Scott

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

UPDATE 9/23/24

Access the article here.

Filed Under: Feedback Informed Treatment - FIT

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