To Give or Not to Give Advice: Is that in Question?
My family and I had a frightening experience this past Memorial Day. While driving through Indiana on the way home to Chicago, our mobile phones began to alert. You know the sound -- part cicada, part microphone feedback, but louder. "Tornado warning in this area." Not a watch, mind you, a ...
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Therapeutic Nudging: How Very Little Can Mean a Lot
It was a curious finding. One we stumbled on quite by accident. Highly effective therapists were more likely to contact their clients between visits than their more average peers. We wondered whether such behavior might account, at least in part, for their superior retention rates and outcomes? Turns out, our ...
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How Does Feedback Informed Treatment Work? I’m Not Surprised
Feedback-Informed Treatment (FIT) -- using measures to solicit feedback about progress and the quality of the therapeutic relationship -- is a transtheoretical, evidence-based approach. The most recent research shows clients whose therapists use FIT on an ongoing basis are 2.5 times more like to experience benefit from treatment. But how ...
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What does losing your keys have in common with the treatment of trauma?
Last week, I was preparing to leave the house and could not locate my keys. Trust me when I say, it's embarrassing to admit this is not an infrequent occurrence. Logic and reason are always my first problem solving choices. That's why I paused after looking in the kitchen drawer ...
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Mountains and Molehills, or What the JFK Assasination and the Therapeutic Relationship have in Common?
Over the last 10 days or so, I've been digesting a recently published article on the therapeutic alliance -- reading, highlighting, tracking down references, rereading, and then discussing the reported findings with colleagues and a peer group of fellow researchers. It's what I do. The particular study has been on ...
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It’s Time to Abandon the “Mean” in Psychotherapy Practice and Research
Recognize this? Yours will likely look at bit different. If you drive an expensive car, it may be motorized, with buttons automatically set to your preferences. All, however, serve the same purpose. Got it? It's the lever for adjusting your car seat. I'm betting you're not impressed. Believe it or ...
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Routine Outcome Monitoring and Deliberate Practice: Fad or Phenomenon?
Would you believe me if I told you there was a way you could more than double the chances of helping your clients? Probably not, eh? As I've documented previously, claims abound regaring new methods for improving the outcome of psychotherapy. It's easy to grow cynical. And yet, findings from a ...
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Good Intentions or The Proverbial “Road to Hell?”: Trying to Understand the APA guidelines for Men and Boys
Several weeks ago, the American Psychological Association (APA) released its latest in a series of practice guidelines for psychologists – this time for “Psychological Practice with Boys and Men.” Prior years had seen guidelines focused on ethnicity, older adults, girls and women, LGBT, and “transgender and gender-non-conforming” persons. Curiously, despite ...
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Surfing and Psychotherapy (or, How Two of My “Love Affairs” in Life are Alike)
I'm neither a great psychotherapist or surfer. I love doing both, however. Turns out, the two share a fundamental similarity critical to successful execution; in a word, responsiveness. /rəˈspänsivnəs/ NOUN The quality of reacting quickly and positively. In surfing, you take advantage of the waves coming your way. In psychotherapy, ...
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Time for a New Paradigm? Psychotherapy Outcomes Stagnant for 40 years
You've heard it said before. Flying is the safest form of transportation. Facts back up the claim. In fact, it's not even close. In terms of distance traveled, the fatality rate per billion kilometers is .003, improving dramatically over the years. Cars, by contrast, are almost 1,000 times more dangerous. Still, since ...
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Beating the Dodo Verdict: Can Psychotherapy Ever Achieve Better Results?
Nearly two decades have passed since I met Saul Rosenzweig at his home in St. Louis, Missouri. He was well into his nineties and still working every day. Truth is, I was surprised to learn he was still alive! In 1936, he'd penned an article --three and a half pages in ...
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“Clients Won’t Like It” and Other Concerns about Feedback Informed Treatment
In my travels each year, I meet 1,000's of clinicians--professionals who truly want to help others, and are willing to try almost anything to do so. That's why I always "lean in" whenever one expresses concern about the rising popularity of using formal measures of progress and the therapeutic relationship ...
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Aren’t You the Anti-Evidence-Based Practice Guy? My Socks. And Other Crazy Questions.
It's just two weeks ago. I was on a call with movers and shakers from a western state. They were looking to implement Feedback Informed Treatment (FIT)--that is, using measures of progress and the therapeutic relationship to monitor and improve the quality and outcome of mental health services. I was ...
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What Works in Psychotherapy? Valuing “What Works” rather than Working with What We Value
Most clinicians agree, the therapeutic relationship is an important ingredient in effective psychotherapy. However, ask them the last time they: (1) read a study on the subject; (2) attended a postgraduate training specifically aimed at improving their skills in this area; or simply to (3) identify and define the factors ...
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“What works” with eating disorders (and how long will it take the field to swallow these results)?
What works in the treatment of people with eating disorders? Search around a bit on the internet, or consult official treatment guidelines, and you'll find cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) listed as the "best-supported" or "preferred" psychological approaches for bulimia, anorexia, and binge eating. Such recommendations strongly imply ...
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What heals trauma?
"Exposure!" a choir of professional voices sings, "its the only proven way." "No, no," others insist, "You can tap yourself to emotional freedom." "Poppycock!" another group jumps in, "Horizontal saccadic eye movements are the ticket!" "Beware the dominant discourse," a few, particularly literate warn, "focusing on what was done to the ...
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