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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Feedback is NOT Enough: A Brief Update about the Empirical Evidence
The use of routine outcome monitoring (ROM) is on the rise. In the United States and abroad, regulatory bodies are actually mandating the gathering of outcome data as the new "standard of care." As agencies rush to implement--often at great cost in terms of time and money--the question remains: just ...
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Science is Real (confusing)
The graphic above is a small sample of the many posts I encountered on social media last week. Obviously, science has a great deal of currency in public discourse. Now, look at the bottom row. On the far left, we are told that drinking wine will help you live a longer life. ...
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Psychotherapy’s Most Closely Held Secret: Some Practitioners are more Effective than Others
Take a good look at the picture below. Do you recognize this person? Let me give you a hint. In 1974, he published the first empirical study documenting one of psychotherapy's most closely held secrets: some therapists are more effective than others. It's true. You know it. I know it. Everyone ...
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Just how good are our theories about the causes and alleviation of mental and emotional suffering?
Does the name Barry Marshall ring a bell? Probably not if you are a mental health professional. For decades, the Australian physician was persona non grata in the field of medicine -- or perhaps stated more accurately, persona sciocca, a fool. Beginning in the early 1980's, Marshall, together with colleague Robin Warren, ...
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I have some magic beans for sale…you want them?
So, you're out for a walk. It's a beautiful day but you're caught up in your thoughts, feeling a bit discouraged and concerned. For whatever reason, some of the people you are working with aren't improving. You're no novice clinician. You know impasses are a common feature of therapeutic work. ...
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Who cares about you anyway? The Role of the Psychotherapist in the Era of Evidence-based Practice
Which of the following are bad for health and longevity? A. Smoking; B. Consuming too much alcohol; C. Being overweight; D. Not flossing regularly. If you answered "yes" to any or all of the items, you are WRONG--that is, at least, if you are determined to rely on evidence ...
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Finding Meaning in Psychotherapy Amidst the Trivia and Trivial
I don't know if you feel the same way I do. Looking back, I'm pretty sure its been going on for a while, but somehow I didn't notice. Professional books and journals fill my bookshelves and are stacked around my desk. I am, and always have been, a voracious--even compulsive--reader. In the last ...
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Symptom Reduction or Well-being: What Outcome should Matter Most in Psychotherapy
So, what contributes to a living a long, healthy life? Clean Air? Being lean versus overweight? The absence of depression or anxiety? Exercising regularly? Getting a flu vaccine? Abstaining from smoking? Minimizing alcohol intake? Personal sense of meaning? Close interpersonal relationships? Social integration? OK, I'll come clean: all contribute--but not equally. Far from it. Some are more important ...
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Ho, Ho, Oh No! Science, politics, and the demise of the National Registry of Evidence-based Programs and Practices
While you were celebrating the Holidays--shopping and spending time with family--government officials were busy at work. On December 28th, the Substance Abuse and Mental Health Services (SAMHSA) sent a formal termination notice to the National Registry of Evidence-based Programs and Practices (NREPP). Ho, ho, oh no...! Briefly, NREPP is "an evidence-based repository and review system ...
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Joint Commission and SAMHSA Set New Standard of Care for Measurement Based Care
The Joint Commission has recently revised their standards of care. To maintain accreditation, organizations are now required to assess outcomes with a standardized measurement tool. The Substance Abuse and Mental Health Services Administration is moving in the same direction. Two scales I developed met the new standard. Both are ...
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Better Results through Deliberate Practice
The legendary cellist Pablo Casals was once interviewed by comedian George Carlin. When asked why, at age 93, he continued to practice three hours a day, Casals replied, "I'm beginning to show some improvement!" Hard not to feel inspired and humbled by such dedication, eh? And while humorous, Casals was ...
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We Need MORE Drugs, Right?
Being human means being conscious. Being conscious means knowing, "reality bites." Little wonder evidence shows people have sought to alter their consciousness since the Stone Age. Whether its music, dance, the ingestion of psychoactive plants, or the modern pharmaceuticals, humans evince a strong desire to move beyond their present reality--to ...
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Clinical Practice Guidelines: Beneficial Development or Bad Therapy?
A couple of weeks ago, the American Psychological Association (APA) released clinical practice guidelines for the treatment of people diagnosed with post-traumatic stress disorder (PTSD). "Developed over four years using a rigorous process," according to an article in the APA Monitor, these are the first of many additional recommendations of specific treatment methods for particular ...
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That’s it. I’m done. It’s time for me to say goodbye.
Ending psychotherapy. Whether formal or informal, planned or unplanned, it's going to happen every time treatment is initiated. What do we know about the subject? Nearly 50% of people who start, discontinue without warning. At the time they end, half have experienced no meaningful improvement in their functioning or well-being. On the ...
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