Making the Impossible, Possible: The Fragile Balance

July 25, 2016 By scottdm 1 Comment

Trip-Advisor scores it # 11 out of 45 things to do Sausalito, California. No, it not’s the iconic Golden Gate Bridge or Point Bonita Lighthouse. Neither is it one of the fantastic local restaurants or bars. What’s more, in what can be a fairly pricey area, this attraction won’t cost you a penny. It’s the gravity-defying rock sculptures of local performance artist, Bill Dan.

So impossible his work seems, most initially assume there’s a trick: magnets, hooks, cement, or pre-worked or prefab construction materials.

Watch for a while, get up close, and you’ll see there are no tricks or shortcuts. Rather, Bill Dan has vision, a deep understanding of the materials he works with, and perseverance. Three qualities that, it turns out, are essential in any implementation.

Over the last decade, I’ve had the pleasure of working with agencies and healthcare systems around the world as they work to implement Feedback-Informed Treatment (FIT). Not long ago, FIT–that is, formally using measures of progress and the therapeutic alliance to guide care–was deemed an evidence-based practice by SAMHSA, and listed on the official NREPP website. Research to date shows that FIT makes the impossible, possible, improving the effectiveness of behavioral health services, while simultaneously decreasing costs, deterioration and dropout rates.

Dan 2

Over the last decade, a number of treatment settings and healthcare systems have beaten the odds. Together with insights gleaned from the field of Implementation Science, they are helping us understand what it takes to be successful.

One such group is Prairie Ridge, an integrated behavioral healthcare agency located in Mason City, Iowa. Recently, I had the privilege of speaking with the clinical leadership and management team at this cutting-edge agency.

Click on the video below to listen in as they share the steps for successfully implementing FIT that have led to improved outcomes and satisfaction across an array of treatment programs, including residential, outpatient, mental health, and addictions.

Until next time,

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

P.S.: Looking for a way to learn the principles and practice of Feedback Informed Treatment? No need to leave home. You can learn and earn CE’s at the ICCE Fall FIT Webinar. Register today at: https://www.eventbrite.ie/e/fall-2016-feedback-informed-treatment-webinar-series-tickets-26431099129.

Do you do psychotherapy?

September 26, 2013 By scottdm 1 Comment

You know psychotherapy works. Forty years of research evidence backs up your faith in the process. And yet, fewer and fewer people are seeking out the services of professionals. Between 1998 and 2007, psychotherapy use decreased by 35%. People still sought help, they just went elsewhere to get it. For instance, use of psychotropic drugs is up 40% over the last decade.

A recent article in Popular Science traced the decline and outlined 3 provocative steps for saving the field. If you provide psychotherapy, it’s worth a read. The article is dead serious when recommending:

1. It’s time to GO BIG;

2. Getting a cute commercial; and

3. Dropping the biology jargon.

You’ve got to admit that the field’s fascination with biology is curious. A mountain of evidence points instead to the relationship between the provider and recipient of care. Other research shows that psychotherapy promotes more lasting change, at less cost and with fewer side effects than medication.

How to get the message out?

Many people and organizations are making a valiant effort. Ryan Howe almost single-handedly established today, September 25, as National Psychotherapy Day. The American Psychological Association published a rare, formal resolution on the efficacy of psychotherapy.

Frankly though, the best commercial for psychotherapy is our results. Consider the approach taken by the Colorado Center for Clinical Excellence. They don’t merely cite studies supporting psychotherapy in general, they report their actual results!

You can begin doing the same by downloading two free, simple to use measures here.

Then, learn how to use the scales to determine your effectiveness at an upcoming Feedback Informed Treatment Intensive (FIT) training.

There, you’ll also learn how to use the data to improve both the quality and outcome of your services. That’s why the Substance Abuse and Mental Health Services Administration (SAMHSA) recently listed FIT on the National Registry of Evidence Based Programs and Practices!

So, now is the time GO BIG by joining us. The next training is coming up in March! Register now at: http://ai2014.eventbrite.ie/.

National Psychotherapy Day: A Recognition, Celebration, and Call for Action

September 24, 2012 By scottdm Leave a Comment

With all the challenges facing the profession, it is important to highlight people and organizations that are working hard to make a difference. On that note, tomorrow, Tuesday the 25th of September 2012 is the very first National Psychotherapy Day. Having a day of unified, active promotion of psychotherapy is the brain child of psychologist Ryan Howes. At his side is the Psychotherapy Foundation (PF), a nonprofit foundation, dedicated to promoting the therapeutic relationship as an “effective, long-lasting, collaborative approach” to resolving emotional, behavioral, and relational problems. What’s not to like? Dr. Howes and the PF are encouraging people who have seen a therapist to talk or blog about their experience. They are calling on therapists to commit to sharing research documenting the effectiveness of psychotherapy with the public (write a letter to the editor of your local paper, offer to do an interview, give a brief presentation at the Chamber of Commerce).

Surveys show that the two primary barriers to seeking the help of a therapist are: (1) cost of the service (cited by 81%); and (2) lack of confidence in the outcome of therapy (78%). Of these two barriers, the first is entirely understandable. Times are tough and treatment costs money. It is for these this reason that Dr. Howe and the PF are asking all who participate in the day to support their local, low-fee counseling centers in whatever way possible.

The second barrier is more troubling and, frankly, difficult to understand and address. Research overwhelmingly supports the efficacy of psychological treatment. Indeed, the American Psychological Association issued a rare, formal resolution this last month recognizing the effectiveness of psychotherapy! Listen to the language:

Whereas the effects of psychotherapy …are widely accepted to be significant and large;
Whereas the results of psychotherapy tend to last long and be less liely to equire additional treatment courses than psychopharmacological treatments;
Whereas comparisons of different forms of psychotherapy most often result in relatively nonsignificant difference, and contextual and relationship factors (not captured by a patient’s diagnosis or by the therapists use of a specific psychotherapy) mediate or moderate outcomes;
Whereas the best research evidence conclusively shows that individual, group, and couple/family psychotherapy are effective for a broad range of…problems with children, adolescents, adults, and older adults;
THEREFORE be it resolved that, as a healing practice and professional service, psychotherapy is effective and highly cost effective…and should be included in the health care system as an established evidence-based practice.

Strong words, right? Even so, it’s very clear that the public’s lingering doubts about effectiveness will require than a proclamation. It is for this reason that Dr. Howes and PF are asking all those currently in care to provide constructive feedback to their therapist. Therapists, in turn, are encouraged to seek and respond to feedback from their clients. As reviewed here on this blog, numerous studies document the positive impact that routine feedback from clients has on retention and outcome of service. Free evidence-based tools are available for download from this website for soliciting formal feedback from consumers. Plus, the International Center for Clinical Excellence web-based community–the largest group of clinicians and researchers dedicated to improving the quality and outcome of psychotherapy via the use of ongoing feedback–stands ready and willing to be of support.

So, why the turquoise? Well, its’ the official color of National Psychotherapy Day. To show your support, Dr. Howes and PF are asking all to wear something with that color tomorrow.

Revolution in Swedish Mental Health Care: Brief Update

May 14, 2012 By scottdm 1 Comment

In April 2010, I blogged about Jan Larsson, a Swedish clinician who works with people on the margins of the mental health system. Jan was dedicated to seeking feedback, using the ORS and SRS to tailor services to the individuals he met. It wasn’t easy. Unilke most, he did not meet his clients in an office or agency setting. Rather, he met them where they were: in the park, on the streets, and in their one room aparments. Critically, wherever they met, Jan had them complete the two measures–“just to be sure,” he said. No computer. No I-phone app. No sophisticated web-based adminsitration system. With a pair of scissors, he simply trimmed copies of the measures to fit in his pocket-sized appointment book! I’ve been following his creative application of the scales ever since.

Not surprisingly, Jan was on top of the story I blogged about yesterday regarding changes in the guidelines governing Swedish mental health care practice. He emailed me as I was writing my post, including the link to the Swedish Radio program about the changes. Today, he emailed again, sending along links to stories appearing in two Swedish newspapers: Dagens Nyheter and Goteborg Posten.

Thanks Jan!

And to everyone else, please continue to send any new links, videos, and comments.