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The Evolution of Psychotherapy: Meeting Michael Hoyt

December 16, 2009 By scottdm 1 Comment

I’m still reeling from the experience in Anaheim this last week.  I met so many leaders in the field, heard so many presentations on cutting edge clinical practice–as well as was reminded of some “classic” principles of effective psychotherapy.

One of the people I met was colleague and friend, Michael F. Hoyt, Ph.D.  Michael and I go back 15+ years, having met–I believe–the first time at a workshop I was giving in Northern California (somewhere in the Bay Area where Michael works and resides).  Since that time, we chatted regularly, and written editorials and book chapters together.  His books (The First Session in Brief Therapy, Brief Therapy & Managed Care, The Handbook of Constructive Therapies, Some Stories are Better than Others) always balance theory and practice and are among my favorites.

My two favorite books are also his most recent: The Present is a Gift and Brief Psychotherapies: Principles & Practice (Hint: his chapters on couples therapy are among the best I’ve ever read).  Anyway, the two of us caught up at the ICCE booth this last week at the Evolution conference.

Filed Under: Behavioral Health, Conferences and Training, excellence, Feedback Tagged With: Brief Psychotherapies: Principles & Practice, brief therapy, constructive therapy, couples therapy, Evolution of Psychotherapy, icce, managed care, Michael F. Hoyt, The Present is a Gift

Five Incredible Days in Anaheim

December 15, 2009 By scottdm 2 Comments

From December 9-13th, eight thousand five hundred mental health practitioners, from countries around the globe, gathered in Anaheim, California to attend the “Evolution of Psychotherapy” conference.  Held every five years since 1985, the conference started big and has grown only larger.  “Only a few places in the US can accommodate such a large gathering,” says Jeffrey K. Zeig, Ph.D., who has organized the conference since the first.

The event, held every five years, brings together 40 of the field’s leading researchers, practitioners, trend setters, and educators to deliver keynote addresses and workshops, host discussion panels, and offer clinical demonstrations on every conceivable subject related to clinical practice.  Naturally, I spoke about my current work on “Achieving Clinical Excellence” as well as served on several topical panels, including “evidence based practice” (with Don Meichenbaum), “Research on Psychotherapy” (with Steven Hayes and David Barlow), and “Severe and Persistent Mental Illness (with Marsha Linnehan and Jeff Zeig).

Most exciting of all, the Evolution of Psychotherapy conference also served as the official launching point for the International Center for Clinical Excellence.  Here I am pictured with long-time colleague and friend, Jeff Zeig, and psychologist and ICCE CEO, Brendan Madden, in front of the ICCE display in the convention center hall.

Over the five days, literally hundreds of visitors stopped by booth #128 chat with me, Brendan, and Senior ICCE Associates and Trainers, Rob Axsen, Jim Walt, Cynthia Maeschalck, Jason Seidel, Bill Andrews, Gunnar Lindfeldt, and Wendy Amey.  Among other things, a cool M and M dispenser passed out goodies to folks (if they pressed the right combination of buttons), we also talked about and handed out leaflets advertising the upcoming “Achieving Clinical Excellence” conference, and finally people watched a brief video introducing the ICCE community.  Take a look yourself:.


More to come from the week in Anaheim….

Filed Under: Behavioral Health, Conferences and Training, excellence, ICCE Tagged With: Acheiving Clinical Excellence, brendan madden, david barlow, Don Meichenbaum, evidence based practice, Evolution of Psychotherapy, icce, Jeff Zeig, jeffrey K. zeig, Marsha Linnehan, mental health, psychotherapy, Steve Hayes

Climate Change in Denmark

December 5, 2009 By scottdm Leave a Comment

hans_christian_andersen_gbHans Christian Andersen, the author of such classic stories as The Ugly Duckling and the Emperor’s New Clothes, once wrote, “Life itself is the most wonderful fairy tale of all.”  That sentiment is certainly true of my own life.  For the last 16 years, I’ve been privileged to travel around the world conducting training and providing consultation.  Each year, I meet literally thousands of therapists and I’m consistently impressed and inspired by their dedication and persistence.  Truth be told, that “spirit”–for lack of a better word–is actually what keeps me in the field.

This last year, I’ve spent a considerable amount of time working with practitioners in Denmark.  Interest in Feedback-Informed Treatment has taken off–and I have the frequent flyer miles to prove it! While I’ve been traveling to the homeland of Hans Christian Andersen for many years (actually my maternal grandfather and his family immigrated to the United States from a small town just outside Copenhagen), momentum really began building following several years of workshops arranged by Henrik and Mette Petersen who run Solution–a top notch organization providing both workshops and year-long certification courses in short-term, solution-focused, and systemic therapies.

In October, I worked with 100+ staff who work at Psykoterapeutisk Center Stolpegård–a large outpatient center just outside of Copenhagen.  For two days, we talked about research and practice in psychotheapy, focusing specifically on using outcome to inform and improve clinical services.  Peter Koefoed, chief psychologist and head of Training organized the event.   I was back in Denmark not quite one month later for two days with Henrik and Mette Petersen and a then third day for a small, intensive training with Toftemosegaard–a center for growth and change–smack dab in the middle of Copenhagen.

At each event, I was honored to be accompanied by Danish psychologist Susanne Bargmann, who is an Associate and Certified Trainer for the Center for Clinical Excellence (ICCE).  I first met Susanne at a two-day workshop sponsored by Solutions a number of years ago.  Her attitude and drive is infectious.  She attended the Training of Trainer’s event in Chicago and now runs a listserve for Danish practitioners interested in feedback-informed treatment (FIT) (by the way, if you are interested in joining the group simply click on her name above to send an email).

Recently, she published an important article in Psycholog Nyt–the official magazine for the Danish Psychological Association. The article is really the first written in Danish by a Danish practitioner to suggest “practice-based evidence” as a scientifically credible alternative to the narrow “specific treatments for specific problems” paradigm that has come to dominate professional discourse and practice the world over.

Anyway, I’ll be back in Denmark several times in 2010.  In May, I’ll be teaching “Supershrinks: Learning from the Field’s Most Effective Practitioners.”  The course, as I understand it, is already sold out.  No worries though as the workshop is being offered again in November–so sign up early (click here to access my workshop calendar).  Also, in September, Susanne and I will jointly teach a course for psychologists on research entitled, “Forskning og Formidling”–a required training for those seeking specialist approval by the Danish Psychological Association. Finally, as I’ve done for the last several years, I’m scheduled to do two days for Solution as well.  If you live and work in Denmark, I truly hope to see you at one of these events.

Bargman Nye Veje For Evidensbegrebet from Scott Miller

 

Filed Under: Behavioral Health, excellence, Feedback Informed Treatment - FIT Tagged With: cdoi, Danish Psychological Association, denmark, icce, international center for cliniclal excellence, ors, outcome rating scale, practice-based evidence, session rating scale, srs, supershrinks

Outcomes in OZ III

December 4, 2009 By scottdm Leave a Comment

Dateline: November 28, 2009 Brisbane, Australia

accor

Crown Plaza Hotel
Pelican Waters Golf Resort & Spa

As their name implies, LifeLine Australia is the group people call when they need a helping hand.  During the last leg of my tour of eastern Australia, I was lucky enough to spend two days working with Lifeline’s dedicated and talented clinicians on improving the retention and outcome of clinical services they offer.

The two-day conference was the kick off for a “transformation project,” as Trevor Carlyon, the executive director of Lifeline Community Care points out in the video segment below, the stated goal of which is “putting clients back at the center of care.”   Nearly 200 clinicians working with a diverse clientele located throughout northern Queensland gathered for the event.  I look forward to returning in the future as the ideas are implemented across services throughout the system.

 

Filed Under: Behavioral Health, CDOI, evidence-based practice, Feedback Informed Treatment - FIT, Implementation Tagged With: australia, lifeline community care, mental health

Outcomes in Oz II

November 25, 2009 By scottdm 4 Comments

Sitting in my hotel room in Brisbane, Australia.  It’s beautiful here: white, sandy beaches and temperatures hovering around 80 degrees.  Can’t say that I’ll be enjoying the sunny weather much.  Tomorrow I’ll be speaking to a group of 135+ practitioners about “Supershrinks.”  I leave for home on Saturday.  While it’s cold and overcast in Chicago, I’m really looking forward to seeing my family after nearly two weeks on the road.

I spent the morning talking to practitioners in New Zealand via satellite for a conference sponsored by Te Pou.  It was a completely new and exciting experience for me, seated in an empty television studio and talking to a camera.  Anyway, organizers of the conference are determined to avoid mistakes made in the U.S., Europe, and elsewhere with the adoption of “evidence-based practice.”  As a result, they organized the event around the therapeutic alliance–the most neglected, yet evidence-based concept in the treatment literature!  More later, including a link to the hour-long presentation.

On Friday and Saturday of this last week, I was in the classic Victorian city of Melbourne, Australia doing two days worth of training at the request of WorkSafe and the Traffic Accident Commission.  The mission of WorkSafe is, “Working with the community to deliver outstanding workplace safety, together with quality care and insurance protection to workers and employers.”  100+ clinicians dedicated to helping Australians recover from work and traffic-related injuries were present for the first day of training which focused on using formal client feedback to improve retention and outcome of psychological services.  On day 2, a smaller group met for an intensive day of training and consultation.  Thanks go to the sponsors and attendees for an exciting two days.  Learn more about how outcomes are being used to inform service delivery by watching the video below with Daniel Claire and Claire Amies from the Health Services Group.

 

Filed Under: Behavioral Health, Top Performance Tagged With: australia, evidence based medicine, evidence based practice, New Zealand, supershrinks

Outcomes in Oz

November 20, 2009 By scottdm Leave a Comment

Greetings from beautiful Melbourne, Australia!   For the next couple of weeks, I’ll be traveling the up and down the east coast of this captivating country, conducting workshops and providing consultations on feedback-informed clinical work.

Actually, I’ve had the privilege of visiting and teaching in Australia about once a year beginning in the late 1990’s. Back then, Liz Sheehan, the editor of the “must read” journal Psychotherapy in Australiabrought me in to speak about the then recently published first edition of the Heart and Soul of Change.  By the way, if you are not from Australia, and are unfamiliar with the journal, please do visit the website.  Liz makes many of the articles that appear in the print version available online.  I’ve been a subscriber for years now and await the arrival of each issue with great anticipation.  I’m never disappointed.

In any event, on Wednesday this week, I spent the entire day with Mark Buckingham, Fiona Craig, and the clinical staff of Kedesh Rehabilitation Services in Wollongong, Australia–a scenic sea-side location about 45 minutes south of Sydney.  Briefly, Kedesh is a residential treatment facility providing cutting-edge, consumer driven, outcome-informed services to people with drug, alcohol, and mental health problems.  The crew at Kedesh is using the ORS and SRS to guide service delivery and is, in fact, one of the first to fully implement CDOI in the country.

I’ll be back with more soon, so please check back tomorrow.  In the meantime, check out the video with Mark and Fiona.

Filed Under: Behavioral Health, evidence-based practice, excellence, Feedback Informed Treatment - FIT, PCOMS Tagged With: australia, kedesh, liz sheehan, psychotherapy

Leading Outcomes in Vermont: The Brattleboro Retreat and Primarilink Project

November 8, 2009 By scottdm 4 Comments

For the last 7 years, I’ve been traveling to the small, picturesque village of Brattleboro, Vermont to work with clinicians, agency managers, and various state officials on integrating outcomes into behavioral health services.  Peter Albert, the director of Governmental Affairs and PrimariLink at the Brattleboro Retreat, has tirelessly crisscrossed the state, promoting outcome-informed clinical work and organizing the trainings and ongoing consultations.   Over time, I’ve done workshops on the common factors, “what works” in therapy, using outcome to inform treatment, working with challenging clinical problems and situations and, most recently, the qualities and practices of super effective therapists.  In truth, outcome-informed clinical work both grew up and “came of age” in Vermont.  Indeed, Peter Albert was the first to bulk-purchase the ASIST program and distribute it for free to any provider interested in tracking and improving the effectiveness of their clinical work.

If you’ve never been to the Brattleboro area, I can state without reservation that it is one of the most beautiful areas I’ve visited in the U.S.–particularly during the Fall, when the leaves are changing color.  If you are looking for a place to stay for a few days, the Crosy House is my first and only choice.  The campus of the Retreat is also worth visiting.  It’s no accident that the trainings are held there as it has been a place for cutting edge services since being founded in 1874.  The radical idea at that time?  Treat people with respect and dignity.  The short film below gives a brief history of the Retreat and a glimpse of the serene setting.

Anyway, this last week, I spent an entire day together with a select group of therapists dedicated to improving outcomes and delivering superior service to their clients.  Briefly, these clinicians have been volunteering their time to participate in a project to implement outcome-informed work in their clinical settings.  We met in the boardroom at the Retreat, discussing the principles and practices of outcome-informed work as well as reviewing graphs of their individual and aggregate ORS and SRS data.

It has been and continues to be an honor to work with each and every one in the PrimariLink project.  Together, they are making a real difference in the lives of those they work with and to the field of behavioral health in Vermont.  If you are a clinician located in Vermont or provide services to people covered by MVP or PrimariLink and would like to participate in the project, please email Peter Albert.  At the same time, if you are a person in need of behavioral health services and looking for a referral, you could do no better than contacting one of the providers in the project!

Filed Under: Behavioral Health, Feedback Informed Treatment - FIT, FIT Software Tools, Practice Based Evidence Tagged With: behavioral health, common factors, consultation, ors, outcome rating scale, session rating scale, srs, supershrinks, therapy, Training

Outcomes in Ohio: The Ohio Council of Behavioral Health & Family Service Providers

October 30, 2009 By scottdm Leave a Comment

Ohio is experiencing the same challenges faced by other states when it comes to behavioral health services: staff and financial cutbacks, increasing oversight and regulation, rising caseloads, unrelenting paperwork, and demands for accountability.  Into the breach, the Ohio Council of Behavioral Health & Family Service Providers organized their 30th annual conference, focused entirely on helping their members meet the challenges and provide the most effective services possible.

On Tuesday, I presented a plenary address summarizing 40 years of research on “What Works” in clinical practice as well as strategies for documenting and improving retention and outcome of behavioral health services.  What can I say?  It was a real pleasure working with the 200+ clinicians, administrators, payers, and business executives in attendance.  Members of OCBHFSP truly live up to their stated mission of, “improving the health of Ohio’s communities and the well-being of Ohio’s families by promoting effective, efficient, and sufficient behavioral health and family services through member excellence and family advocacy.”

For a variety of reasons, the State of Ohio has recently abandoned the outcome measure that had been in use for a number of years.  In my opinion, this is a “good news/bad news” situation.  The good news is that the scale that was being used was neither feasible or clinically useful.  The bad news, at least at this point in time, is that state officials opted for no measure rather than another valid, reliable, and feasible outcome tool.  This does not mean that agencies and providers are not interested in outcome.  Indeed, as I will soon blog about, a number of clinics and therapists in Ohio are using the Outcome and Session Rating Scales to inform and improve service delivery.  At the conference, John Blair and Jonathon Glassman from Myoutcomes.com demonstrated the web-based system for administering, scoring, and interpreting the scales to many attendees.  I caught up with them both in the hall outside the exhibit room.

Anyway, thanks go to the members and directors of OCBHFSP for inviting me to present at the conference.  I look forward to working with you in the future.

Filed Under: Behavioral Health, evidence-based practice, Feedback Informed Treatment - FIT Tagged With: behavioral health, medicine, outcome measurement, outcome measures, outcome rating scale, research, session rating scale, therapiy, therapy

Whoa Nellie! A 25 Million Dollar Study of Treatments for PTSD

October 27, 2009 By scottdm 1 Comment

I have in my hand a frayed and yellowed copy of observations once made by a well known trainer of horses. The trainer’s simple message for leading a productive and successful professional life was, “If the horse you’re riding dies, get off.”

You would think the advice straightforward enough for all to understand and benefit.  And yet, the trainer pointed out, “many professionals don’t always follow it.”  Instead, they choose from an array of alternatives, including:

  1. Buying a strong whip
  2. Switching riders
  3. Moving the dead horse to a new location
  4. Riding the dead horse for longer periods of time
  5. Saying things like, “This is the way we’ve always ridden the horse.”
  6. Appointing a committee to study the horse
  7. Arranging to visit other sites where they ride dead horses more efficiently
  8. Increasing the standards for riding dead horses
  9. Creating a test for measuring our riding ability
  10. Complaining about how the state of the horse the days
  11. Coming up with new styles of riding
  12. Blaming the horse’s parents as the problem is often in the breeding.
When it comes to the treatment of post traumatic stress disorder, it appears the Department of Defense is applying all of the above.  Recently, the DoD awarded the largest grant ever awarded to “discover the best treatments for combat-related post-traumatic stress disorder” (APA Monitor).  Beneficiaries of the award were naturally ecstatic, stating “The DoD has never put this amount of money to this before.”
Missing from the announcements was any mention of research which clearly shows no difference in outcome between approaches intended to be therapeutic—including, the two approaches chosen for comparison in the DoD study!  In June 2008, researchers Benish, Imel, and Wampold, conducted a meta-analysis of all studies in which two or more treatment approaches were directly compared.  The authors conclude, “Given the lack of differential efficacy between treatments, it seems scientifically questionable to recommend one particular treatment over others that appear to be of comparable effectiveness. . . .keeping patients in treatment would appear to be more important in achieving desired outcomes than would prescribing a particular type of psychotherapy” (p. 755).
Ah yes, the horse is dead, but proponents of “specific treatments for specific disorders” ride on.  You can hear their rallying cry, “we will find a more efficient and effective way to ride this dead horse!” My advice? Simple: let’s get off this dead horse. There are any number of effective treatments for PTSD.  The challenge is decidedly not figuring out which one is best for all but rather “what works” for the individual. In these recessionary times, I can think of far better ways to spend 25 million than on another “horse race” between competing therapeutic approaches.  Evidence based methods exist for assessing and adjusting both the “fit and effect” of clinical services—the methods described, for instance, in the scholarly publications sections of my website.  Such methods have been found to improve both outcome and retention by as much as 65%.  What will happen? Though I’m hopeful, I must say that the temptation to stay on the horse you chose at the outset of the race is a strong one.

Filed Under: Behavioral Health, Feedback Informed Treatment - FIT, Practice Based Evidence, PTSD Tagged With: behavioral health, continuing education, evidence based medicine, evidence based practice, icce, meta-analysis, ptst, reimbursement

Achieving Clinical Excellence: The Conference

October 26, 2009 By scottdm Leave a Comment

A few weeks ago, I announced the first International “Achieving Clinical Excellence” (ACE) conference to be held at the Westin Hotel in Kansas City, Missouri on October 20-22nd, 2010.  You can now register for this and all other ICCE events, by clicking here.  Through a variety of keynote addresses and workshops, participants will learn the “science and steps” to excellence in clinical practice.  Attendees will also meet and learn directly from internationally ranked performers from a variety of professions, including medicine, science, music, entertainment, and sports.  I do hope you’ll join us in Kansas City for three days of science, skill building, and inspiration.

In the meantime, I wanted to tell you a bit about one of the conference’s keynote speakers, K. Anders Ericsson, Ph.D. As anyone who has been following my blog knows, Dr. Ericsson is the editor of the massive and influential “Cambridge Handbook of Expertise and Expert Performance.”  He is an internationally known writer, researcher, and speaker who is commonly referred to as “the expert on experts.”

 At the ACE conference, Dr. Ericsson will bring his knowledge and experience to bear on the subject of expertise in behavioral health.  I promise you won’t want to miss it. For a flavor, give his recent article from the Harvard Business Review a read.

Filed Under: Behavioral Health, excellence Tagged With: addiction, cdoi, conferences and training, icce, ors, outcome rating scale, session rating scale, srs, Therapist Effects, training and consultation

International Center for Clinical Excellence: Update and Announcement

October 2, 2009 By scottdm Leave a Comment

On August 25th, right here on the “Top Performance” blog, I announced the formation of the International Center for Clinical Excellence.  As anyone who has been reading my recent posts or publication knows, my work is evolving; specifically, putting prior research on the common factors, measurement of outcome and alliance, and feedback to work in helping diverse providers improve their effectiveness and the services they offer consumers.

Since the announcement, my colleagues and I have been busy at work creating the ICCE web platform.  Based on the latest Web2.0 technology,  the site is specifically designed to support clinical excellence through creating virtual clinical networks, groups and clinical communities where clinicians can be supported in eveloping clinical excellence. We are in the second round of beta-testing right now and are expecting to go live in a very short while. So, stay tuned!  And if you haven’t already done so, please visit the ICCE site and register.  There’s no obligation or cost, and you’ll also be among the first to know when the site is officially lanuched.

In the meantime, I wanted to call attention to the talented and diverse group of clinicians who will be working with the ICCE as “Associates” and “Trainers.”  Included among them are representatives from every discipline within behavioral healthcare (psychology, psychiatry, social work, marriage and family therapy, addictions, criminal justice) and from countries all over the globe.  They are:  William Andrews, Susanne Bargmann, Jim Walt, Reg Fleming, Cynthia Maeschalck, Michael Clark, Alan Scheuermann, Rob Axsen, Stephen Michael, William Plum, Bill Robinson, Michael Hutchison, Jason Seidel, Michelle Sanders, Von Borg, Dave Nylund, Magnus Johannsen, Dave Green, Gunnar Lindfeldt, Gun Eva Langdahl, Wendy Amey, Luci Doppler, Megan Boylan, Melissa Newland, Amanda Pardue, Flip Van Oenen, Mark Crouzen, Frank Asmus, Dee Dee Stout, and Robbie Babins-Wagner. Consistent with the latest web 2.0 technology, each of these ICCE Trainers will have be blogging, uploading short, instructional videos and other content, and providing supervision and consultation to ICCE members.

Membership is easy, by the way, and free.  For now, just register online and we’ll notify you when the site goes live.  Then you can enter, create your own professional profile and begin tapping into the international network of providers and experts that make up the ICCE community.

Filed Under: Behavioral Health, ICCE Tagged With: clinical community, icce, icce associates, icce traininers, international center for cliniclal excellence

How NOT to Achieve Clinical Excellence: The Sorry State of Continuing Professional Education

September 30, 2009 By scottdm 5 Comments

Greg Neimeyer, Ph.D., is causing quite a stir in continuing education circles.  What has he done?  In several scholarly publications, he’s reviewed the existing empirical literature and found that continuing professional education in heavioral health is not particularly, well, …educational.  Indeed, in a soon-to-be published piece in the APA journal, Professional Psychology, he notes, “While the majority of studies report high levels of participants’ satisfaction with their CE experiences, little attention has been paid to assessing actual levels of learning, the translation of learning into practice, or the impact of CE on actual professional service delivery outcomes.”   Neimeyer then goes on to cite a scholarly review published in 2002 by Daniels and Walter which pointed out that “a search [of the research literature] revealed no controlled studies of the impact of continuing education in the…behavioral health disciplines” (p. 368).  Said another way, the near ubiguitous mandate that clinicians attend so many hours per year of approved “CE” events in order to further their knowledge and skill base has no empirical support.

Personally, my guess is that any study that might be done on CE in Behavioral Health would show little or no impact on performance anyway.  Why?  Studies in other fields (i.e., medicine, flight training) have long documented that traditional CE activities (i.e., attending conferences, lectures, reading articles) have no demonstrable effect.  So, what does work?  The same research that calls the efficacy of current CE activities into questions provide clear guidance: namely, brief, circumscribed, skill-based training, followed by observed practice, real-time feedback, and performance measurement. Such characteristics are, in fact, part and parcel of expert performance in any field.  And yet, it is virutally non-existent in behavioral health.

Let me give you an example of a CE offering that arrived in my box just this week.  The oversized, multi-color, tri-fold brochure boldly asserts a workshop on CBT featuring the “top evidence-based techniques.”  Momentarily setting aside the absolute lack of evidence in support of such trainings, consider the promised content–and I’m not kidding: clinical applications of cognitive behavior therapy, motivational interviewing, cognitive therapy, mindfulness and acceptance based therapies, and behavior therapy.  As if that were not enough, the outline for the training indicates that participants will learn 52 other bulleted points, including but not limited to: why CBT, integration of skills intro practice, identifying brain-based CBT strategies, the latest research on CBT, the stages of change, open-ended and reflective listening, behavioral activiation, acceptance and commitment, emotional regulation and distrss tolerance skills, the ABC technique to promote rational beliefs, homework assignments that test core beliefs, rescripting techniques for disturbing memories and images…and so on…AND ALL IN A SINGLE 6 HOUR DAY!  You say you have no money? Your agency has suffered budget cuts?  No worries, the ad states in giant print, as the same content is available via CD, web and podcast.

Such an agenda defies not only the evidence but strains credulity to the breaking point.  Could anyone accomplish so much in so little time?  Clinicians deserve and should demand more from the CE events they register for and, in many instances, are mandated to attend in order to maintain licensure and certification.  The International Center for Clinical Excellence web platform will soon be launched.  The mission of the site, as indicated in my blog post of August 25th, is to “support clinical excellence through creating virtual clinical networks, groups and clinical communities where clinicians can be supported in the key behavior changes required for developing clinical excellence.”  Members of the site will use a variety of social networking and collaborative tools to learn skills, obtain real-time feedback, and measure their performance.    Anyway, kudos to Dr. Greg Neimeyer for confronting the ugly truth about CE in behavioral health and saying it out loud!

Filed Under: Behavioral Health, Conferences and Training, evidence-based practice, Feedback, ICCE Tagged With: behavioral health, brief therapy, CBT, CE, CEUs, continuing professional education, icce, meta-analysis, psychology, psychometrics

Top Resources for Top Performers

September 28, 2009 By scottdm 1 Comment

Since the 1960’s, over 10,000 “how-to” book on psychotherapy have been published.  I joke about this fact at my workshops, stating “Any field that needs ten thousand books to describe what it’s doing…surely doesn’t know what its doing!” I continue, pointing out that, “There aren’t 10,000 plus books on ‘human anatomy,’ for example.  There are a handful!  And the content of each is remarkably similar.”  The mere existence of so many, divergent points of view makes it difficult for any practitioner to sort the proverbial “wheat from the chaff.”

Over the last 100 years or so, the field has employed three solutions to deal with the existence of so many competing theories and approaches.  First, ignore the differences and continue with “business as usual”– this, in fact, is the approach thats been used for most of the history of the field.  Second, force a consolidation or reduction by fiat–this, in my opinion, is what is being attempted with much of the current evidence-based practice (“specific treatments for specific disorders”) movement.  And third, and finally, respect the field’s diverse nature and approaches, while attempting to understand the “DNA” common to all–said another way, identify and train clinicians in the factors common to all approaches so that they can tailor their work to their clients.

Let’s face it: option one is no longer viable.  Changes in both policy and funding make clear that ignoring the problem will result in further erosion of clinical autonomy.  For anyone choosing option two–either enthusistically or by inaction–I will blog later this week about developments in the United States and U.K. on the “evidence-based practice” front that I’m sure will give you pause.  Finally, for those interested in movng beyond the rival factions and delivering the best clinical service to clients, I want to recommend two resources.  First, Derek Truscott’s, Becoming an Effective Psychotherapist.  The title says it all.  Whether you are new to the field or an experienced clinician, this book will help you sort through the various and competing psychotherapy approaches and find a style that works for you and the people you work with.  The second volume, is Mick Cooper’s Essential Research Findings in Counselling and Psychotherapy.  What can I say about this book?  It is a gem.  Thorough, yet readable.  Empirical in nature, but clinically relevant.  When I’m out and about teaching around the globe and people ask me what to read in order to understand the empirical literature on psychotherapy, I recommend this book.

OK, enough for now.  Stay tuned for further updates this week. In the meantime, I did manage to find a new technique making the rounds on the workshop circuit.  Click on the video below.

Filed Under: Behavioral Health, Practice Based Evidence Tagged With: common factors, counselling, Derek Truscott, evidence based practice, icce, Mick Cooper, psychotherapy, randomized clinical trial

History doesn’t repeat itself,

September 20, 2009 By scottdm 2 Comments

Mark Twain photo portrait.

Image via Wikipedia

“History doesn’t repeat itself,” the celebrated American author, Mark Twain once observed, “but it does rhyme.” No better example of Twain’s wry comment than recurring claims about specifc therapeutic approaches. As any clinician knows, every year witnesses the introduction of new treatment models.  Invariably, the developers and proponents claim superior effectivess of the approach over existing treatments.  In the last decade or so, such claims, and the publication of randomized clinical trials, has enabled some to assume the designation of an “evidence-based practice” or “empirically supported treatment.”  Training, continuing education, funding, and policy changes follow.

Without exception, in a few short years, other research appears showing the once widely heralded “advance” to be no more effective than what existed at the time.  Few notice, however, as professional attention is once again captured by a “newer” and “more improved” treatment model.  Studies conducted by my colleagues and I (downloadable from the “scholarly publications” are of my website), document this pattern with treatments for kids, alcohol abuse and dependence, and PTSD over the last 30 plus years.

As folks who’ve attended my recent workshops know, I’ve been using DBT as an example of approaches that have garnered significant professional attention (and funding) despite a relatively small number of studies (and participants) and no evidence of differential effectiveness.  In any event, the American Journal of Psychiatry will soon publish, “A Randomized Trial of Dialectical Behavior Therapy versus General Psychiatric Management for Borderline Personality Disorder.”

As described by the authors, this study is “the largest clinical trial comparing dialectical behavior therapy and an active high-standard, coherent, and principled approach derived from APA guidelines and delivered by clinicians with expertise in treating borderline personality disorder.”

And what did these researchers find?

“Dialectical behavior therapy was not superior to general psychiatric management with both intent-to-treat and per-protocol analyses; the two were equally effective across a range of outcomes.”  Interested readers can request a copy of the paper from the lead investigator, Shelley McMain at: Shelley_McMain@camh.net.

Below, readers can also find a set of slides summarizing and critiquing the current research on DBT. In reviewing the slides, ask yourself, “how could an approach based on such a limited and narrow sample of clients and no evidence of differential effectives achieved worldwide prominence?”

Of course, the results summarized here do not mean that there is nothing of value in the ideas and skills associated with DBT.  Rather, it suggests that the field, including clinicians, researchers, and policy makers, needs to adopt a different approach when attempting to improve the process and outcome of behavioral health practices.  Rather than continuously searching for the “specific treatment” for a “specific diagnosis,” research showing the general equivalence of competing therapeutic approaches indicates that emphasis needs to be placed on: (1) studying factors shared by all approaches that account for success; and (2) developing methods for helping clinicians identify what works for individual clients. This is, in fact, the mission of the International Center for Clinical Excellence: identifying the empirical evidence most likely to lead to superior outcomes in behavioral health.

Dbt Handouts 2009 from Scott Miller

Filed Under: Behavioral Health, Dodo Verdict, Practice Based Evidence Tagged With: alcohol abuse, Americal Psychological Association, American Journal of Psychiatry, APA, behavioral health, CEU, continuing education, CPD, evidence based medicine, evidence based practice, mental health, psychiatry, PTSD, randomized control trial, Training

International "Achieving Clinical Excellence" Conference

September 12, 2009 By scottdm 3 Comments

Mark your calendars!  The International Center for Clinical Excellence is pleased to announce the “Achieving Clinical Excellence” (ACE) conference to be held at the Westin Hotel in Kansas City, Missouri on October 20-22nd, 2010.

K. Anders Erickson, Ph.D., the editor of The Cambridge Handbook of Expertise and Expert Performance and recognized “expert on experts,” will keynote the event. Through a combination of plenary presentations and intensive workshops, an internationally renowned faculty of researchers and educators, including Scott D. Miller, Ph.D. and John Norcross, Ph.D., will help participants discover the means to achieve excellence in clinical practice, leadership, ethics, and personal care.

Attendees will also meet and learn directly from internationally ranked performers from a variety of professions, including medicine, science, music, entertainment, and sports.  As just one example, the Head Coach of the Olympic, Gold-Medal-winning Women’s volleyball team, Hugh McCutcheon, will present at the conference.  In addition to a pre-conference day on ethics and law, internationally renowned concert pianist David Helfgott, whose heart-warming story was featured in the award winning film Shine, will perform on Thursday evening, October 21st. Join us in Kansas City for three days of science, skill building, and inspiration.

Filed Under: Behavioral Health, Conferences and Training, deliberate practice, excellence Tagged With: behavioral health, CEU, conference, CPD, excellence, healthcare, John Norcross, K. Anders Erickson, Training

Practice-Based Evidence Goes Mainstream

September 5, 2009 By scottdm 3 Comments

welcome-to-the-real-worldFor years, my colleagues and I have been using the phrase “practice-based evidence” to refer to clinicians’ use of real-time feedback to develop, guide, and evaluate behavioral health services. Against a tidal wave of support from professional and regulatory bodies, we argued that the “evidence-based practice”–the notion that certain treatments work best for certain diagnosis–was not supported by the evidence.

Along the way, I published, along with my colleagues, several meta-analytic studies, showing that all therapies worked about equally well (click here to access recent studies children, alcohol abuse and dependence, and post-traumatic stress disorder). The challenge, it seemed to me, was not finding what worked for a particular disorder or diagnosis, but rather what worked for a particular individual–and that required ongoing monitoring and feedback.  In 2006, following years of controversy and wrangling, the American Psychological Association, finally revised the official definition to be consistent with “practice-based evidence.” You can read the definition in the May-June issue of the American Psychologist, volume 61, pages 271-285.

Now, a recent report on the Medscape journal of medicine channel provides further evidence that practice-based evidence is going mainstream. I think you’ll find the commentary interesting as it provides compelling evidence that an alternative to the dominent paradigm currently guiding professional discourse is taking hold.  Watch it here.

Filed Under: Behavioral Health, evidence-based practice, Practice Based Evidence Tagged With: behavioral health, conference, deliberate practice, evidence based medicine, evidence based practice, mental health, Therapist Effects

The Evolution of Psychotherapy: Twenty-Five Years On

September 1, 2009 By scottdm Leave a Comment

In 1985, I was starting my second year as a doctoral student at the University of Utah.  Like thousands of other graduate students, I’d watched the “Gloria” films.  Carl Roger, Albert Ellis, Fritz Perls were all impressive if not confusing given their radically different styles.  I also knew that I would soon have the opportunity to meet each one live and in person.  Thanks to Jeffrey K. Zeig, Ph.D. and the dedicated staff at the Milton H. Erickson Foundation, nearly every well known therapist, guru, and psychotherapy cult-leader would gather for the first mega-conference ever held, the field’s Woodstock: The Evolution of Psychotherapy.

Having zero resources at my disposal, I wrote to Jeff asking if I could volunteer for the event in exchange for the price of admission.  Soon after completing the multiple-page application, I received notice that I had been chosen to work at event.  I was ecstatic.  When December finally came around, I loaded up my old car with food and a sleeping bag and, together with a long time friend Paul Finch, drove from Salt Lake City to Phoenix.   What can I say?  It was alternately inspiring and confusing.  I learned so very much and also felt challenged to make sense of the disparate theories and approaches.

At that time, I had no idea that some twenty years later, I’d receive a call from Jeff Zeig asking me to participate as one of the “State of the Art” faculty for the 2005 Evolution Conference.  Actually, I can remember where I was when my cell phone rang: driving on highway 12 on southwest Michigan toward Indian Lake, where my family has a small cottage.  In any event, I’m looking forward to attending and presenting at the 2009 conference.  I encourage all of the readers of my blog to attend.  Registration information can be found at the conference website: www.evolutionofpsychotherapy.com.  The highlight of the event for me is a debate/discussion I’ll be having with my friend and colleague, Don Meichenbaum, Ph.D. on the subject of “evidence-based practice.”

One more thing.  To get a feel for the event, I included a clip of a panel discussion from the first Evolution conference featuring Carl Rogers.  Not trying to be hyperbolic, but listening to Rogers speak changed my life.  I won’t bore you with the details but the night following his presentation, I had a dream…(more later)…

Filed Under: Behavioral Health, Conferences and Training, Dodo Verdict, evidence-based practice, excellence Tagged With: albert ellis, carl roger, Don Meichenbaum, erickson, evidence based practice, Evolution of Psychotherapy, fritz perl, jejjrey k. zeig, psychotherapy

The Debate of the Century

August 27, 2009 By scottdm

doubt_diceWhat causes change in psychotherapy?  Specific treatments applied to specific disorders?  Those in the “evidence-based” say so and have had a huge influence on behavioral healthcare policy and reimbursement.  Over the last 10 years, my colleagues and I have written extensively and traveled the world offering a different perspective: by and large, the effectiveness of care is due to a shared group of factors common to all treatment approaches.

In place of “evidence-based” practice, we’ve argued for “practice-based”evidence.  Said another way, what really matters in the debate is whether clients benefit–not the particular treatment approach.  Here on my website, clinicians can download absolutely free measures that can be used to monitor and improve outcome and retention (click Performance Metrics).

bruce-wampold-364px

Anyway, the message is finally getting through.  Recently, uber-statistician and all around good guy Bruce Wampold, Ph.D. debated prominent EBP proponent Steve Hollon.  Following the exchange, a vote was taken.  Bruce won handily: more than 15:1.

Scroll down to “Closing Debate” (Thursday)

Filed Under: Behavioral Health, Practice Based Evidence Tagged With: bruce wampold, cdoi, evidence based medicine, evidence based practice, ors, outcome rating scale, PCOMS, performance metrics, practice-based evidence, psychotherapy, session rating scale, srs, steve hollon

Announcement: Evolving in a new direction

August 25, 2009 By scottdm Leave a Comment

As those of you who have followed my work and blog know, my perspective is evolving.  The direction I’m heading builds on all of the work done to date including the common factors, measurement of outcome and alliance, and feedback.  Crucially, however, it goes one step further; bridging the common and specific factors divide that has long dominated and splintered the field, and identifying the concrete steps that diverse providers can take to improve their effectiveness and the services they offer consumers.

For the past 10 years much of my work has been available through the Institute for the Study of Therapeutic Change (ISTC) and featured on its website.  In line with the evolution in my perspective my work is now increasingly centered on a new organization, the International Center for Clinical Excellence (ICCE), an international consortium of researchers, educators, and clinicians dedicated to understanding and promoting excellence in behavior healthcare.  My colleague Barry Duncan, co-founder of the ISTC, is also developing his work in new directions and we have therefore decided that the time is now right to dissolve our long-term partnership in the ISTC.  I recognise that for many of you, who have followed my work over the years, that this may come as a surprising development and I am hoping that this post and others to follow will provide guidance, reassurance and most importantly continuity.

Central to the mission of the International Center for Clinical Excellence (ICCE) is the creation of a web-based community of clinicians using the latest Web 2.0 technology where participants can learn from and share with each other.  Based on the principles of Clinical Community Social Software (CCSS) it is specifically designed to support clinical excellence through creating virtual clinical networks, groups and clinical communities where clinicians can be supported in the key behavior changes required for developing clinical excellence.  Participants can, using a variety of social networking and collaborative tools, share clinical insights through discussion forums and video posts as well as improve client outcomes through learning the skills of clinical excellence.

We have finished our first round of beta-testing for the site and you can go to the website at: www.centerforclinicalexcellence.com to register to become a member (its free and you’ll be notified the minute the entire site is live)!

For those of you new to the tremendous opportunities for web-based collaborative social software, let me reassure you that the site will permit access and use at whatever level you desire (everything from the familiar email, to online posts and discussions in real time).  It will provide lots of help to learn how to explore the information and resources on offer as well as the support of colleagues in the community.  I am very excited by this opportunity to interact with behavioral health professionals all over the world in this way. Over the next few days, I’ll be posting more information about the ICCE and our first International Conference on Excellence in Behavioral Health on my blog at www.scottdmiller.com.   I encourage you to follow the updates on my blog and post any questions or comments.

Filed Under: Behavioral Health, evidence-based practice, excellence, Feedback Informed Treatment - FIT, ICCE Tagged With: behavioral health, clinical excellence, e-learning, icce, international center for cliniclal excellence, social networking

Expertise and Excellence: What it Takes to Improve Therapeutic Effectiveness

April 2, 2009 By scottdm 1 Comment

downloadIf you’ve been following my website and the Top Performance Blog you know that my professional interests over the last couples of years have been shifting, away from psychotherapy, the common factors, and feedback and toward the study of expertise and excellence.

Studying this literature (click here for an interesting summary), makes clear that the factors responsible for superior performance are the same regardless of the specific endeavor one sets out to master. The chief principle will come as no surprise: You have to work harder than everyone else at whatever you want to be best at.

In other words, you have to practice.

Hard work is not enough, however.  Research shows that few attain international status as superior performers without access to high levels of support and detailed instruction from exceptional teachers over sustained periods of time. In the massive “Cambridge Handbook of Expertise and Expert Performance,” Feltovich et al. note, “Research on what enabled some individuals to reach expert performance, rather than mediocre achievement, revealed that expert and elite performers seek out teachers and engage in specifically designed training activities…that provide feedback on performance, as well as opportunities for repetition and gradual refinement” (p. 61).

What makes for a “good” teacher? Well, in essence, that is what the “Top Performance” blog is all about. I’m going on a journey, a quest really.  I’ve decided to take up two hoppies–activities I’ve always had a interest in but never had to the time to study seriously–magic and the ukelele.

Practicing is already proving challenging.  Indeed, the process reminds me a lot of when I started out in the field of psychology.  In a word, its daunting.  There are literally thousands of “tricks” and “songs,” (as there are 100’s of treatment models), millions of how-to books, videos, and other instructional media (just as in the therapy world), as well as experts (who, similar to the field of psychotherapy, offer a wide and bewildering array of different and oftentimes contractory opinions).

By starting completely over with subjects I know nothing about, I hope to put into practice the insights gleaned from our study of expertise and expert performance, along the way reporting the challenges, triumphs and failures associated with learning to master new skills.  I’ll review performances, instructional media (live, printed, DVD, etc), and the teachers I met.  Stay tuned.

Filed Under: Behavioral Health, deliberate practice, excellence, Top Performance Tagged With: Feltovich, ors, outcome rating scale, session rating scale, srs

Superior Performance as a Psychotherapist: First Steps

April 1, 2009 By scottdm Leave a Comment

So what is the first step to improving your performance?  Simply put, knowing your baseline.  Whatever the endeavor, you have to keep score.  All great performers do.  As a result, the performance in most fields has been improving steadily over the last 100 years.

Consider, for instance, the Olympics. Over the last century, the best performance for every event has improved–in some cases by 50%!  The Gold Medal winning time for the marathon in the 1896 Olympics was just one minute faster than the entry time currently required just to participate in the Chicago and Boston marathons.

By contrast, the effectiveness of psychological therapies has not improved a single percentage point over the last 30 years.  How, you may wonder, could that be?  During the same time period: (1) more than 10,000 how-to books on psychotherapy have been published; (2) the number of treatment approaches has mushroomed from 60 to 400; and (3) there are presently 145 officially approved, evidenced-based, manualized treatments for 51 of the 397 possible DSM IV diagnostic groups.  Certainly, given such “growth,” we therapists must be more effective with more people than ever before.  Unfortunately, however, instead of advancing, we’ve stagnated, mistaking our feverish peddling for real progress in the Tour de Therapy.

Truth is, no one has been keeping score, least of all we individual practitioners. True, volumes of research now prove beyond any doubt that psychotherapy works.  Relying on such evidence to substantiate the effectiveness of one’s own work, however, is a bit like Tiger Woods telling you the par for a particular hole rather than how many strokes it took him to sink the ball.  The result on outcome, research indicates, is that effectiveness rates plateau very early in most therapists careers while confidence level continue to grow.

In one study, for example, when clinicians were asked to rate their job performance from A+ to F, fully two-thirds considered themselves A or better. No one, not a single person in the lot, rated him or herself as below average. As researchers Sapyta, Riemer, and Bickman (2005) conclude, “most clinicians believe that they produce patient outcomes that are well above average” (p. 146). In another study, Deirdre Hiatt and George Hargrave used peer and provider ratings, as well as a standardized outcome measure, to assess the success rates of therapists in a sample of mental health professionals. As one would expect, providers were found to vary significantly in their effectiveness. What was disturbing is that the least effective therapists in the sample rated themselves on par with the most effective!

The reason for stagnant success rates in psychotherapy should be clear to all: why try to improve when you already think your the best or, barring that, at least above average?

Here again, expanding our search for excellence beyond the narrow field of psychotherapy to the subject of expertise and expert performance in general can provide some helpful insights. In virtually every profession, from carpentry to policework, medicine to mathematics, average performers overestimate their abilities, confidently assigning themselves to the top tier. Therapists are simply doing what everyone else does. Alas, they are average among the average.

Our own work and research proves that clinicians can break away from the crowd of average achievers by using a couple of simple, valid, and reliable tools for assessing outcome. As hard as it may be to believe, the empirical evidence indicates that performance increases between 65-300% (click here to read the studies). Next time, I’ll review these simple tools as well as a few basic methods for determining exactly how effective you are. Subscribe now so you’ll be the first to know.

One more note, after posting last time, I heard from several readers who had difficulty subscribing. After doing some research, we learned that you must use IE 7 or Firefox 3.0.7 or later for the subscribe function to work properly.  Look forward to hearing from you!

In the meantime, the transcript below is of a recent interview I did for Shrinkrap radio.  It’s focused on our current work:

Supershrinks: An Interview with Scott Miller about What Clinicians can Learn from the Field’s Most Effective Practitioners from Scott Miller

 

Filed Under: Behavioral Health, excellence, Top Performance Tagged With: cdoi, evidence based practice, excellence, mental health, outcome measures, psychology, psychotherapy, srs, supershrinks

My New Year’s Resolution: The Study of Expertise

January 2, 2009 By scottdm Leave a Comment

Most of my career has been spent providing and studying psychotherapy.  Together with my colleagues at the Institute for the Study of Therapeutic Change, I’ve now published 8 books and many, many articles and scholarly papers.  If you are interested you can read more about and even download many of my publications here.

Like most clinicians, I spent the early part of my career focused on how to do therapy.  To me, the process was confusing and the prospect of sitting opposite a real, suffering, client, daunting.  I was determined to understand and be helpful so I went graduate school, read books, and attended literally hundreds of seminars.

Unfortunately, as detailed in my article, Losing Faith, written with Mark Hubble, the “secret” to effective clinical practice always seemed to elude me.  Oh, I had ideas and many of the people I worked with claimed our work together helped.  At the same time, doing the work never seemed as simple or effortless as professional books and training it appear.

Each book and paper I’ve authored and co-authored over the last 20 years has been an attempt to mine the “mystery” of how psychotherapy actually works.  Along the way, my colleagues and I have paradoxically uncovered a great deal about what contributes little or nothing to treatment outcome! Topping the list, of course, are treatment models.  In spite of the current emphasis on “evidence-based” practice, there is no evidence that using particular treatment models for specific diagnostic groups improves outcome.  It’s also hugely expensive!  Other factors that occupy a great deal of professional attention but ultimately make little or no difference include: client age, gender, DSM diagnosis, prior treatment history; additionally, therapist age, gender, years of experience, professional discipline, degree, training, amount of supervision, personal therapy, licensure, or certification.

In short, we spend a great deal of time, effort, and money on matters that matter very little.

For the last 10 years, my work has focused on factors common to all therapeutic approaches. The logic guiding these efforts was simple and straightforward. The proven effectiveness of psychotherapy, combined with the failure to find differences between competing approaches, meant that elements shared by all approaches accounted for the success of therapy. And make no mistake, treatment works. The average person in treatment is better off than 80% of those with similar problems that do not get professional help.

In the Heart and Soul of Change, my colleagues and I, joined by some of the field’s leading researchers, summarized what was known about the effective ingredients shared by all therapeutic approaches. The factors included the therapeutic alliance, placebo/hope/expectancy, structure and techniques in combination with a huge, hairy amount of unexplained “stuff” known as “extratherapeutic factors.”

Our argument, at the time, was that effectiveness could be enhanced by practitioners purposefully working to enhance the contribution of these pantheoretical ingredients.  At a minimum, we believed that working in this manner would help move professional practice beyond the schoolism that had long dominated the field.

Ultimately though, we were coming dangerously close to simply proposing a new model of therapy–this one based on the common factors.  In any event, practitioners following the work treated our suggestions as such.  Instead of say, “confronting dysfunctional thinking,” they understood us to be advocating for a “client-directed” or strength-based approach.  Discussion of particular “strategies” and “skills” for accomplishing these objectives did not lag far behind.  Additionally, while the common factors enjoyed overwhelming empirical support (especially as compared to so-called specific factors), their adoption as a guiding framework was de facto illogical.  Think about it.  If the effectiveness of the various and competing treatment approaches is due to a shared set of common factors, and yet all models work equally well, why would anyone need to learn about the common factors?

Since the publication of the first edition of the Heart and Soul of Change in 1999 I’ve struggled to move beyond this point. I’m excited to report that in the last year our understanding of effective clinical practice has taken a dramatic leap forward.  All hype aside, we discovered the reason why our previous efforts had long failed: our research had been too narrow.  Simply put, we’d been focusing on therapy rather than on expertise and expert performance.  The path to excellence, we have learned, will never be found by limiting explorations to the world of psychotherapy, with its attendant theories, tools, and techniques.  Instead, attention needs to be directed to superior performance, regardless of calling or career.

A significant body of research shows that the strategies used by top performers to achieve superior success are the same across a wide array of fields including chess, medicine, sales, sports, computer programming, teaching, music, and therapy!  Not long ago, we published our initial findings from a study of 1000’s of top performing clinicians in an article titled, “Supershrinks.”  I must say, however, that we have just “scratched the surface.”  Using outcome measures to identify and track top performing clinicians over time is enabling us, for the first time in the history of the profession, to “reverse engineer” expertise.  Instead of assuming that popular trainers (and the methods they promote) are effective, we are studying clinicians that have a proven track record.  The results are provocative and revolutionary, and will be reported first here on the Top Performance Blog!  So, stay tuned.  Indeed, why not subscribe? That way, you’ll be among the first to know.

Filed Under: Behavioral Health, excellence, Top Performance Tagged With: behavioral health, cdoi, DSM, feedback informed treatment, mental health, ors, outcome measurement, psychotherapy, routine outcome measurement, srs, supervision, therapeutic alliance, therapy

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