Finding Meaning in Psychotherapy Amidst the Trivia and Trivial

April 1, 2018 By scottdm 11 Comments

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 couple of years, the volume of material has only increased–exponentially so, if I include digital items saved to my desktop.

Now, I’ll be the first to admit: it’s hard keeping up. But that’s really not my problem.

The issue is: I feel like I’m drowning in trivia and the trivial.

How about you? When was the last time you read something truly meaningful?

Increasingly, research journals are filled with studies that are either so narrow in focus as to defy any real world application, or simply revisit the same questions over and over. Just how many more studies does the field need, for example, on cognitive-behavioral therapy? A Google Scholar search on the subject, crossed with the term, “randomized controlled trial,” returns over a million hits!

In terms of translating research into practice, here’s a sample of articles sure to appeal to almost every clinician (and I didn’t have to “dig deep” to find these, by the way, as all were in journals neatly stacked on my desk):

I didn’t make these up. All are real articles in real research journals. If you don’t believe me, click on the links to see for yourself.

Neologisms (#1) and cuteness (#2) aside, their titles often belie a mind-numbing banality in both scope and findings. Take the last study. Can you guess what its about? Satisfaction with life moderates the indirect effect of pain intensity on pain interference through pain catastrophizing. And what findings do you think the authors spent 10 double-column, 10-point font pages relating in one of psychology’s most prestigious journals?

“Satisfaction with life appears to buffer the effect of pain.”

Hmm. Not particularly earth-shattering. And, based on these results, what do the authors recommend? Of course: “Further evaluation in longitudinal and interventional studies” (I foresee another study on cognitive-behavioral therapy in the near future).

Purpose, belonging, sense-making, transcendence, and growth are the foundations of meaning. Most of what shows up in my inbox, is taught at professionals workshops, and appears in scholarly publications has, or engenders, none of those qualities. The cost to our field and the people we serve is staggering. Worldwide, rates of depression, anxiety, and suicide continue to rise. At the same time, fewer and fewer people are seeking psychotherapy–34% fewer according to the latest findings. It is important to note that even when extensive efforts are made, and significant financial support is provided, 85% of those who could benefit choose not go. I just can’t believe its because therapists haven’t attended the latest “amygdala retraining” workshop, or do not know how to “psychodynamize” their cognitive-behavioral interventions.

This last week, I had the pleasure of interviewing Dr. Ben Caldwell. His book, Saving Psychotherapy: Bringing the Talking Cure Back from the Brink, speaks directly to the challenges facing the field as well as steps every clinician can take to restore meaning to both research and practice. Take listen, and then be sure to leave a comment.

Until next time,

Scott

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

Joint Commission and SAMHSA Set New Standard of Care for Measurement Based Care

January 29, 2018 By scottdm 1 Comment

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 listed on the Joint Commission and SAMSHA websites. The Outcome and Session Rating Scales (ORS, SRS) are brief, well-validated tools in use in clinical settings around the world.

The new standard has the potential to significantly improve the effectiveness and efficiency of care. Studies also show, however, that implementation is a complex process with many challenges. Indeed, despite significant investment of time and resources, many organizations fail.

Click here for a free handout to assess the readiness of your agency. It’s one of the many resources provided at the ICCE Feedback-Informed Treatment Implementation workshop—the only evidence-based implementation training on measurement-based care to receive perfect marks for implementation materials, training and support resources, and quality assurance procedures by the National Registry of Evidence-based Programs and Practices (NREPP).

As always, feel free to email me with any questions.

All the best,

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

The Illness and the Cure: Two Free, Evidence-based Resources for What Ails and Can Heal Serious Psychological Distress

April 18, 2017 By scottdm 14 Comments

Findings from several recent studies are sobering. Depression is now the leading cause of ill-health and disability worldwide–more than cancer, heart disease, respiratory problems, and accidents. Yesterday, researchers reported that serious psychological distress is at an all-time high, significantly affecting not only quality but actual life expectancy. And who has not heard about the opioid crisis–33,000 deaths in the U.S. in 2015 and rising?

The research is clear: psychotherapy helps. Indeed, its effectiveness is on par with coronary artery bypass surgery. Despite such results, availability of mental health services in the U.S. and other Westernized nations has seriously eroded over the last decade. Additionally, modern clinical practice is beset by regulation and paperwork, much of which gets in the way of treatment’s most important healing ingredient: the relationship.

What can practitioners do? Students Taking Notes at Desks by VCU_Brandcenter

Completing paperwork together with clients during the visit–a process termed, “collaborative (or concurrent) documentation”–has been shown to save full-time practitioners between 6 and 8 hours per week, thereby improving capacity up to 20%.

It’s a great idea: completing assessments, treatment plans, and progress notes together with clients during rather than after the session. Unfortunately, it’s chief selling point to date seems to be that it saves time on documentation–as though filling out paperwork is an end in and of itself! Clearly, the real challenges facing mental health services are getting people into and keeping them in care. Here, the research literature is clear, people are more likely to stay engaged in care that is: (1) organized around their goals; and (2) works. Collaborating on and coming to a consensus regarding the goals for treatment, for example, has the largest impact on outcome among all of the relationship factors in psychotherapy, including empathy! Additionally, when documentation FITs the clients’ view of the process and is deemed transparent and respectful, trust–another essential ingredient of the therapeutic relationship–improves.

For the last several years, practitioners and agencies around the world have been using the ICCE “Service Delivery Agreement” and “Progress Note” as part of their documentation of clinical services. Both were specifically designed to be completed collaboratively with clients at the time the service is provided and both are focused on documenting what matters to people in treatment. Most important of all, however, both are part of an evidence-based process documented to improve engagement and effectiveness listed on SAMHSA’s National Registry of Evidence-based Programs and Practices.

For the next short while, I’ll send you the forms for free, along with a detailed instruction booklet for incorporating them into your clinical work. Reduce the “paper curtain” in your practice. Just email me at scottdmiller@talkingcure.com. Better yet, register for our upcoming intensive trainings this summer in Chicago. Click on any of the course icons to the right for detailed information.

Until next time,

Scott

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