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.

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….

Evolution of Psychotherapy and the International Center for Clinical Excellence

December 9, 2009 By scottdm Leave a Comment

Dateline: Chicago, Illinois
December 7, 2009

I’ve just finished packing my bags and am heading for the airport. Tomorrow the “Evolution of Psychotherapy” begins. Nearly 25 years after volunteering at the first “Evolution” conference, I’m back a second time to present. Tomorrow, I’ll be talking about “Achieving Clinical Excellence.” On the days that follow, I’m on panels with my friend Don Meichenbaum, as well as David Barlow, Marsha Linnehan, and others. I’m really looking forward to the four days in Anaheim.

Of everything going on in sunny southern California, I have to say that I’m most excited about the launch of the International Center for Clinical Excellence. We have a booth (#128) in the exhibitor hall where folks can stop by, talk, and peruse our new website. As promised, it is a true web 2.0 experience, enabling clinicians researchers. and educators around the world to connect, share, and learn from each other.

We’ll be streaming video to facebook and twitter. Stay tuned to my blog and twitter accounts as well for updates, videos, and pictures from the conference.

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!

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.

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)…

Excellence in Behavioral Health in Arizona

August 29, 2009 By scottdm 4 Comments

For those of you are friends with me on Facebook (and if you’re not already, please do as it’s a blast), you know I was teaching at the 41st Annual Southwestern School for Behavioral Health Studies.

First, let me express my appreciation to the Board and Michelle Brown for bringing me to Tucson to present on “Achieving Clinical Excellence.” If you’ve never attended this particular event, mark your calendar for next year.

This year, the conference theme was “Staying relevant in the 21st Century.” By the time I took the microphone to speak, 350 dedicated professionals from all around the country were on their fifth and last day of the conference. What a crowd! Excited, energized, and dedicated to doing their personal best for consumers of behavioral health services.

I’ve already heard from several folks who were in attendance, relating a personal or clinical story illustrating the principles and practices I talked about during my presentations. Thanks very much for sharing these stories with me.

Meanwhile, you can find the slides I used yesterday below. Feel free to download, use, and forward them to interested friends and colleagues.

In parting, I thought I’d relate one of my own experiences of excellence. It happened two years ago when I was presenting at this same conference. That morning, as I reached into my suitcase to get my clothes, I quickly discovered I’d left my slacks at home! Like this year, I’d worn shorts, a T-shirt, and flip flops on the plane, so no help there. Panicked, I called my co-presenter, Dr. David Mee-Lee—after all, he is a psychiatrist. He offered me an extra pair he had. It was a great idea that we both knew would never work since David is about 8” shorter than me. So I called the front desk. Now, the venue for the SWS for Behavioral Health is at the beautiful Loews Ventana Canyon Resort. It’s nestled in the mountains, miles from the city. Plus it was 7 am. My presentation started in an hour. No store was open at this hour, not even the resort gift shop. But that didn’t stop the dedicated staff at Loews. Within minutes, the manager of the resort shop was at the hotel. We found some pants and a shirt to match but the pants were 6 inches too long. “Not to worry,” the store manager said, she’d take care of it. Within minutes someone from the housekeep staff—not a tailor or seamstress, just a kind, dedicated person—was cutting and sewing the hem on the pants. I made it to the conference hall to present with 5 minutes to spare! I’ve never forgotten their kindness and dedication.

Achieving Clinical Excellence Handouts from Scott Miller