Take a good look at the picture below.   Do you recognize this person?

Let me give you a hint.  In 1974, he published the first empirical study documenting one of psychotherapy’s most closely held secrets: some therapists are more effective than others.

It’s true.  You know it.  I know it.  Everyone knows it.  We just don’t talk about it openly.

The man in the photo is psychologist David F. Ricks, author of “Supershrink: Methods of a Therapist Judged Successful on the Basis of Adult Outcomes of Adolescent Patients.”  And until the publication of this post, no public images of him were available.  Not a single photo on the net.  Hard to believe in our digital age  (I promise to explain how I managed to get this picture later on in the post).

Confirming the controversial and uncomfortable nature of the subject, Rick’s article, though groundbreaking, is rarely cited.  Google Scholar reports a mere 154 citations over the last forty-four years–and most of those are by the same, small group of authors!  More to the point, how to explain the finding that kids treated by one therapist fared far better in adulthood than those cared for by another?

Now, as then, the dominant belief is that any differences in outcome are attributable to the client, their pretreatment level of dysfunction, and the environment in which they live.  In Rick’s (1974) study, however, extreme care was taken to ensure the adolescents seen by different therapists were matched on all such possible variables (e.g., level of functioning/severity, gender, IQ, economic class, age, ethnic background, time period treated, level of familiar and parental pathology).  The results were dramatic, if not shocking.  One the basis of their level of adjustment as adults, seventy-five percent of those seen by the top performing clinician had a positive outcome.  By contrast, 84% of those treated by the other practitioner were classified as having a “schizophrenic outcome.”

Had the kids been asked at the time, the field would not have had to wait so long to discover the factor responsible for their success.  Indeed, all were aware of the important role their therapist played in their lives. Looking back as adults, they affectionately recalled referring to the clinician who had treated them as “the supershrink”–even going so far as to encourage other kids to seek out this particular person for help.  

Despite these results, thirty-years would pass before another empirical analysis appeared in the literature (Okiishi, Lambert, Nielsen, & Ogles, 2003).  The size and scope of this later study dwarfed Rick’s, examining results from standardized measures administered on an ongoing basis to over 1800 people treated by 91 therapists.  The findings?  Those seen by the most effective clinicians experienced a rate of improvement 10 time greater than the mean for the entire sample.  Meanwhile, those treated by the least effective, could expect to feel the same or worse than when they started, even after attending 3 times as many sessions!

Isn’t it time our field confronts reality and asks, “why are some therapists more effective than others?” Clinicians invest a great deal of time, energy, and money in professional growth. They undergo personal therapy, receive ongoing postgraduate supervision, and attend continuing education (CE) events (Rønnestad & Orlinsky, 2005).  Nevertheless, one searches in vain for any evidence that such efforts help therapists accomplish their goal (Miller, Hubble, & Chow, 2017).

After learning a bit more about the life and work of David Ricks, I strongly believe he would counsel us to, “Go for it!”  After all, he was a maverick and pioneer.  I mean that literally!  Born in 1927 in Wilson, Wyoming (population, 32), his log cabin house had no indoor plumbing or electricity.  Hot potatoes lovingly prepared by his mother, warmed his bed and hands during the long, cold winter months.

He literally rode a horse to and from the one-room school house he attended–that is, until the family was forced by the Great Depression to move south in search of more economic opportunities.  There, the hardships continued: his father died when he was 15, his mother was often ill, and the family remained poor.  Throughout it all, David persisted.  Although an elementary school teacher once told his parents, “David can’t learn,” he nonetheless was awarded a full scholarship to attend college, eventually earning a Ph.D. in psychology from the University of Chicago.  Over the course of his career, he taught, did research, and was a professor at Harvard, Cornell, and eventually, the University of Cincinnati.

Ever since I first read his study, I’d wondered about the person behind the research.  Internet searches, as I mentioned above, were futile.  I did learn from a brief online obituary that he had died in March 2004–sadly, just a few years before his findings would begin influencing our own work.  I sent letters and emails to various people and Universities, all to no avail.

Recently, I managed to find a potential link to one of his, now adult, children.  I reached out via Facebook, and the rest is history.  We’ve spoken at length on the phone.  In response to my request, I was given a series of photos, including the one in this post.  Most special, however, was a personal history Dr. Ricks wrote for his grandchildren.  Reading it gave me, I believe, insight into the traits that drove him.  When writing about what his parents had taught him to value in life and relationships, he said, first, honesty, and second, courage.

Recent research has finally provided some answers to the question Ricks posed so many years ago (Golberg, Babbins-Wagner, Rousmaniere, Berzins, Hoyt, Whipple et al. 2016): Why are some therapists more effective than others?   Put succinctly, the amount of time they engage in deliberate practice is a significant predictor of how effective they become.  Indeed, top performing clinicians devote twice as much time to this process than their less effective counterparts.  What does it involve?  Three things: (1) ongoing measurement of one’s results; (2) continuous identification of specific errors and targets for improvement; and (3) development, testing, and successive refinement of new ways of working.

Still the topic remains controversial and the subject of much misunderstanding.  “Please don’t mention anything about supershrinks,” an agency manager advised in hushed tones during a recent phone conversation we were having about topics for a potential in-house training.  When I asked, “Why?” they explained, “Clinicians already feel ‘put upon.’  They don’t want to hear about needing to compete with the best.”  No wonder this research, I instantly thought to myself, is so off putting.   I attempted to clarify, “It’s not about competing with others or even becoming a supershrink, it’s about trying to get a grip on what each of us can do to improve our effectiveness.”

My question to you is, “Did I get the job to do the workshop at that agency?!”

Interested in your responses!

Until next time,

Scott

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

P.S.: Registration for the March 2019 Intensives in Chicago is open.  I know it may seem like a long way off in the future, but these trainings have sold out months in advance for the last several years.  Click now on the images below to join colleagues from around the world for the fun, interactive, and learning-rich experiences.