As a mental health professional, how are you approaching the New Year? Are you filled with hope for our field? Suffering a twinge (or more) of despair? Maybe you’re in reflective mood, longing for the ‘good ole days’? Or is the difference between December 31st and January 1st just like any other twenty four hour period?
While catching up on reading over the Holidays, I came across a word that captured my experience. I’d never seen it before. Anticipointment. Online sources define it as, “The state of mind resulting from anticipating and then being disappointed when expectations are not met.” Truth is, I recognize now I’ve often experienced this, but mistaken it for nostalgia. I t’s not.
So what about you? On one hand, we do have good reason to be hopeful. After all, decades of evidence provide overwhelming proof of the effectiveness of psychotherapy. On the other hand, the same research shows our outcomes have not improved in more than 40 years. Returning to the positive side, researchers have now identified two specific practices — routine outcome monitoring and deliberate practice — that enable clinicians to accomplish something never before recorded in history the history of the field; namely, steadily improve their effectiveness from year to year. On the negative side, the field –researchers, clinicians, payers, and policy makers alike — continues to be strongly attracted to treatment models, I’d say fatally so. Crossing the term, “cognitive behavioral therapy” (CBT) with “randomized controlled trial” (RCT) on Google Scholar results in 1,930,000 hits! In case you glossed over the figure, that’s one million, nine hundred thirty thousand — and that’s just one method out of hundreds. By contrast, a similar search of “tetanus vaccine,” produces slightly more than 18,000 results. I ask, does our field really need to spend precious resources on another study of CBT? It’s discouraging. More broadly, given the clear and overwhelming evidence of equivalence between treatment methods for any DSM diagnosis that’s been tested — and yes, that includes so-called trauma-specific approaches — do we need any more RCT’s pitting one protocol against another? Wouldn’t time be better spent studying how practitioners can improve their ability to attune and respond to their clients? After all, these two transtheoretical skills, researchers Stiles and Horvath, point out, are why “certain therapists are more effective than others” (p. 71)
For me, I approach the New Year with a strong sense of anticipointment. I want to be hopeful, believe there are good empirical reasons to do so. At the same time, I fear little will change. Turns out, some of our field’s beliefs and practices refuse to die.
What can we do to escape these “walking dead?”
A quick Google search of “Surviving the Zombie Apocalypse” turns up in three clear themes. First, make sure you are not a zombie. “The main epidemiological risk of zombies,” says Wikipedia, “is that their population just keeps increasing [as] generations of humans merely ‘surviving’ … feed” them. In the case of psychotherapy, I’ve come to believe practitioners often know certain popular ideas and practices are dead, but go along with them anyway. We must say, “no” or risk infecting the next generation.
The second suggestion makes the first possible: don’t go it alone. In short, you have a better chance of surviving in a group that shares your objectives. If your professional goals as a therapist include improving your results, the near 10,000 members of the International Center for Clinical Excellence might be your people. It’s free.
Third, and finally, focus on the basics. In the case of real zombies, that means securing water, shelter, and food over other, possibly more stimulating interests. Similarly, for therapists, chasing the “new and promising” must give way to personal work; in particular, deepening core skills associated with effective clinical practice. If becoming a more effective version of you is of interest, check out an article on the subject published this week. My colleague Brooke Mathewes and I provide concrete guidance for finding your performance edge and then developing, executing, and evaluating a highly individualized plan for improvement. Normally behind a “paywall,” the article is currently available for free thanks to the generosity of the journal editors.
As always, I’m interested in your thoughts and reflections. Please post them below!
Until next time,
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence