SCOTT D Miller - For the latest and greatest information on Feedback Informed Treatment

  • About
    • About Scott
    • Publications
  • Training and Consultation
  • Workshop Calendar
  • FIT Measures Licensing
  • FIT Software Tools
  • Online Store
  • Top Performance Blog
  • Contact Scott
info@scottdmiller.com 773.404.5130

Implementation: The KEY to Improving the Effectiveness of Psychotherapy

May 7, 2018 By scottdm 7 Comments

The subject line of a recent email immediately caught my attention: what is the future of psychotherapy?   

I couldn’t help myself.  I clicked and began reading.

bright future“The future is incredibly bright,” the two, well-known writers and clinicians asserted.  Don’t worry about “rising rates of trauma, anxiety, bullying, depression, or the precipitous decline in people seeking help from therapists,” they counseled as, “There are things emerging that will take us beyond any paradigm that we grew up in!”

Bold and hopeful claims to be sure.  The truth is our field is founded on hope.  Fundamental to the work is the belief that people can change, that the past is not the future, genes and environment are not destiny.  A happier, healthier, more successful life awaits.  We can help.

blackAnd yet, the fact remains the effectiveness of psychotherapy has not improved in 40+ years.  More, despite widespread belief to the contrary, individual clinicians do not get better with time, training, or experience in the field.  If anything, the evidence shows the opposite: effectiveness declines!

So, what stands in the way of getting better results?  Could it be, as the email in my inbox suggested, the field suffers from a paucity of appropriate methods for helping people?   It’s a tempting idea.  And yet, on reflection, its hard to believe.  The field (and practitioners) have, at their disposal, literally hundreds of “evidence-based” treatment approaches.

lazy_worker-100587076-primary.idgeWhat about a lack of will?  Perhaps practitioners are just too lazy or complacent to improve?  I’ve heard this claim more than once from various sources.  Here again, however, its hard to believe.  Research documents therapists, as a group, overwhelmingly want to get better.  Indeed, continuous improvement is central to their identity, an antidote to compassion fatigue and burnout.

So what is it?  With so many good ideas and intentions, why haven’t outcomes of the field improved?

In a word, the answer is: Implementation.

Although new ideas are plentiful, information_hoseand literally thousands of research articles are published each month, the support necessary for effective execution of clinical innovations in daily practice is sorely lacking.   Despite their best intentions, many practitioners end up paralyzed by what Dr. Sarah Boon has called, “21st century science overload.” Others, faced with demands from regulators and payers, do whatever is necessary to comply with new “minimum” standards.   All too often, the result is merely an increased administrative burden with little or no actual payoff in terms of results.

Feedback-Informed Treatment (FIT) is one of those “new ideas.”  A large and growing number of randomized controlled trials document significantly improved quality, retention, and effectiveness of behavioral health services when standardized measures are used to solicit feedback from consumers of behavioral health services.

free stuffEach week, hundreds of therapists sign up for a free license to use the Outcome and Session Rating Scales in their work.   I answer scores of emails from agency managers about using the tools to meet new standards from SAMHSA and the Joint Commission for “measurement-based care.”

If improving outcomes via FIT were a simple matter of combining evidence with a desire to improve, success would be guaranteed.   Unfortunately, experience proves otherwise.  The majority of clinicians who download the ORS and SRS never use them; the small number who do, stop within a short period of time.  The same fate affects a suprisingly high number of agencies who invest their meager resources in acquiring licenses or software, and sending staff to 2-day training events.

Last week, I interviewed psychologist Heidi Brattland about her new study on implementing FIT in a implementationhospital-based psychiatric clinic.  As in previous investigations, soliciting feedback via the ORS and SRS resulted in significantly better results–indeed, therapies informed by ongoing feedback where two and a half times more likely to prove beneficial.   Interestingly, however, the results weren’t immediate.  In fact, in the first year, FIT made no difference whatsoever.  Instead, confirming what research from the field of implementation science  has long indicated, success took time–the best results being obtained after four years.

Click on the video below to learn what was essential to sustaining the agency’s effort along the way (You can read the complete research report here).  At  the upcoming ICCE Implementation intensive, we’ll help you translate these findings into a step-by-step, evidence-based plan.  It’s the only such training available–a primary reason that SAMHSA gave the ICCE perfect scores for implementation and support resources.

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
FIT Implementation Intensive 2018

 

Filed Under: Feedback Informed Treatment - FIT

Comments

  1. Rob McNeilly says

    May 8, 2018 at 12:06 am

    Thanks for this, Scott. I was left with wondering if the cultural change might be the key, not FIT itself.

    The cultural change that Heidi spoke about that led to improved results and took more than a year might be an expression of the time needed for the culture to change.

    Just wondering …

    Reply
  2. Paula Bellows says

    May 15, 2018 at 12:36 pm

    I follow a lot of Face Book pages for people who have suffered various traumas and issues. I’m trying to understand their point of view. I usually just observe but sometimes ask if they are in counseling. Very few are. The reasons cited are: can’t afford; don’t think it will work; don’t trust professionals; don’t think a person from upper classes can understand them; they don’t know anyone who has had counseling; they think it is for older people; they think they will be manipulated or judged. The pages where people seem to do the best with counseling are the DBT pages, where they get help with skills.

    Reply
    • scottdm says

      May 17, 2018 at 2:57 pm

      Paula…VERY interesting observations about the reasons people do not seek out help. Money is always number one on the list, and not thinking it will work is a close second or third. S

      Reply
      • Jane says

        March 24, 2019 at 9:19 pm

        I would add another reason: timely access. When clients are struggling, but are told that their therapist’s next available opening at a reasonable time is one month away, they are likely to give up on the process. This is typical of most of the larger counseling clinics (medical clinics, too) in my area.

        Reply
  3. Common Sense Counselor says

    May 16, 2018 at 9:39 pm

    Culture change at the national level. President Trump should declare a national mental health emergency:
    https://www.youtube.com/watch?v=jVRj4f2CdjQ

    Reply
    • scottdm says

      May 17, 2018 at 2:59 pm

      At one level, I agree. Our country invests less and less in mental health. On the other hand, WHO is complaining? I find it telling that the vast majority of people who could benefit from our services choose not to go. To me, culturally, there is a mismatch between what we offer, and what people want.

      Reply
  4. Loretta says

    May 17, 2018 at 3:31 pm

    Dr. Miller,

    Glad you asked, but not answering the question to What is the future of
    psychotherapy. From the position of a clinician who can’t afford to attend
    local much less cross country trainings, a conference in another country seems
    out of reach. So I wonder who exactly is participating in these conferences?
    Are the clinicians who are doing the face to face interactions with
    clients/patients getting to hear what is going on and having their voices heard?
    If these conferences are looking to the future of psychotherapy are the
    participants views based in the reality of day to day treatment, or are they
    more from a “perfect” world perspective?
    Just wondering.

    Reply

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

 

SEARCH

Subscribe for updates from my blog.

  

Upcoming Training

Mar
17

Feedback Informed Treatment (FIT) Intensive ONLINE


Mar
22

FIT Supervision Intensive 2021 ONLINE


Mar
30

FIT SPRING CAFÉ


Aug
02

FIT Implementation Intensive 2021


Aug
04

Training of Trainers 2021

FIT Software tools

FIT Software tools

NREPP Certified

HTML tutorial

LinkedIn

Topics of Interest:

  • Behavioral Health (110)
  • behavioral health (4)
  • Brain-based Research (2)
  • CDOI (14)
  • Conferences and Training (67)
  • deliberate practice (27)
  • Dodo Verdict (9)
  • Drug and Alcohol (3)
  • evidence-based practice (65)
  • excellence (61)
  • Feedback (38)
  • Feedback Informed Treatment – FIT (204)
  • FIT (25)
  • FIT Software Tools (12)
  • ICCE (26)
  • Implementation (7)
  • medication adherence (3)
  • obesity (1)
  • PCOMS (11)
  • Practice Based Evidence (38)
  • PTSD (4)
  • Suicide (1)
  • supervision (1)
  • Termination (1)
  • Therapeutic Relationship (8)
  • Top Performance (39)

Recent Posts

  • Developing a Sustainable Deliberate Practice Plan
  • Making Sense of Client Feedback
  • Umpires and Psychotherapists
  • Augmenting the Two-Dimensional Sensory Input of Online Psychotherapy
  • Death of a Friend

Recent Comments

  • Asta on The Expert on Expertise: An Interview with K. Anders Ericsson
  • Michael McCarthy on Culture and Psychotherapy: What Does the Research Say?
  • Jim Reynolds on Culture and Psychotherapy: What Does the Research Say?
  • gloria sayler on Culture and Psychotherapy: What Does the Research Say?
  • Joseph Maizlish on Culture and Psychotherapy: What Does the Research Say?

Tags

addiction Alliance behavioral health brief therapy Carl Rogers CBT cdoi common factors conferences continuing education denmark evidence based medicine evidence based practice Evolution of Psychotherapy excellence feedback feedback informed treatment healthcare holland icce international center for cliniclal excellence medicine mental health meta-analysis Norway NREPP ors outcome measurement outcome rating scale post traumatic stress practice-based evidence psychology psychometrics psychotherapy psychotherapy networker public behavioral health randomized clinical trial SAMHSA session rating scale srs supershrinks sweden Therapist Effects therapy Training