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
scottdmiller@ talkingcure.com +1.773.454.8511

Something New

October 8, 2014 By scottdm 1 Comment

something new ICCE

Actually, it’s more accurate to say, “Everything is new!”  The International Center for Clinical Excellence is coming up on its fifth birthday!   Since its launch in 2010, the ICCE has become the largest, online community of behavioral health practitioners and researchers in the world.  To celebrate, we are launching an entirely new web platform.   All the features you’ve come to expect remain—the discussions with colleagues, the document library, the commercial free atmosphere.   At the same time, everything has been streamlined, made faster, easier, and more intuitive.  Log in today!   Join a forum.  Start a conversation.  Share a presentation or paper with others. As you can see my own website has been completely redone.  The “Top Performance” blog is now front and center.  Plug in your email address and you’ll get regular updates regarding how to improve your effectiveness.   As always, my articles, books, video and audio materials are available with the click of a button.  You can also find an up-to-date schedule of workshops and intensive trainings in feedback informed treatment (FIT).

PCOMS - Partners for change outcome management system Scott D Miller - SAMHSA - NREPP Speaking of FIT, have you visited the www.whatispcoms.com website?  It’s the official website for ICCE’s Partners for Change Outcome Management System.  Here you can learn everything you need to know to get started using the feedback process documented to improve effectiveness and approved by SAMHSA as an evidence-based practice.  What’s new?  Thanks to ICCE members around the world, the site is available in five different languages, including: English, Dutch, Swedish, Norwegian, and Danish.   Until next time!

Filed Under: CDOI, Feedback Informed Treatment - FIT, FIT, ICCE Tagged With: icce, top performance

Is Supervision Important to you?

June 20, 2014 By scottdm 1 Comment

How valuable is clinical supervision to you?  In their massive, long-term international study of therapist development, researchers Orlinsky and Rønnestad (2005) found that “practitioners at all experience levels, theoretical orientations, professions, and nationalities report that supervised client experience is highly important for their current and career development” (p. 188).

Despite the value most of us place on the process, the latest review of the literature found no empirical evidence, “that psychotherapy supervision contributes to patient outcome” (Watkins, 2011).  Said another way, supervision does not produce more effective clinicians.  The result?  In the US, at least, opportunities for clinical supervision are in the decline, replaced by growing documentation requirements and administrative oversight–a trend destined to continue if the dearth of evidence persists.

What can be done?  Simply put, solicit formal feedback from clients regarding their experience of progress and the therapeutic relationship.  Such information, in turn, can be used to guide supervision, providing both a focus for the consultation and data supporting its effectiveness.  After all, multiple studies already document that the process improves outcomes while simultaneously decreasing drop out and deterioration rates (Miller, 2013 ).

Getting started is not difficult.  First, access two, free, easy-to-use scales for monitoring client progress and the relationship.   Second, join colleagues in the largest, online community of behavioral health professionals in the world.  It’s free–no hidden costs or secret levels of premium content.  On the ICCE, you can connect and consult with practitioners who are using feedback to improve the quality and outcome of treatment and supervision.  If you are new to feedback-informed work (FIT)–a SAMHSA certified evidence-based practice–you can get a thorough introduction at: www.whatispcoms.com .

Finally, get the  Feedback-Informed supervision manual and newly released, two-hour DVD.  Both provide step-by step instructions and examples of integrating feedback into supervision.  While you are at it, join us for our Feedback-Informed Supervision Intensive.  Last time around, it sold out months advance.  Registration is now open for our next training in March 2015.

Filed Under: Feedback Informed Treatment - FIT Tagged With: clinical supervision, feedback informed treatment, icce, international center for cliniclal excellence, Orlinsky, ors, outcome rating scale, PCOMS, psychotherapy supervision, Rønnestad, SAMHSA, session rating scale, srs

What can therapists learn from the CIA? Experts versus the "Wisdom of the Crowd"

May 6, 2014 By scottdm Leave a Comment

Central psychotherapy agency

What can we therapists learn from the CIA?  In a phrase, “When it comes to making predictions about important future events, don’t rely on experts!”

After a spate of embarrassing, high-profile intelligence failures, a recent story showed how a relatively small group of average people made better predictions about critical world events than highly-trained analysts with access to classified information.  The four-year study, known as the Good Judgment Project, adds to mounting evidence regarding the power of aggregating independent guesses of regular folks–or what is known as, “the wisdom of the crowd.”

When it comes to therapy, multiple scientific studies show that inviting the “wisdom of the crowd” into treatment as much as doubles effectiveness, while simultaneously cutting drop out and deterioration rates.

Whatever your profession, work setting, or preferred therapeutic approach, the process involves formally soliciting feedback from clients and then comparing the results to empirically established benchmarks.   Getting started is easy:

  • Download and  begin using two free, easy to use tools–one that charts progress, the other the quality of the therapeutic relationship–both of which are listed on SAMHSA’s National Registry of Evidence Based Programs and Practices.
  • Next, access cutting edge technology available on the web, smartphones, and tablets, that makes it easy to anonymously compare the progress of  your clients to effective patterns of practice worldwide.

You can learn more at: www.whatispcoms.com.  Plus, the ICCE–the world’s largest online community of professionals using feedback to enhance clinical judgment–is available at no cost to support you in your efforts.

While you’re at it, be sure and join fellow practitioners from the US, Canada, Europe, and Australia for the “Training of Trainers” or two-day FIT Implementation Intensive coming up this August in Chicago.  You’ll not only learn how to use the measures, but also tap into the collective wisdom of clients and practitioners around the globe.   Space is limited, and we are filling up quickly, so don’t wait to register.

Filed Under: Feedback, Feedback Informed Treatment - FIT Tagged With: feedback, feedback informed treatment, icce, international center for cliniclal excellence, National Registry of Evidence Based Programs and Practices, NREPP, PCOMS, SAMHSA, therapy, Training

Do you know who said, "Sometimes the magic works, sometimes it doesn’t"?

April 30, 2014 By scottdm Leave a Comment

Dan George

Chief Dan George playing the role of Old Lodge Skins in the 1970 movie, “Little Big Man.”  Whether or not you’ve seen or remember the film, if you’re a practicing therapist, you know the wisdom contained in that quote.  No matter how skilled the clinician or devoted the client, “sometimes therapy works, sometimes it doesn’t.”

Evidence from randomized clinical trials indicates that, on average, clinicians achieve a reliable change–that is, a difference not attributable to chance, maturation, or measurement error–with approximately 50% of people treated.  For the most effective therapists, it’s about 70%.  Said another way, all of us fail between 30-50% of the time.

Of greater concern, however, is the finding that we don’t see the failure coming.  Hannan and colleagues (2005) found, for example, that therapists correctly predicted deterioration in only 1 of 550 people treated, despite having been told beforehand the likely percentage of their clients that would worsen and knowing they were participating in a study on the subject!

It’s one thing when “the magic doesn’t work”–nothing is 100%–but it’s an entirely different matter when we go on believing that something is working, when it’s not.  Put bluntly, we are a terminally, and forever hopeful group of professionals!

What to do?  Hannan et al. (2005) found that simple measures of progress in therapy correctly identified 90% of clients “at risk” for a negative outcome or dropout.  Other studies have found that routinely soliciting feedback from people in treatment regarding progress and their experience of the therapeutic relationship as much as doubles effectiveness while simultaneously reducing dropout and deterioration rates.

You can get two, simple, evidence-based measures for free here.   Get started by connecting with and learning from colleagues on the world’s largest, online network of clinicians: The International Center for Clinical Excellence.  It’s free and signing up takes only a minute or two.

Six FIT Manuals-1

Finally, take advantage of a special offer for the 6 Feedback Informed Treatment and Training Manuals, containing step by step instructions for using the scales to guide and improve the services you offer.  These manuals are the reason the ICCE received the perfect scores when SAMHSA reviewed and approved our application for evidence-based status.

Here’s to knowing when our “magic” is working, and when it’s not!

Filed Under: Feedback Informed Treatment - FIT Tagged With: icce, international center for cliniclal excellence, magic, outcome measurement, randomized clinical trial, therapy

How not to be among the 70-95% of practitioners and agencies that fail

April 20, 2014 By scottdm Leave a Comment

fail2

Our field is full of good ideas, strategies that work.  Each year, practitioners and agencies devote considerable time and resources to staying current with new developments.  What does the research say about such efforts?  When it comes to the implementation of new, evidence-based practices, traditional training strategies routinely produce only 5% to 30% success rates.  Said another way, 70-95% of training fails (Fixsen, Blase, Van Dyke, & Metz, 2013).  

In 2013, Feedback Informed Treatment (FIT)–that is, formally using measures of progress and the therapeutic alliance to guide care–was deemed an evidence-based practice by SAMHSA, and listed on the official NREPP website.  It’s one of those good ideas.  Research to date shows that FIT as much as doubles the effectiveness of behavioral health services, while decreasing costs, deterioration and dropout rates. 

As effective as FIT has proven to be in scientific studies, the bigger challenge is helping clinicians and agencies implement the approach in real world clinical settings.  Simply put, it’s not enough to know “what works.”  You have to be able to put “what works” to work.  On this subject, researchers have identified five, evidence-based steps associated with the successful implementation of any evidence-based practice.  The evidence is summarized in a free, manual available online.  You can avoid the 70-95% failure rate by reading it before attending another training, buying that new software, or hiring the latest consultant.

At the International Center for Clinical Excellence, we’ve integrated the research on implementation into all training events, including a special, two-day intensive workshop on implementing Feedback-Informed Treatment (FIT).  Based on the five, scientifically-established steps, clinicians, supervisors, and agency directors will learn how to both plan and execute a successful implementation of this potent evidence-based practice. 

You can register today by clicking on the link above or the “FIT for Management” icon below.  Feel free to e-mail me with any questions.  In the meantime, hope to see you this summer in Chicago!

Fit Imp 2014

Filed Under: Conferences and Training Tagged With: behavioral health, dropout rates, evidence based medicine, evidence based practice, feedback informed treatment, FIT, icce, implementation, international center for cliniclal excellence, NREPP, SAMHSA, Training

How Cool is Kuhl? A Man with Vision on a Mission

April 19, 2013 By scottdm Leave a Comment

This week, my colleague and friend, Dr. David Mee-Lee, sent me a link to a blogpost written by Don Kuhl.  Actually, I was already a subscriber to Don’s Minful MIDweek blog (you should be too), but my travel this week had prevented me from reading his latest installment.  His posts always leave me inspired and give me something to think about.  This week was no different.  More on that in a moment.

In the meantime, let me tell you about Don.  He is the founder and CEO of The Change Companies, a company whose mission is to create tailored materials and programs to support behavioral change for special populatons.  And create they do.  Hundreds of bright, attractive, highly readable publications and guided workbooks for use by professionals and the people they serve.  Their material is exhaustive and comprehensive, including adult behavioral health, criminal justice, education and prevention, clinical assessment, and faith-based programs.  A side note, it was Don and his skillful team at The Change Companies that produced the ICCE Feedback Informed Treatment and Training Manuals.  If you’ve not seen them, you should.  They are the cutting edge of information about FIT.

What is most striking about Don, however, is his passion.  I met him at a conference in San Francisco nearly a decade ago.  On several occasions, he flew to Chicago from his home base in Carson City, Nevada just to meet, talk, and share ideas.  The photo above is from one of the meetings he arranged.  Don is devoted to improving the quality and experience of behavioral health services for professionals and clients alike.  Simply said, Don Kuhl is cool.

In his blogpost this week, Don wrote about that meeting with Jim Prochaska, David Mee-Lee, me, and Bill Miller.  He referred to it as a “highlight” of his recent professional life, a lucky event resulting from his mindful pursuit of relationships with “people who have smiles on their faces and goodness in their hearts.”

My thought?  I was and am the lucky one.  Thanks Don.  Thanks Change Companies.  Keep up the good work.

Filed Under: Top Performance Tagged With: addiction, behavioral health, books, Change Companies, continuing education, Don Kuhl, evidence based practice, excellence, icce

Resources on Feedback-Informed Treatment, Training, & Research

January 24, 2013 By scottdm Leave a Comment

Last week, I spent a day in London working with the clinical staff of the Hertfordshire Partnership NHS Foundation Trust.  The subject?  Feedback, of course!  As soon as I stepped off my transcontinental flight, I knew it was going to be a fun day.  Every way I turned at the Heathrow airport I was greeted by a machine asking for feedback about my experience: after exiting customs, at the baggage claim area, at the duty free shops.  Amazing!

The process was as engaging as it was efficient.  Tell us about your experience…by pressing a button bearing one of four different faces.  The similarity to the ICCE Young Child Outcome Rating Scale was striking (to say the least).  I felt compelled to register my feedback at every opportunity.

From London, I travelled to Gotheburg, Sweden for the first Scandanavian Advanced Intensive Training in Feedack Informed Treatment.  The event, organized by GCK, Gothenburg’s Center for Competence Development, sold out in a week with participants coming from all over Scandanavia.  I taught the course together with ICCE Senior Associate Susanne Bargmann using a curriculum based on the FIT Treatment and Training Manuals.  The series was developed to support, in part, ICCE’s application to the US Substance Abuse and Mental Health Services Administration (SAMSHA) for designation of FIT as an evidence-based practice.  Together with the Training of Trainers (TOT) and Supervision Intensive workshops, the manuals and Advanced Intensive training provides participants with the latest, cutting-edge, evidence-based information and skills in FIT.

Back in October, I blogged about an article that reviewed the evidence regarding psychotherapy training.   In it, the author John Malouff concluded, “There appears to be no evidence that coursework and research completion…have any value to future psychotherapy clients…”.  He continued, “Training programs…carry the responsibility to show that the training they provide have positive benefits for future clients.”

Well…on that score, learning FIT, available evidence shows, leads to direct benefits to consumers of behavioral health services.  Together with New Zealand based psychologist and ICCE Senior Associate Eeuwe Schuckard, I’ve updated the review of the research supporting FIT practice (click here).

Don’t wait to learn about or deepen your understanding of and skills in feedback informed treatment.  The Advanced Intensive scheduled for March 18-321st has a few spots left.  You can register online by clicking here.

By the way, shortly after the publication of Malouff’s review in Psychotherapy in Australia, I wrote to the editor, Liz Sheehan, and asked for permission to reprint the article.  Click here to read it.

Filed Under: Conferences and Training Tagged With: feedback informed treatment, icce, New Zealand, NHS, sweden

Curing Clinician Overconfidence: Try Darting and Frowning

January 10, 2013 By scottdm Leave a Comment

Overconfidence.  It’s a problem that leads to systematic errors in judgement.   Long thought to arise out of hubris or the corrupting effects of the emotion, the evidence actually shows it to be built into humans’ evolved cognitive machinery.  Existimo ergo certus sum (I think, therefore I am…certain).

Behavioral health professionals are not immune.  A recently published study by Walfish, McAlister, O’Donnell, and Lambert (2012) asked clinicians how their effectiveness rates compared to other professionals.  Turns out, clinicians, on average, believed their results were better than 80% of their peers.  Not a single practitioner surveyed viewed themselves as below average and a full quarter (25%) thought they fell at the 90th percentile or higher in skill level and effectiveness!

It’s true that we are not alone in this tendency.  As indicated above, it’s how our brains work.  The typical driver, for example, believes themselves to be better than 80% of others on the road.  University professors, it appears, suffer from the most inflated levels of self-esteem, ranking themselves at the 94th percentile on average.

When it comes to learning, the consequences are significant.  Why change, after all, if you’re already pretty darn good and if the real problem is obvious: other drivers, poor students, etc., difficult life circumstances or the complex nature of some mental disorders?

Researchers have discovered a relatively simple solution to overconfidence: frowning.  That’s right.  Turning that smile upside down short circuits our reptilian wiring, making us more analytical and vigilant in our thinking, in the process enabling us to “question stories that we would otherwise unreflectively accept as true because they are facile and coherent” ( Holt, 2011).

What else can clinicians do?  Do something to gain perspective.  Take on another, divergent point of view, for example.  Practically speaking, scan rather than fix your gaze.  Literally, move your eyes.

Everyone has heard of “tunnel vision.”  Turns out, despite pledges to remain open and flexible, it ain’t so easy.  If you don’t agree, try a little experiment.    Fix your eyes on the flashing red and/or green dot at the center of the graphic and notice what happens to the surrounding yellow ones.  Be patient if the image hasn’t loaded.  It can take a minute or two.

They either blinked on and off or disappeared completely.  Interesting enough but here’s what’s really strange: the yellow dots actually never disappear.  They are always there despite what you see.  And no, the computer did not scan your visual field and cause the yellow dots to blink.  Neither is this an optical illusion.  Once again, it’s the way we are wired.  We think we are seeing everything…but we are not.  The result: overconfidence.  It’s why, following an automobile accident, people will say, “the other driver came out of nowhere.”  It’s why surgeons leave sponges inside their patients or miss seeing bleeds or small nicks of the scalpel.  It’s also why behavioral health practitioners routinely fail to detect deterioration and people at risk for dropping out of services (Hannan, et al. 2005).

Now, look again.  This time, however, shift your eyes about while watching the flashing dot in the center.  In other words, don’t fix your gaze.  If that doesn’t change what you see, then step back from the image and view it from a distance.  There, see!  The yellow dots are present the entire time.

Helping busy practitioners step back, shift their gaze, and otherwise improve their critical faculties and skills is the mission of ICCE.  Members connect, learn from, and share with the largest online community of mental health professionals in the world.  Thousands of members, hundreds of discussion forums, a massive and every growing library of research and other supportive documents, and how-to videos are available for free 24-7-365.

Many of the members and associates will be meeting in Amsterdam, Holland for the Achieving Clinical Excellence conference on May 16-18th.  Conference coordinator, Liz Pluut, has organized an line-up of international speakers, researchers, and practitioners that is guaranteed to push your clinical performance to the next level!  Participants are coming from all over Europe, the US, Canada, Asia, Australia, and more.  Don’t wait to register.  Space is limited and the response has been amazing.

OK, here’s something fun.  Take a look at the video below.  Oh yeah, make sure you smile and keep your eyes fixed on my hands!

Filed Under: Conferences and Training, Feedback Informed Treatment - FIT Tagged With: behavioral health, icce

What is the Real Source of Effectiveness in Smoking Cessation Treatment? New Research on Feedback Informed Treatment

November 24, 2012 By scottdm Leave a Comment

When it rains, it pours!  So much news to relay regarding recent research on Feedback Informed Treatment (FIT).  Just received news this week from ICCE Associate Stephen Michaels that research using the ORS and SRS in smoking cessation treatment is in print!   A few days prior to that, Kelley Quirk sent a copy of our long-awaited article on the validity and reliability of the Group Session Rating Scale.  On that very same day, the editors from the journal Psychotherapy sent proofs of an article written by me, Mark Hubble, Daryl Chow, and Jason Seidel for the 50th anniversary issue of the publication.

Let’s start with the validity and reliability study.  Many clinicians have already downloaded and been using Group Session Rating Scale.  The measure is part of the packet of FIT tools available in 20+ languages on both my personal and the International Center for Clinical Excellence websites.   The article presents the first research on the validity and reliability of the measure.  The data for the study was gathered at two sites I’ve worked with for many years.   Thanks to Kelley Quirk and Jesse Owen for crunching the numbers and writing up the results!   Since the alliance is one of the most robust predictors of outcome, the GSRS provides yet another method for helping therapists obtain feedback from consumers of behavior health services.

Moving on, if there were a Nobel Prize for patience and persistence, it would have to go to Stephen Michaels, the lead author of the study, Assessing Counsellor Effects on Quit Rates and Life Satisfactions Scores at a Tobacco Quitline” (Michael, Seltzer, Miller, and Wampold, 2012).  Over the last four years, Stephen has trained Quitline staff in FIT, implemented the ORS and SRS in Quitline tobacco cessation services, gathered outcome and alliance data on nearly 3,000 Quitline users, completed an in-depth review of the available smoking cessation literature, and finally, organized, analyzed, and written up the results.

What did he find?  Statistically significant differences in quit rates attributable to counselor effects.  In other words, as I’ve been saying for some time, some helpers are more helpful than others–even when the treatment provided is highly manualized and structured.  In short, it’s not the method that matters (including the use of the ORS and SRS), it’s the therapist.

What is responsible for the difference in effectiveness among therapists?  The answer to that question is the subject of the article, “The Outcome of Psychotherapy: Yesterday, Today, and Tomorrow” slated to appear in the 50th anniversary issue of Psychotherapy.  In it, we review controversies surround the question, “What makes therapy work?” and tip findings from another, soon-to-be-published empirical analysis of top performing clinicians.  Stay tuned.

Filed Under: Feedback Informed Treatment - FIT Tagged With: addiction, behavioral health, cdoi, Certified Trainers, evidence based practice, excellence, feedback, healthcare, icce, Smoking cessation, Therapist Effects

Clinical Support Tools for the ORS and SRS

November 20, 2012 By scottdm 1 Comment

I have so much to be grateful for at this time.  Most of all, I’m happy to be home with my family.  As we have in the past, this year we’ll be spending the holiday at the home of our long time friends John and Renee Dalton.  The two always put out a fantastic spread and our son, Michael, is fast friends with their two kids.

I’m also grateful for the International Center for Clinical Excellence (ICCE) community.  Currently, ICCE has over 4200 members located around the world, making the organization the largest, web-based community of professionals, educators, managers, and clinicians dedicated to using feedback to pursue excellence in the delivery of behavioral health services.  Recently, the site was highlighted as one of the best resources for practitioners available on the web.  Articles, how-to videos, and discussion forums are available everyday, all day–and for free!  No come-ons for books or webinars and no “cult of personality”–just sharing among peers.  If you are not a member, you can join at: www.centerforclinicalexcellence.com

A special thanks goes to several ICCE senior advisors and associates, including Susanne Bargmann, Jason Seidel, Cynthia Maeschalck, Bob Bertolino, Bill Plum, Julie Tilsen, and Robbie Babbins-Wagner.  These folks are the backbone of the organization.  Together, they make it work.  Most recently, we all joined together to create the ICCE Feedback Informed Treatment and Training Manuals, a cutting edge series covering every aspect of FIT–from the empirical foundations to implementation–in support of our application to SAMSHA for recognition as an “evidence-based practice.”

As a way of supporting everyone using the ORS and SRS, I wanted to make a couple of clinical support tools available.  If you are using the measures, the first item will need no introduction.  It’s a 10 cm ruler!  Save the file and print it off and you also have a ready reminder of the upcoming Achieving Clinical Excellence conference, coming up in May 2013.  Like last time, this will feature the latest inforamtion about feedback informed practice!  The second item is a reliable change graph.  If you are using the paper and pencil measures, rather than one of the existing web based systems (www.fit-outcomes.com, www.myoutcomes.com), you can use this tool to determine whether a change in scores from session to session is reliable (that is, greater than chance, the passage of time, and measurement error [and therefore, due to the care being provided]) or even clinically significant (that is, both reliable and indicating recovered).  The last item is an impressive summary of various systems for monitoring progress in treatment.

In addition ACE Health have developed openFIT, a plug-in which seamlessly integrates the ORS, SRS and associated algorithms into any existing Electronic Health Record, Case Management System of eMental Health application.

I wish everyone a peaceful and rewarding Thanksgiving holiday.

 

Filed Under: FIT Software Tools Tagged With: behavioral health, cdoi, excellence, feedback, healthcare, icce, mental health, ors, Outcome, practice-based evidence, srs

Is Psychotherapy Getting Better?

October 11, 2012 By scottdm Leave a Comment

This last month, I spent a significant amount of time traveling around Europe and Scandanavia (Germany, Sweden, Denmark, the Netherlands) working with clinicians and mental health agencies implementing Feedback-Informed Treatment.  Not infrequently, people ask me, “doesn’t all the travel wear you out?”  My pat response is, “No, not at all!  The worst part is being away from my family.  But, meeting with practitioners and agency managers always buoys my spirits.”  I mean it.  I miss my family and the airlines (and airport food) are a real drag.  Practitioners are, on the other hand, a different story.  Despite the numerous challenges (funding, documentation, regulatory demands, etc.), they persist, working to improve their skills and provide effective help to their clients.

As happened a few months ago, I was in the SAS lounge at the Copenhagen airport, waiting for a flight, enjoying a cup of coffee, and catching up on the news, when I ran across another article by Thomas Friedman that caught my eye.  “The plan,” he said, “to work hard and play by the rules to get ahead is now outdated.  It takes much more than that.”

Wow, I thought, he’s so right–especially when it comes to the field of mental health.  I was raised in an era when “working hard at your job” was the formula for success, the pathway to a fruitful and enjoyable career.  As I travel the world, however, I see just how little reason there is to believe in this ideal any longer.  The rules have changed.  The world, observed Friedman, “is now a more open system.  Technology and globalization are wiping out lower-skilled jobs faster, while raising the skill level required for new jobs.  More than ever now, lifelong learning is the key to getting into and staying in the middle class.”

As I said earlier, the therapists I meet are working very hard–harder than either I or they ever anticipated.  They are putting in more hours and, in many cases, making less money than they did a few years earlier.  It’s true!  Did you know, psychologists incomes are down 17% in the last decade?  Simply put, working hard is a recipe for…eventual failure.  If we are to survive and thrive, a change of order–not magnitude–is required.

Recently, Diane Cole addressed the challenges facing practitioners in a special issue of the Psychotherapy Networker.  It’s worth a read (click here).  Importantly, she doesn’t just bemoan the problems currently facing the field, but provides crucial information for helping each and every one of us take charge of our fate.

Filed Under: evidence-based practice, Top Performance Tagged With: denmark, Germany, holland, icce, psychotherapy networker, randomized clinical trial, sweden, Thomas Friedman

National Psychotherapy Day: A Recognition, Celebration, and Call for Action

September 24, 2012 By scottdm Leave a Comment

With all the challenges facing the profession, it is important to highlight people and organizations that are working hard to make a difference.  On that note, tomorrow, Tuesday the 25th of September 2012 is the very first National Psychotherapy Day.  Having a day of unified, active promotion of psychotherapy is the brain child of psychologist Ryan Howes.  At his side is the Psychotherapy Foundation (PF), a nonprofit foundation, dedicated to promoting the therapeutic relationship as an “effective, long-lasting, collaborative approach” to resolving emotional, behavioral, and relational problems.  What’s not to like?  Dr. Howes and the PF are encouraging people who have seen a therapist to talk or blog about their experience.  They are calling on therapists to commit to sharing research documenting the effectiveness of psychotherapy with the public (write a letter to the editor of your local paper, offer to do an interview, give a brief presentation at the Chamber of Commerce).

Surveys show that the two primary barriers to seeking the help of a therapist are: (1) cost of the service (cited by 81%); and (2) lack of confidence in the outcome of therapy (78%).  Of these two barriers, the first is entirely understandable.  Times are tough and treatment costs money.  It is for these this reason that Dr. Howe and the PF are asking all who participate in the day to support their local, low-fee counseling centers in whatever way possible.

The second barrier is more troubling and, frankly, difficult to understand and address.  Research overwhelmingly supports the efficacy of psychological treatment.  Indeed, the American Psychological Association issued a rare, formal resolution this last month recognizing the effectiveness of psychotherapy!  Listen to the language:

  • Whereas the effects of psychotherapy …are widely accepted to be significant and large;
  • Whereas the results of psychotherapy tend to last long and be less liely to equire additional treatment courses than psychopharmacological treatments;
  • Whereas comparisons of different forms of psychotherapy most often result in relatively nonsignificant difference, and contextual and relationship factors (not captured by a patient’s diagnosis or by the therapists use of a specific psychotherapy) mediate or moderate outcomes;
  • Whereas the best research evidence conclusively shows that individual, group, and couple/family psychotherapy are effective for a broad range of…problems with children, adolescents, adults, and older adults;
  • THEREFORE be it resolved that, as a healing practice and professional service, psychotherapy is effective and highly cost effective…and should be included in the health care system as an established evidence-based practice.

Strong words, right?  Even so, it’s very clear that the public’s lingering doubts about effectiveness will require than a proclamation.  It is for this reason that Dr. Howes and PF are asking all those currently in care to provide constructive feedback to their therapist.  Therapists, in turn, are encouraged to seek and respond to feedback from their clients.   As reviewed here on this blog, numerous studies document the positive impact that routine feedback from clients has on retention and outcome of service.  Free evidence-based tools are available for download from this website for soliciting formal feedback from consumers.  Plus, the International Center for Clinical Excellence web-based community–the largest group of clinicians and researchers dedicated to improving the quality and outcome of psychotherapy via the use of ongoing feedback–stands ready and willing to be of support.

So, why the turquoise?  Well, its’ the official color of National Psychotherapy Day.  To show your support, Dr. Howes and PF are asking all to wear something with that color tomorrow.

Filed Under: behavioral health, Practice Based Evidence Tagged With: brief therapy, cdoi, icce, randomized clinical trial

Looking for Results in All the Wrong Places: What Makes Feedback Work?

September 16, 2012 By scottdm Leave a Comment

As anyone knows who reads this blog or has been to one of my workshops, I am a fan of feedback.  Back in the mid-1990’s, I began using Lynn Johnson’s 10-item Session Rating Scale in my clinical work.  His book, Psychotherapy in the Age of Accountability, and our long relationship, convinced me that I needed to check in regularly with my clients.  At the same time, I started using the Outcome Questionnaire (OQ-45).  The developer, Michael Lambert, a professor and mentor, was finding that routinely measuring outcome helped clinicians catch and prevent deterioration in treatment.  In time, I worked with colleagues to develop a set of tools, the brevity of which made the process of asking for and receiving feedback about the relationship and outcome of care, feasible.

Initial research on the measures and feedback process was promising.   Formally and routinely asking for feedback was associated with improved outcomes, decreased drop-out rates, and cost savings in service delivery!  As I warned in my blogpost last February, however, such results, while important, were merely “first steps” in a scientific journey.  Most importantly, the research to date said nothing about why the use of the measures improved outcomes.  Given the history of our field, it would be easy to begin thinking of the measures as an “intervention” that, if faithfully adopted and used, would result in better outcomes.  Not surprisingly, this is exactly what has happened, with some claiming that the measures improve outcomes more than anything since the beginning of psychotherapy.  Sadly, such claims rarely live up to their initial promise.  For decades the quest for the holy grail has locked the field into a vicious cycle of hope and despair, one that ultimately eclipses the opportunity to conduct the very research needed to facilitate understanding of the complex processes at work in any intervention.

In February, I wrote about several indirect, but empirically robust, avenues of evidence indicating that another variable might be responsible for the effect found in the initial feedback research.  Now, before I go on, let me remind you that I’m a fan of feedback, a big fan.  At the same time, its important to understand why it works and, specifically, what factors are responsible for the effect.  Doing otherwise risks mistaking method with cause, what we believe with reality.  Yes, it could be the measures.  But, the type research conducted at the time did not make it possible to reach that conclusion.  Plus, it seemed to me, other data pointed elsewhere; namely to the therapist.  Consider, for example, the following findings: (1) therapists did not appear to learn from the feedback provided by measures of the alliance and outcome; (2) therapists did not become more effective over time as a result of being exposed to feedback.  In other words, as with every other “intervention” in the history of psychotherapy, the effect of routinely monitoring the alliance and outcome seems to vary by therapist.

Such results, if true, would have significant implications for the feedback movement (and the field of behavioral health in general).  Instead of focusing on methods and interventions, efforts to improve the outcome of behavioral health practice should focus on those providing the service.  And guess what?  This is precisely what the latest research on routine outcome measurement (ROM) has now found. Hot off the press, in the latest issue of the journal, Psychotherapy Research, Dutch investigators de Jong, van Sluis, Nugter, Heiser, and Spinhoven (2012) found that feedback was not effective under all circumstances.  What variable was responsible for the difference?  You guessed it: the therapist–in particular, their interest in receiving feedback, sense of self-efficacy, commitment to use the tools to receive feedback, and…their gender (with women being more willing to use the measures).  Consistent with ICCE’s emphasis on supporting organizations with implementation, other research points to the significant role setting and structure plays in success.  Simon, Simon, Harris and Lambert (2011), Reimer and Bickman (2012), and de Jong (2012) have all found that organizational and administrative issues loom large in mediating the use and impact of feedback in care.

Together with colleagues, we are currently investigating both the individual therapist and contextual variables that enable clinicians to benefit from feedback.  The results are enticing.  The first will be presented at the upcoming Achieving Clinical Excellence conference in Holland, May 16-18th.  Other results will be reported in the 50th anniversayry issue of the journal, Psychotherapy, to which we’ve been asked to contribute.  Stay tuned.

Filed Under: Feedback Informed Treatment - FIT Tagged With: cdoi, continuing education, holland, icce, Michael Lambert, post traumatic stress

REACHing the Next Level of Clinical Performance: What it Really Takes

September 1, 2012 By scottdm 2 Comments


Do any of these people look familiar?  Well, of course, I’m the guy in the middle pointing.  To my left is the rock and roll guitarist Joe Walsh.  On my right is world-renowned, card mechanic Richard Turner.  Why have I pictured myself sandwiched between these two?  Because they are both inspiring examples of what can be accomplished when individuals push beyond the “tried and true,” to reach the next level of performance.

Back in June, I read an article about Joe Walsh in the Chicago Tribune.  Buried deep in the piece was a brief biography of the guitarist that exemplifies what it takes to achieve excellence.  Walsh, who is 67 years old, began playing back in the late 1960’s.  Like many of his generation, he was inspired by the Beatles.  One day, he was listening to the band’s song, “And Your Bird can Sing,” which contains a “ridiculously finger stretching George Harrison guitar solo.”  According to the article, Walsh worked tirelessly until he mastered the riff.  It was only years later, long after he’d become famous, that he met Ringo Starr.  Walsh related the story to the drummer who “looked at Walsh like he was nuts.”  Harrison, Ringo told him, had played two guitar parts separately and tracked them on top of each other and later tracked them together in the studio.

Good thing no one told Walsh the truth.  As a result, he did what no one–even now–thought posssible.

On to Richard Turner.  Unless you are into magic or gambling, this may be the first time you’ve ever heard of this person.  Author Alex Stone, in his phenomenally fun and informative book, Fooling Houdini, describes him as “a card handler without equal, a man whose prowess with a deck borders on the supernatural.”  The supernaturnal?  Really?  I would have deemd such praise so much more hype, typical of “hollywood” and the media, if I hadn’t meet Turner personally and seen him work.  Simply put, there’s nothing he can’t do with a deck of cards.

Watch the brief video below filmed at this year’s “Training of Trainers” event in Chicago.  At all training events, we bring in top performers to entertain, inspire, and inform participants about what it takes to achieve excellence.

Not bad eh?  Especially when one considers that Turner is blind.  And the video above is only the tiniest snippet of his performance.  At one point, he dealt out hands of poker and black jack, asking audience members which position they would like to have dealt the winning cards.  Sure enough, whatever position was called, luck struck there and only there.  “Give me a number between 1 and 52,” he asked.  Whatever number was called out, he cut the cards to that exact position in the deck.  Did I mention he’s also a 6th degree black belt?  Simply put, Turner is a performer that is always pushing the limits.  Once he was cited for a driving motor cycle while blind!  How does he do it?  Practice.  Yep, seventeen hours a day!  For years, he slept with a deck of cards.  Like Walsh, he persisted until he mastered moves that no one considered possible or, more accurately, no one ever even imagined.

So, what can mental health professionals do to REACH the next level of clinical performance?  Over the last few years, together with my colleagues, we’ve been writing about the steps thrapists can take to achieving excellence.  This year, I was privileged to summarize the current state of the research on the subject in a keynote address at the Psychotherapy Networker conference in Washington, DC.  Here, for the first time, is “Part 1” of that address (the second half will follow soon).  In it, I lay out what the evidence says it takes to excel.

Filed Under: Conferences and Training, Top Performance Tagged With: icce, randomized clinical trial, Training

Obesity Redux: The RFL Results and complex Nature of Truth and Science

August 28, 2012 By scottdm 2 Comments

Back in April, I blogged about research published by Ryan Sorrell on the use of feedback-informed treatment in a telephonically-divered weight management program.  The study, which appeared in the journal Disease Management*, not only found that the program and feedback led to weight loss, but also significant improvements in distress, health eating behaviors (70%), exercise (65%), and presenteeism on the job (64%)–the latter being critical to employers who were paying for the service.

Despite these results, the post garnered no attention until four months later during the first week of August when three clinicians posted comments on the very same day–that’s the beauty of the web, a long memory and an even longer reach.

What can I say?  I’m having to eat my hat (or, the bird on my shoulder is…).  I learned a great deal from the feedback:

  • Despite having sourced the figure from the American Academy of Child and Adolescent Psychiatry, the claim that weight gain due to poor diet and a lack of exercise was responsible for 300,000 deaths was false.  According to the comments, the figure is closer to 26,000, a mere 10% of the number claimed!
  • The same was true regarding the reported annual cost of obesity.  The 100 billion dollar figure reported on the AACAP website is, I was told, “grossly inflated” and worse, missed the point.  By focusing on BMI, the writer counseled, “we will have wasted money spent on the 51% of the healthy people who are deemed ‘unhealthy’ based on weight and the 18% unhealthy ones who are overlooked because their weight looks fine (see Wildman et al., 2008).”

Solid points both.  Thankfully, one of the writers noted what was supposed to have been the main point of the post; namely, ” the importance of “practice-based” evidence” in guiding service delivery, “making clear that finding the ‘right’ or ‘evidence-based’ approach for obesity (or any problem for that matter) is less important than finding out “what works” for each person in need of help.”

I want to make sure readers have access to the results of the study because they are an impressive demonstration of what’s possible when the feedback is sought from and used to guide service to people “in care.”  Weight loss aside, Ryan also reported significant improvements in distress, healthy eating behaviors (70%), exercise (65%), and presenteeism on the job (64%).  All this by using two simple, 4-question scales.

*Sorrell, R. (September, 2007).  Application of an Outcome-Directed Behavioral Modification Model for Obesity on a Telephonic, Web-based Platform.Disease Management, 10, Supplement 1, 23-26.

PS: An AP article that came out this last weekend and was discussed on NPR suggests the truth about the “weight of the nation” may be more complicated than either I or those who commented on my blog may realize.  Among the many changes that have occured over the last decades, the piece declares, “Who are we?  Fatter.  The average woman has gained 18 pounds since 1990, to 160 pounds; the average man is up 16 pounds, to 196.”   Hmm.

Filed Under: Feedback Informed Treatment - FIT, obesity Tagged With: American Academy of Child and Adolescent Psychiatry, Chronic Disease, cognitive-behavioral therapy, disease management, evidence based practice, icce, Weight Management

Feedback Informed Treatment: Update

August 16, 2012 By scottdm Leave a Comment

Chicago, IL (USA)

The last two weeks have been a whirlwind of activity here in Chicago.  First, the “Advanced Intensive.”  Next came the annual “Training of Trainers.”  Each week, the room was filled to capacity with practitioners, researchers, supervisors, and agency directors from around the globe receiving in-depth training in feedback-informed practice.  It was a phenomenal experience.  As the video below shows, we worked and played hard!

Already, people are signing up for the next “Advanced Intensive” scheduled for the third week of March 2013 and the new three-day intensive training on FIT supervision scheduled for the 6-9th of August 2013.   Both events follow and are designed to complement the newly released ICCE FIT Treatment and Training Manuals.  In fact, all participants receive copies of the 6 manuals, covering every detail of FIT practice, from the empirical evidence to implementation.  The manuals were developed and submitted to support ICCE’s submission of FIT to the National Registry of Evidence Based Practices (NREPP).  As I blogged about last March, ICCE trainings fill up early.  Register today and get the early bird discount.

Filed Under: CDOI, Conferences and Training, evidence-based practice, Feedback Informed Treatment - FIT, FIT Tagged With: cdoi, icce

A Lotta Help from One’s Friends: The Role of Community in the Pursuit of Excellence

August 3, 2012 By scottdm Leave a Comment

Dateline: Chicago, IL USA

Hard not to be impressed with the USA Women’s Gymnastic team.  What skill, percision, expertise, and excellence.

By now, I’m sure you’ve seen the interviews.  In all instances, each and every one has focused on the team.  Despite some in the media attempting to make stars out of the individual members, the atheletes have continually highlighted, “The Team.”  When asked to account for their success or the source of their ambition, the reason cited has been: THE TEAM.

Sixteen year old McKayla Maroney said, “I think we’re as close as we can be.  We’ve all been working and training together for a long time…I’ve known (fellow team member) Kyla since I was 6 years old.  We are all best of friends.  They did so great today and I just love this team so much.”

As highlighted in our recent article, “The Road to Mastery,” excellence does not occur in a vacuum.  Surrounding every great performer is a community (teachers, coaches, mentors, and peers).  In the busy world that is modern clinical practice, where can practitioners finda trsutworthy and supportive community of peers?  A group of colleagues that will challenge them to keep growing as professionals and people?

In a word, the ICCE.  In December 2009, the International Center for Clinical Excellence was launched and since them become the largest, global, web-based community of clinicians, researchers, administrators, and policy makers dedicated to excellence in behavioral health.  The ICCE has it’s own gold-medal winning team!  Practitioners working together in locations around the globe.

Practitioners like Jason Seidel, Psy.D., who represented ICCE at last week’s meeting of the American Psychological Association.  Jason presented on Feedback Informed Treatment (FIT) and then participated in a panel discussion on Practice Based Evidence together with Paul Clement, Michael Lambert, Bill Stiles, Carol Goodheart, and David Barlow.  Jason rocked the packed house with his tight summary of the empirical support for FIT and argument in favor of practice-based evidence!

Then there’s Daryl Chow, a psychologist from Singapore, who is currently finishing up a quantitative study of “Supershrinks.” His research is the first to employ a sophisticated statistical analysis of therapists practices related to superior outcomes.  Suffice it to say, his results are mind blowing.  Daryl’s work won him a scholarship to this year’s “Training of Trainers” course.  If you’re not signed up for that event, you can meet him today by joining the ICCE and looking him up!

There are many, many other dedicated and supportive members.  Join and share your expertise with the community today!

Filed Under: excellence, Top Performance Tagged With: cdoi, continuing education, feedback informed treatment, icce

The International Center for Clinical Excellence: Using Social Networks for "Real Time" Research

June 6, 2012 By scottdm 1 Comment

The International Center for Clinical Excellence was officially lauched at the Evolution of Psychotherapy Conference in December 2009.  Since that time, membership has grown steadily.  With over 3800 members, the ICCE is the largest, web-based community of behavioral health professionals dedicated to improving the quality and outcome of service delivery.  The site features nearly a hundred discussion forums, taking place in a number of languages, on topics specific to treatment and research.

Many agencies and systems of care are using the site to coordinate implementation of feedback-informed treatment.  Of course, those attending ICCE training events (e.g., the Advanced Intensive, Training of Trainers, and Achieving Clinical Excellence conference), use the site for both pre and post training support and continuing education.

And now, the site is being used for a new purpose: research.  ICCE member and associate Wendy Amey was the first.  She used the site successfully for her dissertation, surveying members about how they work with trauma.  I am pleased to announce two new research projects that will access the ICCE community.

The first is being conducted by McGill University counseling psychology doctoral candidate Ionita Gabriela.  Her study focuses on clinicians’ experiences with using measures to monitor client progress in the services they offer.  Implementation is the challenge most clinician and agencies face when incorporating routine outcome monitoring into practice.  All participants will be entered into a drawing for a $100 Amazon gift certificate.  More importantly, participants will contribute to the expanding knowledge base on feedback informed treatment.  Whether or not you are a member of ICCE, you can contribute by taking part in the study.  Click here to send an email to Ionita to complete the interview (it only takes about 15 minutes).

The second study is being conducted by me and ICCE Associate Daryl Chow as part of ICCE’s continuing emphasis on clinical excellence.  The study builds on groundbreaking research by Ronnestad and Orlinksy on the subject of therapist development.  Particpants are asked to complete a brief (8-12 minutes), online survey with questions pertaining to your development as a clinician.   All participants will be entered into a drawing, the winner receiving all 6 of the newly released FIT Treatment and Training Manuals (valued at $100).  Again, you can participant whether or not you are currently a member of the ICCE.  In fact, please ask your colleagues to participate as well!  Click here to complete the secure, online survey (no identifying information will be sought).

Filed Under: Conferences and Training, ICCE Tagged With: continuing education, icce

Feedback Informed Treatment as Evidence-Based Practice

May 23, 2012 By scottdm Leave a Comment

Back in November, I blogged about the ICCE application to SAMSHA’s National Registry for consideration of FIT as an official evidence-based approach (EBP).  Given the definition of EBP by the Institute of Medicine and the American Psychological Association, Feedback Informed Treatment seems a perfect, well, FIT.  According to the IOM and APA, evidence-based practice means using the best evidence and tailoring services to the client, their preferences, culture, and circumstances.  Additionally, when evidence-based, clinicians must monitor “patient progress (and of changes in the patient’s circumstances—e.g.,job loss, major illness) that may suggest the need to adjust the treatment. If progress is not proceeding adequately, the psychologist alters or addresses problematic aspects of the treatment (e.g., problems in the therapeutic relationship or in the implementation of the goals of the treatment) as appropriate.”

In late Summer 2011, ICCE submitted 1000’s of pages of supporting documents, research studies, as well as video in support of the application.  This week, we heard that FIT passed the “Quality of Research” phase of the review.  Now, the committee is looking at the “Readiness for Dissemination” materials, including the six detailed treatment and implementation manuals on feedback informed treatment.  Keep your fingers crossed.  We’ve been told that the entire process should be completed sometime in late fall.

In the meantime, we are preparing for this summer’s Advanced Intensive and Training of Trainer workshops.  Once again, clinicians, educators, and researchers from around the world will be coming together for cutting edge training.  Only a few spots remain, so register now.

Filed Under: Feedback Informed Treatment - FIT Tagged With: American Psychological Association, evidence based medicine, evidence based practice, feedback informed treatment, FIT, icce, Institute of Medicine, NREPP, practice-based evidence, SAMHSA, Training

Revolution in Swedish Mental Health Care: Brief Update

May 14, 2012 By scottdm 1 Comment

In April 2010, I blogged about Jan Larsson, a Swedish clinician who works with people on the margins of the mental health system.  Jan was dedicated to seeking feedback, using the ORS and SRS to tailor services to the individuals he met.  It wasn’t easy.  Unilke most, he did not meet his clients in an office or agency setting.  Rather, he met them where they were: in the park, on the streets, and in their one room aparments.  Critically, wherever they met, Jan had them complete the two measures–“just to be sure,” he said.  No computer.  No I-phone app.  No sophisticated web-based adminsitration system.  With a pair of scissors, he simply trimmed copies of the measures to fit in his pocket-sized appointment book! I’ve been following his creative application of the scales ever since.

Not surprisingly, Jan was on top of the story I blogged about yesterday regarding changes in the guidelines governing Swedish mental health care practice.  He emailed me as I was writing my post, including the link to the Swedish Radio program about the changes.  Today, he emailed again, sending along links to stories appearing in two Swedish newspapers: Dagens Nyheter and Goteborg Posten.

Thanks Jan!

And to everyone else, please continue to send any new links, videos, and comments.

Filed Under: behavioral health, excellence, Feedback Informed Treatment - FIT, Top Performance Tagged With: continuing education, Dagens Nyheter, evidence based practice, Goteborg Posten, icce, ors, outcome rating scale, session rating scale, srs, sweden

Revolution in Swedish Mental Health Practice: The Cognitive Behavioral Therapy Monopoly Gives Way

May 13, 2012 By scottdm 34 Comments

Sunday, May 13th, 2012
Arlanda Airport, Sweden

Over the last decade, Sweden, like most Western countries, embraced the call for “evidence-based practice.”  Socialstyrelsen, the country’s National Board of Health and Welfare, developed and disseminated a set of guidelines (“riktlinger”) for mental health practice.  Topping the list of methods was, not surprisingly, cognitive-behavioral therapy. 

The Swedish State took the list seriously, restricting payment for training of clinicians and treatment of clients to cognitive behavioral methods.  In the last three years, a billion Swedish crowns were spent on training clinicians in CBT.  Another billion was spent on providing CBT to people with diagnoses of depression and anxiety.  No funding was provided for training or treatment in other methods. 

The State’s motives were pure: use the best methods to decrease the number of people who become disabled as result of depression and anxiety.  Like other countries, the percentage of people in Sweden who exit the work force and draw disability pensions has increased dramatically.  As a result, costs skyrocketed.  Even more troubling, far too many became permanently disabled. 

The solution?  Identify methods which have scientific support, or what some called, “evidence-based practice.” The result?  Despite substantial evidence that all methods work equally well, CBT became the treatment of choice throughout the country.  In point of fact, CBT became the only choice.

As noted above, Sweden is not alone in embracing practice guidelines.  The U.K. and U.S. have charted similar paths, as have many professional organizations.  Indeed, the American Psychological Association has now resurrected its plan to develop and disseminate a series of guidelines advocating specific treatments for specific disorders.  Earlier efforts by Division 12 (“Clinical Psychology”) met with resistance from the general membership as well as scientists who pointed to the lack of evidence for differential effectiveness among treatment approaches. 

Perhaps APA and other countries can learn from Sweden’s experience.  The latest issue of Socionomen, the official journal for Swedish social workers, reported the results of the government’s two billion Swedish crown investment in CBT.  The widespread adoption of the method has had no effect whatsoever on the outcome of people disabled by depression and anxiety.  Moreover, a significant number of people who were not disabled at the time they were treated with CBT became disabled, costing the government an additional one billion Swedish crowns.  Finally, nearly a quarter of those who started treatment, dropped out, costing an additional 340 million!

In sum, billions training therapists in and treating clients with CBT to little or no effect.  

Since the publication of Escape from Babel in 1995, my colleagues and I at the International Center for Clinical Excellence have gathered, summarized, published, and taught about research documenting little or no difference in outcome between treatment approaches.  All approaches worked about equally well, we argued, suggesting that efforts to identify specific approaches for specific psychiatric diagnoses were a waste of precious time and resources.  We made the same argument, citing volumes of research in two editions of The Heart and Soul of Change.

Yesterday, I presented at Psykoterapi Mässan, the country’s largest free-standing mental health conference.  As I have on previous visits, I talked about “what works” in behavioral health, highlighting data documenting that the focus of care should shift away from treatment model and technique, focusing instead on tailoring services to the individual client via ongoing measurement and feedback.  My colleague and co-author, Bruce Wampold had been in the country a month or so before singing the same tune.

One thing about Sweden:  the country takes data seriously.  As I sat down this morning to eat breakfast at the home of my long-time Swedish friend, Gunnar Lindfeldt, the newscaster announced on the radio that Socialstyrelsen had officially decided to end the CBT monopoly (listen here).  The experiment had failed.  To be helped, people must have a choice. 

“What have we learned?” Rolf Holmqvist asks in Socionomen, “Treatment works…at the same time, we have the possibility of exploring…new perspectives.  First, getting feedback during treatment…taking direction from the patient at every session while also tracking progress and the development of the therapeutic relationship!”

“Precis,” (exactly) my friend Gunnar said. 

And, as readers of my blog know, using the best evidence, informed by clients’ preferences and ongoing monitoring of progress and alliance is evidence-based practice.  However the concept ever got translated into creating lists of preferred treatment is anyone’s guess and, now, unimportant.  Time to move forward.  The challenge ahead is helping practitioners learn to integrate client feedback into care—and here, Sweden is leading the way.

“Skål Sverige!”

Filed Under: Behavioral Health, evidence-based practice, Feedback Informed Treatment - FIT, Practice Based Evidence Tagged With: CBG, continuing education, evidence based practice, icce, Socialstyrelsen, sweden

A Handy "Little Helper" for the Outcome Rating Scale: A Freebie from the ACE Conference Committee

April 24, 2012 By scottdm Leave a Comment

This last week the planning committee for the upcoming Achieving Clinical Excellence (ACE) conference meet once again in Horsholm, Denmark.  In the picture from left to right: Liz Plutt, Bill Andrews, myself, Rick Plutt (Conference Chair), and Bogdan Ion.  Taking the photo was Susanne Bargmann.

The agenda for the three day event is now set: (1) one day pre-conference on feedback informed treatment (FIT); (2) two days of plenaries and presentations by an international group of clinicians, researchers, and educators.

On day one, the conference kicks off with a keynote address by the world’s “expert on expertise,” Dr. K. Anders Ericsson.  Throughout the day, other speakers will translate Dr. Ericsson’s research into practical steps for enhancing the performance of mental health professionals, agencies, and systems of care.

Day two kicks off with a keynote address by Dr. Robbie Wagner addressing the question, “what barriers stand in the way of improving our effectiveness?”  Once again, the rest of the day will be spent identifying solutions for the problems standing in the way of expertise and expert performance.

We still have several openings for presentations at the conference.  If you have experiences or data related to: (1) measuring outcomes; (2) implementing feedback informed treatment; (3) the qualities of super effective clinicians or treatment approaches, then PLEASE click go to the ICCE website and submit a description for consideration.

It’ll be a fun, inspiring, and rewarding three days in Amsterdam.  Don’t miss it!  Register today and get the early bird special, saving you 100’s of dollars!

In the meantime, click on the link below to download a handy little tool for scoring the Outcome and Session Rating Scales.  It’s a combination bookmark and 10 centimeter ruler.

Ace Ruler (PDF Format)

Filed Under: Conferences and Training, excellence Tagged With: cdoi, denmark, feedback informed treatment, icce, ors, outcome rating scale, session rating scale, srs, Therapist Effects

The Outcome and Session Rating Scales: Support Tools

March 30, 2012 By scottdm 6 Comments

Japan, Sweden, Norway, Denmark, Germany, France, Israel, Poland, Chile, Guam, Finland, Hungary, Mexico, Australia, China, the United States…and many, many more.  What do all these countries have in common?  In each, clinicians and agencies are using the ORS and SRS scales to inform and improve behavioral health services.  Some are using web-based systems for administration, scoring, interpretation and data aggregation (e.g., myoutcomes.com and fit-outcomes), many are accessing paper and pencil versions of the measures for free and then administering and scoring by hand.

Even if one is not using a web-based system to compare individual client progress to cutting edge norms, practitioners can still determine simply and easily whether reliable change is being made by using the “Reliable Change Chart” below.  Recall, a change on the ORS is considered reliable when the difference in scores exceeds the contribution attributable to chance, maturation, and measurement error. Feel free to print out the graph and use it in your practice.

To learn how to get the most out of the measures, be sure and download the six FIT Treatment and Training Manuals.  The six manuals cover every aspect of feedback-informed practice including: empirical foundations, basic and advanced applications (including FIT in groups, couples, and with special populations), supervision, data analysis, and agency implementation. Each manual is written in clear, step-by-step, non-technical language, and is specifically designed to help practitioners and agencies integrate FIT into routine clinical practice. Indeed, the manuals were submitted as part of ICCE’s application for consideration of FIT as an “evidence-based practice” to the National Registry of Evidence-Based Programs and Practices

ORS Reliable Change Chart

Filed Under: Behavioral Health, excellence, Feedback Informed Treatment - FIT Tagged With: cdoi, Hypertension, icce, NREPP, ors, outcome rating scale, SAMHSA, session rating scale, srs

Is the "Summer of Love" Over? Positive Publication Bias Plagues Pharmaceutical Research

March 27, 2012 By scottdm Leave a Comment


Evidence-based practice is only as good as the available “evidence”–and on this subject, research points to a continuing problem with both the methodology and type of studies that make it into the professional literature.  Last week, PloS Medicine, a peer-reviewed, open access journal of the Public Library of Science, published a study showing a positive publication bias in research on so-called atypical antipsychotic drugs.  In comparing articles appearing in journals to the FDA database, researchers found that almost all postive studies were published while clinical trials with negative or questionable results were not or–and get this–were published as having positive results!

Not long ago, similar yet stronger results appeared in the same journal on anti-depressants.  Again, in a comparison with the FDA registry, researchers found all postive studies were published while clinical trials with negative or questionable results were not or–and get this–were published as having positive results!  The problem is far from insignificant.  Indeed, a staggering 46% of studies with negative results were not published or published but reported as positive.

Maybe the “summer of love” is finally over for the field and broader American public.  Today’s Chicago Tribune has a story by Kate Kelland and Ben Hirschler reporting data about sagging sales of anti-depressants and multiple failures to bring new, “more effective” drug therapies to market.  Taken together, robust placebo effects, the FDA mandate to list all trials (positive and negative), and an emphasis in research on conducting fair comparisons (e.g., comparing any new “products” to existing ones) make claims about “new and improved” effectiveness challenging.

Still one sees ads on TV making claims about the biological basis of depression–the so called, “biochemical imbalance.”  Perhaps this explains why a recent study of Medicaid clients found that costs of treating depression rose by 30% over the last decade while the outcomes did not improve at all during the same period.  The cause for the rise in costs?    Increased use of psychiatric drugs–in particular, anti-psychotics in cases of depression.

“It’s a great time for brain science, but at the same time a poor time for drug discovery for brain disorders,” says David Nutt, professor of neuropsychopharmacology, cited in the Chicago Tribune, “That’s an amazing paradox which we need to do something about.”

Here’s an idea: how about not assuming that problems in living are reduceable to brain chemistry?   That the direction of causality for much of what ails people is not brain to behavior but perhaps behavior to brain?  On this note, it is sad to note that while the percentage of clients prescribed drugs rose from 81 to 87%–with no improvement in effect–the number of those receiving psychotherapy dropped from 57 to 38%.

Here’s what we know about psychotherapy: it works and it has a far less troublesome side effect profile than psychotropic drugs.  No warnings needed for dry mouth, dizziness, blood and liver problems, or sexual dysfunction.  The time has come to get over the collective 1960’s delusion of better living through chemistry.

Filed Under: Practice Based Evidence Tagged With: behavioral health, continuing education, depression, evidence based practice, icce, Medicaid, mental health, psychotherapy

A Progress Report on the Science (and Art ) of Psychotherapy: The Psychotherapy Networker 30th Anniversary Edition

March 18, 2012 By scottdm Leave a Comment

The 30th Anniversary Edition of the Psychotherapy Networker has hit newsstands.  In it, is an article by Diane Cole taking the measure of psychotherapy.  Her question? Has the field gotten any better over the last three decades?  The entire issue is a “must read,” starting with editor Rich Simon’s lengthy and thought provoking editorial, “Still Crazy After All These Years.”

Even if you are not a subscriber, much of the current edition is available FOR FREE online at the Networker website.  It is an honor that the work that I have been doing on excellence and expert performance, together with many Senior Associates at ICCE (Susanne Bargman, Cynthia Maeschalck, Julie Tilsen, Rob Axsen, Jason Seidel, and Bob Bertolino) is featured prominently in this special issue magazine.

Don’t miss it!  And don’t miss the Networker conference scheduled this week in Washington, D.C.   I’ll be there on Friday delivering the luncheon keynote address and a workshop on pushing your clinical performance to the next level of effectiveness!

Filed Under: Top Performance Tagged With: cdoi, continuing education, icce, psychotherapy networker

Goodbye Mr. & Ms. Know-it-All: Redefining Competence in the Era of Increasing Complexity

February 12, 2012 By scottdm 3 Comments

Every day behavioral health professionals make hundreds of decisions.  As experts in the field, they meet and work successfully with diverse clients presenting an array of different difficulties.  Available evidence indicates that the average person who receives care is better off than 80% of those with similar problems that do not.  Outcomes in mental health are on par or better than most medical treatments and, crucially, have far few side effects!  Psychotherapy, for example, is equal in effect to coronary artery bypass surgery and three times more effective than flouride for cavities.

Not all the news is good, however.  Drop out rates run around 25% or higher.  Said another way, clinicians do great work with the people who stay.  Unfortunately, many do not, resulting in increased costs and lost opportunities.  Another problem is that therapists, the data indicate, are not particularly adept at identifying clients at risk for dropping out or deterioration.  For decades, research has has shown that approximately 10% of people worsen while in treatment.  Practitioners, despite what they may believe, are none the wiser.  Finally, it turns out that a small percentage (between 10-20%) of people in care account for lion’s share of expenses in behavioral health service delivery (In case you are wondering, roughly the same figures apply in the field of medicine).  Such people continue in care for long periods, often receiving an escalating and complicated array of services, without relief.  At the same time, clinician caseloads and agency waiting lists grow.

What can be done?

At one time, being a professional meant that one possessed the knowledge, training, and skills to deliver the right services to the right people for the right problem in a consistent, correct, and safe manner.  To that end, training requirements–including schooling, certification, and continuing professional development–expanded, exponentially so.  Today’s behavioral health professionals spend more time training and are more highly specialized than ever before.  And yet, the above noted problems persist.

Some call for more training, others for increasing standardization of treatment approaches, many for more rigorous licensing and accreditation standards.  The emphasis on “empirically supported treatments”–specific methods for specific diagnoses–typify this approach.  However, relying as these solutions do on an antiquated view of professional knowledge and behavior, each is doomed to fail.

In an earlier era, professionals were “masters of their domain.”  Trained and skillful, the clinician diagnosed, developed a plan for treatment, then executed, evaluated, and tailored services to maximize the benefit to the individual client.  Such a view assumes that problems are either simple or complicated, puzzles that are solvable if the process is broken down into a series of steps.  Unfortunately, the shortcomings in behavioral health outcomes noted above (drop out rates, failure to identify deterioration and lack of progress) appear to be problems that are not so much simple or complicated but complex in nature.  In such instances, outcomes are remain uncertain throughout the process.  Getting things right is less about following the formula than continually making adjustments, as “what works” with one person or situation may not easily transfer to another time or place.  Managing such complexity requires a change of heart and direction, a new professional identity.  One in which the playing field between providers and clients is leveled, where power is moved to the center of the dyad and shared, where ongoing client feedback takes precedence over theory and protocol.

In his delightful and engaging book, The Checklist Manifesto, physician and surgeon Atul Gawande provides numerous examples in medicine, air travel, computer programming, and construction where simple feedback tools have resulted in dramatic improvements in efficiency, effectiveness, and safety.  The dramatic decrease in airplane related disasters over the last three decades is one example among many–all due to the introduction of simple feedback tools.  Research in the field of behavioral health documents similar improvements.  Multiple studies document that routinely soliciting feedback regarding progress and the alliance results in significantly improved effectiveness, lower drop out rates, and less client deterioration–and all this while decreasing the cost of service delivery.  The research and tools are described in detail in a new series of treatment manuals produced by the members and associates of the International Center for Clinical Excellence–six simple, straightforward, how-to guidebooks covering everything from the empirical foundations, administration and interpretation of feedback tools, to implementation in diverse practice settings.  Importantly, the ICCE Manuals on Feedback Informed Treatment (FIT) are not a recipe or cookbook.  They will teach not to you how to do treatment.  You will learn, however, skills for managing the increasingly complex nature of modern behavioral health practice.

In the meantime, here’s a fantastic video of Dr. Gawande on the subject.  Use the cursor to skip ahead to the 2:18 mark:

Filed Under: Behavioral Health, Feedback Informed Treatment - FIT, Practice Based Evidence Tagged With: Atul Gawande, behavioral health, feedback informed treatment, icce, The Checklist Manifesto

The New Average: Meeting the Need to Exceed

February 10, 2012 By scottdm Leave a Comment

No matter where you look,good is no longer “good enough.”  In a recent article in the New York Times, author and trend watcher, Thomas L. Friedman, declared, “Average is Over.”  It’s an argument similar to the one made over a decade ago by Robert Reich, former Secretary of Labor under Bill Clinton, in his phenomenally prescient book The Future of Success.  I read it at the time with a mixture of apprehension and anticipation.  Globalization and advances in information technology were then and are now challenging the status quo.  At one time, being average enabled one to live an average life, live in an average neighborhood and, most importantly, earn an average living.  Not so anymore.

Average is now plentiful, easily accessible, and cheap.  What technology can’t do in either an average or better way, a younger, less-trained but equally effective provider can do for less. A variety of computer programs and web-based systems provide both psychological advice and treatment.  (By the way, studies to date document outcomes equal to face-to-face services for at least the most common mental health related issues).  At the same time, as reviewed here previously on this blog, the evidence again and again shows no difference in outcome between professionally trained clinicians and students or paraprofessionals.  Uh-oh.

What is the solution?  Friedman says, “everyone needs to find their extra–their unique value contribution that makes them stand out in whatever is their field.”  Yeah, exactly.  As my father used to say, “Do your best and then a little better.  What can behavioral health professionals do to stand out?  Well, if you are trained, licensed or certified, practicing evidence-based, know the latest methods and research findings, and understand how the brain works, then you are, in a word, average.  Going forward, standing out will require evidence that you are effective; measures documenting not only who you help but identifying those you do not.  Professional development will be less about learning a new method than documenting what you do to “do your best and then a little better.”

Helping clincians stand out is what the ICCE is all about.  Everyday, thousands meet online to learn, share, and support each other in both measuring and improving the impact of their clinical work.  Each year, the ICCE offers two intensive training opportunities: The Advanced Intensive and the Training of Trainers.  Both events are designed to help professionals achieve their personal best.  The Training of Trainers is specifically designed for participants, such as supervisors, managers, and agency directors, who wish to train others or transform public or private agencies for achieving success.   The Advanced Intensive scheduled for March is sold out.  By popular demand, we are offering an unprecedented second opportunity to attend the Advanced Intensive this summer.  Don’t wait to register.  Despite only announcing this event last week, half of the seats are already booked.  Either event will insure that you have the tools and skills necessary to meet the need to exceed.  Email us with any questions at: training@centerforclinicalexcellence.com.

(By the way, if you are interested, you catch watch a clip of Friedman delivering his message to the Hudson Society here).

Filed Under: Behavioral Health, Conferences and Training, excellence, Top Performance Tagged With: icce, Thomas Friedman, training of trainers

Feedback-Informed Treatment as Evidence-based Practice: APA, SAMSHA, and NREPP

November 1, 2011 By scottdm 1 Comment

What is evidence-based practice?  Visit the UK-based NICE website, or talk to proponents of particular theoretical schools or therapeutic models, and they will tell you that being “evidence-based” means using the approach research has deemed effective for a particular diagnosis  (e.g., CBT for depression, EMDR for trauma).  Over the last two decades, numerous organizations and interest groups have promoted lists of “approved” treatment approaches–guidelines that clinicians and funding bodies should follow when making practice decisions.  Throughout the 1990’s, for example, division 12 within the American Psychological Association (APA) promoted the idea of “empirically supported treatments.”

However, when one considers the official definition of evidence-based practice offered by the Institute of Medicine and the APA, it is hard to fathom how anyone could come to such a conclusion.  According to the APA, evidence-based practice is, “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” (see American Psychologist, May 2006).  Nothing here about “empirically supported treatments” or the mindless application of specific treatment protocols.  Rather, according to the APA and IOM, clinicians must FIT the treatment to the client, their preferences, culture, and circumstances.  And how can one do that?  Well, conspicuously absent from the definition is, “consult a set of treatment guidelines.”  Rather, when evidence-based, clinicians must monitor “patient progress (and of changes in the patient’s circumstances—e.g.,job loss, major illness) that may suggest the need to adjust the treatment. If progress is not proceeding adequately, the psychologist alters or addresses problematic aspects of the treatment (e.g., problems in the therapeutic relationship or in the implementation of the goals of the treatment) as appropriate.”

The principles and practices of feedback-informed treatment (FIT) are not only consistent with but operationalize the American Psychological Association’s (APA) definition of evidence-based practice.  To wit, routinely and formally soliciting feedback from consumers regarding the therapeutic alliance and outcome of care and using the resulting information to inform  and tailor service delivery.  And indeed, over the last 9 months, together with Senior Associates, I completed and submitted an application for FIT to be reviewed by NREPP–SAMSHA’s National Registry of Evidence-based Practices and Approaches!  As part of that application and ICCE’s commitment to improving the quality and outcome of behavioral health, we developed a list of “core competencies” for FIT practice, a series of six detailed treatment and implementation manuals, a gap assessment tool that organizations can use to quickly and expertly assess implementation and fidelity problems, and supportive documentation and paperwork.  Finally, we developed and rigorously tested training curricula and administered the first standardized exam for certifying FIT practitioners and trainers.  We are in the final stages of that review process soon and I’m sure I’ll be making a major announcement right here on this blog shortly.  So, stay tuned.

In the meantime, this last Saturday, clinicians located the globe–Canada, New Zealand, Australia, the US,a nd Romania–sat for the first administration of ICCE “Core Competency” Exam.  Taking the test is the last step in becoming an ICCE “Certified Trainer.”   The other requirements include: (1) attending the “Advanced Intensive” and “Training of Trainers” workshops; and (2) submitting a training video on FIT for review.  The exam was administered online using the latest technology.


The members, directors, and senior associates of ICCE want to congratulate (from top left):

  • Eeuwe Schuckard, Psychologist, Wellington, New Zealand;
  • Aaron Frost, Psychologist, Brisbane, Australia;
  • Cindy Hansen, BA-Psych, HHP, Manager Myoutcomes;
  • David Prescott, Director of Professional Development, Becket Family of Services, Portland, Maine;
  • Arnold Woodruff, LMFT, Clinical Director, Home for Good, Richmond, Virginia;
  • Bogdan, Ion, Ph.D., Bucharest University, Bucharest, Romania;
  • Daniel Buccino, Clinical Supervisor, Community Psychiatry Program. Johns Hopkins;
  • Dwayne Cameron, Outreach Counselor, Prince Albert, Saskatoon, Canada;
  • Mark Goheen, the Clinical Practice Lead at Fraser Health, British Columbia.

If you are not yet a member of the ICCE community, please join the largest, fastest growing, and friendly group of behavioral health professionals today at: www.centerforclinicalexcellence.com.

Filed Under: Conferences and Training, Feedback Informed Treatment - FIT, ICCE Tagged With: APA, cdoi, continuing education, evidence based practice, HHS, icce, NREPP, SAMHSA

Are Mental Health Practioners Afraid of Research and Statistics?

September 30, 2011 By scottdm Leave a Comment

A few weeks back I received an email from Dr. Kevin Carroll, a marriage and family therapist in Iowa.  Attached were the findings from his doctoral dissertation.  The subject was near and dear to my heart: the measurement of outcome in routine clinical practice.  The findings were inspiring.  Although few graduate level programs include training on using outcome measures to inform clinical practice, Dr. Carroll found that 64% of those surveyed reporting utilizing such scales with about 70% of their clients!  It was particularly rewarding for me to learn that the most common measures employed were the…Outcome and Session Rating Scales (ORS & SRS)

As readers of this blog know, there are multiple randomized clinical trials documenting the impact that routine use of the ORS and SRS has on retention, quality, and outcome of behavioral health services.  Such scales also provide direct evidence of effectiveness.  Last week, I posted a tongue-in-cheek response to Alan Kazdin’s broadside against individual psychotherapy practitioners.  He was bemoaning the fact that he could not find clinicians who utilized “empirically supported treatments.”  Such treatments when utilized, it is assumed, lead to better outcomes.  However, as all beginning psychology students know, there is a difference between “efficacy” and “effectiveness” studies.  The former tell us whether a treatment has an effect, the latter looks at how much benefit actual people gain from “real life” therapy.  If you were a client which kind of study would you prefer?  Unfortunately, most of the guidelines regarding treatment models are based on efficacy rather than effectiveness research.  The sine qua non of effectiveness research is measuring the quality and outcome of psychotherapy locally.  After all, what client, having sought out but ultimately gained nothing from psychotherapy, would say, “Well, at least the treatment I got was empircally supported.”  Ludicrous.

Dr. Carroll’s research clearly indicates that clinicians are not afraid of measurement, research, and even statistics.  In fact, this last week, I was in Denmark teaching a specialty course in research design and statistics for practitioners.  That’s right.  Not a course on research in psychotherapy or treatment.  Rather, measurement, research design, and statistics.  Pure and simple.  Their response convinces me even more that the much talked about “clinician-researcher” gap is not due to a lack of interest on practitioners’ parts but rather, and most often, a result of different agendas.  Clinicians want to know “what will work” for this client.  Research rarely address this question and the aims and goals of some in the field remain hopelessly far removed from day to day clinical practice.  Anyway, watch the video yourself:

Filed Under: Feedback, Feedback Informed Treatment - FIT Tagged With: continuing education, holland, icce, ors, Outcome, psychotherapy, Session Rating Scales, srs

Psychologist Alan Kazdin Needs Help: Please Give

September 25, 2011 By scottdm Leave a Comment

Look at this picture.  This man needs help.  He is psychologist, Alan Kazdin, former president of the American Psychological Association, and current Professor of Psychology at Yale University.  A little over a week ago, to the surprise and shock of many in the field, he disclosed a problem in his professional life.  In an interview that appeared online at TimeHealthland Dr. Kazdin reported being unable to find a therapist or treatment program to which he could refer clients–even in Manhattan, New York, the nation’s largest city!

After traveling the length and breadth of the United States for the last decade, and meeting and working with hundreds of agencies and tens of thousands of therapists, I know there are many clinicians that can help Dr. Kazdin with his problem.  Our group has been tracking the outcome of numerous practitioners over the last decade and found average outcomes to be on par with those obtained in tightly controlled randomized clinical trails!  That’s good news for Dr. Kazdin.

Now, just to be sure, it should be pointed out that Dr. Kazdin is asking for practitioners who adhere to the Cochrane Review’s and the American Psychological Association’s definition of evidence-based practice (EBP)–or, I should say, I believe that is what he is asking for as the interview is not entirely clear on this point and appears to imply that EBP is about using specific treatment methods (the most popular, of course, being CBT).  The actual definition contains three main points, and clearly states that EBP is the integration of:

  1. The best available research;
  2. Clinical expertise; and
  3. The client’s culture, values, and preferences.

Interestingly, the official APA policy on evidence-based practice further defines clinical expertise as the “monitoring of patient progress (and of changes in the patient’s circumstances)…that may suggest the need to adjust the treatment.  If progress is not proceeding adequately, the psychologist alters or addresses problematic aspects of the treatment (e.g., problems in the therapeutic relationship or in the implementation of the goals of the treatment) as appropriate.”

I say “interestingly” for two reasons.  First, the definition of EBP clearly indicates that clinicians must tailor psychotherapy to the individual client.  And yet, the interview with Dr. Kazdin specifically quotes him as saying, “That’s a red herring. The research shows that no one knows how to do that. [And they don’t know how to monitor your progress].”   Now, admittedly, the research is new and, as Dr. Kazdin says, “Most people practicing who are 50 years or older”–like himself–may not know about it, but there are over a dozen randomized clinical trials documenting how routinely monitoring progress and the relationship and adjusting accordingly improves outcome.  The interview also reports him saying that “there is no real evidence” that the relationship (aka alliance) between the therapist and client matters when, in fact, the APA Interdivisional Task Force on Evidence-Based Therapy Relationships concluded that there is abundant evidence that “the therapy relationship accounts for substantial and consistent contributions to…outcome….at least as much as the particular method.”  (Incidently, the complete APA policy statement on EBP can be found in the May-June 2006 issue of the American Psychologist).

Who knows how these two major bloopers managed to slip through the editing process?  I sure know I’d be embarrased and immediately issue a clarification if I’d been misquoted making statements so clearly at odds with the facts.  Perhaps Dr. Kazdin is still busy looking for someone to whom he can refer clients.  If you are a professional who uses your clinical expertise to tailor the application of scientifically sound psychotherapy practices to client preferences, values, and culture, then you can help.

Filed Under: evidence-based practice, Top Performance Tagged With: Alan Kazdin, American Psychological Association, brief therapy, Carl Rogers, CBT, continuing education, evidence based practice, icce, medicine, therapy

  • 1
  • 2
  • 3
  • Next Page »

SEARCH

Subscribe for updates from my blog.

loader

Email Address*

Name

Upcoming Training

Oct
01

Training of Trainers 2025


Nov
20

FIT Implementation Intensive 2025

FIT Software tools

FIT Software tools

LinkedIn

Topics of Interest:

  • Behavioral Health (112)
  • behavioral health (5)
  • Brain-based Research (2)
  • CDOI (14)
  • Conferences and Training (67)
  • deliberate practice (31)
  • Dodo Verdict (9)
  • Drug and Alcohol (3)
  • evidence-based practice (67)
  • excellence (63)
  • Feedback (40)
  • Feedback Informed Treatment – FIT (246)
  • FIT (29)
  • FIT Software Tools (12)
  • ICCE (26)
  • Implementation (7)
  • medication adherence (3)
  • obesity (1)
  • PCOMS (11)
  • Practice Based Evidence (39)
  • PTSD (4)
  • Suicide (1)
  • supervision (1)
  • Termination (1)
  • Therapeutic Relationship (9)
  • Top Performance (40)

Recent Posts

  • Agape
  • Snippets
  • Results from the first bona fide study of deliberate practice
  • Fasten your seatbelt
  • A not so helpful, helping hand

Recent Comments

  • Dr Martin Russell on Agape
  • hima on Simple, not Easy: Using the ORS and SRS Effectively
  • hima on The Cryptonite of Behavioral Health: Making Mistakes
  • himalaya on Alas, it seems everyone comes from Lake Wobegon
  • himalayan on Do certain people respond better to specific forms of psychotherapy?

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