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.

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

May 6, 2014 By scottdm Leave a Comment

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.

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

April 30, 2014 By scottdm Leave a Comment

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.

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!