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The Impact of Mentors

July 20, 2010 By scottdm Leave a Comment

Brendan Madden   Scott D. Miller   Jeffrey K. Zeig

A little over month ago, I blogged about how the outcome and session rating scales were originally conceived of and developed.  A few days prior to that, I wrote about where the whole idea of using measures to solicit feedback had started.  In both instances, my teachers and supervisors played a significant role. Immediately following a two day workshop I’d given in Israel, psychologist Haim Omer suggested developing a visual analog scale that could be used in lieu of the longer Outcome Questionnaire 45.2–an idea that literally changed the entire arc of my professional career.  Drs. Lynn Johnson and Michael Lambert–a supervisor and professor I met and worked with as a graduate student–were the first to pioneer feedback-informed treatment (FIT).  Some twenty plus years into my career, I remain in contact with both, calling, seeking input, discussing ideas, and soliciting feedback.

“Professional coaches,” says the noted “expert on experts” K. Anders Erickson, “…play an essential role in guiding…future experts in a safe and effective manner” (p. 698).   Needless to say, I’ve been very fortunate to have such visionary mentors.  One more story.

In 1984, I wrote a letter to Dr. Jeffrey K. Zeig, the director of the Milton H. Erickson Institute.  I was in my second year of a Ph.D. program in psychology and, like many graduate students, dead broke.  While taking a course on hypnosis as part of my studies, I’d become interested in the work of Milton Erickson.

“I’d like to learn more,” I wrote at the time, “Would it be possible for me to visit the Institute, watch some videos and have a chance to talk with you?”  I wasn’t too far away.  I could drive to Phoenix where the Institute was located.  I could even arrange to stay with friends to save money.  “Dr. Zeig,” I continued, “I’m a graduate student and don’t have much money, but I’d be willing to do some work in kind.”  I’d pasted mailing labels on thousands of brochures for the local hypnosis and therapy organizations, for example, in exchange for being able to attend professional continuing education events.  “I’ll vacuum and clean the office, wash vehicles, do filing.  Whatever might be helpful to you or the Institute.”

Within a couple of weeks, an envelop from the Milton H. Erickson Institute arrived.  In it was a letter that was brief and to the point.  “Please call me,” it said, and was signed Jeffrey K. Zeig, Ph.D.  Needless to say, I called straight away.  We chatted for a few minutes.  He told me that I was welcome to visit the Institute, watch videos, talk with some of the staff and even spend some time with him.  And then he asked, “Do you think you could afford five dollars?”  I was floored.

Ever since meeting him on that hot summer day in Phoenix, he’s been an important teacher and mentor.  It’s particularly noteworthy that whenever we talk–by phone, email, or in chance meetings on airplanes while criss-crossing the globe–he invariably asks, “What are you learning?”  And then he listens, intently.

Last week, we were catching up on the phone and Jeff told me that his long-held desire to open an international psychotherapy training and research facility had finally been fulfilled.  Briefly, The Institute for Applied Therapeutic Change is a real clinic where professionals and students can learn the latest in behavioral healthcare from leading experts in the field and while working with real clients (click on the text above for the complete press release).

“I can hardly wait to attend some of the events,” I said.  “And when are you available to teach?” he responded.   Stunned again.  I’m so fortunate and can hardly wait to participate in the Institute activities as both a presenter and student.  Stay tuned to the Foundation website for more details!

Filed Under: excellence, Feedback, Feedback Informed Treatment - FIT Tagged With: Carl Rogers, cdoi, Erickson Institute, Jeff Zeig, K. Anders Erickson, Lynn Johnson, Michael Lambert, psychology, psychometrics, The Institute for Applied Therapeutic Change

So you want to be a better therapist? Take a hike!

July 16, 2010 By scottdm Leave a Comment

How best to improve your performance as a clinician?  Take the continuing education multiple-choice quiz:

a. Attend a two-day training;
b. Have an hour of supervision from a recognized expert in a particular treatment approach;
c. Read a professional book, article, or research study;
d. Take a walk or nap.

If you chose a, b, or c, welcome to the world of average performance!  As reviewed on my blog (March 2010), there is exactly zero evidence that attending a continuing education event improves performance.  Zero.  And supervision?  In the most recent review of the research, researchers Beutler et al. (2005) concluded, “Supervision of psychotherapy cases has been the major method of ensuring that therapists develop proficiency and skill…unfortunately, studies are sparse…and apparently, supervisors tend to rate highly the performance of those who agree with them” (p. 246).  As far as professional books, articles, and studies are concerned–including those for which a continuing education or “professional development” point may be earned–the picture is equally grim.  No evidence.  That leaves taking a walk or nap!

K. Anders Ericsson–the leading researcher in the area of expertise and expert performance–points out the type and intensity of practice required to improve performance, “requires concentration that can be maintained only for limited periods of time.”  As a result, he says, “expert performers from many domains engage in practice without rest for only around an hour…The limit…holds true for a wide range of elite performers in difference domains…as does their increased tendency to recperative take naps”  (p.699, Erickson, 2006).  By the way, Ericsson will deliver a keynote address at the upcoming “Achieving Clinical Excellence” conference.  Sign up now for this event to reserve your space!


Two recently released studies add to the evidence base on rest and expertise.  The first, conducted at the University of California, Berkeley by psychologist Matthew Walker found that a midday nap markedly improved the brain’s learning capacity.  The second, published last week in the European Journal of Developmental Psychology, found that simply taking a walk–one where you are free to choose the speed–similarly improved performance on complex cognitive tasks.

So, there you go.  I’d say more but I’m feeling sleepy.

Filed Under: Behavioral Health, deliberate practice, evidence-based practice, excellence Tagged With: cdoi, European Journal of Developmental Psychology, evidence based practice, K. Anders Erickson, professional development, psychotherapy, supervision

The Road to Clinical Excellence is Paved with Practice, Mistakes, & Hard Work

May 19, 2010 By scottdm Leave a Comment

Last week, I received an email from David Claud.  I’ve known Dave for the better part of a decade, having met–I believe–at a Ericksonian Conference in Florida where he lives and works.  He and the crew at the Center for Family Service in Palm Beach County figure prominently in the history of routine outcome measure and feedback.  After hearing me speak, Dave took the measures back to the center and, together with the staff, became one of the first agencies in the country to formally adopt and use the ORS and SRS.  Additionally, data gathered at CFS was used in some of the initial validation studies of the measures.  Finally, their own research, cited in the second edition of The Heart and Soul of Change document dramatic improvements in outcome as well as decreased lengths of stay, cancellation and no show rates (40, 40, and 25% respectively).

Anyway, in his email, Dave included a link to a recent article by Ann Hulbert in Slate magazine.  I’m lucky to have friends like Dave and others who keep me informed and up-to-date.  The title of the piece certainly got my attention: “The Dark Side of the New Theories of Success: What the New Success Books Don’t tell you about Superachievement.”

As readers of my blog know, I’ve been pouring through the literature on excellence over this last year in an attempt to understand why some clinicians achieve reliably better outcomes than others.  I first wrote about our findings in an article titled, “Supershrinks: Learning from the Field’s Most Effective Practitioners” that appeared in the Psychotherapy Networker.  Since then, I’ve continued to work and research, together with senior associates at the International Center for Clinical Excellence, to deepen and refine the “steps to clinical excellence” that any therapist could follow to improve performance.

Alas, I’m not alone in my interest in the literature on expertise.  A number of books, starting with Gladwell’s delightfully engaging Outliers, have appeared in the last year or so on the subject, including: The Talent Code, Bounce: The Science of Success, The Genius in All of Us: Why Everything You’ve Been Told About Genetics, Talent, and IQ Is Wrong and my personal favorite Talent Is Overrated: What Really Separates World-Class Performers from Everybody Else.  The appearance of so many books is interesting.  With few exceptions (i.e., sports psychology), K. Anders Erickson and colleagues labored in viritual academic obscurity for decades formulating hypotheses, conducting research and assembling evidence.  And then suddenly: boom!  EVERYBODY is talking about their work.

Always wanting to “hear” both sides of the story, I immediately clicked on the link in Dave’s email and read the article.  I was dumbfounded.  Hulbert’s gripe about the recent spate of books is in fact the central point of each: achieving superior performance in any field is bloody hard work.  “They don’t always do realistic justice to the grunt work they champion,” whines Hulbert, tending instead to, “gloss over the sweaty specifics….distracting us from how arduous, tedious, and dependent on adult pushiness it can be…[and] glamorizing its intensity.”

My response: “Oh, contraire mon fraire!”

All of the books and research studies point to the years of dedicated and painstaking work involved in achieving world class levels of performance across a variety of domains (sports, music, medicine, computer programming, and psychology).  K. Ander’s Erickson–who will, by the way, be one of the keynote presenters at the upcoming “Achieving Clinical Excellence” conference–is fond of saying, “Unlike play, deliberate practice is not inherently motivating; and unlike work, it does not lead to immediate social and monetary rewards…and actually generates costs…”.  Little wonder few of us–myself included–engage in it on any regular basis.

The question that begs an answer is, “why would anyone do it?”  Consider the brief video clip below:

Impressive, huh?  I can’t imagine the amount of time it must have taken to master such a performance.  No camera tricks. Just plain old fashioned trial-and-error, practice, and hard work.

We are finding the same pattern among top performing therapists.  In short, they have an “error-centric” approach to practice–constantly looking for what they do that doesn’t work and taking time to plan, identify and try alternatives, and then reflect and refine their process-improvement efforts.  Such activity is cognitively taxing and, in most instances, not immediately rewarding (financially or otherwise).  But there is more to the story.  It turns out that superior performance is not a matter of working harder.  Most of us work hard at our jobs.  Rather, becoming a better clinician is about working smarter.   Here, the literature on expertise provides clear, empirically-supported guidelines.

If you’re feeling inspired, why not pick up one of the books?  Also, be sure and join us at the upcoming “Achieving Clinical Excellence” conference where the ideas and steps will be discussed in detail.

Filed Under: Behavioral Health, Conferences and Training, deliberate practice, excellence Tagged With: achieving clinical excellence, excellence, implementations, K. Anders Erickson

International "Achieving Clinical Excellence" Conference

September 12, 2009 By scottdm 3 Comments

Mark your calendars!  The International Center for Clinical Excellence is pleased to announce the “Achieving Clinical Excellence” (ACE) conference to be held at the Westin Hotel in Kansas City, Missouri on October 20-22nd, 2010.

K. Anders Erickson, Ph.D., the editor of The Cambridge Handbook of Expertise and Expert Performance and recognized “expert on experts,” will keynote the event. Through a combination of plenary presentations and intensive workshops, an internationally renowned faculty of researchers and educators, including Scott D. Miller, Ph.D. and John Norcross, Ph.D., will help participants discover the means to achieve excellence in clinical practice, leadership, ethics, and personal care.

Attendees will also meet and learn directly from internationally ranked performers from a variety of professions, including medicine, science, music, entertainment, and sports.  As just one example, the Head Coach of the Olympic, Gold-Medal-winning Women’s volleyball team, Hugh McCutcheon, will present at the conference.  In addition to a pre-conference day on ethics and law, internationally renowned concert pianist David Helfgott, whose heart-warming story was featured in the award winning film Shine, will perform on Thursday evening, October 21st. Join us in Kansas City for three days of science, skill building, and inspiration.

Filed Under: Behavioral Health, Conferences and Training, deliberate practice, excellence Tagged With: behavioral health, CEU, conference, CPD, excellence, healthcare, John Norcross, K. Anders Erickson, Training

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