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’s in an Acronym? CDOI, FIT, PCOMS, ORS, SRS … all BS?

June 7, 2014 By scottdm Leave a Comment

“What’s in a name?”

–William Shakespeare

A little over a week ago, I received an email from Anna Graham Anderson, a graduate student in psychology at Aarhus University in Denmark. “I’m writing,” she said, “in hopes of receiving some clarifications.”

Anna Graham Anderson

Without reading any further, I knew exactly where Anna was going. I’d fielded the same question before. As interest in measurement and feedback has expanded, it comes up more and more frequently.

Anna continued, “I cannot find any literature on the difference between CDOI, FIT, PCOMS, ORS, and SRS. No matter where I search, I cannot find any satisfying clues. Is it safe to say they are the same?” Or, as another asked more pointedly, “Are all these acronyms just a bunch of branding B.S.?”

I answered, “B.S.? No. Confusing? Absolutely. So, what is the difference?”

As spelled out in each of the six treatment and training manuals, FIT, or feedback-informed treatment, is, “a panetheoretical approach for evaluating and improving the quality and effectiveness of behavioral health services. It involves routinely and formally soliciting feedback from consumers regarding the therapeutic relationship and outcome of care and using the resulting information to inform and tailor service deliver.”

Importantly, FIT is agnostic regarding both the method of treatment and the particular measures a practitioner may employ. Some practitioners use the ORS and SRS, two brief, simple-to-use, and free measures of progress and the therapeutic relationship–but any other valid and reliable scales could be used.

Of all the acronyms associated with my work, CDOI is the one I no longer use. For me, it had always problematic as it came precariously close to being a treatment model, a way of doing therapy. I wasn’t interested in creating a new therapeutic approach. My work and writing on the common factors had long ago convinced me the field needed no more therapeutic schools. The phrase, “client-directed, outcome-informed” described the team’s position at the time, with one foot in the past (how to do therapy), the other in the future (feedback).

And PCOMS? A long time ago, my colleagues and I had a dream of launching a web-based “system for both monitoring and improving the effectiveness of treatment” (Miller et. al, 2005). We did some testing at an employee assistance program in located in Texas, formed a corporation called PCOMS (Partners for Change Outcome Management System), and even hired a developer to build the site. In the end, nothing happened. Overtime, the acronym, PCOMS, began to be used as an overall term referring to the ORS, SRS, and norms for interpreting the scores. In February 2013, the Substance Abuse and Mental Health Service Adminstration (SAMHSA) formally recognized PCOMS as an evidence-based practice. You can read more about PCOMS at: www.whatispcoms.com.

I expect there will be new names and acronyms as the work evolves. While some remain, others, like fossils, are left behind; evidence of what has come before, their sum total a record of development over time.

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.

The Debate of the Century

August 27, 2009 By scottdm

What causes change in psychotherapy? Specific treatments applied to specific disorders? Those in the “evidence-based” say so and have had a huge influence on behavioral healthcare policy and reimbursement. Over the last 10 years, my colleagues and I have written extensively and traveled the world offering a different perspective: by and large, the effectiveness of care is due to a shared group of factors common to all treatment approaches.

In place of “evidence-based” practice, we’ve argued for “practice-based”evidence. Said another way, what really matters in the debate is whether clients benefit–not the particular treatment approach. Here on my website, clinicians can download absolutely free measures that can be used to monitor and improve outcome and retention (click Performance Metrics).

Anyway, the message is finally getting through. Recently, uber-statistician and all around good guy Bruce Wampold, Ph.D. debated prominent EBP proponent Steve Hollon. Following the exchange, a vote was taken. Bruce won handily: more than 15:1.

Scroll down to “Closing Debate” (Thursday)