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 “The plan,” he said, “to work hard and play by the rules to get ahead is now outdated.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.

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!

Is Psychotherapy Dead?

August 26, 2011 By scottdm 1 Comment

“AMERICANS PREFER DRUGS” screams the headline posted by the Reuters news service and attributed to Consumer Reports–one of the most respected periodical for the average American reader. “NEARLY 80 PERCENT TAKE A PILL FOR DEPRESSION,” the article continues. Read a little further and do some searching around on the internet and a different story emerges. Americans it turns out don’t necessarily prefer drugs but rather, “78 percent of those seeking treatment for depression or anxiety were prescribed antidepressants.”

With respected news agencies advertizing for the pharaceutical companies, is it any wonder why the practice of “talk therapy” is suffering? AA’s Executive Director for Professional Practice, Dr. Kaherine Nordal, in a recent editorial asked, “Where has all the psychotherapy gone?” The percentage of Americans who receive outpatinet mental health care has remained unchanged over the last several decades. Moreover, as Dr. Mark Hubble and I point out in the lead article in the May-June issue of the Psychotherapy Networker, “median incomes for psychologists, both applied and academic, have dropped between 17 and 33 percent at the same time that workloads have increaed, profssional autonomy has been subverted, and funding for public behavioral healthcare has all but disappeared.”

In a recent, highly publicized exchange on psychotherapy that appeared on Medscape: Psychiatry and Health, panel participants (all psychiatrists) repeated the same, old, tired argument about the field. To wit, “the research base is insufficient.” How such statements can be made with a straight face, much less by mental health professionals, on a public website, defies explanation. The truth is, the evidence-base for psychological treatments is as large and robust as any. What’s more, seeing a talk therapist does not require invasive surgery or a black box warning. Clearly, the issue is not research. It is about awareness.

The members and associates of the International Center for Clinical Excellence (ICCE) are working diligently to raise consciousness among the public and policy makers. Every day, 1000’s of professionals connect to, learn from, and share with colleagues around the world. The mission of the organization? To use community to improve the quality and outcome of behavioral health services. On the ICCE web-based community, clinicians share experiences and real world data regarding the effectiveness of talk therapy. For example, ICCE associate Dan Buccino shared outcomes from a 7 year project aimed at “promoting recovery and accountability.” Using the Outcome and Session Ratings Scales, Dan documented effectiveness levels that far exceeded national benchmarks for clinical practice. Why not email him for a copy of the report? Meanwhile, providers serving US Airforce personnel began using the same measures in early 2010 and have reported very similar findings. Finally, to date, more than a dozen randomized clinical trials, involving thousands of clients and numerous therapists, have established that using feedback to inform services increases effectiveness of individual practitioners three fold, cuts dropout rates by 50 percent, reduces the rate of deterioration by 33 percent, and speeds recovery by 66 percent, while simultaensouly improving client satisfaction and reducing the cost of care.

To paraphrase Mark Twain, the rumored death of psychotherapy has been greatly exaggerated. Now is not the time, however, to merely hope for a better future. Join the discussion taking place on ICCE right now. Membership is free and a strong, supportive community just a few clicks away.