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!

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.

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.