“Really?” I responded, somewhat incredulous. After all, I didn’t recall ever saying such a thing. More to the point, it’s just not something I would say. Its wrong. Then again, it was clear he didn’t know that I was Scott Miller. Not wanting to disrupt the presenter before me at the conference, I’d quietly snuck into the room, dressed in my “civies,” shortly after the meeting had started.
“Yep,” he replied, his voice full of certainty, “as I understand it, he says it all the time.” Making “air” quote marks with his fingers, “If the client is not changing within three visits, you should terminate the treatment.”
You should have seen the look on his face when later our eyes met as I took to the stage to do my presentation.
On many occasions over the years, I’ve heard people quote me saying things I’ve never said. Here’s a common one:
“Scott Miller says all you need for successful treatment is a good therapeutic relationship.”
Just so you know, I’ve never said this. Ever. And yet, once, after I corrected a nationally known practitioner in front of a large audience, he nonetheless repeated it in his newsletter. Here’s what I have said and continue to say:
- All treatment models work equally well. All.
- Of all the factors affecting outcome, the specific approach used has the smallest impact. By comparison, the relationship between client and therapist contributes eight to nine times more.
Once again, I’ve never said this. In this instance, the misquote is more understandable. Here’s what I do say at almost every workshop:
- Decades of research and hundreds of study document psychotherapy works.
- The effectiveness of psychotherapy has remained fairly stable over the years.
- In most studies, the average treated client is better off than 80% of the untreated comparison sample.
I’m certain it’s the last of these statements that causes problems. Presented, as it, is in “researchspeak,” it’s easy to misunderstand. Read it again and you’ll see it does not mean we help 80% of our clients. Rather, its about the advantage therapy offers relative to receiving no treatment at all. By contrast, the percentage we help — as I’ve blogged about on numerous occasions — is actually around 50%.
Now, in the interest of fairness, let me mention something I often say but have never heard misquoted. At nearly of all my workshops, I joke, “The ORS and SRS may not be the best scales ever developed … but they are free!” The latter part of that statement is absolutely true. Clinicians wishing to solicit feedback from clients about their progress and the quality of the therapeutic relationship simply need to register for a free paper and pencil license. That said, recent research out of the University of Nottingham is giving me pause about the other half.
Just last week, I interviewed Professor Sam Malins who, together with a team of others, has been studying the use of the scales in real world clinical settings for a number of years. In addition to replicating a number of important findings (e.g., the longer you use the ORS and SRS, the more impact they have on retention and effectiveness; spending time gathering information for diagnosis and treatment planning results in poorer outcomes, the scales can be used to identify skill development opportunities), he also found the Outcome Rating Scale predicted … oh, just watch the video yourself. That way, I won’t be misquoted!
Until next time,
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence