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Where is Scott Miller going? The Continuing Evolution

November 16, 2009 By scottdm 2 Comments

I’ve just returned from a week in Denmark providing training for two important groups.  On Wednesday and Thursday, I worked with close to 100 mental health professionals presenting the latest information on “What Works” in Therapy at the Kulturkuset in downtown Copenhagen.  On Friday, I worked with a small group of select clinicians working on implementing feedback-informed treatment (FIT) in agencies around Denmark.  The day was organized by Toftemosegaard and held at the beautiful and comfortable Imperial Hotel.

In any event, while I was away, I received a letter from my colleague and friend, M. Duncan Stanton.  For many years, “Duke,” as he’s known, has been sending me press clippings and articles both helping me stay “up to date” and, on occasion, giving me a good laugh.  Enclosed in the envelope was the picture posted above, along with a post-it note asking me, “Are you going into a new business?!”

As readers of my blog know, while I’m not going into the hair-styling and spa business, there’s a grain of truth in Duke’s question.  My work is indeed evolving.  For most of the last decade, my writing, research, and training focused on factors common to all therapeutic approaches. The logic guiding these efforts was simple and straightforward. The proven effectiveness of psychotherapy, combined with the failure to find differences between competing approaches, meant that elements shared by all approaches accounted for the success of therapy (e.g., the therapeutic alliance, placebo/hope/expectancy, structure and techniques, extratherapeutic factors).  As first spelled out in Escape from Babel: Toward a Unifying Language for Psychotherapy Practice, the idea was that effectiveness could be enhanced by practitioners purposefully working to enhance the contribution of these pantheoretical ingredients.  Ultimately though, I realized the ideas my colleagues and I were proposing came dangerously close to a new model of therapy.  More importantly, there was (and is) no evidence that teaching clinicians a “common factors” perspective led to improved outcomes–which, by the way, had been my goal from the outset.

The measurable improvements in outcome and retention–following my introduction of the Outcome and Session Rating Scales to the work being done by me and my colleagues at the Institute for the Study of Therapeutic Change–provided the first clues to the coming evolution.  Something happened when formal feedback from consumers was provided to clinicians on an ongoing basis–something beyond either the common or specific factors–a process I believed held the potential for clarifying how therapists could improve their clinical knowledge and skills.  As I began exploring, I discovered an entire literature of which I’d previously been unaware; that is, the extensive research on experts and expert performance.  I wrote about our preliminary thoughts and findings together with my colleagues Mark Hubble and Barry Duncan in an article entitled, “Supershrinks” that appeared in the Psychotherapy Networker.

Since then, I’ve been fortunate to be joined by an internationally renowned group of researchers, educators, and clinicians, in the formation of the International Center for Clinical Excellence (ICCE).  Briefly, the ICCE is a web-based community where participants can connect, learn from, and share with each other.  It has been specifically designed using the latest web 2.0 technology to help behavioral health practitioners reach their personal best.  If you haven’t already done so, please visit the website at www.iccexcellence.com to register to become a member (its free and you’ll be notified the minute the entire site is live)!

As I’ve said before, I am very excited by this opportunity to interact with behavioral health professionals all over the world in this way.  Stay tuned, after months of hard work and testing by the dedicated trainers, associates, and “top performers” of ICCE, the site is nearly ready to launch.

Filed Under: excellence, Feedback Informed Treatment - FIT, Top Performance Tagged With: denmark, icce, Institute for the Study of Therapeutic Change, international center for cliniclal excellence, istc, mental health, ors, outcome rating scale, psychotherapy, psychotherapy networker, session rating scale, srs, supershrinks, therapy

Comments

  1. Susanne Bargmann says

    November 16, 2009 at 9:45 am

    Hi Scott

    As always I enjoy reading your posts on this blog. And this reacent post really strikes something that is very important to me! There’s so much potential in what you’re developing now – the idea that we can actually improve our effectiveness as clinicians is so appealing to me. After first hearing of the work by Paul Clement I was so discouraged: What if we really don’t improve our effect as clinicians during our work life? That idea is very hard to accept because all I want is to become better at helping the people that come to see me…. So for this reason your perspective is very important! If what you’re saying is true, then we all have a possibility to move beyond the .8 effectsize, if we are willing to incorporate the ideas of the “Supershrinks” – and if we’re willing to put in the time….

    In any event – thank you for turning your attention in the direction of therapist development. Thanks for making it accessible for therapists worldwide (which is even more important for somebody like me, who lives in a tiny country in Northern Europe…) by making it available online. In the end isn’t this what we are all hoping for in the end – to become increasingly better at what we do?

    Reply
  2. -bernie says

    November 16, 2009 at 9:26 pm

    First off – I absolutely love your stuff.

    While it might not be sufficient in and of itself, I believe the clinician needs to really “give a shit” about his or her client, or ought I say “patient”.

    (The word “patient” comes from the Latin verb “patior” meaning “to suffer”. Thus, the word “patient” — as a noun denoting “someone who suffers”.)

    I believe the the SRS and the ORS, regularly (each session)gives the patient the message that the therapist cares about their suffering and recovery, and wishes to know what the patient’s areas of concern are, and where the patient feels that the therapist is helpful or might be more helpful.

    I think that this is extraordinarilly important. There is considerable research to support the notion that “how” treatment is provided is often as, or perhapes even more, important than “what” is provided.

    My first sponsor in recovery was a Psychiatric Nurse Practitioner. Early in my recovery we stopped for a bite to eat after a meeting. When deciding where to eat, I suggested a restaurant where smoking was still allowed. But, recognizing that he was a non-smoker, I suggested that perhaps we should go somewhere else. His response was “No, if you feel comfortable going there (despite the fact that it was a smoking restaurant)that’s where we should go”. While I didn’t consciously think about it at length at the time, I recognized that he was willing to forego his comfort for mine.

    That was huge.

    I believe that the SRS and ORS says, in essence “I am concerned about what you are concerned about, and I want you to tell me if I am being as helpful to you as I can”.

    What a powerful message that is.

    Reply

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