Measuring client outcomes is fast, easy, and essential. Current measurement tools are up to the task, and if more therapists used them, we could get better at our work.
Research
Therapy robots are already here
Therapists often fear manualized treatments in psychotherapy. If the therapy process is boiled down to a script, the fear goes, the actual therapist becomes interchangeable with anyone else following the same script. Taken to its logical end, if therapy is just a set of manualized techniques, we could easily be replaced by robots.
Saving Psychotherapy: An interview with Scott Miller
We’re big fans of Scott Miller and his Top Performance Blog around here. Miller has allowed his career to be guided by emerging research, a trait that is surprisingly rare in the psychotherapy world. It has led him to some very useful conclusions about how we can become more effective. Deliberate practice and using outcome data are two specific things that we all could do that would almost certainly improve our outcomes.
There are many things about his work to admire. But what I appreciate most is his skill at walking the difficult line between being alarmist — it’s kind of a big deal that therapy outcomes haven’t gotten better in 40 years — and being supportive and uplifting for therapists who are doing their own part individually to improve. So it was an honor to meet him at the 2017 Evolution of Psychotherapy Conference, and to have him interview me earlier this year for his blog.
AA should not be the frontline referral for every client with alcohol issues
A couple of weeks ago, we took a quote about alcohol treatment (AA, specifically) from Saving Psychotherapy and put it in an Instagram and Facebook post. It didn’t go well!
You can see our post there to the right. That was the image we shared. Here’s a sampling of how people responded:
- I find this to be a dangerous overgeneralization.
- Be careful with this. Lives are at stake.
- This is just wrong!!
- Dangerous, irresponsible statement!
Not only do we stand by the quote, the finding itself isn’t especially controversial in the world of research on treatment for substance use disorders. It’s mostly controversial among professionals who don’t want it to be true.
Prove yourself: Accountability is changing mental health care
We can’t say we didn’t see this coming. In the first edition of The Heart and Soul of Change: What Works in Therapy, published in 1999, authors Mark Hubble, Barry Duncan, and Scott Miller predicted that psychotherapists would soon be facing a new era of accountability for their work. Clients, payors, and policymakers would all demand hard evidence that psychotherapy was effective. That era is well underway, and so far we have provided a wealth of the kind of information these parties have demanded.
We can demonstrate that therapy works as an overall conclusion, and within the contexts of specific problems and populations. Proving the effectiveness of specific models has been helpful in many ways (showing that model-based treatment is superior to no treatment) and enlightening in others (showing that, for most problems, the model of therapy has little to no impact on outcome). The brain research discussed by Siegel, Cozolino, and others explains why therapy works. Psychotherapy in general is being held accountable, and it is passing the test with flying colors.
The same cannot be said of specific therapists, or of therapy training programs – yet.