As tremendously effective as psychotherapy is, and as much as we try to help out students and new professionals, there are some things about working in this field that we don’t eagerly share. It’s not that we don’t want you to know, necessarily, it’s just… these things don’t look so good.
Here are three secrets we keep about the world of therapy. Each one is true, even if we don’t talk about them much.
A few weeks ago, I sat down with John Webber and RJ Thomas from the popular Talking Therapy podcast. We talked about license exams, the high cost of becoming a therapist, the importance of measuring outcomes, my book Saving Psychotherapy, and a lot more. It’s a wide-ranging interview, and I hope you find it interesting and informative.
You can find my specific episode on this page, or just directly download the mp3 here.
Ranked by page views.
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2013 was a big year here on the blog. I’ve crossed 250K pageviews, which is certainly humbling, and broke my monthly traffic record multiple times. Here are the four posts that drew the most eyeballs in 2013, counting down to the top:
DivorceCorp opens in January. It looks great — with one little caveat.
Divorce is big business. Many people can have a hand in the divorce process: lawyers, mediators, custody evaluators, therapists, court systems, and others all say they want to help divorcing couples. And all want to be paid for their services. The entire system can suffer from what might rightly be called perverse incentives — strong pulls for people to act in ways that are more out of self-interest than the true long-term best interest of the couple they claim to be trying to help.
This is the thrust of the documentary DivorceCorp, opening in major cities January 10. The movie looks good and important. Dr. Drew narrates, and it features interviews with some well-known law experts, including Gloria Allred. Here’s the trailer: More information on the film, including local theaters showing the film when it opens, can be found on the official DivorceCorp website. One cautionary note, though: The opening statement in the trailer, “50% of all US marriages end in divorce,” is wrong. As you can read about in more detail over at the excellent DivorceSource web site, the US divorce rate probably never topped 41% and has been declining for several years. As Tara Parker-Pope documented quite well in her book For Better, divorce rates are especially low among those with at least a college education. Over Twitter, the film’s reps have said that there were bigger fish to fry, so to speak. I get that. They’re looking at an entire divorce industry, and my caution is with one statistic. I believe the social conversation about the divorce rate is one specific part of the larger social conversation about divorce that especially needs to change, for reasons I’ll save for a separate post, but don’t let that take you away from the big picture. I’m happy to support the film and eager to see it. # # # Your comments are welcome. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.It isn’t experience, and it isn’t the kind of training we usually do.
I’m blogging this week from the Evolution of Psychotherapy Conference in Anaheim, where many of the world’s leaders in psychotherapy gather to discuss the state of the field and share new and innovative research findings.
Therapy is tremendously effective. The average treated client ends up better off than 80% of untreated people with similar problems. Psychotherapy for mental health problems is as effective as coronary bypass surgery for heart problems and four times as effective as flouride toothpaste in preventing dental problems. But we’re not getting better, Scott Miller said in yesterday’s opening workshop.
Miller summarizes our field’s efforts to figure this out thusly: We started by looking at our treatment models, hoping to build better techniques to reach better outcomes. This is where many training programs still live: We teach manualized, empirically-supported treatments in hopes that it will make for the most effective therapists. Except it doesn’t; the models formalize and standardize our work, but they don’t make us any more effective, according to outcome studies.
So we then moved to looking at common factors, those things that work across all theoretical models. But teaching common factors doesn’t seem to make us more effective, nor does it relieve the need to know specific models, since it is through those models that the common factors work. (My good friend Sean Davis has the leading text on common factors in couple and family therapy, and in it he makes the same point.)
So the focus then shifted to the study of outcomes rather than methods, and what we found was that some therapists consistently achieve better outcomes than their peers. That has moved the field into a close examination of excellence and expertise.
The findings there are striking, and I can’t do them full justice here — I’ll address the training issues in more detail in a future post. But the short version is this: We don’t spend a ton of time training students to do the things that actually seem to make them better therapists (“better” here meaning more effective). Miller cited a vast literature identifying deliberate practice — not just more hours seeing clients, but significant time focused on reviewing weaknesses in those sessions while not actively in them and then taking action to address those weaknesses — as the key task in making people more effective. What I hear in my therapy-teacher framework: We need to be doing a lot more videotaping.
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Your comments are welcome. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.