2013 Evolution of Psychotherapy Conference

Therapy: No improvement for 40 years

The Independent Newspaper for PractitionersVol. 23 No. 1

By John Thomas, Associate EditorAnaheim – The good news is that psychotherapy con-

tinues to help around 80 percent of the people who seek theassistance of therapists to deal with their problems.

The bad news is that psychotherapyhas not shown any improvement duringthe last 40 years in how well therapistsdeliver their services.

The good news/bad news scenariowas delivered by Scott Miller, Ph.D., toseveral hundred therapists attending hisworkshop at the quadrennial Evolutionof Psychotherapy conference, whichattracted nearly 8,000 psychologists,psychiatrists and other therapists inDecember. It is sponsored by the MiltonH. Erickson Foundation, California StateUniversity Fullerton and CaliforniaSouthern University.

Those attending Miller’s entertain-ing three-hour lecture were seekingways to avoid becoming average thera-pists and enhance their performance andjoin the group of so-called top perform-ers who achieve about 50 percent betteroutcomes than their equally trained andcredentialed peers.

Over the last decade, Miller and hiscolleagues at the International Center forClinical Excellence in Chicago havebeen tracking the outcomes of thousandsof clinicians around the world to identifythe practices that make them well aboveaverage.

Miller said practice for most clini-cians is “like riding an exercise bike. Wework up a sweat, but we don’t get any-where.” While psychology as a profes-sion seems stuck in the 1970s in termsof its effectiveness, athletic performanc-es have increased by more than 50 per-cent during the same period of time.

Available evidence, he added,

demonstrates that attending a typicalcontinuing education workshop, special-izing in the treatment of a particularproblem or learning a new treatmentmodel does little to improve therapeuticeffectiveness. And despite what manypsychologists and other therapists think,there isn’t any evidence that they getbetter over their careers.

Client dropout from therapy contin-ues at around 47 percent, Miller said,and every tenth person in therapy leavesworse off than when they started. Thereis little difference in outcomes, whethertherapy is provided by experienced pro-fessionals, students, early career practi-tioners or paraprofessionals.

When he asked for suggestionsfrom the audience as to why psychologyis stuck in the 1970s in terms of itseffectiveness, responses generally chal-lenged the findings that Miller present-ed, including polling error and misinter-pretation of data.

“And I thought it was only yourclients who are in denial,” he responded,to a roomful of laughter.

Generally, the top performers inpsychotherapy know more, see more anddo more than psychologists and othertherapists who never leave the ranks ofaverage, Miller said. But, how they dothat involves time and effort many thera-pists aren’t willing to undertake, despitetheir desires to do better than average.

Miller used two examples toimpress upon his audience the singlemost important element in becoming atop performer.

First he asked for a show of handson a short series of questions concerningchampionship chess players. Two of theanswer choices dealt with the amount oftime a chess player devotes to playingthe game, while the third involved read-ing books about various proven chessstrategies.

Almost everyone chose the answersdealing with the amount of time champi-ons spent playing chess. It appearedonly one person chose the third choicethat involved reading about chess, whichwas the correct response.

“You can’t do better therapy byattending workshops and you can’timprove your therapy skills while doingtherapy,” Miller said.

His second example was an 8-year-old girl who played a piano so wellsome of her listeners thought it was arecording. Miller learned from the girlthat her skills were developed over afew years by practicing the piano fourhours a day every day.

“The only two days she didn’t prac-tice was on Christmas and her birthday,”Miller explained. The girl also toldMiller that if she was having trouble get-ting through a tough spot on the pieceshe was playing, she would concentratesolely on that piece until she got it right.

“This is what top performers intherapy do. They spend a great amountof time constantly going over their mis-takes until they get it right,” Miller said.Top performers spend a lot of time get-ting ready for therapy sessions and a lotof time afterward critiquing their per-formances. Many rely on being observedby highly regarded colleagues to see ifthey are doing well.

Average therapists can also improvetheir performance by adopting FeedbackInformed Treatment (FIT), which allowsclients to tell clinicians what they like or

dislike about their treatment.He noted that the Substance Abuse

and Mental Health Services Administra-tion has deemed FIT an evidence-basedtreatment practice. Research conductedat multiple sites across a wide range ofclients and presenting complaints indi-cates that clinicians can improve the out-come of those cases most at risk for fail-ure by as much as 65 percent withoutchanging their preferred treatmentapproach or learning any new treatmenttechniques.

While many sessions dealt with thepast, one dealt with facilitating theRNA/DNA epigenetics on creating newconsciousness as the next step in theevolution of psychotherapy.

Led by Ernest Rossi, Ph.D., andKathryn Rossi, Ph.D., the workshop onRNA/DNA epigenetics looked more likea course on biology than psychology andexperiential treatment sessions looked alot like Transcendental Meditation.

The goal of Epigenetics Psychologyis the practical application of knowledgegained from epigenetic research. Thefield helps to explain how nurtureshapes nature, where nature refers tobiological heredity and nurture refers tovirtually everything that occurs duringthe lifespan.

Other sessions featured many of the“big names” of psychotherapy, such asAaron Beck, M.D.; Martin Seligman,Ph.D.; Salvador Minuchin, M.D.; StevenFrankel, Ph.D., J.D., and Irving Yalom.M.D. Showcasing leaders and pioneersin the field has been the hallmark of theEvolution conferences since the first washeld in 1985 in Phoenix, Ariz.----------

This article is reprinted with permis-sion from The National Psychologist.It is intended for personal use only.This permission does not apply toreproduction for advertising, promo-tion, resale or other commercial pur-poses.

January/February 2014