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Psychotherapists & counsellors who don't monitor their outcomes are at risk of being both incompetent & potentially dangerous

I find the recent paper by Kraus & colleagues a bit scary - "Therapist effectiveness: Implications for accountability and patient care" - with its abstract reading "Significant therapist variability has been demonstrated in both psychotherapy outcomes and process (e.g., the working alliance). In an attempt to provide prevalence estimates of "effective" and "harmful" therapists, the outcomes of 6960 patients seen by 696 therapists in the context of naturalistic treatment were analyzed across multiple symptom and functioning domains. Therapists were defined based on whether their average client reliably improved, worsened, or neither improved nor worsened. Results varied by domain with the widespread pervasiveness of unclassifiable/ineffective and harmful therapists ranging from 33 to 65%.

Learning MBSR: fifth evening of the course - the value of "difficult" practice sessions & of "concentration"

Yesterday evening was the fifth session of the MBSR course that I'm attending.  I'd missed the fourth session because of my wife's birthday, but I did jot down some thoughts last week in the blog post "Learning MBSR: ... body scan, Damasio on identity, and informal practice".  There were seven of us attending tonight's session, so two were missing.  We began with a straight 45 minute sitting meditation - slightly "marines" when my usual practice is 20 minutes.  The experience of "swimming out" into a longer group practice echoes back for me to a series of meditation retreats I went to in my 20's.  Memories, not so much visual or verbal, more a sense in my body of poignancy, happiness, strength, youthfulness, openness.  Strange.

Learning MBSR: fourth evening of the course - body scan, Damasio on identity, and informal practice

I wrote last week about the third evening of this eight session MBSR course.  The fourth session was yesterday evening and I missed it.  It was my wife's birthday and I'd told the course teacher when I enrolled that I wouldn't get to this fourth meeting ... or to the seventh meeting when I'll also be away.  It's not ideal.  My practice has been poorer this last week, both because I've been particularly busy and also because I haven't been back to get the weekly commitment boost that tends to come from attending the class.  I've still practised mindfulness meditations every day, but it's felt more like a routine to be squeezed in than a particularly rich exploration over these last several days. 

Peer groups: Scottish Mixed Group – final morning

 The final morning of the group.  Still strong feelings settling from the evening before.  Caring for each other.  Re-strengthening the group "container".  We wobbled a good deal later on on Sunday, but I think everyone can feel good about "keeping the show on the road".  Potentially very helpful learning. 

Peer groups: Scottish Mixed Group – second full day: bumps, maintaining the group, emotions & cognitive processing

I wrote in the last blog post about the first part of the second full day at Glassie.  Later on in the afternoon we moved into a more "bumpy" phase of the group.  Often in these more difficult interactions there is the richest learning for everyone involved if one has the courage and openness to digest what happened.  Irvin Yalom, in his research on process groups, found that best outcomes were associated both with a great deal of caring, empathy & emotional "holding" and also with a great deal of "chewing over" and trying to understand what was brought up by events in the groups.  Interestingly, and in contrast, best outcomes were associated with a medium level - not too much & not too little - conflict & challenge.

Peer groups: Scottish Mixed Group – second full day: emotional ‘cooking’ in the group, and personal work too

I wrote yesterday about the first full day of this "long weekend" residential peer group.  The second day of the weekend was particularly rich - very nourishing or a bit too much depending partly on one's digestion.  So after the usual walks, talks, meditations, long chatty breakfasts, we began again in the full group at 10.00am.  Often at these residentials we start the morning with small support groups before moving on to the full group.  Over these three days we've reversed this sequence, starting with the full group and then, after a coffee break, moving on to the small support groups.  Both ways of organizing things have their benefits.  Yesterday starting with the full group worked particularly well.  As so often happens, one of the everyday experiences of living with others for three days had pushed buttons for someone, open

Peer groups: Scottish Mixed Group – beginning, initial thoughts, exciting & edgy

About 6.30 in the morning.  The lights of Aberfeldy shining through the dark from down in the valley.  We're at Glassie Farm Bunkhouse - fourteen of us staying here for three days.  I've written about this kind of peer group residential on a whole series of occasions on this blog - for example a UK Mixed Group in Cumbria this spring and a UK Men's Group in the Peak District last autumn.  The UK Men's Group, which has been running annually since 1993, spawned a Scottish Men's Group a good few years' ago, but the UK Mixed Group, which has been running since '91, never followed suit until now. 

Learning MBSR: third evening of the course - the surprising importance of practising mindfulness during movement

Well last night was the third session of this MBSR course.  I wrote last week about the second evening and also about mindfulness during daily activities.  We packed a lot into this session - there were four practical meditation exercises involving attending to sounds, breath & body awareness, mindfulness during movement & a brief breathing space.  We also had quite extensive group discussions of our experience during each of these practices, a pair exercise to discuss our "homework" last week (it felt helpful to me that this was a bit longer than last session's pair discussion) and more general "homework" exploration in the group.