Last updated on 20th June 2013
On Wednesday evening I flew into Amsterdam Schiphol airport for three days of workshop & conference on feedback systems & the development of excellence in psychotherapy. What a fascinating subject area to explore. What a treat. From the airport I caught a train to Amsterdam Zuid and then walked up through the sunny streets to my hotel. They were short of rooms and upgraded me to the 6th floor ... two walls of windows and a view to die for. A good start!
Yesterday was the pre-conference workshop - "Pushing your clinical effectiveness to the next level" - with Scott Miller. A blunt title, but a good description of what the workshop was trying to achieve. Flying to Amsterdam for three days of workshop & conference is part of a journey for me that began nearly two year's ago at the British Association for Behavioural & Cognitive Psychotherapies (BABCP) summer conference in Guildford. I went to a plenary lecture by Michael Lambert at that conference entitled "What shall we do about the fact that there are supershrinks and pseudoshrinks?". I wrote a long blog post about the talk saying that, for me, it was the most important input of the conference. And so it proved. I wrote a series of posts triggered by what Michael Lambert had said including "Barry Duncan's book 'On becoming a better therapist'", "The heart & soul of change: delivering what works in therapy", "The Norway feedback project: a clear and sensible way to make psychotherapy more helpful" and "Orlinsky & Ronnestad's 'How psychotherapists develop: a study of therapeutic work and professional growth'". Then a couple of months after hearing Lambert speak I travelled to Copenhagen to follow up these ideas further at a Scott Miller workshop.
I have continued to write about and use these ideas - see the posts "Psychotherapists & counsellors who don't monitor their outcomes are at risk of being both incompetent & potentially dangerous", "Orlinsky & Ronnestad's "How psychotherapists develop": three key recommendations for maintaining effectiveness", "Five recent research studies on the worrying variability both in psychotherapist effectiveness and also in willingness to change" and the "Feedback informed treatment" website.
So how was this one day workshop with Scott Miller? Well for such status quo challenging subject matter, the workshop structure itself was rather traditional. Mostly we just sat and listened to Scott lecturing ... although it should be noted he does this entertainingly and well. Interestingly some of the significant challenges to this standard teaching format come from the very "deliberate practice" expertise development literature that this conference is due to discuss - see Deslauriers et al's 2011 paper "Improved learning in a large-enrollment physics class". Many of the slides from Scott's previous talks & workshops are downloadable (as PDF's rather than slides) from the "Scholarly publications" section of his website.
As I suspect he usually starts his talks, Scott gave an initial half full/half empty introduction to the field of psychotherapy. So the situation is "half full" because with a typical effect size of 0.8, psychotherapy & counselling are genuinely valuable interventions (statistically a "Cohen's d" of 0.8 is usually considered a "large" effect size). Their helpfulness compares well with many more high tech treatments, so Wampold in his 2007 article "Psychotherapy: the humanistic (and effective) treatment" notes " ... a perusal of the University of Toronto's Centre for Evidence-Based Medicine Web site reveals that psychotherapy is more effective than many evidence-based medical practices, some of which are costly and produce significant side effects, including almost all interventions in cardiology (e.g., beta-blockers, angioplasty), geriatric medicine (e.g., calcium and alendronate sodium for osteoporosis), and asthma (e.g., budesonide); influenza vaccine; and cataract surgery, among other treatments. Moreover, when directly compared in clinical trials, psychotherapy typically is as effective as pharmacological treatments of mental disorders." It's noteworthy too that psychotherapy's "side effects" are usually pretty benign compared with the potential adverse effects of other treatments, including most drug alternatives. We in the audience were asked to turn to our neighbours at this stage, shake hands and congratulate each other on a job being done well. Now came the "half empty" section. Despite huge amounts of research and the flowering of a profusion of different psychotherapeutic approaches there's very little evidence that we're any more effective now than when psychotherapy outcomes first began to be measured forty or so years ago - see, for example, the classic Ost meta-analysis "Cognitive behavior therapy for anxiety disorders: 40 years of progress.". To make matters worse, it doesn't seem that for individual psychotherapists, all the years of training & experience lead to any better results. And to top it off, research suggests that as practitioners we are blissfully ... and worryingly ... unaware of what results we are getting and how good or bad we are at our jobs. See, for example, "What shall we do about the fact that there are supershrinks and pseudoshrinks?" and "Psychotherapists & counsellors who don't monitor their outcomes are at risk of being both incompetent & potentially dangerous".
More to follow ...