All in the timing: How To Understand & Connect With the Precontemplative Person(mostly) TRUE THINGS
To change habits - e.g. smoking or eating the wrong foods in personal life, or introduce new processes in a workplace - we need a combination of desire and competence. Health care providers and educators can unintentionally sabotage change efforts when information and interventions designed for people ready for action are applied to people who are precontemplaitve - which research shows may be as many as 85% of those who present for help with a problem. This presentation explores how to understand and connect with a precontemplative person.
The Identity Crisis: The Story of a Social Media DisasterJenniferDong95
Living in the new world of social media and technology, society has developed an identity crisis. We have become obsessed with creating an appearance of happiness, success, and perfection. Our obsession with self-presentation is deceiving and dangerous. We have lost the ability to see reality by fostering a false sense of identity developed through our social networks. From “selfie addictions” to low self-esteem, we have already been warned of the dangerous implications. However, what is most terrifying is our utter ignorance to our “loss of self.” In the words of Stephen Marche, “The more you try to be happy, the less happy you are.” By continuing down this path of addiction, obsession, and instability, how can we ever achieve a state of true happiness? Most importantly, how can we find ourselves amidst a world of technological madness?
All in the timing: How To Understand & Connect With the Precontemplative Person(mostly) TRUE THINGS
To change habits - e.g. smoking or eating the wrong foods in personal life, or introduce new processes in a workplace - we need a combination of desire and competence. Health care providers and educators can unintentionally sabotage change efforts when information and interventions designed for people ready for action are applied to people who are precontemplaitve - which research shows may be as many as 85% of those who present for help with a problem. This presentation explores how to understand and connect with a precontemplative person.
The Identity Crisis: The Story of a Social Media DisasterJenniferDong95
Living in the new world of social media and technology, society has developed an identity crisis. We have become obsessed with creating an appearance of happiness, success, and perfection. Our obsession with self-presentation is deceiving and dangerous. We have lost the ability to see reality by fostering a false sense of identity developed through our social networks. From “selfie addictions” to low self-esteem, we have already been warned of the dangerous implications. However, what is most terrifying is our utter ignorance to our “loss of self.” In the words of Stephen Marche, “The more you try to be happy, the less happy you are.” By continuing down this path of addiction, obsession, and instability, how can we ever achieve a state of true happiness? Most importantly, how can we find ourselves amidst a world of technological madness?
Expanding the Lens of EBP: A Common Factors in AgreementScott Miller
The authors explore the limitations of the traditional view of evidence-based practice with its emphasis on specific methods and diagnosis. An alternative is proposed based on the common factors.
The art of being a failure as a therapist (haley, 1969)Scott Miller
A fantastic article written nearly 50 years ago that is as timely today as it was then. The author outlines several beliefs and practices sure to increase your chances of failing as a therapist.
The study of supershrinks (Chow, 2014)Scott Miller
Dissertation by Daryl Chow studying the difference between top performing and average psychotherapists. The study documents the role that deliberate practice plays in the effectiveness
Description of research in Sweden on a program to help people leave the disability rolls and go back to work. Several years ago, leaders adopted CBT as the primary treatment model. All practitioners were trained and over a billion Swedish Crowns were spent. The result? No effect. In fact, the percentage of people disabled by depression increased.
Training of Therapists (Evolution Conference 2013)Scott Miller
Here are the slides from a panel presentation on the cost and effectiveness of traditional training of psychotherapists at the 2013 Evolution of Psychotherapy.
Transform Healthcare, Tap Into A Great Low Cost Resourcedandelt
Transform healthcare by tapping into a great low-cost resource ‒
Focus the patient experience on healing by empowering each person to be an agent of healing.
Expanding the Lens of EBP: A Common Factors in AgreementScott Miller
The authors explore the limitations of the traditional view of evidence-based practice with its emphasis on specific methods and diagnosis. An alternative is proposed based on the common factors.
The art of being a failure as a therapist (haley, 1969)Scott Miller
A fantastic article written nearly 50 years ago that is as timely today as it was then. The author outlines several beliefs and practices sure to increase your chances of failing as a therapist.
The study of supershrinks (Chow, 2014)Scott Miller
Dissertation by Daryl Chow studying the difference between top performing and average psychotherapists. The study documents the role that deliberate practice plays in the effectiveness
Description of research in Sweden on a program to help people leave the disability rolls and go back to work. Several years ago, leaders adopted CBT as the primary treatment model. All practitioners were trained and over a billion Swedish Crowns were spent. The result? No effect. In fact, the percentage of people disabled by depression increased.
Training of Therapists (Evolution Conference 2013)Scott Miller
Here are the slides from a panel presentation on the cost and effectiveness of traditional training of psychotherapists at the 2013 Evolution of Psychotherapy.
Transform Healthcare, Tap Into A Great Low Cost Resourcedandelt
Transform healthcare by tapping into a great low-cost resource ‒
Focus the patient experience on healing by empowering each person to be an agent of healing.
For our second edition of our brand new e-zine, we’re shining the spotlight on the intriguing topic of patient insights. We discuss the role of patient insights and what impact it has on improving patient outcomes, and highlight new ways pharma can engage with patients.
So what are you waiting for? Head over to the website now for the latest edition of Spotlight On. Again, if you like what you see, feel free to share it with others. And if the first edition passed you by, don’t worry, it’s still available to read. Enjoy!
Why Do You Want to Be a Nurse (300 Words) - PHDessay.com. Why Do You Want to Be a Nurse? Essay Writing Tips. Essay on Why I Want to Become a Nurse for all Class in 100 to 500 Words. How to Write an Essay on Why Do You Want to Be a Nurse – Wr1ter. Why Do You Want To Be A Nurse Essay Example - Reasons for Become a eNurse. Why you want to be a nurse essay by Williams April - Issuu. Business paper: Why do i want to be a nurse practitioner essay. Magnificent Reasons To Become A Nurse Essay ~ Thatsnotus. Why I Want To Become A Nurse Essay – Telegraph. The Reasons Why I Want To Be A Nurse Argumentative Essay [Essay Example .... Why I Want To Be A Nurse Essay Example | Topics and Well Written Essays .... Why i want to be a nurse essay - Writing Center 24/7.. Why i Want to Be a Nurse Essay (4) | Compassion | Nursing.
Amazing High School Essay ~ Thatsnotus. 002 Essay Example Sample High School Admission Essays Writing Prompts .... FREE 8+ School Essay Samples in MS Word | PDF. English Oral Test Form 4 Sample Essay.
14 RESEARCH HEALTHCARE Counselling and Psychotherapy Jour.docxaulasnilda
14 RESEARCH HEALTHCARE Counselling and Psychotherapy Journal October 2018
SEX ADDICTION:
THE SEARCH FOR
A SECURE BASE
JOANNA BENFIELD PROPOSES AN
ATTACHMENT-BASED APPROACH
TO WORKING WITH
SEXUAL COMPULSIVITY
UNDERSTANDING SEX ADDICTION
For many therapists with no specialised
training in psychosexual therapy or
addiction treatment, a client’s
pronouncement that they are a sex addict
might cause alarm bells to ring. A number
of questions are likely to spring to mind:
does such a diagnosis actually exist? If it
does exist, how do we recognise it? And,
what is the most effective way of treating it?
The jury is still out on whether sex
addiction can be seen as a true addiction
or even mental disorder. The World
Health Organisation recently included
‘compulsive sexual behaviour disorder’
as an impulse-control disorder in the
International Classification of Diseases
(ICD-11),1 but the American Psychiatric
Association failed to recognise sex
addiction in the latest version of the
Diagnostic and Statistical Manual of
Mental Disorders (DSM-5).2 There was
disappointment among many sex addiction
therapists at this omission from the DSM-5
as, on a daily basis, they come face to face
with individuals who suffer greatly as
a result of their out-of-control sexual
behaviour. For some clients, this might take
the form of prolific pornography use, while
for others, it might be weekly visits to
escorts or a never-ending stream of
one-night stands. It is not the behaviour
per se that is the marker of sex addiction,
but rather the negative impact that it has
on the individual’s life. For these clients,
rather than being a pleasurable experience,
sex is used compulsively to relieve
negative emotional states and, as a result,
often causes significant distress.3 Despite
this distress, they feel unable to stop the
behaviour. Clients usually only walk into
the therapist’s consulting room once the
addiction has become completely
unmanageable, for example because it
has resulted in loss of employment due
to pornography use on work computers,
financial ruin due to numerous escort
visits or marriage breakdown due to
multiple affairs.
Whether or not we wish to use the term
‘sex addiction’, or prefer to refer to this
as out-of-control sexual behaviour,
hypersexuality or sexual compulsivity,
what is clear is that it poses a significant
problem for an ever-growing number
of people. The availability of free online
pornography and ‘hook-up’ apps has
done nothing to alleviate the problem.
We are likely, therefore, to see an
increasing number of clients walking
through our doors for whom out-of-control
sexual behaviour causes mental and
emotional distress.
Most sex addiction treatment strategies
are based on a cognitive-behavioural
approach.4 Sex addiction therapists will
typically work with clients to help them
to identify their addiction cycle, recognise
the triggers for acti ...
14 RESEARCH HEALTHCARE Counselling and Psychotherapy Jour.docxjesusamckone
14 RESEARCH HEALTHCARE Counselling and Psychotherapy Journal October 2018
SEX ADDICTION:
THE SEARCH FOR
A SECURE BASE
JOANNA BENFIELD PROPOSES AN
ATTACHMENT-BASED APPROACH
TO WORKING WITH
SEXUAL COMPULSIVITY
UNDERSTANDING SEX ADDICTION
For many therapists with no specialised
training in psychosexual therapy or
addiction treatment, a client’s
pronouncement that they are a sex addict
might cause alarm bells to ring. A number
of questions are likely to spring to mind:
does such a diagnosis actually exist? If it
does exist, how do we recognise it? And,
what is the most effective way of treating it?
The jury is still out on whether sex
addiction can be seen as a true addiction
or even mental disorder. The World
Health Organisation recently included
‘compulsive sexual behaviour disorder’
as an impulse-control disorder in the
International Classification of Diseases
(ICD-11),1 but the American Psychiatric
Association failed to recognise sex
addiction in the latest version of the
Diagnostic and Statistical Manual of
Mental Disorders (DSM-5).2 There was
disappointment among many sex addiction
therapists at this omission from the DSM-5
as, on a daily basis, they come face to face
with individuals who suffer greatly as
a result of their out-of-control sexual
behaviour. For some clients, this might take
the form of prolific pornography use, while
for others, it might be weekly visits to
escorts or a never-ending stream of
one-night stands. It is not the behaviour
per se that is the marker of sex addiction,
but rather the negative impact that it has
on the individual’s life. For these clients,
rather than being a pleasurable experience,
sex is used compulsively to relieve
negative emotional states and, as a result,
often causes significant distress.3 Despite
this distress, they feel unable to stop the
behaviour. Clients usually only walk into
the therapist’s consulting room once the
addiction has become completely
unmanageable, for example because it
has resulted in loss of employment due
to pornography use on work computers,
financial ruin due to numerous escort
visits or marriage breakdown due to
multiple affairs.
Whether or not we wish to use the term
‘sex addiction’, or prefer to refer to this
as out-of-control sexual behaviour,
hypersexuality or sexual compulsivity,
what is clear is that it poses a significant
problem for an ever-growing number
of people. The availability of free online
pornography and ‘hook-up’ apps has
done nothing to alleviate the problem.
We are likely, therefore, to see an
increasing number of clients walking
through our doors for whom out-of-control
sexual behaviour causes mental and
emotional distress.
Most sex addiction treatment strategies
are based on a cognitive-behavioural
approach.4 Sex addiction therapists will
typically work with clients to help them
to identify their addiction cycle, recognise
the triggers for acti.
14 RESEARCH HEALTHCARE Counselling and Psychotherapy Jour.docxherminaprocter
14 RESEARCH HEALTHCARE Counselling and Psychotherapy Journal October 2018
SEX ADDICTION:
THE SEARCH FOR
A SECURE BASE
JOANNA BENFIELD PROPOSES AN
ATTACHMENT-BASED APPROACH
TO WORKING WITH
SEXUAL COMPULSIVITY
UNDERSTANDING SEX ADDICTION
For many therapists with no specialised
training in psychosexual therapy or
addiction treatment, a client’s
pronouncement that they are a sex addict
might cause alarm bells to ring. A number
of questions are likely to spring to mind:
does such a diagnosis actually exist? If it
does exist, how do we recognise it? And,
what is the most effective way of treating it?
The jury is still out on whether sex
addiction can be seen as a true addiction
or even mental disorder. The World
Health Organisation recently included
‘compulsive sexual behaviour disorder’
as an impulse-control disorder in the
International Classification of Diseases
(ICD-11),1 but the American Psychiatric
Association failed to recognise sex
addiction in the latest version of the
Diagnostic and Statistical Manual of
Mental Disorders (DSM-5).2 There was
disappointment among many sex addiction
therapists at this omission from the DSM-5
as, on a daily basis, they come face to face
with individuals who suffer greatly as
a result of their out-of-control sexual
behaviour. For some clients, this might take
the form of prolific pornography use, while
for others, it might be weekly visits to
escorts or a never-ending stream of
one-night stands. It is not the behaviour
per se that is the marker of sex addiction,
but rather the negative impact that it has
on the individual’s life. For these clients,
rather than being a pleasurable experience,
sex is used compulsively to relieve
negative emotional states and, as a result,
often causes significant distress.3 Despite
this distress, they feel unable to stop the
behaviour. Clients usually only walk into
the therapist’s consulting room once the
addiction has become completely
unmanageable, for example because it
has resulted in loss of employment due
to pornography use on work computers,
financial ruin due to numerous escort
visits or marriage breakdown due to
multiple affairs.
Whether or not we wish to use the term
‘sex addiction’, or prefer to refer to this
as out-of-control sexual behaviour,
hypersexuality or sexual compulsivity,
what is clear is that it poses a significant
problem for an ever-growing number
of people. The availability of free online
pornography and ‘hook-up’ apps has
done nothing to alleviate the problem.
We are likely, therefore, to see an
increasing number of clients walking
through our doors for whom out-of-control
sexual behaviour causes mental and
emotional distress.
Most sex addiction treatment strategies
are based on a cognitive-behavioural
approach.4 Sex addiction therapists will
typically work with clients to help them
to identify their addiction cycle, recognise
the triggers for acti.
A mock opinion piece on the Singularity and the future of healthcare for the Trillion Dollar Challenges class. Explores the relationship between health technology and human interaction.
50 Free Persuasive Essay Examples (+BEST Topics) ᐅ TemplateLab. Example Of A Persuasive Essay About School Uniforms | Sitedoct.org. Best 25+ Persuasive writing examples ideas on Pinterest | What is .... Beautiful Best Persuasive Essay Topics ~ Thatsnotus. Outline For Persuasive Essay Template | PDF. Persuasive Essay Writing prompts and Template for Free. ⚡ Top 10 persuasive topics. 120+ Good Persuasive Essay Topics From Easy .... persuasive essay writing persuasive essay writer tufadmersincom .... Writing the persuasive essay. Persuasive Essay Examples | Preview. 48 Amazing Persuasive Essay Examples – RedlineSP. 013 Good Persuasive Essay Topics Example ~ Thatsnotus. 013 Persuasive Essay Sample Example Arg V Pers Animal Testing Bw O .... Persuasive Text For 4th Grade - Shawn Woodard's Reading Worksheets. Need Help Writing A Persuasive Essay. Help Me Write A Persuasive Essay. FREE 8+ Persuasive Essay Samples in MS Word | PDF. Examples How To Write A Persuasive Essay - Acker Script. 006 Examples Of Persuasive Essays Essay Example ~ Thatsnotus.
Summary of current research on routine outcome measurement, feedback, the validity, reliability, and effectiveness of the ORS and SRS (or PCOMS Outcome Management System)
Qualitative study of therapists working at Stangehjelp in Norway who are applying the principles of deliberate practice in their efforts to deliver more effective treatment services.
The Therapeutic Alliance, Ruptures, and Session-by-Session FeedbackScott Miller
Chris Laraway's doctoral dissertation presents a thorough review of the literature on the link between the therapeutic alliance and outcome, and how session by session feedback can be used to repair ruptures in the therapeutic relationship.
Effect size of common versus specific factorsScott Miller
Graphic representation of the contribution made by common versus specific factors to the outcome of psychotherapy. The slide documents the negligible contribution of the method, competence, and adherence.
Article in Division 29's journal, psychotherapy that reviews the research on routine outcome monitoring, arguing that current efforts are at risk for repeating the history of failed efforts to improve the outcome of psychotherapy.
The Carlat Psychiatry Report (Interview with Scott Miller, April 2015)Scott Miller
The April 2015 issue of the Carlat Psychiatry Report, an unbiased report/review of "all things psychiatric." The issue contains a lengthy interview with Dr. Scott Miller on the subject of top performing clinicians.
Why most therapists are average (german, 2014)Scott Miller
Interview with Scott Miller, reviewing outcome research from the field of therapy and addressing the question of why most therapists don't improve with time and experience.
How to Improve Quality of Services by Integrating Common Factors into Treatme...Scott Miller
Presentation by Dr. Bruce Wampold about how the outcome and quality of psychotherapy can be improved by adding common factors to the treatment. Wampold documents the lack of difference in outcome between competing treatment methods AND the relatively large contribution made by common factors to outcome.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
2. day. The result is that we're warier
and more compartmentalized than
everbefore. Therapy needs to acknowl-
edge how increasingly fragmented
we're becoming and explore how to
help people connect different parts of
themselves,even if we never saya word
about global climate change.
Evolution has designed us to
respond to proximal information-
how things smell, look, sound, and
who and what we can touch. But
all of a sudden with our global
communication system, there's no
such thing as distal information-
all information is proximal. That's
doing odd things to our arousal sys-
tems, our sleep system,our cogni-
tive-appraisal systems.
Along the same lines, National
Public Radio recently ran a fascinat-
ing report on Alex Bentley's meta-
analysis of the emotional content
of printed words over the last cen-
turv. They no$' have computers that
can take all the words that appear
in print and perform massiveanaly-
ses of how the use of language has
changed. What these analysesshow
is that, contrary to what we think in
our psychologizedculture, we aren't
using more emotional words now
than we used in the early part of the
century and the words we actually
use have changed. The roaring'20s
were the high point for words that
expressedhappiness;the World War
II years were the era in which sad-
ness was most frequently expressed.
But the last part of the 20th century
sawa dramatic increase in the use of
words communicating fear. In 2008,
the last year of the study, we used
more fearful words than during any
year in the last century.
In many ways,we're treating people
in therapy offices asif it were 1960.But
it's a really different time, and there
are a lot of issueswe're not approach-
ing becausewe don't know how.
For me, as a therapist, the most
interesting question to ask is still
"What's your emotional experience of
the world?" And if you ask that ques-
tion in the right way,the result can be
a conversation that increasesthe mor-
al imagination of both therapist and
client, which I believe is one of the
most important goalsof therapy.@
Mary Piphea PhD, is a therapist and the
authorof nine books.
identity or message to the public
about what we can offer people.
We might actually learn a thing or
two about public relations from Big
Pharma, Much of its successreflects
the fact that it didn't just sell drugs:
it sold an idea. Starting with the mar-
keting of Prozac in the
'80s,
it pro-
moted the idea that depression was
a biochemical illness. Forget that
there was never any evidence for this
notion. Consumers, and dare I say a
fair number of therapists,bought the
idea that what was troubling people
wasthe result of some chemical prob-
lem in their brains. In sharp contrast,
despite all the empirical evidence of
our effectiveness,we've failed miser-
ably to sell people the truth: psycho-
therapy has been proven to help peo-
ple live healthier, happier lives, all
without frightening side effects,such
as dry mouth, erectile dysfunction,
kidney failure, and death.
Part of the problem has been our
own continuing lack of public clar-
ity over what makes psychotherapy
work. I think our recent fascination
with neurobiology or mindfulness
or this or that technique amount to
running away from what's actually
responsible for the central efficacy
of our work: the therapeutic rela-
tionship. Somehow, PET scans and
new clinical techniques get atten-
tion, while decadesof data show that
neither contributes much, if any-
thing, to the overall effectiveness of
psychotherapy.
On a related note, I find it strange
that whenever one of us is inter-
viewed in a public forum, most of the
time is spent talking about the prob-
lems people have, rather than the
strength of the solution we have to
offer. We need to embrace what our
research tells us: a professional rela-
tionship organized around empa-
thy, genuineness,respect,openness,
congruence, collaboration, and goal
consensushelps people change.And
these are things we're good at.
How can we get even better? The
answer is really quite simple and
straightforward: garner and usemore
client feedback. Evidence shows that
RuoluingOurldentitylrisis
y now research has demonstrat-
ed that people by and large feel
helped by psychotherapy. And
even more than that, it's a real
B Y S C O T T M I L L E R
bargain: the amount of change you
get for the cost of the servicesis out
of proportion to most other kinds of
professional services,be it lawyersor
physiciansor a masseuse.So there's
a lot right with psychotherapy that
we should embrace, even trumpet.
But how can we improve what
we do and th'e results we achieve?
We first need to face up to our
continuing identity confusion as
a profession. Who exactly are we
in the world, and what is it that
we do? The fact is, as a field, we
seem to shift our focus every few
yearsand emphasize different ideas
and theoretical perspectives.In the
'60s,
we were all about behavior
and strategy.Through the
'70s
and
'80s,
we zeroed in on cognitions
and thoughts. Then in the
'90s,
of course, we began the so-called
decade of the brain. Now every-
where you look, we're talking about
bringing more mindfulness into
therapy. But we lack a consistent
r"
P s Y c H o r H E R A P Y N E r w o R K e n . o n of J
3. we're not particularly good at detect-
ing which clients aren't progress-
ing or are actually getting worse.
By monitoring our work and for-
mally seeking and responding to cli-
ent feedback regarding therapeu-
tic progress and the quality of the
relationship, outcomes improve and
dropouts decline.
We need to augment our intuition
with a systematic metric to measure
the progress of therapy. We live in a
highly technical world, where clients
can check every aspectabout us in an
instant. Accurately and reliably mea-
suring our own work, in turn, allows
us to communicate more accurate-
ly who we are and what we have to
offer. This is something that almost
every successful business does; con-
stantly seek feedback from consum-
ers, try to aggregate and understand
it, and make changes accordingly.
Here's another finding from
research about us therapists:we want
to see ourselves as developing pro-
fessionally over the course of our
careers. Of course, we want to get
better at what we do! And yet avail-
able evidence indicates that we don't,
not with time and experience alone.
Although we may like to see ourselves
as becoming wiser and better as we
age, that wisdom doesn't translate
into better outcomes, which is what
our clients want. Continuing educa-
tion workshops won't enhance your
craft. Rather, to get better, you have to
identi!' your specific errors in clinical
practice-not his or hers, but yours-
the times when you failed to engage
the person you were working with.
It comes down to payng attention
to the relationship qualities men-
tioned above. You have to identifu
when you uniquely failed to do that
and then develop a plan for how
you're going to address it next time.
This means not learning some fan-
cy new technique, but going back to
the basicsof therapeutic communica-
tion. Researchshowsthat most errors
that lead to clients' disengagement
and
'dropout
are a result of their
experiencing the therapeutic interac-
tion as not empathic, not consistent
with their values and preferences,
and not addressingwhat they want.
{hat we're learning is that the
better therapists are, the more time
they spend outside of work engaged
in activities specifically designed to
address their errors-what we call
reflective or deliberate practice. If
you want to be average or below aver-
age,it's fine to leaveyourjob at work,
but top performers don't do that:
they read, they consult with peers,
they get consultation, they plan.
There's no magic to it. Theyjust sim-
ply do it more than the rest of us. @
Scott Millet PhD, is the founder of the
InternationalCenterfor ClinicalExcellence.
B Y K E N N E T H H A R D Y
"legitimate." Many of these commu-
nity-based approaches are chang-
ing disconnected lives,even though
they may not match the current cri-
teria of what constitutes "good" evi-
dence-based psychotherapy. Plenty
of people are working in placeslike
the Bronx, North Philadelphia, and
Oakland who are doing really cre-
ative work that wouldn't be pub-
Iished in our professionaljournals.
In two important ways,good com-
munity work stands apart from the
kind of approaches being encour-
aged in the field today. First, there
aren't rigid prescriptions governing
who shows up for treatment, where
the treatment takes place, or how
many providers are engaged in the
process. Therapists doing commu-
nity work might invite participation
from a client's nonblood-related
aunt, homeboys, or someone else
who's not a blood relative but might
have an instrumental role in the
person's life. Second, when you're
dealing with multiproblem fami-
lies, there isn't the same pressure to
focus on the saliencyof a single pre-
senting problem. You find yourself
dealing with whatever the problem
dujour happens to be.
Just last week, I supervised an
inner-city community-based case
in which an adolescent, Thsha, was
the Identified Patient because of
chronic truancy. She had an older
TheAttailon0iuedty
s a profession, we've become
increasingly focused on our
economic survival and seem to
have turned a blind eye toward
the broader socialcondition, voicing
little about matters that aren't cen-
tral to our professional interest. For
example, we've been mute around
the recent race-related issues con-
nected to Ferguson, Missouri, and
Staten Island, New York. I don't
hear therapists becoming part of
the cultural conversation about the
strain in the relationship between
police and communities of color,
even though no professional group
is more qualified to address relation-
ship conflict than we are.
A tendency to ignore the wider
social context is reflected in our
increasing embrace of more manu-
alized approaches to therapy, pred-
icated on the notion that cultural
differences don't matter much, and
you can apply techniques more or
less uniformly across different treat-
ment populations. While I don't
think that's the intentional goal of
manualized treatment, you might
even see the increasing manualiza-
tion as an indirect attack on diversi-
ty, squeezing out people who live on
the margins of mainstream society.
Meanwhile, therapists on the
ground in the barrios, in the hoods,
and in the trenches often receive
no recognition that what they do is
2 4 r s y c H o r H E R A p y N E T W o R K E R . M A R C H / A I R I L2 o r 5