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Scott D. Miller

@scott-d-miller · 6 positions · 0 changes of mind

Founder of the International Center for Clinical Excellence and originator of Feedback-Informed Treatment. Writes about what actually makes therapists effective, usually against the field's own assumptions.

Everything they publish, on ppll ↗

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  1. A therapy is only shown to be more effective if it is compared against another treatment intended to help, not against a control nobody expected to work.

    If one really wanted to know whether a treatment (e.g., CBT, IPT, ACT, EMDR) was more effective, it had to be directly compared to an approach intended to help - what Wampold and colleagues termed, a "bona fide" treatment. Doing otherwise, they argued, conflated artifacts of research design with actual research results.

    Results from the first bona fide study of deliberate practicewritings.scottdmiller.com

    EMDRPsychotherapyCBT

  2. 3 weeks earlier
  3. Therapists overestimate their own effectiveness by about 65%, and it is not a Western cultural artifact.

    Since 2012 when the first study appeared in the literature, others have been published documenting the tendency of practitioners to overestimate their effectiveness - on average, by 65% (1, 2).

    Alas, it seems everyone comes from Lake Wobegonwritings.scottdmiller.com

    Psychotherapy

  4. 7 weeks earlier
  5. Training a therapist in a treatment model does not make them more effective, however well the model performs in a trial.

    Over the last 50 years, treatment methods have proliferated despite a lack of evidence of differential effectiveness between approaches. And even when a randomized controlled trial indicates a particular approach works, none show practitioners become more effective when they are trained in that modality.

    How to (and not to) become a more effective therapistwritings.scottdmiller.com

    Psychotherapy

  6. What does make a therapist more effective is trainable interpersonal skill, not treatment technology.

    It turns out that therapists who perform well on the FIS establish stronger relationships and are more effective (2). More to the point, the evidence shows FIS-related skills are trainable and that such training leads to better results (3, 4, 5).

    How to (and not to) become a more effective therapistwritings.scottdmiller.com

    Psychotherapy

  7. 6 weeks earlier
  8. Therapists do not improve with experience: on average they become less effective, and their clients drop out more the longer they have practised.

    Indeed, as I've reported in previous posts, research not only shows therapists do not improve with time and experience in the field, but on average become less effective (1, 2, 3, 4).

    What therapist experience, a nickel, and cup of coffee have in commonwritings.scottdmiller.com

    Psychotherapy

  9. The field should stop attributing benefits to clinical experience, because believing in it is itself what stops therapists improving.

    It's time for the field to stop attributing benefits to clinical experience. Beyond the obvious ethical concerns, doing so actually prevents us from improving our effectiveness!

    What therapist experience, a nickel, and cup of coffee have in commonwritings.scottdmiller.com

    Psychotherapy