Daryl Chow

Clinical psychology outcomes research, and studies of high performance in other fields, indicate that the critical factors separating high-performing psychotherapists from average therapists have little to do with experience or the use of empirically-supported treatments. Instead, there appear to be systematic differences in how practitioners implement the tools of their trade (regardless of their therapeutic orientation). As therapists shift their focus from traditional methods of accumulating knowledge and experience toward a more empirically-supported methodology for improving performance (including the formal collection of feedback, a stance of non-defensive openness, and individually tuned programs of delib- erate practice), evidence suggests that the individual practitioner will be able to achieve superior outcomes, measure these outcomes, and compete more effectively in the behavioral healthcare marketplace.

Although the working alliance-outcome association is well-established for adults, the working alliance has accounted for 1% of the variance in adolescent therapy outcomes. How the working alliance unfolds in therapy and is modeled in therapy studies may substantially affect how much variance is attributed to the working alliance. The sample included 2,990 military youth who were treated by 98 therapists and attended at least 8 therapy sessions. The average age was 14.91 years (SD = 1.79). Each session, clients completed the Outcome Rating Scale as a measure of psychological well-being/distress and the Session Rating Scale as a measure of working alliance. We utilized 3 models to examine the working alliance-outcome association in therapy: (a) mono-method model (i.e., 1 rating of working alliance correlated with outcomes), (b) aggregate-assessment model (i.e., multiple sessions aggregated and correlated with outcomes), and (c) change-based model (i.e., changes in working alliance sco...

More than a dozen randomized controlled trials and several meta-analyses have provided strong empirical support for routine outcome monitoring (ROM) in clinical practice. Despite current enthusiasm, advances in implementation, and the growing belief among some proponents and policymakers that ROM represents a major revolution in the practice of psychotherapy, other research has suggested that the focus on measurement and monitoring is in danger of missing the point. Any clinical tool or technology is only as good as the therapist who uses it. Failing to attend to the therapist's contribution, the long neglected variable in psychotherapy outcome, ensures that efforts to create, research, and refine new outcome measurement systems will inevitably fall short. Research from the field of expertise and expert performance provides guidance for realizing the full potential of ROM. (PsycINFO Database Record

Little empirical research exists about highly effective psychotherapists, and none about the factors that mediate the acquisition and maintenance of superior performance skills (e.g., Ericsson, 1996, 2006; Ericsson, Krampe, & Tesch-Romer, 1993). In the full sample, a 3-level multilevel modeling (Level 1: clients; Level 2: therapists; Level 3: organization types) of practitioner outcomes was used to examine the contribution of the therapist to treatment effectiveness. Consistent with prior research, in the full sample (n = 69 therapists; n = 4,580 clients) it was found that therapist effects explained 5.1% of the variance in outcome, after adjusting for initial severity. Therapist gender, caseload, and age were not found to be significant predictors. In a subsample of therapists, the relationship between outcome and therapist demographic variables, professional development activities, and work practices was analyzed (n = 17 therapists, n = 1,632 clients). Therapist characteristics (e...

Although it is well established that, on average, psychotherapy is effective, outcomes have remained flat for more than five decades. Since the 1990s, the effort to identify " empirically supported treatment " approaches has done little to alter this fact. Even more sobering, studies either fail to show therapists improve with specialized training or their outcomes steadily decline with time and experience. The aim of this paper is to illuminate how findings from the literature on expertise and expert performance illuminate new paths for the field of psychotherapy. Results to date point to new possibilities for helping practitioners realize improvements in the quality and outcome of their work.

More than a dozen randomized controlled trials and several meta-analyses have provided strong empirical support for routine outcome monitoring (ROM) in clinical practice. Despite current enthusi- asm, advances in implementation, and the growing belief among some proponents and policymakers that ROM represents a major revolution in the practice of psychotherapy, other research has suggested that the focus on measurement and monitoring is in danger of missing the point. Any clinical tool or technology is only as good as the therapist who uses it. Failing to attend to the therapist’s contribution, the long neglected variable in psychotherapy outcome, ensures that efforts to create, research, and refine new outcome measurement systems will inevitably fall short. Research from the field of expertise and expert performance provides guidance for realizing the full potential of ROM.

Objective: Although the working alliance-outcome association is well-established for adults, the working alliance has accounted for 1% of the variance in adolescent therapy outcomes. How the working alliance unfolds in therapy and is modeled in therapy studies may substantially affect how much variance is attributed to the working alliance. Method: The sample included 2,990 military youth who were treated by 98 therapists and attended at least 8 therapy sessions. The average age was 14.91 years (SD 􏰁 1.79). Each session, clients completed the Outcome Rating Scale as a measure of psychological well-being/ distress and the Session Rating Scale as a measure of working alliance. We utilized 3 models to examine the working alliance-outcome association in therapy: (a) mono-method model (i.e., 1 rating of working alliance correlated with outcomes), (b) aggregate-assessment model (i.e., multiple sessions aggregated and correlated with outcomes), and (c) change-based model (i.e., changes in working alliance scores correlated with outcomes). Results: Findings supported the change-based model. The amount of variance explained in youth outcomes via growth in working alliance scores in the change-based model was approximately 9.8%, which suggests that a key mechanism of client-perceived change for adolescents in therapy may be the continual development of the working alliance over the course of treatment. Conclusions: The monitoring of and continual promotion of the working alliance among military youth in the early phases of therapy may help therapists improve treatment outcomes.

Little empirical research exists about highly effective psychotherapists, and none about the factors that mediate the acquisition and maintenance of superior performance (e.g., Ericsson, 1996; Ericsson, 2006; Ericsson, Krampe, & Tesch-Romer, 1993). In the full sample, a three-level multilevel modeling (Level 1: clients, Level 2: therapists; Level 3: organization types) of practitioner outcomes was used to examine the contribution of the therapist to treatment effectiveness. Consistent with prior research, in the full sample (n = 69 therapists; n = 4580 clients) found that therapist effects explained 5.1% of the variance in outcome, after adjusting for initial severity. Therapist gender, caseload, and age were not found to be significant predictors. In a subsample of therapists, the relationship between outcome and therapist demographic variables, professional development activities and work practices was analyzed (n= 17 therapists, n = 1632 clients). Therapist characteristics (e.g., years of experience, gender, age, profession, highest qualification, caseload, and degree of theoretical integration) did not significantly predict client-reported outcomes. Consistent with the literature on expertise and expert performance, the amount of time spent targeted at improving therapeutic skills was a significant predictor of client outcomes. Further, highly effective therapists indicated requiring more effort in reviewing therapy recordings alone than the rest of the cohort. Caveats and implications for clinical practice, continuing professional development, and training are discussed.

In 1963, the first issue of the journal Psychotherapy appeared. Responding to findings reported in a previous publication by Eysenck (1952), Strupp wrote of the ‘staggering research problems’ confronting the field and the necessity of conducting ‘properly planned and executed studies’ to resolve questions about the process and outcome of psychotherapy. Today, both the efficacy and effectiveness of psychotherapy has been well established. Despite the consistent findings substantiating the field’s worth, a significant question remains the subject of debate: How does psychotherapy work? On this subject, debate continues to divide the profession. In this paper, a ‘way out’ is proposed informed by research on the therapist’s contribution to treatment outcome and findings from studies on the acquisition of expertise.

A growing body of evidence suggests that psychotherapists’ outcomes vary to a significant extent (Blatt, Sanislow, Zuroff, & Pilkonis, 1996; Kim, Wampold, & Bolt, 2006; Luborsky, Mclellan, Diguer, Woody, & Seligman, 1997; Okiishi et al., 2006; Okiishi, Lambert, Nielsen, & Ogles, 2003). There is a paucity of empirical evidence of how highly effective psychotherapists develop their therapeutic skills, and to what extent the engagement of domain specific deliberate practice (e.g., Ericsson, 1996; Ericsson, 2006a; Ericsson, Krampe, & Tesch-Romer, 1993) mediates the acquisition and maintenance of superior performance. In order to investigate the contribution of the therapist, three-level multilevel modeling (Raudenbush & Bryk, 2002; Snijders, 1999) was employed in a study of practitioners’ outcomes from the Human Givens Institute Practice Research Network (HGIPRN). In Study I (N = 69 therapists; N = 4580 clients), findings revealed that therapist effects explain about 5.1% of the variance in outcome, after adjusting for initial severity and treatment sites. The number of sessions and planned/unplanned endings at both the client and therapist levels explained about 65% of the variance between therapists. Therapist gender, caseload, and age range were not significant predictors in the final model. The variability on outcome that was due to therapists was greater with clients not on medication, compared with those who are on prescribed medication.
Building upon the rank ordering of therapists derived in Study I, 17 therapists from Study I (N = 1632 clients) participated in further investigations about the impact of their professional work practices, professional development, and self-assessments in Study II. Based on the generalised linear mixed modeling (GLMM), the findings indicated that
The Study of Supershrinks
xii
therapist demographic factors did not significantly predict client outcomes. The amount of time spent in solitary practice targeted at improving one’s therapeutic skills was a significant predictor of client outcomes. The number of times therapists were surprised by clients’ feedback about the session was also a significant predictor of client outcomes. Therapist who reported higher levels of healing involvement (HI) in their clinical practice were more likely to perform poorly, in terms of client outcomes. Compared with their peers, therapists’ self- assessment of effectiveness was not correlated with actual outcomes, in spite of the use of outcome measures in their clinical practice. Finally, therapists’ self-ratings about their mindsets were not predictive of client outcomes. The preliminary results from Study II must be interpreted with caution, due to the small sample size of therapists and large number of therapist variables involved in the analysis. Implications for the employment of deliberate practice and use of feedback to enhance clinical practice, continuing professional development, and training were discussed.

In 1963, the first issue of the journal Psychotherapy appeared. Responding to findings reported in a previous publication by Eysenck (1952), Strupp wrote of the “staggering research problems” (p. 2) confronting the field and the necessity of conducting “properly planned an executed experimental
studies” to resolve questions about the process and outcome of psychotherapy. Today, both the efficacy
and effectiveness of psychotherapy has been well established. Despite the consistent findings substantiating the field’s worth, a significant question remains the subject of debate: how does psychotherapy work? On this subject, debate continues to divide the profession. In this paper, a “way out” is proposed informed by research on the therapist’s contribution to treatment outcome and findings from studies on the acquisition of expertise.

Objective: The measurement of clinical change via single-group pre-post effect size has become increasingly common in
psychotherapy settings that collect practice-based evidence and engage in feedback-informed treatment. Different methods
of calculating effect size for the same sample of clients and the same measure can lead to wide-ranging results, reducing
interpretability. Method: Effect sizes from therapists—including those drawn from a large web-based database of practicing
clinicians—were calculated using nine different methods. Results: The resulting effect sizes varied significantly depending
on the method employed. Differences between measurement methods routinely exceeded 0.40 for individual therapists.
Conclusions: Three methods for calculating effect sizes are recommended for moderating these differences, including two
equations that show promise as valid and practical methods for use by clinicians in professional practice.

Purpose – To replicate the Luton pilot study (Andrews et al., 2011), both by investigating treatment changes
using the Human Givens (HG) approach via a practice research network (PRN) and by assessing the viability
of replacing the 34-item Clinical Outcome in Routine Evaluation Outcome Measure (CORE-OM) with the
ten-item version (CORE-10).
Design/methodology/approach – Clients were included if they were offered the HG approach to manage
psychological distress and attended at least one measured treatment session following their initial
assessment. Pre-post treatment effect size (Cohen’s d) was benchmarked against data from Clark et al.
(2009). Potential differences in treatment effects based on type of termination (planned vs unplanned) and
medication use were examined.
Findings – High correlation between the CORE-10 and CORE-OM and near-identical calculated effect
sizes support the utilisation of CORE-10 as a routine outcome measure. Pre-post treatment effect size
suggests that clients treated using the HG approach experienced relief from psychological distress.
Research limitations/implications – There was no experimental control nor evidence about the precise
components of the HG treatment. Data on problem description and duration may not be reliable.
Practical implications – This larger study, involving thousands of cases in a wide variety of settings,
reinforces the findings from the pilot study as to the plausibility of the HG approach in the relief of emotional
distress.
Originality/value – The viability of using a ten-item scale to reliably measure treatment effectiveness will
allow organisations to assess the quality of their treatment with minimal disruption to their service delivery
allowing for true evidence-based practice. A PRN provides a suitable mechanism to assess psychotherapy
treatment effectiveness in real-world settings.
Keywords Evidence-based clinical practice, Human Givens, Practice-based evidence,
Practice research networks, Pragmatic methodology
Paper type Research paper

Factor analyses indicated that emotional intelligence consisted of seven oblique factors : emotional awareness, emotional mastery, self-efficacy, problem-solving skills, empathy, social skills, and social acceptance. While most of the emotional intelligence factors were associated with ...

The purpose of this study was to establish the reliability and validity of the scores on a brief strengths-based assessment, the 22-item Personal Strengths Inventory (PSI). In Study 1, findings
from exploratory factor analysis of 410 adolescents provided evidence for a five-factor solution—social competence (four items), emotional awareness (five items), goal setting (six items), emotional regulation (four items), and empathy (three items). Preliminary evidence of convergent validity was also reported. In Study 2, results from confirmatory factor analysis of 598 adolescents provided additional support for the results obtained from Study 1. Moderate to high reliability coefficients were obtained for the PSI scores. The results are discussed in comparison with other research on social–emotional competence, and further research is suggested.

From the back page:
  Is recovery possible?
  What if you or a loved one struggled from a mental health concern such as schizophrenia, depression, obsessive compulsive disorder, or equally difficult issues such as low self-esteem and social stigma?
  Filled with personal stories, artworks, and poetry from people who have sought professional help, the Write to Recovery is a book about ordinary people and their extraordinary quests towards recovery from mental health concerns. Trusted mental health professionals also augment the powerful stories with insightful reflections.
  The Write to Recovery offers an earnest and personal reading experience and reaches out to those who would like to know more about how others find meaning and motivation in the process of healing.
  Most importantly, these personal contributions illustrate that recovery is indeed possible.


GO TO THIS URL TO DOWNLOAD THE COMPLETE BOOK: http://darylchow.com/Daryl_Chow/Blog/wordpress/fullcircles/book-on-recovery/