This chapters reviews the supervision literature and covers the four steps of PCOMS supervision.
This article, a magazine style version of a chapter that Jacqueline Sparks and I wrote in the first edition of The Heroic Client, was originally published in the Psychotherapy Networker, March/April 2000 and was recognized by Project... more
This article, a magazine style version of a chapter that Jacqueline Sparks and I wrote in the first edition of The Heroic Client, was originally published in the Psychotherapy Networker, March/April 2000 and was recognized by Project Censored as one of the ten top underreported stories by mainstream media of 2000. This article also received recognition as one of the top ten most influential articles in the Networker’s first 20 years. It was inspired by a brochure that came in the June (1998) issue of the Family Therapy News. The splashy “Intimacy and Depression” brochure made our hearts sink when its exquisite design, original art, glossy photos, poignant text, heavy paper, and devastating message washed over us—profoundly disheartening us with the feel, look, and smell of creative marketing that could only come from big corporate money. But no it couldn’t be. Our national organization surely wouldn’t enter a relationship with a drug company or promote its products. Say it ain’t so. But it was. Glaxo Wellcome, a drug company, funded the project.It opened our eyes to the extent of drug company influence and fueled Jackie and my continued interest in mythmakers of psychiatric drugs.
Duncan, B. (2011). What therapists want. Psychotherapy Networker, May/June, 40-43, 47, 62. Duncan, B. (2011). Opening a path. Psychotherapy Networker, May/June, 46-47. These articles discuss what motivate therapists and how PCOMS can... more
Duncan, B. (2011). What therapists want. Psychotherapy Networker, May/June, 40-43, 47, 62.
Duncan, B. (2011). Opening a path. Psychotherapy Networker, May/June, 46-47.
These articles discuss what motivate therapists and how PCOMS can serve those motivations.
Duncan, B. (2011). Opening a path. Psychotherapy Networker, May/June, 46-47.
These articles discuss what motivate therapists and how PCOMS can serve those motivations.
BARRY DUNCAN elaborates on four questions about becoming a 'master' therapist posed by Jeffrey Kottler and Jon Carlson for their forthcoming book, 'Becoming a Master Therapist'. His answers, illustrated with clinical vignettes, integrate... more
BARRY DUNCAN elaborates on four questions about becoming a 'master' therapist posed by Jeffrey Kottler and Jon Carlson for their forthcoming book, 'Becoming a Master Therapist'. His answers, illustrated with clinical vignettes, integrate the latest research about what matters in effective psychotherapy to challenge the prevailing view that to be an accomplished psychotherapist one must be well-versed in evidence-based treatments. Psychotherapy is a relational endeavour, one wholly dependent on the participants and the quality of their interpersonal connection. After the client, the therapist is the most potent aspect of change in therapy, and in most respects is the therapy. Soliciting feedback engages clients in the collaborative monitoring of outcome, heightens hope for improvement, fits client preferences, maximises the alliance potential and client participation, and is itself a core feature of therapeutic change.
Brief overview published in The Iowa Psychologist of the common factors and feedback effect.
THIS CHAPTER DISCUSSES
•The empirical evidence supporting a strengths-based approach
•Specific practice guidelines for recruiting client resources to promote change
•The link between pluralistic counselling and a focus on client strengths
•The empirical evidence supporting a strengths-based approach
•Specific practice guidelines for recruiting client resources to promote change
•The link between pluralistic counselling and a focus on client strengths
THIS CHAPTER DISCUSSES •Systematic feedback and the Partners for Change Outcome Management System (PCOMS) •PCOMS as a way to truly privilege clients, include them as full partners in decision-making and operationalize social justice and a... more
THIS CHAPTER DISCUSSES
•Systematic feedback and the Partners for Change Outcome Management System (PCOMS)
•PCOMS as a way to truly privilege clients, include them as full partners in decision-making and operationalize social justice and a pluralistic approach
•Systematic feedback and the Partners for Change Outcome Management System (PCOMS)
•PCOMS as a way to truly privilege clients, include them as full partners in decision-making and operationalize social justice and a pluralistic approach
This study examined gender differences in session one alliances and in the trajectory of the alliance over the course of couple therapy. Additionally, this study examined the association between men and women's pre-therapy relationship... more
This study examined gender differences in session one alliances and in the trajectory of the alliance over the course of couple therapy. Additionally, this study examined the association between men and women's pre-therapy relationship adjustment and alliance at session one and over the course of therapy. A total of 316 couples seeking outpatient couple therapy were given the Locke–Wallace marital adjustment test at pre-therapy to measure relationship adjustment and the session rating scale after each session to measure alliance with the therapist. The results showed that men had lower alliance ratings after session one than women. Men's pre-therapy relationship adjustment was positively associated with their own session one alliance as well as their own alliance trajectory over the course of therapy. Men's pre-therapy relationship adjustment was also positively associated with their partner's session one alliance. Women's pre-therapy relationship adjustment showed no significant relationship with their own alliance or their partners at session one or the alliance trajectory over the course of therapy. The implications for how these gender differences may impact on the process of couple therapy with heterosexual couples are discussed.
Two continuous monitoring and feedback models have demonstrated gains in randomized clinical trials (RCTs): Lambert's Outcome Questionnaire (OQ) System and the Partners for Change Outcome Management System (PCOMS). This article chronicles... more
Two continuous monitoring and feedback models have demonstrated gains in randomized clinical trials (RCTs): Lambert's Outcome Questionnaire (OQ) System and the Partners for Change Outcome Management System (PCOMS). This article chronicles the evolution of PCOMS from a simple way to discuss the benefit of services with clients to its emergence as an evidenced based practice to improve outcomes. Although based in Lambert's model, several differences are described: PCOMS is integrated into the ongoing psychotherapy process and includes a transparent discussion of the feedback with the client; PCOMS assesses the alliance every session; and the Outcome Rating Scale, rather than a list of symptoms rated on a Likert Scale, is a clinical tool as well as an outcome instrument that requires collaboration with clients. The research supporting the psychometrics of the measures and the PCOMS intervention is presented and the clinical process summarised. Examples of successful transportation to public behav-ioural health are offered and an implementation process that values consumer involvement, recovery, social justice, and the needs of the front-line clinician is discussed. With now nine RCTs and American Psychological Association endorsements to support it, it is argued that client-based outcome feedback offers a pragmatic way to transport research to practice.
This chapter reviews the clients who most impacted Barry Duncan's career and journey to a relational model of psychotherapy and away from a medical model. This chapter appeared in In K. J. Schneider, J.F. Pierson, & J.F.T. Bugental (Eds.)... more
This chapter reviews the clients who most impacted Barry Duncan's career and journey to a relational model of psychotherapy and away from a medical model. This chapter appeared in In K. J. Schneider, J.F. Pierson, & J.F.T. Bugental (Eds.) The Handbook of Humanistic Psychology (2nd Ed.), Sage Publishing Co.
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Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates... more
Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates (Baldwin & Imel, 2013), are poor judges of negative outcomes (Chapman et al., 2012), and grossly overestimate their effectiveness (Walfish, McAlister, O’Donnell, & Lambert, 2012). Systematic client feedback offers 1 solution (Duncan, 2014). Several feedback systems
have emerged (Castonguay, Barkham, Lutz, & McAleavey, 2013), but only 2 have randomized clinical trial support and are included in the Substance Abuse and Mental Health Administration’s National Registry of Evidence-Based Programs and Practices: The Outcome Questionnaire– 45.2 System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012). This article presents the current status of PCOMS, the psychometrics of the PCOMS measures, its empirical
support, and its clinical and training applications. Future directions and implications of PCOMS research, training, and practice are detailed. Finally, we propose that systematic feedback offers a way, via large-scale data collection, to reprioritize what matters to psychotherapy outcome, reclaim our empirically validated core values and identity, and change the conversation from a medical model dominated discourse to a more scientific, relational perspective.
have emerged (Castonguay, Barkham, Lutz, & McAleavey, 2013), but only 2 have randomized clinical trial support and are included in the Substance Abuse and Mental Health Administration’s National Registry of Evidence-Based Programs and Practices: The Outcome Questionnaire– 45.2 System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012). This article presents the current status of PCOMS, the psychometrics of the PCOMS measures, its empirical
support, and its clinical and training applications. Future directions and implications of PCOMS research, training, and practice are detailed. Finally, we propose that systematic feedback offers a way, via large-scale data collection, to reprioritize what matters to psychotherapy outcome, reclaim our empirically validated core values and identity, and change the conversation from a medical model dominated discourse to a more scientific, relational perspective.
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... AUTHOR AFFILIATIONS. Barry L. Duncan, Dayton Institute for Family Therapy. M. Bernadine Parks, Wright State University. Mary Ann Kraus, Bellefaire Residential Treatment Center, Shaker Heights, OH. © 1987 American Psychological... more
... AUTHOR AFFILIATIONS. Barry L. Duncan, Dayton Institute for Family Therapy. M. Bernadine Parks, Wright State University. Mary Ann Kraus, Bellefaire Residential Treatment Center, Shaker Heights, OH. © 1987 American Psychological Association. CITATION. ...
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The development of an eclectic paradigm has been hampered by fundamental differences in theoretical conceptualization. This article proposes a technical eclecticism that extends a strategic model to include the contributions of diverse... more
The development of an eclectic paradigm has been hampered by fundamental differences in theoretical conceptualization. This article proposes a technical eclecticism that extends a strategic model to include the contributions of diverse therapy approaches. A strategic eclecticism is presented that attempts to maximize common factor effects, as well as to enable the selective application of both content and technique from
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... A review of the outcome research (Lambert, Shapiro & Bergin, 1986) suggests that 30% of outcome variance is accounted for by the common factors (variables found in a variety of therapies regardless of the therapist's... more
... A review of the outcome research (Lambert, Shapiro & Bergin, 1986) suggests that 30% of outcome variance is accounted for by the common factors (variables found in a variety of therapies regardless of the therapist's theoretical orienta-tion). ...
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This article provides commentary on Saul Rosenzweig’s classic 1936 paper, "Some Implicit Common Factors in Diverse Methods of Psychotherapy," with particular emphasis on his clever and prophetic invocation of the dodo... more
This article provides commentary on Saul Rosenzweig’s classic 1936 paper, "Some Implicit Common Factors in Diverse Methods of Psychotherapy," with particular emphasis on his clever and prophetic invocation of the dodo bird verdict from Alice in Wonderland. The impact of this seminal contribution is discussed by a comparison of Rosenzweig’s original common factors proposal with modern formulations of common factors. The paradox inherent to the tenacious veracity of the dodo bird verdict and the pursuit of empirically validated treatments are explored. In the spirit of Rosenzweig’s legacy and the wisdom of the dodo, this article suggests that psychotherapy abandon the empirically bankrupt pursuit of prescriptive interventions for specific disorders based on a medical model of psychopathology. Instead, a call is made for a systematic application of the common factors based on a relational model of client competence.
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In preparation for a commentary on Saul Rosenzweig's classic 1936 paper, Some Implicit Common Methods in Diverse Forms of Psychotherapy, an amazing discovery was made: Saul Rosenzweig is not only alive but also still contributing... more
In preparation for a commentary on Saul Rosenzweig's classic 1936 paper, Some Implicit Common Methods in Diverse Forms of Psychotherapy, an amazing discovery was made: Saul Rosenzweig is not only alive but also still contributing to science and society at age 93. This article sets ...
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... Fulfillment of two conditions, (a) the mishandling of the difficulty, and (b) applying more of the same when the original solution attempts ... A behavioral-systems approach to the treatment of marital jealousy. ... Integrative... more
... Fulfillment of two conditions, (a) the mishandling of the difficulty, and (b) applying more of the same when the original solution attempts ... A behavioral-systems approach to the treatment of marital jealousy. ... Integrative problem-centered therapy: Toward the synthesis of family and ...
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This study investigated whether routine monitoring of client progress, often called “client feedback,” via an abbreviated version of the Partners for Change Outcome Management System (PCOMS) resulted in improved outcomes for soldiers... more
This study investigated whether routine monitoring of client progress, often called “client feedback,” via an abbreviated version of the Partners for Change Outcome Management System (PCOMS) resulted in improved outcomes for soldiers receiving group treatment at an Army Substance Abuse Outpatient Treatment Program (ASAP). Participants (N = 263) were active-duty male and female soldiers randomized into a group feedback condition (n = 137) or a group treatment-as-usual (TAU) condition (n = 126). Results indicated that clients in the feedback condition achieved significantly more improvement on the outcome rating scale (d = 0.28), higher rates of clinically significant change, higher percentage of successful ratings by both clinicians and commanders, and attended significantly more sessions compared to the TAU condition. Despite a reduced PCOMS protocol and a limited duration of intervention, preliminary results suggest that the benefits of client feedback appear to extend to group psychotherapy with clients in the military struggling with substance abuse.
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Objective:The purpose of this review is to assess whether evidence supports a favorable risk/benefit profile for pediatric antidepressant use and reconsideration of the black box.Method:The review examines studies post-black box... more
Objective:The purpose of this review is to assess whether evidence supports a favorable risk/benefit profile for pediatric antidepressant use and reconsideration of the black box.Method:The review examines studies post-black box purporting to show declines in pediatric antidepressant use and rising youth suicide, summarizes evidence for efficacy and safety of pediatric antidepressants, and discusses irregularities in recent meta-analyses of fluoxetine for youth.Results:Pediatric antidepressant prescription did not significantly decline post-black box and youth suicide has risen only in recent years. Recent meta-analyses fail to undermine evidence that antidepressants are associated with increased risk of suicidality in youth.Conclusions:First line prescription of antidepressants for youth is not advisable. The black box and international warnings on pediatric use of antidepressants are warranted. Wider availability of psychosocial options for depressed youth is recommended.
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Prescriptions for psychiatric drugs to children and adolescents have skyrocketed in the past 10 years. This article presents evidence that the superior effectiveness of stimulants and antidepressants is largely a presumption based on an... more
Prescriptions for psychiatric drugs to children and adolescents have skyrocketed in the past 10 years. This article presents evidence that the superior effectiveness of stimulants and antidepressants is largely a presumption based on an empirical house of cards, driven by an industry that has no conscience about the implications of its ever growing, and disturbingly younger, list of consumers. Recognizing that most mental health professionals do not have the time, and sometimes feel ill-equipped to explore the controversy regarding pharmacological treatment of children, this article discusses the four fatal flaws of drug studies to enable critical examination of research addressing the drugging of children. The four flaws are illustrated by the Emslie studies of Prozac and children, which offer not only a strident example of marketing masquerading as science, but also, given the recent FDA approval of Prozac for children, a brutal reminder of the danger inherent in not knowing how t...
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The purpose of this study was to evaluate the effectiveness of a large public behavioral health (PBH) agency serving only clients at or below the federal poverty level that had implemented continuous outcome feedback as a quality... more
The purpose of this study was to evaluate the effectiveness of a large public behavioral health (PBH) agency serving only clients at or below the federal poverty level that had implemented continuous outcome feedback as a quality improvement strategy. The authors investigated the post treatment outcomes of 5,168 individuals seeking treatment for a broad range of diagnoses who completed at least 2 psychotherapy sessions. The Outcome Rating Scale (ORS; Duncan, 2011; Miller & Duncan, 2004) was used to measure outcomes. Clients had a mean age of 36.7 years and were predominantly female (60.7%) and White (67.8%), with 17.7% being Hispanic, 9.3% being African American, and 2.8% being Native American. Forty-six percent were diagnosed with depression, mood, and anxiety disorders; 18.8% were diagnosed with substance abuse disorders; and 14.4% were diagnosed with bipolar disorder and schizophrenia. A subset of clients with a primary diagnosis of a depressive disorder was compared to treatment...
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This study examined whether therapist gender, professional discipline, experience conducting couple therapy, and average second-session alliance score would account for the variance in outcomes attributed to the therapist. The authors... more
This study examined whether therapist gender, professional discipline, experience conducting couple therapy, and average second-session alliance score would account for the variance in outcomes attributed to the therapist. The authors investigated therapist variability in couple therapy with 158 couples randomly assigned to and treated by 18 therapists in a naturalistic setting. Consistent with previous studies in individual therapy, in this study therapists accounted for 8.0% of the variance in client outcomes and 10% of the variance in client alliance scores. Therapist average alliance score and experience conducting couple therapy were salient predictors of client outcomes attributed to therapist. In contrast, therapist gender and discipline did not significantly account for the variance in client outcomes attributed to therapists. Tests of incremental validity demonstrated that therapist average alliance score and therapist experience uniquely accounted for the variance in outcomes attributed to the therapist. Emphasis on improving therapist alliance quality and specificity of therapist experience in couple therapy are discussed.
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... result for their funding source (eg, see Antonuccio, Danton, & McClanahan, 20032. Antonuccio, DO, Danton, WG and McClanahan, TM 2003 ... For example, Emslie's 20029. Emslie, GJ, Heiligenstein, JH, Wagner, KD,... more
... result for their funding source (eg, see Antonuccio, Danton, & McClanahan, 20032. Antonuccio, DO, Danton, WG and McClanahan, TM 2003 ... For example, Emslie's 20029. Emslie, GJ, Heiligenstein, JH, Wagner, KD, Hoog, SL, Ernest, DE, Brown, E., Nilsson, M. and Jacobson, JG ...
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Despite the overall efficacy of psychotherapy, dropouts are substantial, many clients do not benefit, therapists vary in effectiveness, and there may be a crisis of confidence among consumers. A research paradigm called patient-focused... more
Despite the overall efficacy of psychotherapy, dropouts are substantial, many clients do not benefit, therapists vary in effectiveness, and there may be a crisis of confidence among consumers. A research paradigm called patient-focused research--a method of enhancing outcome via continuous progress feedback--holds promise to address these problems. Although feedback has been demonstrated to improve individual psychotherapy outcomes, no studies have examined couple therapy. The current study investigated the effects of providing treatment progress and alliance information to both clients and therapists during couple therapy. Outpatients (N = 410) at a community family counseling clinic were randomly assigned to 1 of 2 groups: treatment as usual (TAU) or feedback. Couples in the feedback condition demonstrated significantly greater improvement than those in the TAU condition at posttreatment, achieved nearly 4 times the rate of clinically significant change, and maintained a significant advantage on the primary measure at 6-month follow-up while attaining a significantly lower rate of separation or divorce. Mounting evidence of feedback effects with different measures and populations suggests that the time for routine tracking of client progress has arrived.
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Research Interests: Psychology, Sex, Social Interaction, Prediction, Treatment, and 21 moreConsulting, Interpersonal Relationship, Norway, Humans, Effect size, Female, Therapy, Male, Behavior change, Follow-up studies, Feedback, Patient Satisfaction, Rating Scale, Rating Scales, Questionnaires, Adult, Sex Factors, Reliable Change Index, Prognosis, Couples Therapy, and Family Conflict
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The two major forms of treatment for drug abuse, psychosocial treatments and pharmacologic treatments, have a number of differences in terms of their mode of action, time to effect, target symptoms, durability, and applicability across... more
The two major forms of treatment for drug abuse, psychosocial treatments and pharmacologic treatments, have a number of differences in terms of their mode of action, time to effect, target symptoms, durability, and applicability across drugs of abuse. While each has specific indications and strengths, no psychotherapy or pharmacotherapy is universally effective, and both forms of treatment have some limitations,
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Reply to comments on an article by Duncan and Sparks (see record 2018-10637-001). Østergård and Hougaard (2020) reiterate the flawed conclusions of their meta-analysis of the Partners for Change Outcome Management System (PCOMS) and... more
Reply to comments on an article by Duncan and Sparks (see record 2018-10637-001). Østergård and Hougaard (2020) reiterate the flawed conclusions of their meta-analysis of the Partners for Change Outcome Management System (PCOMS) and obfuscate the main point of our critique (Duncan & Sparks, 2020). Despite the lauded statistics and selection criteria, the inclusion of six significantly confounded investigations resulted in a misleading overattribution of meaning to studies of questionable methodology that warranted exclusion. Further, their hypothesis that social desirability leads to inflated effect sizes on the Outcome Rating Scale (ORS) is insufficient. It is not supported by studies finding comparable results to the ORS on independent outcome measures or investigations reporting that change on measures of life functioning, like the ORS, precedes that depicted on symptom scales. While more research is needed, the totality of credible research supports the efficacy of PCOMS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Brief overview published in The Iowa Psychologist of the common factors and feedback effect.
Research Interests: Philosophy and Soul
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With a simple focus on "what works, " this practical book spells out a compelling rationale and practical blueprint for time-efficient, collaborative problem solving in the schools. Demonstrating that every contact with clients... more
With a simple focus on "what works, " this practical book spells out a compelling rationale and practical blueprint for time-efficient, collaborative problem solving in the schools. Demonstrating that every contact with clients is an opportunity for empowerment and change, the authors draw upon extensive hands-on experience and the latest findings in psychotherapy outcome research to present effective strategies for handling behavioral, academic, and psychosocial problems. Tables and figures highlight the building blocks of this unique approach, and extensive case examples and sample dialogues guide school practitioners and trainees through the interview and intervention process. Addressing a range of commonly encountered difficulties, such as recurring disciplinary problems, poor academic performance, and anxiety, chapters show readers how to build a positive relationship with students, teachers, and parents; concentrate on strengths and avoid exclusive focus on clients' deficiencies; assume alternative perspectives to encourage new solutions; alter problem cycles and validate clients' values and ideas about change; and evaluate and maintain progress.
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Page 1. The Heart And Soul Of Change, 2Ed: Delivering What Works In Therapy Table of Contents Contributors Foreword David E. Orlinsky Preface Prologue: Saul Rosenzweig: The Founder of Common Factors Barry L. Duncan ...
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How can therapists become better at doing what they love, avoid burnout, and prevent client dropout? Respected therapist, trainer, and researcher Barry Duncan asserts that getting better at this work requires therapists to dedicate... more
How can therapists become better at doing what they love, avoid burnout, and prevent client dropout? Respected therapist, trainer, and researcher Barry Duncan asserts that getting better at this work requires therapists to dedicate themselves to two key tasks: obtaining systematic client feedback and taking charge of their own development as a therapist. This book describes his 'Partners for Change Outcome Management System' (PCOMS), which provides systematic feedback from clients, thereby enabling therapists to identify and target clients who aren't responding to traditional treatment before they drop out. Duncan examines the common factors inherent to all successful therapies and details the importance of the therapeutic alliance as the foundation of effective therapy. He encourages therapists to expand their theoretical breadth, think deeply about the lessons they learn from their clients, and integrate these lessons into their performance. Scholarly yet deeply personal, with lively case examples and unfailing good humor, Duncan's work is essential reading for anyone who seeks to rediscover purpose in their work. New to this edition are two chapters, one demonstrating PCOMS with couples, families, and youth and the other presenting how to implement PCOMS on an organizational scale. This book also integrates the author's responses to many thoughtful questions raised by trainees and readers of the last edition.
Research Interests: Psychology and Trainer
T he ' boisea trivittatus', better known as the box elder bug, emerges from the recesses of homes and dwellings in early spring. While feared neither for its bite nor sting, most people consider the tiny insect a pest. The... more
T he ' boisea trivittatus', better known as the box elder bug, emerges from the recesses of homes and dwellings in early spring. While feared neither for its bite nor sting, most people consider the tiny insect a pest. The critter comes out by the thousands, resting in the sun and ...
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ABSTRACT
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Research Interests: Philosophy and Treasure
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Prescriptions for psychiatric drugs to children and adolescents have skyrocketed in the past 10 years. This article presents evidence that the superior effectiveness of stimulants and antidepressants is largely a presumption based on an... more
Prescriptions for psychiatric drugs to children and adolescents have skyrocketed in the past 10 years. This article presents evidence that the superior effectiveness of stimulants and antidepressants is largely a presumption based on an empirical house of cards, driven by an industry that has no conscience about the implications of its ever growing, and disturbingly younger, list of consumers. Recognizing that most mental health professionals do not have the time, and sometimes feel ill-equipped to explore the controversy regarding pharmacological treatment of children, this article discusses the four fatal flaws of drug studies to enable critical examination of research addressing the drugging of children. The four flaws are illustrated by the Emslie studies of Prozac and children, which offer not only a strident example of marketing masquerading as science, but also, given the recent FDA approval of Prozac for children, a brutal reminder of the danger inherent in not knowing how to distinguish science from science fiction. The authors argue that an ethical path requires the challenge of the automatic medical response to medicate children, with an accompanying demand for untainted science and balanced information to inform critical decisions by child caretakers.
Research Interests: Mental Health, Conscience, Conflict of Interest, Adolescent, Medicine, and 15 moreHumans, Child, Child Advocacy, Placebos, Children and Adolescents, FLUOXETINE, Marketing of Health Services, Minors, Drug Industry, Clinical Trials as Topic, Attention deficit disorder with hyperactivity, Presumption, Antidepressive agents, Drug prescriptions, and Medical prescription
Introduction: Many suggest that the next step for integrated care is widespread implementation of measurement-based care (MBC). Although the measures most associated with MBC are standardized, no randomized clinical trial has demonstrated... more
Introduction: Many suggest that the next step for integrated care is widespread implementation of measurement-based care (MBC). Although the measures most associated with MBC are standardized, no randomized clinical trial has demonstrated their use to improve psychotherapeutic outcomes with embedded behavioral health providers in integrated care. Two evidence-based MBC systems have been studied in a variety of behavioral health environments, but neither system has been investigated in integrated health care. Addressing this gap in the literature, the present study evaluated the use of MBC, specifically the Partners for Change Outcome Management System, in three integrated care sites. Method: Using a randomized design within routine care, treatment as usual (TAU; n = 133) was compared using the Outcome Rating Scale (ORS) and Patient Health Questionnaire-9 (PHQ-9) with a feedback condition (n = 147) in which behavioral health providers had access to patient-generated outcome (ORS only) and alliance information at each session. Results: Patients in the feedback condition demonstrated significantly more improvement than those in the TAU condition posttreatment on the ORS. Patients in the feedback condition also achieved significantly more clinically significant change as measured by both the ORS and PHQ-9. Feedback condition patients also attended significantly more sessions and dropped out significantly less that TAU patients. Discussion: Although our findings need to be replicated, this study offers evidence that the improved outcomes and reduced dropouts associated with MBC in traditional behavioral health centers also occur in integrated care settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Accountability via the application of research to practice is the raison d'etre of the empirically supported treatment (EST), evidence-based treatment (EBT), and evidence-based practice (EBP) movements. Although basing practice on... more
Accountability via the application of research to practice is the raison d'etre of the empirically supported treatment (EST), evidence-based treatment (EBT), and evidence-based practice (EBP) movements. Although basing practice on empirical findings seems only reasonable, application becomes complex when unfurled in the various social, political, economic, and other ideological contexts that influence the delivery of mental health services (Norcross, Beutler, & Levant, 2006). This chapter describes two different approaches to defining and disseminating evidence (Littell, 2010)—one that seeks to improve clinical practice via the dissemination of treatments meeting a minimum standard of empirical support (EBT) and another that describes a process of research application to practice that includes clinical judgment and client preferences (EBP). We unfold the controversy by addressing the nature of evidence, how it is transported to real-world settings, and ultimately, whether such evidence improves client outcomes. To further inform the debate surrounding the two approaches, this chapter also discusses the randomized clinical trial (RCT), its specificity assumption, and the connection of the RCT to a medical model way of understanding psychotherapy. Finally, we strike at the heart of the controversy by tackling the thorny question of whether EBTs should be mandated. Keywords: evidence-based treatments; evidence-based practice; dodo verdict; common factors
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Research Interests: Psychology and Mythology
The purpose of this study was to explore the relationship between the alliance and outcome in couple therapy and examine whether the alliance predicted outcomes over and above early change. The authors also investigated partner influence... more
The purpose of this study was to explore the relationship between the alliance and outcome in couple therapy and examine whether the alliance predicted outcomes over and above early change. The authors also investigated partner influence and gender and sought to identify couple alliance patterns that predicted couple outcomes. The authors examined the alliances and outcomes at posttreatment and follow-up of 250 couples seeking treatment for marital distress in a naturalistic setting. The Session Rating Scale was used to measure the alliance; the Outcome Rating Scale and Locke Wallace Marital Adjustment Scale were used to measure outcomes. Couples were White, Euro-Scandinavian, and heterosexual, with a mean age of 38.5 years and average number of years together of 11.8. On a subsample (n = 118) that included couples with 4 or more sessions, the authors investigated the relationship between the alliance and outcome controlling for early change, and patterns of alliance development were delineated. In the full sample, first-session alliances were not predictive of outcomes, but last-session alliances were predictive for both individuals and their partners. In the subsample, third-session alliances predicted outcome significantly above early change (d = 0.25) that exceeded the reliable change index. Couple alliances that started over the mean and increased were associated with significantly more couples achieving reliable or clinically significant change. Gender influences were mixed. Given the current findings suggesting a potential alliance impact over and above symptom relief as well as the importance of ascending alliance scores, continuous assessment of the alliance appears warranted.
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... result for their funding source (eg, see Antonuccio, Danton, & McClanahan, 20032. Antonuccio, DO, Danton, WG and McClanahan, TM 2003 ... For example, Emslie's 20029. Emslie, GJ, Heiligenstein, JH, Wagner, KD,... more
... result for their funding source (eg, see Antonuccio, Danton, & McClanahan, 20032. Antonuccio, DO, Danton, WG and McClanahan, TM 2003 ... For example, Emslie's 20029. Emslie, GJ, Heiligenstein, JH, Wagner, KD, Hoog, SL, Ernest, DE, Brown, E., Nilsson, M. and Jacobson, JG ...
Research Interests: Psychology, Psychiatry, Depression, Clinical Trial, Medicine, and 15 moreReview, Children, Adolescents, Psychostimulants, Risks, Children and Adolescents, Antidepressants, Critical Analysis, Harm, Public health systems and services research, Benefits, Family Psychotherapy, Psychotropic medication, Attention deficit hyperactivity disorder, and Medical prescription
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... to 32% who made some progress) in a sample of 275 randomly selected clients, seen ... the author to a group of adolescent offenders in a secure facility to a matched control ... Since the publication of the Gingerich and Eisengart... more
... to 32% who made some progress) in a sample of 275 randomly selected clients, seen ... the author to a group of adolescent offenders in a secure facility to a matched control ... Since the publication of the Gingerich and Eisengart (2000) review, one additional study has appeared ...
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... DOI: 10.1080/08975350801904122 Jacqueline A. Sparks a * & ... A far more accurate account of the data might be, It appears that some adolescents benefit from it but most do not. Contrary to their stated opinion,... more
... DOI: 10.1080/08975350801904122 Jacqueline A. Sparks a * & ... A far more accurate account of the data might be, It appears that some adolescents benefit from it but most do not. Contrary to their stated opinion, psychotherapy fares much better than these meager results (APA ...
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Have we got the medication issue terribly wrong? Could it be that deliberate misinformation, misguided hopefulness, sheer ignorance and vested interests have combined to mislead us utterly in the usefulness of drugs? In this critique of... more
Have we got the medication issue terribly wrong? Could it be that deliberate misinformation, misguided hopefulness, sheer ignorance and vested interests have combined to mislead us utterly in the usefulness of drugs? In this critique of psychiatric medication, [the author] argues that drugs must always be subordinate to the therapeutic relationship. (editor abstract)
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ABSTRACT Describes the principles of a client-directed, outcome-informed approach to couples therapy. This approach is based on outcome research that identifies 4 factors common to effective therapies: extra-therapeutic or client factors;... more
ABSTRACT Describes the principles of a client-directed, outcome-informed approach to couples therapy. This approach is based on outcome research that identifies 4 factors common to effective therapies: extra-therapeutic or client factors; a positive therapeutic relationship; placebo, hope, and expectancy; and factors related to models and techniques, which are beliefs and procedures unique to specific treatments. This chapter brings to life the voices of Mike and Jan, the illustrative case presented by the editors, in an imagined therapy. Following discussion of the therapist skills and attributes, constructed dialogue with Mike and Jan is presented, so that the reader may get a feel for the in-the-moment reliance on the clients' resources, experiences, goals, and perspectives that predominate the client-directed approach. (PsycINFO Database Record (c) 2012 APA, all rights reserved)