Interpersonal Wisdom Allowing your natural gifts to flourish in talk therapy - PowerPoint Presentation

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Interpersonal Wisdom

Allowing your natural gifts to flourish in talk therapy

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Why is this Important?

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Mental Health Crisis in America

Depression and Anxiety on the increase.

2/3 of women report extreme stress.

Middle aged men in deep despair.

Crisis of resilience on college campuses.

Drug abuse up.

Mass shootings way up.

Faith in government way down.

Trust in each other way down.

Pharmaceutical use way up.

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Are excellent Talk Therapists born or bred?

Are there natural Healers?

What qualities do they possess?

Is there a Talk Therapy personality type?

Are there bad shrink personalities? – people that should not be therapists.

Why do people become therapists?

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Born or Bred continued

Can great therapy be taught?

Does our current educational process cultivate great therapists?

Does clinical supervision cultivate great therapists?

Which life experiences cultivate great therapists?

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Does graduate education work?

Source – Miller and Hubble, The Road to Mastery, Psych Networker (May 2011)

In a comparative study of licensed doctoral-level providers, pre- doctoral interns, and practicum students that appeared in

the

Journal of Counseling & Development

, Scott Nyman, Mark Nafziger, and Timothy Smith found “the extensive efforts involved in educating graduate students to become licensed professionals result in

no observable differences

in client outcome

.”

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Interpersonal Wisdom

The everyday excellent talk therapist capacities, which are a constellation of skills, attitudes, behaviors, beliefs, and some difficult to describe ways of being.

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Superiority Complex?

Despite common counseling folklore, there is little or no difference in outcome between treatment approaches. No model has proven to be any better than any other model. All approaches work about equally well (Wampold, Miller).

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CBT off its pedestal

Socialstyrelsen, the National Mental Health Board in Sweden has officially ended the CBT mandate. Providers are now encouraged to be flexible and offer their clients choices.

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What we think we know

Demographic factors (race, gender, age, cultural background), professional identity (counseling vs. psychology vs. social work) and even professional experience (defined as years of practice) are unrelated to counseling outcome (or at least overrated in the therapeutic relationship).

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What this means

Matching of clients and counselors on these dimensions (e.g. client and counselor of same race working together) does not (necessarily) result in increased efficacy.

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End psychiatry monopoly?

Allen Frances, MD New York Times (May 2012)

The psychiatrist who lead the DSM - 4 Task Force now says he believes psychiatrists should not be the only professionals given the right to determine what is or is not a mental illness.

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What he did not say

There is little evidence to suggest that a particular psychiatric diagnosis guides the practitioner toward the selection of a particular treatment.

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What does all this mean?

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Essential psychotherapy ingredients-Frank

An

emotionally–charged

confiding relationship with a helping person.

A

healing setting

.

A rationale, conceptual scheme, or

myth.

A

ritual

or procedure.

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Jerome Frank Creed

Psychotherapy achieves its effects largely by directly treating

demoralization

and only indirectly treating overt symptoms of covert psychopathology.

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Inspiration from Carl Whitaker

“

Psychotherapy is by its very nature a counter-cultural enterprise.”

“All great psychotherapy involves risk.”

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Ways we professionals get in trouble

Distancing ourselves from others’ pain (therapeutic defense or burnout).

Acting like an “expert” unless they want us to act like an expert.

Hiding behind our roles.

Poor differentiation.

Ego investment in others’ recovery.

Sticking to a manual – more later.

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Talk Therapy works

The average treated psychotherapy client is better off than 80% of the untreated sample (Wambold, 2001).

The average psychotherapy client does 4 times better than the untreated client.

But there is a great range of effectiveness among clients and therapists.

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Hot off the PressesDoes Publication Bias Inflate the Apparent Efficacy of Psychological Treatment for Major Depressive Disorder? A Systematic Review and Meta-Analysis of US National Institutes of Health-Funded

Trials - Elllen

Driessen ,

Steven

D. Hollon,

Claudi

L. H. Bockting,

Pim

Cuijpers,

Erick

H.

Turner - September 30, 2015 The efficacy of psychological interventions for depression has been overestimated in the published literature, just as it has been for pharmacotherapy. Both are efficacious but not to the extent that the published literature would suggest.Published literature overestimates the effects of the predominant treatments for depression. Studies with poor outcomes are omitted from the literature. In other words, researchers lie.

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Good News from this new study

Psychotherapy was found clearly superior to a variety of placebo and no-treatment controls, including treatment-as-usual, pill-placebo, and non-specific control conditions.

No

differences in outcome were found between treatment

approaches

No differences in outcome were found between psychological treatments and anti-depressant medication.

Finally, the effect of psychotherapy plus medications was superior to anti-depressant medication alone.

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Perceptions

The least effective therapists often believe they are as effective as the most effective therapists. (Duncan, 2006)

Consumers have a very low perception of the therapy profession, rating us below car salesman and just above lawyers. (CR)

How can we change that?

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Are providers interchangeable?

In most effectiveness studies it is assumed that the therapist can be an independent variable that can apply the specific model ingredients with absolute fidelity.

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Not PC Therapy Truths

All Models Work! (Dodo)

The alliance is king.

It’s the Therapist Stupid!

General Effects Prevail.

Allegiance Effects - Critical.

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Talk Therapy Truths continued

Between Therapist Differences exceed Between Treatment Differences.

Therapy is:

4 X as Effective as No Treatment.

2 X as Effective as Placebo.

25% of Clients Improve Before Therapy.

50% Change after 7-9 Sessions.

50% Recover After 7-9 Sessions.

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Debunking a myth

Past Treatment Failures do not predict whether the client will have a bad outcome in a current encounter. -Wambold

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Common Factors Radicalism

Extra-therapeutic Factors.

Relationship Factors.

Hope and Expectancy.

Model and Technique.

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Treatment approach

Accounts for a small portion of the variance in client outcomes – in some studies zero.

Setting

and

Therapist

factors have a significantly higher positive effect.

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Shrink Relationships

M

atter

In one study the top third of psychiatrists had better outcomes even with a placebo than the bottom third psychiatrists with an SSRI. Apparently the

person

of the psychiatrist makes a difference in the response to anti-depressant medication.

McKay, Imel, and Wampold, Journal of Affective Disorders (2006)

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It’s the Relationship

Interpersonally wise talk therapists recognize that their ability to balance allegiance to an approach, boldness (especially early in treatment), empathy, and responsiveness creates the best opportunity for a healing alliance.

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What do clients want?

When clients are asked after the conclusion of therapy what made it work for them, most people say, “I could tell my therapist liked (respected) me”.

Therefore, if you cannot like (respect) your client refer her/him to someone else.

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Being in alliance

Determining and aligning with the client’s stage of change (MI, P and D, and De Shazer).

Applying Rogerian principles.

Working with goals.

Working with tasks.

Seeking regular feedback.

Continuously maneuvering within the evolving relationship.

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Client-Direction

Bring your relational complexity to the process and “feel out” how that fits with what that client likes and needs.

- Barry Duncan 2006

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Supershrink qualities (Scott Miller)

Have lower initial SRS scores

Non-conventional people

Supervisors and other therapists could not tell which therapists were super.

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Model infidelity

Not Model Fidelity

The erroneous EST mythology.

If we can’t measure it then it does not exist. – What?

We need courageous therapists that practice outside the box.

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Documentation Nightmare

In clinic settings, therapists spend up to 50% of their time doing paperwork.

R

esearch

shows that a high documentation to clinical service ratio leads to higher rates of:

Burnout and job dissatisfaction among clinical

staff.

Fewer scheduled treatment

appointments.

No shows, cancellations, and disengagement among consumers

.

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Let’s talk about

Interpersonal Wisdom

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Being is more important than doing

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Character is more important than competence

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Being self-confident without taking

your self too seriously

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Able to elicit “change talk”

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A curious personality

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Caring the right amount - Providing some direction AND containment when needed.

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Flexible maneuvering but solid grounding

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Artful continuous relational assessment

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Interpretations that hit the emotional mark

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Early and well-timed risk-taking

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Good timing, especially when challenging clients

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Skillful repair of alliance disruptions.

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In charge but not controlling

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Transmit positive energy

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Just hang in there

until something good happens

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Using stall tactics until the reptile crawls away

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Have Faith in the Universe

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Interpersonal Wisdom

The talk therapy field should shift its training emphasis from masters, models, and madness to:

building character and increasing interpersonal capacities. The most important capacities are alliance building and adaptive maneuvering.

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Optimizing yourself

Making peace with your strengths and weaknesses.

Developing transparency and humility.

Developing the courage to be bold.

Learning to tolerate ambiguity.

Learning to manage anxiety.

Learning how to like a lot of different people.

Accepting the existence of your triggers.

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Optimizing yourself continued

Developing good differentiation.

Feeding your belief in human potential.

Finding hope so you can offer hope.

Maintaining emotional fitness.

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Faith in the universe

There is something powerful and grand in the universe that is bigger than human beings. It is larger than our ego’s projection. Experiencing the Deity, how ever one does that (for me it is often being in the state of awe), diminishes our own tendencies toward narcissism and our controlling instincts. It helps us see order in things and brings peace. This belief motivates us to do good things out of respect for that amazing order. It also humbles us.

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In Conclusion

Interpersonal Wisdom

is more than a series of skills. It is a spiritual awareness that encompasses a deep appreciation for humanity. The awareness gives us both humility and confidence. We embrace the trust given to us by the community to do our best to guide help-seekers to positive changes and we are compelled to use our humanity and our power for good.