Scott Miller on Why Most Therapists Are Just Average (and How We Can Improve)
Scott Miller, expert researcher on what makes a good therapist, breaks down the difference between the masters and the rest of us.
Sections in this Interview:
| Back to Top ▲ |
Escape from Babel
|Tony Rousmaniere:||Many people know you as a Common Factors researcher, but recently you’ve transitioned away from that. Could you explain both what Common Factors is and your transition away from it?|
|Scott Miller:||Sure. As old-fashioned as it sounds, I’m interested in the truth—what it is that really matters in the effectiveness of treatment. Early on in my career, I learned and promoted and helped develop a very specific model of treatment, solution-focused therapy. We had some researchers come in near the end of my tenure at the Family Therapy Center in Milwaukee who found that, while what we were doing was effective, it wasn’t any more effective than anything else. Now, for somebody who had been running around claiming that doing solution-focused work would make you more effective in a shorter period of time, that was a huge shock.|
All models are equivalent. Pick one that appeals to you and your client.
It was at that point that I started to cast about looking for an alternate explanation for the findings, which concluded that virtually everything clinicians did, however it was named, seemed to work despite the differences. That led back to the Common Factors—the theory that there are components shared by the various psychotherapy methodologies and that those shared components account more for positive therapy outcomes than any components that are unique to an approach. It was something that one of my college professors, Mike Lambert, had talked about, but that I had dismissed as not very sexy or interesting. I thought, how could that possibly be true?
It was at that time that I ran into a couple of people that I worked with for some time, Mark Hubble and Barry Duncan, and we had written several books about this. If you read Escape from Babel, which we coauthored, the argument wasn’t that Common Factors were a way of doing therapy, but rather a frame for people—therapists speaking different languages—to share and meet with each other. They were a common ground.
But by 1999, it was very clear to me that Common Factors were being turned into a model by folks, including members of our own team, and viewed as a way to do therapy. But you can’t do a Common Factors model of therapy—it’s illogical. The Common Factors are based on all models. This caused a large amount of consternation and difficulty, numerous discussions, and eventually I suggested to the team that the way therapists work didn’t make much of a difference.
What was critical was whether it worked with a particular client and a particular therapist at a particular time. Mike Lambert was already moving in this direction and said, “Let’s just measure them. Let’s find out. Who cares what model you use? Let’s make sure that the client is engaged by it and that it’s helping them.” So we began measuring, and what became clear very quickly was that some therapists were better at it than others.
So, since about 2004, Mark Hubble and others at the International Center for Clinical Excellence (ICCE) have been researching the practice patterns of top performing therapists. It’s not that I don’t believe, and in fact know, that the Common Factors are what accounts for effective psychotherapy. It’s just that an explanation is not the same as a strategy for effecting change. And the Common Factors can never be used as such. All models are equivalent. Pick one that appeals to you and your client. ... Continue Reading Interview >>
© 2013 Psychotherapy.net LLC. All rights reserved.
Scott Miller, PhD is co-founder of the Institute for the Study of Therapeutic Change, a private group of clinicians and researchers dedicated to studying "what works" in mental health and substance abuse treatment. Dr. Miller conducts workshops and training, and speaks at conferences worldwide. He is the author of numerous articles and co-author of The Heart and Soul of Change: What Works in Therapy, The Heroic Client: A Revolutionary Way to Improve Effectiveness through Client-Directed, Outcome-Informed Therapy, and the forthcoming What Works in Drug and Alcohol Treatment. Tony Rousmaniere, PsyD, is a psychologist in private practice in Seattle and Clinical Faculty at the University of Washington. He is the editor of the forthcoming edited volume The Cycle of Expertise: Using Deliberate Practice in Supervision, Training, and Independent Practice (with co-editors Rod Goodyear, Scott Miller, and Bruce Wampold; Wiley Press), author of the forthcoming book Deliberate Practice for Psychotherapists: A Guide to Improving Clinical Effectiveness (Taylor & Francis), and co-editor of Using Technology for Clinical Supervision: A Practical Handbook (ACA Press). Dr. Rousmaniere provides clinical training and supervision to therapists around the world, with an emphasis on using deliberate practice to improve the effectiveness of clinical skill development. www.drtonyr.com
I am frankly quite tired of Outcomes being preached over Process. "Being" in the therapy is the healing. "Measuring of Outcomes" is (reflective of) the pathology . This, I know, is only a brief comment subject to multiple rebuttals. I would be happy too further engage in the topic in a more comprehensive forum.
Stephen Vernon, MFT
Great article. A subject that is truly close to my heart. I train other therapists this way as well. I really love the "dig into the one you know." I agree. So many of us are running around trying to keep a full caseload and thinking that the "next" therapeutic idea or course is the answer. Let's all rush out and hang up our shingle and then what? What happens to our substance? It is the critical thinking part that a lot of us forget about and begin to trade dollars for hours. Thank you for a very enlightening article. I am printing it out and hanging it on my "Mental Health Awareness Bulletin Board"!
Elaine Beckwith, LMHC
CE credits: 1
- Describe the Common Factors research and how it is has come to be misunderstood.
- Understand the role of deliberate practice in effective therapy and learn methods to improve your practice.
- Illustrate the common misperceptions therapists have about the efficacy of their own work.
Order CE Test
EARN 1.0 CREDITS
$15.00 or 1.0 CE PointAdd to Cart