Training clinicians in 'evidence-based,' manualized therapies, diagnosis, and even the alliance has little if any impact on outcome - Scott Miller
This weekend I had the pleasure of attending the day-long workshop, Supershrinks presented by Scott Miller, the founder of the International Center for Clinical Excellence. Scott's presentation basically covered several themes, what works in therapy, how clinical excellence is achieved, creating a culture of feedback from clients, and what deliberate practice looks like. All of which nicely book-ended some of what I heard at David Epston's and Stephen Madigan's recent workshop. They had additional ideas about excellence, apprenticeship, practice, reflection, and more practice before and after sessions.
As the day progressed I was asking myself if these ideas about generating feedback fit with my poststructural leanings in therapy. As the day progressed I gradually became more and more comfortable with trying them out, and actually believed that they could be an effective tool for several reasons:
1. The ORS & SRS could go a long way toward flattening the hierarchy in the room. It seemed that tools like these could really put skin on the idea that the people who consult with us direct the treatment they receive, rather than the other way around.
2. Scott Miller was great about naming, and re-naming our fields go-to position of blaming the client if things don't work out in therapy, or people don't come back, etc. Tools like these would shift the burden of helpful therapy back to the therapist, where it belongs. But rather than a "beat up the therapist" evaluative tool, the ORS/SRS could in fact make us all better clinicians and more closely align us with peoples hopes and dreams.
3. How about using the OTRS/SRS in University training clinics or in supervision settings? Are trainees and interns getting what they need? Do you want to know supervisors? Have you created a culture where feedback is given, or have your trainees and interns "gone underground?" Once again, maybe a helpful tool to begin to flatten hierarchy, dissolve power in supervision settings, or at least start to have a conversation.
4. And what about excellence? What are our thoughts about being a more helpful clinician? How do we apprentice? What is our accountability to those we work with?
5. I also found it interesting, and it raised my curiousity, that a few of the people involved with ICCE including lead U.S. Trainer Julie Tilsen, are narratively inclined.
I have been using the ORS/SRS sparingly over the last few months at CYS. This week I intend to be more deliberate in using the ORS/SRS and begin to track my results. I am currently looking for a tool like Myoutcomes.com to track and hopefully share the results. For those that have shied away from tools like this because it would "kill the creativity" in the work. I get it, but this is something you do in the beginning and toward the end, and not necessarily in every session. I still will be able to stay very creative in my question development or narrative inquiry, but these tools seem to be a pretty effective resource at moving me closer to people's experiences, hopes, and dreams.
I am really interested in asking those I work with to help me become a better clinician. I mean really, who is more qualified for the task?
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