Deliberate Practice with Scott D. Miller
In this episode, Rob interviews Scott D. Miller, the founder of the International Center for Clinical Excellence, about his personal story and what drove him to pursue coaching other clinicians about feedback informed treatment. Rob and Scott discuss surfing, Scott’s relationships throughout his career, deliberate practice, and how it applies to clinicians today.
Related Blogs
https://bit.ly/how-to-find-a-good-therapist
https://bit.ly/group-therapy-know-your-options
https://bit.ly/equine-therapy-teen-mental-health
Resources
Staying on Top and Keeping the Sand Out of Your Pants: A Surfer’s Guide to the Good Life: Miller, Scott, Hubble, Mark, Houdeshell, Seth, Byrne, John: 9780757300332: Amazon.com: Books
Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness on JSTOR
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About Rob
Rob Gent, M.A. LPC, is the Chief Clinical Officer and one of the founding members of Embark Behavioral Health. Rob has been with the company for 15 years and has led the Embark organization in clinical development and growth of numerous programs. He is the lead developer of the proprietary CASA Developmental Framework, which is pervasive throughout Embark’s programs.
Through his dedication to advancing clinical development, practice, and research, he has become a nationally recognized expert in the field. His specialization in clinical development is enhanced by his therapeutic expertise and has yielded such accomplishments as the development of; The CASA Developmental Framework, Vive Family Intensive Program, Calo Preteens, Canine Attachment Therapy-Transferable Attachment Program, and other specialized programs.
Rob’s dedication has led him to pursue his Ph.D in Psychology with an emphasis on development and attachment. He remains passionate about neurological, psychological, and physiological development and continues to focus on advancing research and the effectiveness of therapeutic interventions.
He resides in Tempe, Arizona, with his wife and two boys.
Transcript
Welcome, everybody to our Sessions Podcast. I'm Rob Gent,
Speaker:Chief Clinical Officer of Embark. Just super elated and
Speaker:privileged to have our guest today is Scott D. Miller. We
Speaker:could sing his accolades all day long, but, really Scott, thank
Speaker:you so much for joining us. Well, welcome to the podcast. I
Speaker:know I'm looking forward to us doing some work later on in the
Speaker:year with you. But yeah, so thank you for joining us.
Speaker:It's my pleasure.
Speaker:Great.
Speaker:So just a little bit about Scott, Scott and his colleagues
Speaker:have significantly influenced and dare I say, transformed the
Speaker:way that psychotherapy and psychotherapists assess
Speaker:effectiveness for client outcomes. Him and his colleagues
Speaker:have used the data and develop methodology to inform therapist
Speaker:how to become more effective. How am I doing with that Scott?
Speaker:That's good.
Speaker:Great, awesome. Yes, Scott is widely known for his expertise.
Speaker:He's, he's widely known for his speaking and teaching ability,
Speaker:he has a ton of resources. And he's got has been doing this for
Speaker:a while and has made it his purpose and his mission. And
Speaker:he's certainly known for his profound critical thought if you
Speaker:guys have read his resources and his books, you'll know that his
Speaker:his team and him have done their due diligence to think
Speaker:critically about everything, and really look at the data and help
Speaker:us as therapists and as clients really make some movement. So we
Speaker:could talk about all that. But what I wanted to do is have a
Speaker:personal conversation with Scott to get to know his story. Is
Speaker:that ok?
Speaker:Awesome. Well, I've got to be honest, I'm looking into Scott,
Speaker:Yeah, sure.
Speaker:and I've known about him over the years as a psychotherapist,
Speaker:and knowing this thing, what is feedback-informed treatment?
Speaker:Let's look at the data. What are we really doing? And personally,
Speaker:I've bought his book a few of his books early on. And then
Speaker:recently, his new book "Better Results: Using Deliberate
Speaker:Practice." And of course, being in charge if we want to do
Speaker:better supervision and deliberate practice came
Speaker:screaming out at me. And like, yeah, what can we do? What is
Speaker:this thing we call deliberate practice? So that initially
Speaker:caught my attention. And then this is where I have to be
Speaker:honest. Scott's book called "Staying on Top and Keeping the
Sand Out of Your Pants:A Surfer's Guide to the Good Life"
Sand Out of Your Pants:is what really roped me in Scott.
Sand Out of Your Pants:Well, I know from one surfer to the next how important a part of
Sand Out of Your Pants:my life Surfing has been.
Sand Out of Your Pants:Well, me and Scott briefly got a chance to talk about it. And it
Sand Out of Your Pants:from that conversation, I was hooked because from one server
Sand Out of Your Pants:to the next, we had a wonderful conversation about, oh, how long
Sand Out of Your Pants:where have you from? I grew up in California. So did I, we had
Sand Out of Your Pants:this wonderful engagement. So we've had a little bit of
Sand Out of Your Pants:correspondence regarding that. So kindred spirits, Scott.
Sand Out of Your Pants:That's right. It was really enjoyable to catch up around
Sand Out of Your Pants:that. Usually I'm asked about psychotherapy research, you and
Sand Out of Your Pants:I got the chat about surfspots, around California. And as you
Sand Out of Your Pants:said, I grew up I think, during the heyday, the best time to
Sand Out of Your Pants:have surfed and maybe I'm gonna offend somebody by saying that,
Sand Out of Your Pants:but
Sand Out of Your Pants:I don't care.
Sand Out of Your Pants:The late 60s, early 70s. The beaches weren't crowded. You
Sand Out of Your Pants:could go out in the morning in the late afternoon. And the
Sand Out of Your Pants:waves were great. It was it was a phenomenal childhood,
Sand Out of Your Pants:actually.
Sand Out of Your Pants:Well, so appreciate that. Yeah. Remind me, Scott it was Southern
Sand Out of Your Pants:California, correct?
Sand Out of Your Pants:It was Southern California. Yeah. And we used to -- gas I
Sand Out of Your Pants:think was, I'm embarrassed to say, it was under $1 a gallon.
Sand Out of Your Pants:And it took us about maybe 20 minutes to drive from our home
Sand Out of Your Pants:to the beach, we usually surfed in Newport Beach. And nowadays,
Sand Out of Your Pants:that drive would probably take about 75 to 90 minutes to get
Sand Out of Your Pants:from my home down down to the beach, but we would beg for
Sand Out of Your Pants:money, my friends and I would drive down surf in the morning,
Sand Out of Your Pants:sit at the Crab Cooker and eat clam chowder and eat breadsticks
Sand Out of Your Pants:because that's what we could afford. And then we would go
Sand Out of Your Pants:back out in the late afternoon, after all, what we disparagingly
Sand Out of Your Pants:referred to as "tourists" went home and we would have sort of
Sand Out of Your Pants:free freedom to do what we wanted on the waves without
Sand Out of Your Pants:worrying about running our boards into somebody.
Sand Out of Your Pants:Well, it's got to bring back a lot of memories for me just I'm
Sand Out of Your Pants:laughing about the Crab Cooker. I've spent my time there and
Sand Out of Your Pants:they've recently redone it. They built another one inland
Sand Out of Your Pants:somewhere so that's great.
Sand Out of Your Pants:They did,
Sand Out of Your Pants:as good but maybe it's just the atmosphere. The environment was
Sand Out of Your Pants:so cool inside and that just was a place to walk down in your
Sand Out of Your Pants:board shorts and tank top and get some lunch and really on the
Sand Out of Your Pants:cheap. I am probably reminiscing too much, Rob, but i think a
Sand Out of Your Pants:bowl of clam chowder was a buck. And you could eat as many
Sand Out of Your Pants:breadsticks and these little bread balls as a as you wanted
Sand Out of Your Pants:and, you know, filled you up and then you could go back and serve
Sand Out of Your Pants:again once they took the flags down. You could go up and surf
Sand Out of Your Pants:from about four four o'clock on without without hindrance with
Sand Out of Your Pants:the with the sunbathers and swimmers.
Sand Out of Your Pants:Yeah, so great, Scott. Now you need to have $50 in your pocket
Sand Out of Your Pants:to do that exact same thing.
Sand Out of Your Pants:Yeah,
Sand Out of Your Pants:that's exactly right.
Sand Out of Your Pants:You pay for parking, and those little bread balls are super
Sand Out of Your Pants:expensive now.
Sand Out of Your Pants:Yeah.
Sand Out of Your Pants:Really great. Scott. Thank you. Well, I know you're currently
Sand Out of Your Pants:stationed in Chicago, is that correct?
Sand Out of Your Pants:That's right. I've lived here since about 1993-94.
Sand Out of Your Pants:Okay, terrific. And I imagine that's kind of a central
Sand Out of Your Pants:location to get wherever you need to in the country pretty
Sand Out of Your Pants:fast.
Sand Out of Your Pants:You know,
Sand Out of Your Pants:it's really facilitated my career, which right up into the
Sand Out of Your Pants:pandemic, I was gone every week, I was on the road somewhere in
Sand Out of Your Pants:the United States, in Asia or in Europe, traveling, teaching and
Sand Out of Your Pants:consulting. And so being in Chicago meant that I could get
Sand Out of Your Pants:anywhere in the states in a maximum of about four hours, I
Sand Out of Your Pants:could get to Europe in eight, I could get to Australia and Asia
Sand Out of Your Pants:in about 14 with a direct flight. So it really was a great
Sand Out of Your Pants:place to be. And all of that was very serendipitous. A wave came
Sand Out of Your Pants:by, so to speak, happened to be woman named Karen. And we hit it
Sand Out of Your Pants:off. She lived here. I was working in Milwaukee at the
Sand Out of Your Pants:time. And I decided I would move here to be with her. And it's
Sand Out of Your Pants:really been a great it's really been a great move.
Sand Out of Your Pants:Yeah, terrific. Terrific. That's great to hear. Scott, you're
Sand Out of Your Pants:surfing probably suffers a little bit, being in Chicago.
Sand Out of Your Pants:You know,
Sand Out of Your Pants:they do surf here. It's not the same and wind surfing is really
Sand Out of Your Pants:quite big south on the south part of like Michigan, given the
Sand Out of Your Pants:winds and there are some tributaries outside of Lake
Sand Out of Your Pants:Michigan that people do a lot of parasailing and such. But board
Sand Out of Your Pants:surfing, it's not going to be like it is in any of the beaches
Sand Out of Your Pants:or in Hawaii.
Sand Out of Your Pants:Yeah. Well, I wonder if the foiling has taken off a little
Sand Out of Your Pants:bit.
Sand Out of Your Pants:I don't know.
Sand Out of Your Pants:The foil boards are quite the big thing. Now you get a mix of
Sand Out of Your Pants:surfing and foiling. It's really fascinating. I'm sure they're
Sand Out of Your Pants:doing that there. But so great, Scott. So if you don't mind,
Sand Out of Your Pants:let's shift gears. It's interesting that you're in
Sand Out of Your Pants:Chicago. Now you've had this amazing career, if we don't
Sand Out of Your Pants:mind, kind of taking a step back. Where, Where did that
Sand Out of Your Pants:story really, really begin for you?
Sand Out of Your Pants:The story of?
Sand Out of Your Pants:The story of you, right? Growing up in Southern California. I
Sand Out of Your Pants:know I want to touch in, you've got this amazing story about
Sand Out of Your Pants:being a Mormon and a chance to read that book. I'm just
Sand Out of Your Pants:curious, like, what does it really start off? Any siblings,
Sand Out of Your Pants:what are your parents like?
Sand Out of Your Pants:Well, I think I had a pretty uneventful and normal childhood
Sand Out of Your Pants:had a great family, parents and two brothers. I was right in the
Sand Out of Your Pants:middle. When I went away to college. And in my house, my
Sand Out of Your Pants:father was a high school, or rather, an elementary school
Sand Out of Your Pants:principal his entire life. Education was really an
Sand Out of Your Pants:important thing in my household. If you did well, in school, you
Sand Out of Your Pants:could do just about anything else. They were very tolerant
Sand Out of Your Pants:and forgiving people. So I knew college was in my future on the
Sand Out of Your Pants:radar. I left after graduating from Glendora High School moved
Sand Out of Your Pants:to go to college. And while I was there originally I was going
Sand Out of Your Pants:to be an accountant. And I sometimes joke that that's
Sand Out of Your Pants:because my mother thought that at least I would be near money.
Sand Out of Your Pants:I don't think she had any belief that I would be rich, but at
Sand Out of Your Pants:least I could count other people's dough. I went for a
Sand Out of Your Pants:year and I met a professor, his name (no relationship) was Hal
Sand Out of Your Pants:Miller he was a student from of Skinner's from Harvard. And
Sand Out of Your Pants:really, I wanted to be Hal Miller. He was so interesting,
Sand Out of Your Pants:so provocative, so free thinking. And so I became a
Sand Out of Your Pants:research assistant as an undergraduate. At one point, he
Sand Out of Your Pants:said because he was a an experimental psychologist, and I
Sand Out of Your Pants:thought that I would go and do a traditional teaching rap, become
Sand Out of Your Pants:a professor. He thought otherwise. He said that you
Sand Out of Your Pants:unless you scored on the top on your GREs, you got the best
Sand Out of Your Pants:university context that you are pretty much destined to make
Sand Out of Your Pants:very little money, and to have a long and difficult career
Sand Out of Your Pants:publishing, seeking grants, etc. And he thought that I was well
Sand Out of Your Pants:suited for clinical work. So he sent me over to talk to another
Sand Out of Your Pants:professor. His name was Michael Lambert. And Michael Lambert,
Sand Out of Your Pants:really changed the arc of my life. He was a clinical
Sand Out of Your Pants:psychologist. He was very interested in what made
Sand Out of Your Pants:treatment work. And particularly interested in identifying cases
Sand Out of Your Pants:that are at risk for deterioration. And Michael and I
Sand Out of Your Pants:remained friends to this particular day, even though I
Sand Out of Your Pants:graduated from my undergraduate school in 1980. So from there, I
Sand Out of Your Pants:went with his help and advice to graduate school. And I've been
Sand Out of Your Pants:driven by really one chief question. And that was, "how
Sand Out of Your Pants:could I be effective?" And that's what's been the guiding
Sand Out of Your Pants:influence during my entire career. I wasn't interested in
Sand Out of Your Pants:specializing in one population or the next or particular
Sand Out of Your Pants:technique or not, I really want -- and that's because I think I
Sand Out of Your Pants:was a very anxious clinician. When I was in the room with
Sand Out of Your Pants:people, I could definitely sense just how much they were
Sand Out of Your Pants:struggling. In my own personal life, I've not really struggled
Sand Out of Your Pants:in the way that many of the people who came to see me as a
Sand Out of Your Pants:practicum student or an intern seem to be struggling. I wanted
Sand Out of Your Pants:somebody to tell me what was it I was supposed to do in that
Sand Out of Your Pants:room. And I have to say, quite often, I felt like I had been
Sand Out of Your Pants:ripped off in graduate school, I must have missed the day where
Sand Out of Your Pants:they taught the secret about how all this works. In addition,
Sand Out of Your Pants:many of my fellow students around me, seemed much more
Sand Out of Your Pants:confident about how this was supposed to work. So that's
Sand Out of Your Pants:still a driving influence in my professional career. It's what's
Sand Out of Your Pants:driven really all, with very few exceptions, all of my
Sand Out of Your Pants:publications, all of the teams that I've been a part of over
Sand Out of Your Pants:the last 30 plus years of my career.
Sand Out of Your Pants:Wow, thanks for that. Scott. It sounds like you had some
Sand Out of Your Pants:significant mentors in your life early on.
Sand Out of Your Pants:It's amazing. And if I had any advice for anybody who was
Sand Out of Your Pants:heading down the academic route, I would say, relationships are
Sand Out of Your Pants:much more important than books. Books are definitely important,
Sand Out of Your Pants:videos that you want to learn from also important. But the
Sand Out of Your Pants:people that I met along the way, and that are still important
Sand Out of Your Pants:relationships to me, I mentioned one, Michael Lambert, who was a
Sand Out of Your Pants:pivotal person. Harold Miller, Hal Miller is I knew him was
Sand Out of Your Pants:another. Bruce Wampold who was my stats professor, in my first
Sand Out of Your Pants:year of my graduate program, he and I still collaborate on
Sand Out of Your Pants:publications. That's been an amazing and important resource.
Sand Out of Your Pants:Scott, as a therapist, I'm so intrigued by the story,
Sand Out of Your Pants:hopefully many of us can resonate, because you have this
Sand Out of Your Pants:experience of the numbers being analytical, trying to search for
Sand Out of Your Pants:some real knowable, reliable, valid data in life. And then, us
Sand Out of Your Pants:as therapists, we tend to be high emotional, wanting to
Sand Out of Your Pants:connect, and it sounds like here, you are really trying to
Sand Out of Your Pants:bridge that gap between those two things.
Sand Out of Your Pants:I suppose I have tried to bridge that particular gap, the
Sand Out of Your Pants:research literature, it's interesting is massive. And yet
Sand Out of Your Pants:most of us practitioners rely on someone to interpret it for us,
Sand Out of Your Pants:someone who might have an ideological slant to their work.
Sand Out of Your Pants:I think, as well, however, that many of us are looking for what
Sand Out of Your Pants:to do. Truth be told, when I say that even after 30 years when
Sand Out of Your Pants:I'm sitting in the room with a person who's struggling, and I'm
Sand Out of Your Pants:thinking in my head, even though my exterior certainly
Sand Out of Your Pants:communicates confidence, that I wonder what the hell I should do
Sand Out of Your Pants:here. I guess another thing for me is that much of what our
Sand Out of Your Pants:field has taught, simply didn't ring true in the room. So there
Sand Out of Your Pants:were lots of theories about what I was supposed to do, whether
Sand Out of Your Pants:they were psychoanalytic, which they were for me in the
Sand Out of Your Pants:beginning, or more recently, cognitive behavioral traditions.
Sand Out of Your Pants:But all of that still seems not to really capture the essence of
Sand Out of Your Pants:the work that we do. And plus, I've been really struck by
Sand Out of Your Pants:research which indicates and this is a very controversial
Sand Out of Your Pants:thing, which is surprising to me. It's not even taught
Sand Out of Your Pants:nowadays in graduate school. There is no difference in
Sand Out of Your Pants:outcome between these various and competing treatment
Sand Out of Your Pants:approaches. So what clinicians tend to do or what the field
Sand Out of Your Pants:tends to do is either align with one or pick and choose and make
Sand Out of Your Pants:some amalgamation that is used with clients on an ongoing
Sand Out of Your Pants:basis. That's all perfectly fine until you confront literature
Sand Out of Your Pants:which indicates that therapist outcomes are no better, that is
Sand Out of Your Pants:experienced therapists, outcomes are no better than students
Sand Out of Your Pants:outcomes. It's it's also a challenge when you look at the
Sand Out of Your Pants:data that shows that clinicians do not improve with time and
Sand Out of Your Pants:experience in the in the field, even though they think they do.
Sand Out of Your Pants:So whether it's emotions or thoughts or models, etc. For me,
Sand Out of Your Pants:the focus, again, comes back to how can I reliably show that the
Sand Out of Your Pants:work I'm doing is helping more people? And that's why our team
Sand Out of Your Pants:has really been at the forefront of saying, "why not measure your
Sand Out of Your Pants:results and be sure?" And I promise you, it's going to be
Sand Out of Your Pants:quite humbling, as you do that, because you're going to find out
Sand Out of Your Pants:very quickly that your mother was wrong about you. You're
Sand Out of Your Pants:you're not special. The average clinician, get this, multiple
Sand Out of Your Pants:studies now show the average clinicians thinks that they are
Sand Out of Your Pants:more effective than 80% of their peers. Well, just think about
Sand Out of Your Pants:that, that sort of like self esteem on crack or something, it
Sand Out of Your Pants:really doesn't line up with the data. So whether again, it's
Sand Out of Your Pants:emotions, or thinking or models or math, what we have to do is
Sand Out of Your Pants:know our work and know how effective we are not just with
Sand Out of Your Pants:this person in front of us, not with them just saying "Oh, yes,
Sand Out of Your Pants:I've been helped." Not with our model saying we're practicing in
Sand Out of Your Pants:a theoretically or technically correct way. But when we crunch
Sand Out of Your Pants:the numbers, they show that in fact, we're helping people.
Sand Out of Your Pants:And you have, and I can't emphasize this enough, that
Sand Out of Your Pants:you've provided so much of your work has been about providing
Sand Out of Your Pants:the resources to be able to effectively do that, as a
Sand Out of Your Pants:clinician.
Sand Out of Your Pants:So let me rewind,
Sand Out of Your Pants:Well, thanks for that. Now, we we do make some very simple
Sand Out of Your Pants:There's a lot in there. I know.
Sand Out of Your Pants:tools available on my website, we've done that since the
Sand Out of Your Pants:measures were developed back in the late 90s. The turn, right at
Sand Out of Your Pants:the turn of the millennium. And believe me this, this was a
Sand Out of Your Pants:journey for me professionally, I didn't start here, I tried to
Sand Out of Your Pants:follow what the data said. So anybody who's knows my history,
Sand Out of Your Pants:That's the fire-- No, no, it's so wonderful. Thank you, Scott,
Sand Out of Your Pants:as a practitioner knows that I moved from sunny Southern
Sand Out of Your Pants:California to Milwaukee, Wisconsin, because I was in
Sand Out of Your Pants:pursuit of a job. And also somebody who would give me
Sand Out of Your Pants:direct specific guidance about what to do in the therapy room.
Sand Out of Your Pants:I had the distinct honor and privilege of going to work at
Sand Out of Your Pants:the Brief Family Therapy Center, where Steve de Shazer and Insoo
Sand Out of Your Pants:Berg worked. And together, we worked on the Solution-Focused
Sand Out of Your Pants:Therapy model. And believe me, I got a lot more confidence in the
Sand Out of Your Pants:room, I could do SFBT in my sleep backwards and forwards and
Sand Out of Your Pants:in multiple languages. What what happened though, was researchers
Sand Out of Your Pants:came and they studied our clients. And they came back
Sand Out of Your Pants:eventually to us. And they said, there's good news and bad news.
Sand Out of Your Pants:The good news was that what we did worked, the bad news was it
Sand Out of Your Pants:didn't work anything any better than anything else. So there we
Sand Out of Your Pants:were right back to the dilemma. Because if you want to improve,
Sand Out of Your Pants:you have to know what your data say, and then look into the
Sand Out of Your Pants:abyss, you have to look for where your traditional beliefs
Sand Out of Your Pants:and practices fall short. So we left that formed a different
Sand Out of Your Pants:team. And we began looking for ways to figure out how could we
Sand Out of Your Pants:be more effective. And in time, that led me back to two mentors
Sand Out of Your Pants:of mine first, Michael Lambert and another one, Lynn Johnson.
Sand Out of Your Pants:Michael was suggesting that well, we may never find the
Sand Out of Your Pants:because just as a clinician, I'm trying to reflect on well, I
Sand Out of Your Pants:"right" way to do treatment, this technique for that
Sand Out of Your Pants:particular problem. But what we can know, right now is whether
Sand Out of Your Pants:or not we're helping this client, by simply measuring.
Sand Out of Your Pants:Lynn Johnson developed a measurement tool that allowed us
Sand Out of Your Pants:to assess one of the key contributors to success:
Sand Out of Your Pants:establishing a good therapeutic alliance. And here's what's key.
Sand Out of Your Pants:That therapeutic relationship therapists' views of that
Sand Out of Your Pants:relationship have historically correlated very low with the
Sand Out of Your Pants:clients' experience of the relationship. As a result, if
Sand Out of Your Pants:you're in supervision with me, I don't really care what you think
Sand Out of Your Pants:of the relationship, because your view isn't predictive of
Sand Out of Your Pants:whether the client stays in treatment, or gets better. What
Sand Out of Your Pants:I really care about is soliciting that information from
Sand Out of Your Pants:the client, and seeing if I can close the gap between what I'm
Sand Out of Your Pants:thinking and experiencing and what the client wants from me.
Sand Out of Your Pants:So together we've called that feedback-informed treatment, non
Sand Out of Your Pants:theoretical, non ideological, doesn't matter whether you're a
Sand Out of Your Pants:want to ask a few questions. One is, is to sort of reflect on and
Sand Out of Your Pants:psychoanalytic in orientation, or you dig CBT or Acceptance and
Sand Out of Your Pants:Commitment Therapy, we can all measure our results at that
Sand Out of Your Pants:moment with our client. By doing so, we can also identify those
Sand Out of Your Pants:clients where we're not having an impact or making a connection
Sand Out of Your Pants:that improves probably what is the number one predictor of
Sand Out of Your Pants:treatment results which is therapists responsiveness to
Sand Out of Your Pants:individual differences. So that's what feedback-informed
Sand Out of Your Pants:care is really all about.
Sand Out of Your Pants:say, so what you're saying, Scott is, is that my perception
Sand Out of Your Pants:of the relationship with the client is not connected to the
Sand Out of Your Pants:outcomes as far as the client's perception of the relationship.
Sand Out of Your Pants:Right, it's their view that's going to predict whether there
Sand Out of Your Pants:stay or not. About one quarter of the people we work with drop
Sand Out of Your Pants:out without experiencing any improvement. So a lot of those
Sand Out of Your Pants:folks are dropping out. Because there isn't a sort of love
Sand Out of Your Pants:connection, there isn't a sense of felt empathy on the client's
Sand Out of Your Pants:part. So I really -- and given the historically low
Sand Out of Your Pants:correlations in the research between therapists' view of the
Sand Out of Your Pants:relationship and clients' view of the relationship, I really
Sand Out of Your Pants:think I have to try to solicit that from them. And keep my
Sand Out of Your Pants:ideology out of it, that it's a distortion, that it's a sign of
Sand Out of Your Pants:their pathology, however, they may view it. If I want to
Sand Out of Your Pants:rearrange the furniture, I have to be inside the client's house.
Sand Out of Your Pants:Boy, that's a great analogy. So I can't help it ask, what is
Sand Out of Your Pants:your hypothesis on? You've worked with so many therapists,
Sand Out of Your Pants:and I think the trends are saying is that we, as
Sand Out of Your Pants:therapists, tend to overrate our perception of success. We tend
Sand Out of Your Pants:to boil in all of this stuff. Scott, in all your experience,
Sand Out of Your Pants:why do you think that is? Why do you think that the therapist
Sand Out of Your Pants:naturally we are inclined to tell ourselves that we're more
Sand Out of Your Pants:effective than 80% of that? What do you think that happened?
Sand Out of Your Pants:I think this is the result of a number of things. But it's
Sand Out of Your Pants:really related to our latest work on deliberate practice. So
Sand Out of Your Pants:this is simply the way we operate as a species, when we
Sand Out of Your Pants:approach a new activity, whether for example, it's learning
Sand Out of Your Pants:therapy, or driving a car. Initially, if you can remember
Sand Out of Your Pants:back to your first experiences with a client, or even role
Sand Out of Your Pants:playing in a practicum context with another student, you were
Sand Out of Your Pants:highly conscious of everything that you did every move you
Sand Out of Your Pants:made, how long you had eye contact, how you're breathing,
Sand Out of Your Pants:whether your legs were crossed, or your arms folded, you were
Sand Out of Your Pants:aware of all of those things. In time, as you're trying to master
Sand Out of Your Pants:therapy, those things become automatic. This is the language
Sand Out of Your Pants:of deliberate practice, the more automatic they become, the more
Sand Out of Your Pants:seamless they seem. And if there aren't major errors, like in
Sand Out of Your Pants:driving a big car accident, or say in learning to walk, you're
Sand Out of Your Pants:constantly falling down. If that doesn't happen, then we begin to
Sand Out of Your Pants:assume a greater and greater ability than is actually the
Sand Out of Your Pants:case. So I think the reason why we do that is that it's simply
Sand Out of Your Pants:human nature, we become proficient at an activity and
Sand Out of Your Pants:the absence of large, gross and catastrophic errors causes us to
Sand Out of Your Pants:assume more ability than actually exists. And there's a
Sand Out of Your Pants:big problem with that. Automaticity, combined with that
Sand Out of Your Pants:assumption, leads to a lack of learning. After all, why would
Sand Out of Your Pants:you need to learn anything new, because you're already doing it
Sand Out of Your Pants:relatively well? In addition, our continuing education system,
Sand Out of Your Pants:the way it's structured, and organized facilitates that kind
Sand Out of Your Pants:of belief. It doesn't challenge us. In fact, the data indicate
Sand Out of Your Pants:that attending a continuing education workshop likely
Sand Out of Your Pants:reinforces false assumptions therapists have about the
Sand Out of Your Pants:breadth and depth of their skills and abilities. Think
Sand Out of Your Pants:about that for a second. So
Sand Out of Your Pants:What you're
Sand Out of Your Pants:saying is sacrilege. Oh my gosh, right? I mean, most people
Sand Out of Your Pants:feel--
Sand Out of Your Pants:respects, for average people coming through our door, it
Sand Out of Your Pants:In many
Sand Out of Your Pants:doesn't make any difference. If you're driving to the grocery
Sand Out of Your Pants:store every day, you know, it probably doesn't make any
Sand Out of Your Pants:difference. You don't have to be Mario Andretti in order to get
Sand Out of Your Pants:there, or some other highly skilled driver. However, since
Sand Out of Your Pants:we're seeing clients year after year, the more automatic our
Sand Out of Your Pants:thinking and skill execution is, the narrower that ability
Sand Out of Your Pants:becomes with time and experience, the only way to
Sand Out of Your Pants:countervene that is to begin to get feedback. So I have to
Sand Out of Your Pants:measure and begin to show you where, in fact, your abilities
Sand Out of Your Pants:break down. So for example, that you're not you're not in line
Sand Out of Your Pants:with your client about goals, or their sense of identity and
Sand Out of Your Pants:preferences or about what exactly they were hoping for
Sand Out of Your Pants:from you in the interaction, feeding that back on an ongoing
Sand Out of Your Pants:basis, has a very predictable impact on automaticity. It makes
Sand Out of Your Pants:us aware again, of our behavior in the room, which gives us the
Sand Out of Your Pants:ability to exercise influence over our behaviors. That is a
Sand Out of Your Pants:very disruptive process. So people really don't like
Sand Out of Your Pants:deliberate practice. They're infatuated with the concept
Sand Out of Your Pants:right now, which we introduced to the field back in 2007. In an
article called "Super Shrinks:
Speaker:What's the Secret to Their
article called "Super Shrinks:
Speaker:Success?", you can get that online, just type in the title
article called "Super Shrinks:
Speaker:for free from my website, for example. And lots of people like
article called "Super Shrinks:
Speaker:that idea. But the reality of it is very different. There is a
article called "Super Shrinks:
Speaker:reason there are so few Olympic athletes. Because it's not
article called "Super Shrinks:
Speaker:because of their natural ability. It's because pushing
article called "Super Shrinks:
Speaker:your performance a bit over time, every day is painful, and
article called "Super Shrinks:
Speaker:disruptive and time consuming. And being proficient most of the
article called "Super Shrinks:
Speaker:time is good enough.
article called "Super Shrinks:
Speaker:So how have you sort of been speaking to the average
article called "Super Shrinks:
Speaker:therapist talking about maybe the word dissonance or pressure
article called "Super Shrinks:
Speaker:between that comfort zone? And that place of objectivity, where
article called "Super Shrinks:
Speaker:we're looking at feedback, we're able to step out of our ego,
article called "Super Shrinks:
Speaker:because even reading your books, especially your recent one, I'm
article called "Super Shrinks:
Speaker:thinking, "wow, this was an ego pitch to me," right? I mean,
article called "Super Shrinks:
Speaker:"oh, I'm married to my modality, I'm married to my intervention.
article called "Super Shrinks:
Speaker:I've spent so much time and trying to master this particular
article called "Super Shrinks:
Speaker:thing." And you're telling me "no, no, that's less than what
article called "Super Shrinks:
Speaker:your modality interventions less than 1% of the variance in this
article called "Super Shrinks:
Speaker:outcome, client change. And Rob, your best chance of really
article called "Super Shrinks:
Speaker:making change is looking at the feedback." And that's really
article called "Super Shrinks:
Speaker:hard to do. How do most of us therapists wrestle with that
article called "Super Shrinks:
Speaker:whether we're conscious or pre consciously aware of? This is an
article called "Super Shrinks:
Speaker:ego pinch? I mean, this is really
article called "Super Shrinks:
Speaker:hard.
article called "Super Shrinks:
Speaker:Yeah, I guess I would say that, I truly believe in the depths of
article called "Super Shrinks:
Speaker:my soul, that, that therapists are a pretty smart group of
article called "Super Shrinks:
Speaker:people. And I've noticed that when I simply give them the
article called "Super Shrinks:
Speaker:information about this, when I start to say, when I start to
article called "Super Shrinks:
Speaker:acknowledge experiences in the consulting room, like I did
article called "Super Shrinks:
Speaker:earlier and say, "Geez, you know, I'm not sure I know what
article called "Super Shrinks:
Speaker:to do with this particular person" that a lot of people
article called "Super Shrinks:
Speaker:raise their hand and say, "I have that experience multiple
article called "Super Shrinks:
Speaker:times per week." There are a few people on the margins who are
article called "Super Shrinks:
Speaker:ideological zealots, "I do CBT. And that CBT solves all
article called "Super Shrinks:
Speaker:problems." Or "EMDR is the thing that cures truamas." I see those
article called "Super Shrinks:
Speaker:people and mostly I see them on social media, frankly. The
article called "Super Shrinks:
Speaker:average therapist in the room with a client, I think, does an
article called "Super Shrinks:
Speaker:honest effort to try to figure out how to accommodate to
article called "Super Shrinks:
Speaker:clients. But to me, that's a little bit like a physician,
article called "Super Shrinks:
Speaker:trying to guess your blood pressure. By looking at you. Can
article called "Super Shrinks:
Speaker:it be done? Yeah, it you can actually be trained to look for
article called "Super Shrinks:
Speaker:small signs. But it's much easier to put a cuff on and let
article called "Super Shrinks:
Speaker:the technology do it for you. So one step in this process, once
article called "Super Shrinks:
Speaker:you get beyond is I think as I say, therapists are a smart
article called "Super Shrinks:
Speaker:group, I just have to let them know about this, most of them
article called "Super Shrinks:
Speaker:can identify their next question is, "well, what do I do? What do
article called "Super Shrinks:
Speaker:I do about this?" I say "you got to start to measure." And from
article called "Super Shrinks:
Speaker:here, therapists really need support. Because you're going to
article called "Super Shrinks:
Speaker:get lots of information, and you're not going to know what to
article called "Super Shrinks:
Speaker:do with it at the moment, you're going to see a client who's
article called "Super Shrinks:
Speaker:telling you that, that in fact, they don't experience you as
article called "Super Shrinks:
Speaker:aligned or empathizing with them or working on what they think is
article called "Super Shrinks:
Speaker:important. And it's not as easy as simply saying, well, I'll do
article called "Super Shrinks:
Speaker:what the client says. So there needs to be a supportive
article called "Super Shrinks:
Speaker:community around clinicians that are also using measures
article called "Super Shrinks:
Speaker:integrating client feedback into their care. Once you do that,
article called "Super Shrinks:
Speaker:there's a whole nother step. And that's the step to deliberate
article called "Super Shrinks:
Speaker:practice, which means now, I'm not just trying to improve my
article called "Super Shrinks:
Speaker:responsiveness in the moment, which is a big challenge. Our
article called "Super Shrinks:
Speaker:clients are, thank goodness, increasingly diverse, they don't
article called "Super Shrinks:
Speaker:all look like me anymore. That therapy is having broad ranging,
article called "Super Shrinks:
Speaker:finally, a broad reach in our field. So that next step after
article called "Super Shrinks:
Speaker:that big challenge, is to begin to look for the holes in my
article called "Super Shrinks:
Speaker:clinical work. Where is it I fall short? So does it happen to
article called "Super Shrinks:
Speaker:be with certain problems, depression versus substance
article called "Super Shrinks:
Speaker:abuse, people of a certain gender identification versus
article called "Super Shrinks:
Speaker:others? Is it because during certain times of the day, I'm
article called "Super Shrinks:
Speaker:more on than at other times of the day? I'm looking for those
article called "Super Shrinks:
Speaker:leverage points. Again, that takes time and cognitive effort.
article called "Super Shrinks:
Speaker:If you're seeing six to eight clients a day, the last thing
article called "Super Shrinks:
Speaker:you're going to want to do when you get home, is spend time
article called "Super Shrinks:
Speaker:looking at your data and trying to develop strategies. Heck, I
article called "Super Shrinks:
Speaker:meet therapists nowadays that are so busy, they don't even
article called "Super Shrinks:
Speaker:read what they wrote in their clinical notes about the last
article called "Super Shrinks:
Speaker:visit before they meet with their client for the current
article called "Super Shrinks:
Speaker:visit. So that means that the ability to do deliberate
article called "Super Shrinks:
Speaker:practice spending the time mining our data, looking for
article called "Super Shrinks:
Speaker:those small objectives, getting the coaching that we might need
article called "Super Shrinks:
Speaker:a round that particular objective from knowledgeable
article called "Super Shrinks:
Speaker:experts in the field, that's going to really even be a bigger
article called "Super Shrinks:
Speaker:challenge. And so once again, community is really going to be
article called "Super Shrinks:
Speaker:important. Second thing that's important is having a system. So
article called "Super Shrinks:
Speaker:anybody who's successful at deliberate practice, they don't
article called "Super Shrinks:
Speaker:have a goal to deliberately practice. They have a system,
article called "Super Shrinks:
Speaker:for example, that's automatic, they do it at the same time
article called "Super Shrinks:
Speaker:every day. In fact, I think it's the creator, what is his name,
article called "Super Shrinks:
Speaker:Scott Adams, who created the cartoon Dilbert, he says, if you
article called "Super Shrinks:
Speaker:set goals, you are always in a state of pre success failure.
article called "Super Shrinks:
Speaker:If you simply have a system -- "I will do deliberate practice
article called "Super Shrinks:
Speaker:every morning from seven until 7:30." You can measure your
article called "Super Shrinks:
Speaker:success by whether you follow through on that particular
article called "Super Shrinks:
Speaker:objective. So having a system makes it much easier to
article called "Super Shrinks:
Speaker:continue. And last but not least what we call the census
article called "Super Shrinks:
Speaker:community, you need a group of people who are going to support
article called "Super Shrinks:
Speaker:you, because deliberate practice is difficult. And the amount of
article called "Super Shrinks:
Speaker:progress can be glacial. But the studies that we do have so far,
article called "Super Shrinks:
Speaker:and they're limited, but we do have a few suggest think about
article called "Super Shrinks:
Speaker:this, that when therapists engage in measurement of their
article called "Super Shrinks:
Speaker:results, and then deliberate practice, the improvement they
article called "Super Shrinks:
Speaker:they achieve in overtime, is about the same that you see in
article called "Super Shrinks:
Speaker:Olympic athletes over time. It's small and consistent over time.
article called "Super Shrinks:
Speaker:So we're not talking about dramatic differences. But small,
article called "Super Shrinks:
Speaker:consistent differences over time that end up in the long run,
article called "Super Shrinks:
Speaker:helping many more clients, which, as I say, has been my
article called "Super Shrinks:
Speaker:objective since I was a graduate student.
article called "Super Shrinks:
Speaker:Slow and steady wins the race.
article called "Super Shrinks:
Speaker:In the case of deliberate practice, that's absolutely and
article called "Super Shrinks:
Speaker:slow and steady also means you need a cheerleading section, and
article called "Super Shrinks:
Speaker:the right coaches telling you to move one foot in front of the
article called "Super Shrinks:
Speaker:other and to keep going absolutely,
article called "Super Shrinks:
Speaker:Boy, Scott, I really appreciate this push towards creating a
article called "Super Shrinks:
Speaker:system and more importantly, having these coaches I always
article called "Super Shrinks:
Speaker:like the definition of a coach, a coach highlights what we just
article called "Super Shrinks:
Speaker:can't see. Right?
article called "Super Shrinks:
Speaker:Yeah, that's exactly right.
article called "Super Shrinks:
Speaker:In our own performance. I mean, and how many of us, "Hey, I've
article called "Super Shrinks:
Speaker:been doing this for X amount of years, I slipped into this
article called "Super Shrinks:
Speaker:automated way. And like it or not, my perception, my
article called "Super Shrinks:
Speaker:experience in therapy might be just reinforcing to my own
article called "Super Shrinks:
Speaker:stuff."
article called "Super Shrinks:
Speaker:It absolutely will be. And I'd say once again, let's look to a
article called "Super Shrinks:
Speaker:group that really does push themselves on an ongoing basis.
article called "Super Shrinks:
Speaker:That's Olympic athletes, most Olympic athletes nowadays, and I
article called "Super Shrinks:
Speaker:would say professional athletes in basketball, football, etc.
article called "Super Shrinks:
Speaker:They don't have one coach. So I'm a big fan of female ice
article called "Super Shrinks:
Speaker:skating. Mostly because for me, the combination of absolute
article called "Super Shrinks:
Speaker:athleticism with grace is like a combination that I find hard to
article called "Super Shrinks:
Speaker:look away from. These female figure skaters have a coach for
article called "Super Shrinks:
Speaker:equipment, they have a coach for dress, they have a coach for
article called "Super Shrinks:
Speaker:upper body strength for lower body strength, for choreography,
article called "Super Shrinks:
Speaker:it, it goes on and on and on. What do therapists have? O ne
article called "Super Shrinks:
Speaker:supervisor, and usually it's low hanging fruit, meaning that it's
article called "Super Shrinks:
Speaker:the person next door or the person that you got assigned to.
article called "Super Shrinks:
Speaker:So I say don't do that. And I Not that I need to serve as an
article called "Super Shrinks:
Speaker:example. But again, from the time I was an undergraduate,
article called "Super Shrinks:
Speaker:actually, I simply asked people for help. So I had a
article called "Super Shrinks:
Speaker:conversation with BF Skinner back in the 80s. It would have
article called "Super Shrinks:
Speaker:been early 80s. When I had a challenging undergraduate
article called "Super Shrinks:
Speaker:course, well, was probably more about 1979, actually. And we had
article called "Super Shrinks:
Speaker:this ongoing correspondence. How did it start? I called him on
article called "Super Shrinks:
Speaker:the phone. He was amazingly friendly and you won't know
article called "Super Shrinks:
Speaker:unless you pick up the phone. So I guess what I'm saying is,
article called "Super Shrinks:
Speaker:don't just look for the person next door. Access to solid
article called "Super Shrinks:
Speaker:teachers is one of the distinguishing characteristic
article called "Super Shrinks:
Speaker:Successful deliberate practice. By achieving small gains and
article called "Super Shrinks:
Speaker:performance, it must open the door to newer, better, more
article called "Super Shrinks:
Speaker:knowledgeable teachers.
article called "Super Shrinks:
Speaker:You're really driving the point home for me, Scott right now is
article called "Super Shrinks:
Speaker:to just really, if we see it more objectively, just have the
article called "Super Shrinks:
Speaker:courage to reach out beyond our immediate supervision reach. I
article called "Super Shrinks:
Speaker:mean, just like you're saying, I called BF Skinner up on the
article called "Super Shrinks:
Speaker:phone. I mean, who would think to do that? Right? I mean,
article called "Super Shrinks:
Speaker:that's amazing.
article called "Super Shrinks:
Speaker:All they can say is no and I have been I have been turned
article called "Super Shrinks:
Speaker:down by, by by some people, but I find most of these people if I
article called "Super Shrinks:
Speaker:can find an avenue to reach them, have been amazingly
article called "Super Shrinks:
Speaker:willing to talk with me.
article called "Super Shrinks:
Speaker:That's tremendous. I guess my question is, Have you always
article called "Super Shrinks:
Speaker:been so objective, or it hasn't been a journey moving from into
article called "Super Shrinks:
Speaker:this really objectivity because I'm seeing this interesting
article called "Super Shrinks:
Speaker:relationship that for you, it's, the more objective I can be, the
article called "Super Shrinks:
Speaker:more rewarding that is, in some way.
article called "Super Shrinks:
Speaker:I wouldn't call what I do objective, I would maybe call it
article called "Super Shrinks:
Speaker:quantifiable. Numbers are easy to make comparisons between my
article called "Super Shrinks:
Speaker:internal sense can often be misleading the numbers tell no
article called "Super Shrinks:
Speaker:lies once I begin to crunch those numbers and look at the
article called "Super Shrinks:
Speaker:difference between then. And now. The other thing I think I
article called "Super Shrinks:
Speaker:am is driven, seated opposite people. That I'm not helping
article called "Super Shrinks:
Speaker:bugs me. It bugs me deeply, I have a hard time letting it go.
article called "Super Shrinks:
Speaker:And I've never felt my anxiety has never been mollified by
article called "Super Shrinks:
Speaker:attributing the difficulty to the client. So they're in
article called "Super Shrinks:
Speaker:denial, they're resistant. They, they have X disorder, etc. It's
article called "Super Shrinks:
Speaker:not a very it's personally a very unsatisfying, X experience
article called "Super Shrinks:
Speaker:to me, I wanted to know, what more could I do? How can I have
article called "Super Shrinks:
Speaker:a greater impact? How can I be have them be more engaged, so
article called "Super Shrinks:
Speaker:that their lives can be better by the time they leave? Do I
article called "Super Shrinks:
Speaker:succeed all the time? Absolutely not. But that's my growth edge.
article called "Super Shrinks:
Speaker:That's, that's where I can learn something. Otherwise, I'm just
article called "Super Shrinks:
Speaker:doing what everybody has done. And what I've always done,
article called "Super Shrinks:
Speaker:Can you put your finger on where that drive came from? For you?
article called "Super Shrinks:
Speaker:I think this is a in nowadays, in our current sort of
article called "Super Shrinks:
Speaker:postmodern society, it's going to sound very old fashioned. I'm
article called "Super Shrinks:
Speaker:interested in the truth. I'm not interested in anything but the
article called "Super Shrinks:
Speaker:truth. And that is, unfortunately, not there isn't a
article called "Super Shrinks:
Speaker:direct route to that. So it means struggling.
article called "Super Shrinks:
Speaker:Well, and that somewhat flies in the face of our cultural sort of
article called "Super Shrinks:
Speaker:cliches of truth is relative.
article called "Super Shrinks:
Speaker:Yeah, and it may be contextually relative, and it's certainly
article called "Super Shrinks:
Speaker:relative in the in the person's life. So that means I'm going to
article called "Super Shrinks:
Speaker:have to bend to accommodate other people's way of being in
article called "Super Shrinks:
Speaker:the room that is in a service of a larger truth, which is
article called "Super Shrinks:
Speaker:connection, and relationship is what leads to engagement. And
article called "Super Shrinks:
Speaker:engagement is the number one predictor of treatment outcome.
article called "Super Shrinks:
Speaker:So I don't see necessarily a a contradiction between those two
article called "Super Shrinks:
Speaker:things. Because I think that I, well, if that's just been the
article called "Super Shrinks:
Speaker:driving influence, I don't know what more to say.
article called "Super Shrinks:
Speaker:Well, I'm hearing and I'm just appreciate this so much that
article called "Super Shrinks:
Speaker:truth and engagement can go together. They don't need to be
article called "Super Shrinks:
Speaker:separate are conflicting, is what you're saying. So
article called "Super Shrinks:
Speaker:I initially I was taught in a very analytic way, I then went
article called "Super Shrinks:
Speaker:and started working in a very solution focused way. And that
article called "Super Shrinks:
Speaker:was the truth. We viewed, every person who came in had
article called "Super Shrinks:
Speaker:unexplored exceptions and unimagined miracles. That was
article called "Super Shrinks:
Speaker:just the nature of the work. Was it the truth that that's what
article called "Super Shrinks:
Speaker:really made a difference? No. What really made a difference
article called "Super Shrinks:
Speaker:was the clients left the room hopeful and expecting something
article called "Super Shrinks:
Speaker:different? And that could be accomplished by any host of
article called "Super Shrinks:
Speaker:means. Not just solution focused, but a host of other
article called "Super Shrinks:
Speaker:ways of working. So for example, we just finished a study where
article called "Super Shrinks:
Speaker:we were looking at people who went to see psychics. Did you
article called "Super Shrinks:
Speaker:know psychics have outcomes that are on par with therapist
article called "Super Shrinks:
Speaker:outcomes? And in some cases even better? Well, I think it's
article called "Super Shrinks:
Speaker:because they accommodate clients points of view in the service of
article called "Super Shrinks:
Speaker:engagement. Am I telling everybody to run out and buy a
article called "Super Shrinks:
Speaker:deck of tarot cards and a crystal ball? I think that would
article called "Super Shrinks:
Speaker:be been far too literal. What it really means is searching for
article called "Super Shrinks:
Speaker:that greater truth. That indicates what is it that really
article called "Super Shrinks:
Speaker:helps people?
article called "Super Shrinks:
Speaker:Yeah.
article called "Super Shrinks:
Speaker:And thanks to your book, I remember reading that about the
article called "Super Shrinks:
Speaker:psychics and I was like, "Oh my gosh." Again, it's that wanting
article called "Super Shrinks:
Speaker:to quantify and feeling value in that quantification of that. One
article called "Super Shrinks:
Speaker:question I did have is that I noticed early on in your career,
article called "Super Shrinks:
Speaker:especially a Brief Solution-Focused focusing on
article called "Super Shrinks:
Speaker:therapy, you worked with addicts or alcoholics and underserved
article called "Super Shrinks:
Speaker:population.
article called "Super Shrinks:
Speaker:Yeah.
article called "Super Shrinks:
Speaker:How did that impact your trajectory? Or what was that
article called "Super Shrinks:
Speaker:like for? Scott, I'm
article called "Super Shrinks:
Speaker:wondering.
article called "Super Shrinks:
Speaker:Well, beginning to work with this group of folks was really
article called "Super Shrinks:
Speaker:an accident. I went back from my second year of graduate school,
article called "Super Shrinks:
Speaker:thinking that I would pick up with my assistantship that paid
article called "Super Shrinks:
Speaker:for part of my college and housing that I had the prior
article called "Super Shrinks:
Speaker:year, I went in to see the professor, a very interesting
article called "Super Shrinks:
Speaker:guy named Tom Kale. And Tom said, "What are you doing here?"
article called "Super Shrinks:
Speaker:I said, "Well, I've come back start to my my assistantship."
article called "Super Shrinks:
Speaker:He goes, "Well, I didn't think you wanted to." I said, "Well,
article called "Super Shrinks:
Speaker:why would you think that?" "Well, you didn't apply again."
article called "Super Shrinks:
Speaker:I said, "I didn't know I had to apply." I was I was at pressure
article called "Super Shrinks:
Speaker:to find work very quickly. And I took a job as a case manager at
article called "Super Shrinks:
Speaker:Weaver County Drug and Alcohol. Another very formulaitve
article called "Super Shrinks:
Speaker:experience. It was about an hour north of where I was going to
article called "Super Shrinks:
Speaker:university in Salt Lake City. And there I met a supervisor,
article called "Super Shrinks:
Speaker:Vern Vetter, who was a really amazing guy, very helpful
article called "Super Shrinks:
Speaker:person. And that's where I got to work with this population of
article called "Super Shrinks:
Speaker:folks, people with substance use issues and concerns. And I just
article called "Super Shrinks:
Speaker:thought it was great. I thought it was fantastic. And I didn't
article called "Super Shrinks:
Speaker:see a whole lot of difference between the struggles they had
article called "Super Shrinks:
Speaker:and the struggles everyone else had. So writing about that, in
article called "Super Shrinks:
Speaker:the 1980s and 90s, when the dominant view was the Johnsonian
article called "Super Shrinks:
Speaker:Intervention Model. And AA and we were saying, "Well, you know,
article called "Super Shrinks:
Speaker:you really need to do that." Wow, was that was that
article called "Super Shrinks:
Speaker:controversial.
article called "Super Shrinks:
Speaker:Very, yeah.
article called "Super Shrinks:
Speaker:But it was very clear that while AA and the Johnsonian model,
article called "Super Shrinks:
Speaker:plus, so help some that the need was far greater, and that many
article called "Super Shrinks:
Speaker:people didn't get the help they needed from those. And that's
article called "Super Shrinks:
Speaker:what I wanted to do. I wanted to figure out how to help more
article called "Super Shrinks:
Speaker:people. So that's in part what led me to get hired at the FTC
article called "Super Shrinks:
Speaker:in Milwaukee was Steven ensue. They were looking for somebody
article called "Super Shrinks:
Speaker:because the population of folks they were working with at the
article called "Super Shrinks:
Speaker:time, many of them, including homeless population, they had a
article called "Super Shrinks:
Speaker:project going, had problems with substances. And so I was just
article called "Super Shrinks:
Speaker:bringing my experience to the center when I started there.
article called "Super Shrinks:
Speaker:And when I really appreciated you saying, "Hey look, it
article called "Super Shrinks:
Speaker:doesn't matter the population. Are we willing to look at
article called "Super Shrinks:
Speaker:outcomes feedback-informed treatment, and and look at the
article called "Super Shrinks:
Speaker:effectiveness and this regardless of the population?"
article called "Super Shrinks:
Speaker:and your knowledge about drugs and the lives of people who are
article called "Super Shrinks:
Speaker:Sure
article called "Super Shrinks:
Speaker:who who struggle because of those things. That knowledge is
article called "Super Shrinks:
Speaker:important, I think, not because it gives you some expert
article called "Super Shrinks:
Speaker:technique, but because it allows you to convey that you get it
article called "Super Shrinks:
Speaker:that you understand the person and the situation that they find
article called "Super Shrinks:
Speaker:themselves in. So I would never poopoo needing to learn a bit
article called "Super Shrinks:
Speaker:about drugs and alcohol, but especially the lived experience
article called "Super Shrinks:
Speaker:of the folks that have those particular concerns and are
article called "Super Shrinks:
Speaker:coming to you for help. But to claim that somehow this
article called "Super Shrinks:
Speaker:technique or that technique for this population will make you
article called "Super Shrinks:
Speaker:more effective. I just don't see the evidence of that. And plus,
article called "Super Shrinks:
Speaker:I think it's the the the really the wrong approach to take. The
article called "Super Shrinks:
Speaker:question isn't what approach will help solve drug and alcohol
article called "Super Shrinks:
Speaker:problems? The question is, how can I engage this person who
article called "Super Shrinks:
Speaker:happens to have those as problems? What can I do? And
article called "Super Shrinks:
Speaker:believe me, I'm willing to do almost anything to keep them
article called "Super Shrinks:
Speaker:engaged long enough that their life wellbeing and substance use
article called "Super Shrinks:
Speaker:improve?
article called "Super Shrinks:
Speaker:Yeah.
article called "Super Shrinks:
Speaker:So it's got correct me if I'm wrong, but I am hearing a
article called "Super Shrinks:
Speaker:tremendous amount of compassion and empathy. And it's paired up
article called "Super Shrinks:
Speaker:with this sense of, they're not mutually exclusive, but some how
article called "Super Shrinks:
Speaker:they complement each other, is what you're saying.
article called "Super Shrinks:
Speaker:Well, how are you going to improve your empathic engagement
article called "Super Shrinks:
Speaker:with somebody if you don't know when you're not doing it?
article called "Super Shrinks:
Speaker:Or when they're experiencing it?
article called "Super Shrinks:
Speaker:Yeah. Is that Yes, exactly. So that's that's the whole nature
article called "Super Shrinks:
Speaker:of this recursive feedback process. I've got to get the
article called "Super Shrinks:
Speaker:feedback from from the person. And very often that reveals
article called "Super Shrinks:
Speaker:small blind spots of mine. That that I can then work with a
article called "Super Shrinks:
Speaker:coach, talk it through roleplay deliberately practice in an
article called "Super Shrinks:
Speaker:effort to widen my abilities to connect.
article called "Super Shrinks:
Speaker:A mentor, right?
article called "Super Shrinks:
Speaker:I would say a coach.
article called "Super Shrinks:
Speaker:Yeah, I would say a coach. I think mentors are fine. You
article called "Super Shrinks:
Speaker:Seek out coaching.
article called "Super Shrinks:
Speaker:know, Michael, and Bruce and Lynn Johnson, all of these
article called "Super Shrinks:
Speaker:people have been important mentors. But they're also very
article called "Super Shrinks:
Speaker:good at saying, "This is not what I know, best. So let's get
article called "Super Shrinks:
Speaker:you to somebody else." That's what Hal Miller did. You know,
article called "Super Shrinks:
Speaker:"thinking about you moving forward? I think you had to go
article called "Super Shrinks:
Speaker:talk to Mike Lambert." It changed my life. Mike Lambert
article called "Super Shrinks:
Speaker:talking to me about which graduate school to go to and
article called "Super Shrinks:
Speaker:saying, "here's a person who is on the cutting edge of
article called "Super Shrinks:
Speaker:statistical analysis, maybe think about going to that
article called "Super Shrinks:
Speaker:particular graduate school program." Lynn Johnson was the
article called "Super Shrinks:
Speaker:person who said, "have you read Steve de Shazer's and Insoo
article called "Super Shrinks:
Speaker:Berg's work? Have you read it?" At the time I hadn't. "Well, you
article called "Super Shrinks:
Speaker:ought to read it." That led me lo and behold, I reached out to
article called "Super Shrinks:
Speaker:Insoo. And I had been up to Nebraska to interview at the
article called "Super Shrinks:
Speaker:time with Bill O'Hanlon.
article called "Super Shrinks:
Speaker:Oh, wow, wow.
article called "Super Shrinks:
Speaker:I just met him at a conference. I said, "Can I come talk to
article called "Super Shrinks:
Speaker:you?" He said, Yeah, I send an email to Insoo, or maybe it was
article called "Super Shrinks:
Speaker:a call I can't remember. And I said, "Hey, I'm gonna go
article called "Super Shrinks:
Speaker:interview after for a job after graduate school in Omaha,
article called "Super Shrinks:
Speaker:Nebraska." That's where Bill was at the time. And she said, Well,
article called "Super Shrinks:
Speaker:she says, "before you agree to go work there, make sure you
article called "Super Shrinks:
Speaker:come see us." So this was all just about picking up the phone.
article called "Super Shrinks:
Speaker:Now. There were I, I don't want to make it sound all all rosy,
article called "Super Shrinks:
Speaker:because when I moved from Southern California, to
article called "Super Shrinks:
Speaker:Milwaukee, there were costs. So I went from a high paying job to
article called "Super Shrinks:
Speaker:a job that paid nearly nothing. But my student loans and
article called "Super Shrinks:
Speaker:outstanding debt were the same. I was leaving behind a
article called "Super Shrinks:
Speaker:relationship because the person that I was with at the time,
article called "Super Shrinks:
Speaker:really could think of no good reason to live after Palm
article called "Super Shrinks:
Speaker:Springs, moving to Milwaukee, Wisconsin. So there were there
article called "Super Shrinks:
Speaker:were costs I don't mean to imply as such. But that comes back to
article called "Super Shrinks:
Speaker:my sort of driven nature. I was really interested in getting
article called "Super Shrinks:
Speaker:better, and doing so by continuously questioning, what
article called "Super Shrinks:
Speaker:was the truth about this?
article called "Super Shrinks:
Speaker:And then where does vision play a role for you because I am
article called "Super Shrinks:
Speaker:hearing this ability to delay gratification to have some sort
article called "Super Shrinks:
Speaker:of vision. You use the term "driven," I'm just, I wonder if
article called "Super Shrinks:
Speaker:those those words are part of Scott Miller, too?
article called "Super Shrinks:
Speaker:That is what's gratifying to me. So I don't think I've delayed
article called "Super Shrinks:
Speaker:gratification as much as I identify gratification with
article called "Super Shrinks:
Speaker:improving my skills or abilities. And believe me, I
article called "Super Shrinks:
Speaker:fall short in every way possible as a clinician still. But I find
article called "Super Shrinks:
Speaker:that process of exposing areas where I might improve, deeply
article called "Super Shrinks:
Speaker:gratifying. That next objective, the next time that I call
article called "Super Shrinks:
Speaker:somebody on the phone and say here's what I'm trying to solve
article called "Super Shrinks:
Speaker:an address. So for example, K. Anders Ericsson is the
article called "Super Shrinks:
Speaker:researcher who coined the term "deliberate practice." And I had
article called "Super Shrinks:
Speaker:read somebody else's book, a general book about deliberate
article called "Super Shrinks:
Speaker:practice that had mentioned Ericsson's work, I went and read
article called "Super Shrinks:
Speaker:most of it. And then I picked up the phone, and I called him. And
article called "Super Shrinks:
Speaker:I said, "we're really needing some coaching to do some
article called "Super Shrinks:
Speaker:research that's never been done in the field on this subject, as
article called "Super Shrinks:
Speaker:applied to psychotherapy improvement as a
article called "Super Shrinks:
Speaker:psychotherapist." Anders Ericsson said, "Sure." Shocking.
article called "Super Shrinks:
Speaker:Yeah.
article called "Super Shrinks:
Speaker:So and he coached us for several years, right up to the first
article called "Super Shrinks:
Speaker:year of the pandemic, and unfortunately died, not from
article called "Super Shrinks:
Speaker:COVID, during the summer of 2020. It's a huge loss. And by
article called "Super Shrinks:
Speaker:that time, we've been working with him for close to seven
article called "Super Shrinks:
Speaker:years now. So yeah.
article called "Super Shrinks:
Speaker:Wow.
article called "Super Shrinks:
Speaker:Having the courage to reach out. I'm really quite inspired. Thank
article called "Super Shrinks:
Speaker:you, Scott, for that. I gotta --
article called "Super Shrinks:
Speaker:My pleasure.
article called "Super Shrinks:
Speaker:Yeah. Well, I wanted to ask, there's so much to uncover, I'd
article called "Super Shrinks:
Speaker:love to do a part two, because there's so much resource I was
article called "Super Shrinks:
Speaker:just really blown away just even by looking at the ORS and the
article called "Super Shrinks:
Speaker:SRS, and you've set up primers and manuals and how to do this
article called "Super Shrinks:
Speaker:and you've you've made it almost seamless for an organization or
article called "Super Shrinks:
Speaker:a therapist by themselves, an outpatient therapist, whatever,
article called "Super Shrinks:
Speaker:to really engage in this process that you've described.
article called "Super Shrinks:
Speaker:You know,
article called "Super Shrinks:
Speaker:together with a team of great people. Cynthia Maeschalck,
article called "Super Shrinks:
Speaker:Susanne Bargmann, Brooke Mathewes, these, Mark Hubble,
article called "Super Shrinks:
Speaker:these folks have made all of that possible. And it's
article called "Super Shrinks:
Speaker:interesting because I think we share that common if there is a
article called "Super Shrinks:
Speaker:vision, it's that common interest in how can we how can
article called "Super Shrinks:
Speaker:we get better? And I want to cut to the chase and get to the
article called "Super Shrinks:
Speaker:truth cut through all the folderol that is commonly
article called "Super Shrinks:
Speaker:characteristic of our field, the the ideological commitments that
article called "Super Shrinks:
Speaker:don't have an empirical payoff, that's, that's they share that
article called "Super Shrinks:
Speaker:they share that passion.
article called "Super Shrinks:
Speaker:What a wonderful support system in a team, you've, you have with
article called "Super Shrinks:
Speaker:you. Just two more questions, Scott, I know you've published
article called "Super Shrinks:
Speaker:over 28 books, and countless speaking engagements, and you've
article called "Super Shrinks:
Speaker:just have all these resources, you've had such an amazing
article called "Super Shrinks:
Speaker:career. I don't know if you can boil it down. But when you think
article called "Super Shrinks:
Speaker:about all that, what aspect of that has been most rewarding for
article called "Super Shrinks:
Speaker:you?
article called "Super Shrinks:
Speaker:I think it's eight or nine books actually not 20. You know, there
article called "Super Shrinks:
Speaker:are several 100 research articles that have been been
article called "Super Shrinks:
Speaker:published. And, you know, I spent my life on the road. So
article called "Super Shrinks:
Speaker:hundreds and hundreds of presentations. The most
article called "Super Shrinks:
Speaker:rewarding project is the one I'm working on right now. And it's
article called "Super Shrinks:
Speaker:always that way. It's the being on the learning edge that is
article called "Super Shrinks:
Speaker:rewarding. And actually, once the book is done, I hate to say
article called "Super Shrinks:
Speaker:this, I'm no longer interested in the subject. So I'm on to
article called "Super Shrinks:
Speaker:sort of the next little area that we're trying to make clear,
article called "Super Shrinks:
Speaker:shine a light on and then resolve that next objective.
article called "Super Shrinks:
Speaker:Wow,
article called "Super Shrinks:
Speaker:I really appreciate that. One of my patent questions that I love
article called "Super Shrinks:
Speaker:to ask, what part of your story is untold?
article called "Super Shrinks:
Speaker:I think I've been very fortunate that people have been willing to
article called "Super Shrinks:
Speaker:follow me on this journey. I mean, the team of people I work
article called "Super Shrinks:
Speaker:with, and as well as the 10s of 1000s of people I've met over
article called "Super Shrinks:
Speaker:the last 30 years while I'm training that people sit in the
article called "Super Shrinks:
Speaker:audience and listen and ask questions and challenge. They
article called "Super Shrinks:
Speaker:email me. They comment on blog posts, so I don't feel like
article called "Super Shrinks:
Speaker:there's anything that is, that is un -- What did you say? What
article called "Super Shrinks:
Speaker:did you call it?
article called "Super Shrinks:
Speaker:Untold
article called "Super Shrinks:
Speaker:Untold ,that's, that's important, really. I like sushi.
article called "Super Shrinks:
Speaker:Well, I want to just communicate such a great appreciation,
article called "Super Shrinks:
Speaker:because much like you, it took an email from me and Scott
article called "Super Shrinks:
Speaker:Miller is a real person, you responded to me, we were able to
article called "Super Shrinks:
Speaker:connect and just so appreciative of our time together, Scott. So
article called "Super Shrinks:
Speaker:wonderful to learn about you and all that you've done in your
article called "Super Shrinks:
Speaker:practice. I really, really appreciate you.
article called "Super Shrinks:
Speaker:Thanks very much for that, Rob, for this opportunity to speak to
article called "Super Shrinks:
Speaker:you and to the people who listen to your podcast.
article called "Super Shrinks:
Speaker:Yeah, great. I do want to make a little plug if it's, you're
article called "Super Shrinks:
Speaker:going to be at the Evolution of Psychotherapy Conference
article called "Super Shrinks:
Speaker:That's right
article called "Super Shrinks:
Speaker:in December, and then you'll be one of the key presenters there.
article called "Super Shrinks:
Speaker:And you'll be actually working with me, we're doing a pre
article called "Super Shrinks:
Speaker:conference event, which I'm super excited about. So the
article called "Super Shrinks:
Speaker:listeners can look, look into that and get to experience more
article called "Super Shrinks:
Speaker:of Scott D. Miller.
article called "Super Shrinks:
Speaker:Would love to see you at either or both.
article called "Super Shrinks:
Speaker:Oh, fantastic. Well, Scott, thank you so much. Again,
article called "Super Shrinks:
Speaker:appreciate for your time.