Talking Cure

Heart and Soul Conference Announcements

2008-04-16T06:25:00.000-07:00

Speaker Change: We are sorry to report that Wolfgang Lutz has sustained a broken leg from a sporting accident and will not be able to travel to the Heart and Soul Conference. We wish him a speedy recovery. Coming through at the last minute for us, Michael Lambert, noted client feedback pioneer, will present the keynote on the second day of the conference. Thanks Dr. Lambert! Please join us for this exciting conference. Register at:
www.ti-sbh.org/displayconvention.cfm

The ISTC Research Award: Thanks to all who submitted proposals for the research award. There were so many great proposals that it was too difficult to choose just one. So, we are dividing the award. The winners are:
R. Jeff Reese for his study entitled: Does a Popular Feedback Model Improve Psychotherapy Outcome?
Donald L. Schuman for his study entitled: Measuring the Impact and Relevance of Feedback on the Treatment Experience. Come see their poster presentations at the Heart and Soul Conference.

Also at the Heart and Soul of Change Conference in Phoenix: Day 3, June 7, 2008
Achieving Excellence in Practice and Supervision with Scott Miller, Barry Duncan, Bob Bohanske, Mike Franczak, Bill Andrews, & Jim Walt

Excellence in clinical practice has traditionally been expected to emerge from training in specific content areas combined with supervised experience over time. Unfortunately, these methods have not been shown to matter much in terms of effectiveness, let alone clinical excellence. Thanks to several recent studies, it's possible to identify who the highly effective clinicians are and incorporate their practice secrets. In this workshop, you’ll learn the surprising facts about what distinguishes the “supershrinks” from the “pseudoshrinks.” You'll find out how you can develop a profile of your own and your supervisee’s most and least effective moments in therapy—based in an easily replicable feedback system—and translate that data into effective strategies for supervision and improved outcomes. You’ll come away with concrete tools that'll immediately boost your supervisee’s clinical abilities (and your own) as well as the power of your supervision. Four coherent modules (including all the presenters) will hasten your journey to clinical excellence in practice and supervision.

Come join us!

Barry Duncan and Scott Miller

Anyone for Controversy?

2008-04-13T09:08:00.000-07:00

Let's face it. Sometimes conferences are boring! But not this one, and that's why I am calling your attention to the CAMFT's May 1-4 2008 Annual Conference: Controversy: Current Debates Within a Changing Profession
http://www.camft.org/Conf_Workshops/2008Con/Greeting.htm This conference is really taking on the big ones: evidence based practice (EBP) and kids and psychiatric drugs. I am debating Thomas Sexton of Functional Family Therapy fame (he came down with a bad back and was unable to attend our scheduled debate at the Networker a couple of years back) who will be arguing for EBP while I will be highlighting the pitfalls of EBP and the benefits of practice based evidence.

I will also be presenting a keynote about the risks and benefits of psychiatric drugs based on the thorough review of the APA Working Group on Psychoactive Drugs for Children and Adolescents as well as the risk/benefit analysis conducted by Jacqueline Sparks and I that will soon be available on this website. If my recent experience in Colorado Springs is in any indication, sparks will likely fly!

I think this conference is a cut above most. So if you live in the Los Angeles area, check it out and look me up and say hi.

And don't forget to register now for the Heart and Soul of Change conference in Phoenix, June 5-7. Both of the above topics are covered as well as many others of note. For example, Noted school psychologist John Murphy will address how schools can become outcome informed by using the Child Outcome Rating Scale and the Child Session Rating Scale. Register at:
www.ti-sbh.org/displayconvention.cfm

Hope to see you at one or both of these events.

Barry

University of Colorado fails to act

2008-04-07T19:35:00.000-07:00

Many of you are aware of, and participated in, our efforts to bring the behavior of the researcher who made outlandish, unsubstantiated comments in Newsweek regarding the connection between a rise in youth suicides and the drop in prescriptions for SSRIs. Because his study in NO way supported his over-the-top assertions, we filed a formal complaint with the University of Colorado. We just heard back from the University of Colorado Committee on Research Ethics (CRE), specifically, John E. Repine, M.D. who informed us that the CRE did not find sufficient evidence to warrant an inquiry. I invite you to judge for yourself. Here is our complaint:

I am filing this complaint in behalf of a group of scholars at the Institute for the Study of Therapeutic Change in response to Dr. Valuck's comments in the July 16 Newsweek article “Trouble in a Black Box.” Here are excerpts from that article and his comments:

"According to a new study in The Journal of American Psychiatry, the number of SSRI prescriptions for pediatric depression (ages 5 to 18) tumbled more than 50 percent between 2003 and 2005. In a troubling parallel development, the number of teen suicides jumped a record 18 percent between 2003 and 2004, the most recent year for which data exist. Are the two trends connected? Many experts say yes…

'You may induce two suicides by treatment, but by stopping treatment you're going to lose dozens to hundreds of kids. You're losing more than you're saving. That's the calculus,' says Dr. Robert Valuck, of the University of Colorado Heath Sciences Center, coauthor of the new paper.’"

The problem is that an examination of the study revealed that the "parallel" development was not parallel at all. An inspection of Figure 3 in the study clearly shows that the precipitous drop in prescriptions occurred AFTER the increase in suicides. Lifting the black box warning could put many children at risk. It is an egregious ethical violation for a researcher to respond to the findings as a "parallel development" while understanding full well that the precipitous drop in his study occurred after the increase in suicides. In addition, examination of the suicide data from the CDC reveals that the "jump" in suicides from 2003 to 2004 was in fact a return to normal levels after an unexplained temporary decline for the years 2002 and 2003. Again, this shows no relationship to prescribing patterns whatsoever reported in his study referenced in the Newsweek article.

While sloppy journalism and lack of fact checking is expected from the media, the bold and even outrageous comments that Dr. Valuck made went well beyond just an unfortunate misrepresentation of the data. His comments bordered on hysteria and fear mongering, far removed from an objective interpretation of the facts and offered a conclusion from the data that he must have known, as a study co-author, to be false. This is a serious ethical violation because it created unjustified fear and could potentially influence the repeal of a warning label implemented, after extensive scientific debate, to protect children. This was neither balanced nor ethical science especially as it involves a life-and-death issue impacting our nation’s youth. A New York Times article has since appeared raising this issue and questioning the conclusions of "experts" like Dr. Valuck.

Researchers, especially those funded by corporate interests have to be held accountable.
Thank you for your consideration.

If you disagree with the University of Colorado’s decision that there was not sufficient evidence to warrant an inquiry, please contact John E. Repine, M.D. at john.repine@uchsc.edu

FYI: The National Center For Health Statistics (a branch of the CDC) released preliminary death data for 2005. The suicide rate dropped from 10.9 per 100,000 in 2004 to 10.6 per 100,000 in 2005, a decrease of about 3 percent. 2005 was the first full year of the black box warning of possible suicides and suicidal ideation. The new data won't be broken out by age groups, genders and race until next summer, so for now it isn't possible to say how the 2004 and 2005 suicide data compared. But it appears to be a fly in the ointment to the increase in suicides caused by the Black Box Warning argument.

And finally, even if the two events (rise in suicide and decrease in SSRI prescriptions) did occur (but they didn’t), one should be cautious before reading much into a correlation, especially at such a large population level. Many other factors are involved. Following their logic, it could be argued that the dramatic increase in antipsychotic prescriptions to youth is causative to increased suicides.
Barry

Prescriptive Authority for Psychologists

2008-03-09T18:42:00.000-07:00

Many of you know the American Psychological Association is hell-bent for leather to gain prescriptive authority for psychologists. An oft-mentioned tagline for prescriptive authority—the ability to prescribe carries with it the ability NOT to prescribe—seems satirical. Psychiatrists, at one time, were trained as psychotherapists. Despite the underwhelming data supporting drug efficacy, and under the intoxicating influence of massive marketing and increased personal income, psychiatrists regressed into the pill pushers they are today. The current fervor for prescriptive authority combined with a disturbing lack of awareness of the data does not inspire confidence in psychologist’s abilities to swim upstream against the strong rapids of corporate influence and personal financial success.

Discovering a psychiatrist who doesn’t prescribe occurs with about the same frequency as a discussion of the evidence or a dissenting opinion on the pages of the APA Monitor on Psychology (hereafter Monitor). Drug efficacy is portrayed as a foregone conclusion and prescriptive authority as a necessary step to expand the practice of psychologists. For example, a column (“Neuroscience and Prescriptive Authority”) by APA President Sharon Stephens Brehm (2007) lamented the rift between science and practice and asserted that the rising interest in biology among scientists (neuroscience) and practitioners (prescriptive authority) might bridge the divide. Brehm called for the unity of science and practice “to serve psychology’s common self-interests” (p. 5). And the tale is told: The push for prescriptive authority seems more about self-interest than science, and is far removed from our consumer base. A never cited finding from a 2004 APA survey is that 91% preferred a helper who would emphasize talk therapy as a first course of action, not drugs. A letter challenging the assumptions of the column was sent but not published.

Returning to the tagline, consider a special feature on psychopharmacology that appeared in the February issue of Monitor. Prescriptive authority was lauded as providing “one-stop shopping for patients” and the following example provided:
"Thinking about how being able to prescribe has improved patient care, he mentions a patient diagnosed with bipolar disorder. Fain put him on a combination of medications no one had tried with him before. The medication brought relief from his manic symptoms for the first time. Fain says, “He tells me every time, he pats me on the shoulder and says, ‘You saved me.’”

The ability NOT to prescribe? The psychologist put the client on a combination of medications never tried before. No combination of medications is FDA approved so all combinations are guinea pig experimentations. So much for NOT prescribing—sounds exactly like the whatever comes to mind multiple medication concoctions that psychiatrists regularly inflict on clients! And what about the “You saved me” part! Holy cow! Talk about a God complex and doctor wanna be. And we are supposed to believe that psychologists won’t wind up under the sway of corporate influence and personal financial success pushing unsupported and unapproved poly-pharmaceutical solutions just like psychiatrists. Yeah, right!

Another letter and more

2008-02-18T07:54:00.000-08:00

Those of you who follow our exploits know we like to write letters when drug issues are misrepresented. Here is one I wrote to the Networker after yet another positive spin by a drug company spokesperson. They chose not to publish it...

I write again in response to the Clinician’s Digest report of psychotropics with children, in this case the MTA and stimulants—and I am asking the Networker to set a higher standard of journalism. The expert cited, Peter Jensen, is extensively linked to Novartis, the makers of Ritalin, the drug investigated in the MTA, perhaps explaining his decided pro-drug spin and glaring lack of mention of adverse effects. Contrast Jensen’s comments with another MTA investigator, William Pelham, who said on a recent BBC documentary, "There's no indication that medication's better than nothing in the long run." Pelham also added that the impact (of Ritalin) was seemingly negative.

The original MTA study found that 64% of children had adverse drug reactions. The 36 month follow-up reported that decreases in growth in medicated children averaged 2.0 cm and 2.7 kg less than not medicated groups, without evidence of growth rebound at 3 years. The lack of differences in effectiveness among the groups in the MTA (and other studies) combined with notable as well as largely unknown long-term side effects led the American Psychological Association Working Group on Children and Psychotropics to conclude: “With regard to use over a period of 2 to 3 years, the risk–benefit analysis of stimulant medication does not appear to be favorable because beneficial effects appear to dissipate while side effects (e.g., growth) do not.”

I respectfully request that articles addressing medication rely on primary sources or include experts without ties to drug companies to provide counterbalance to pharmaceutical spins.

Oh well. You can't win them all! Come to the Heart and Soul of Change 4 in Phoenix (June 5-7)and hear the real story about kids and drugs from Jacqueline Sparks. Also learn the latest about client directed outcome informed clinical work with substance abusing clients from Cynthia Maeschalck and Rob Axsen. Hope to see you there.

Barry

Check It Out

2008-01-26T06:48:00.000-08:00

Barry is presenting “Lessons of the ‘Supershrinks’” at the upcoming Psychotherapy Networker Symposium on March 14 at the historic Omni Shoreham Hotel in Washington, D.C.

The new subscription service is in the works and we are looking at a May 1 start up. Get the inside scoop on the latest happenings of client directed outcome informed work (CDOI) as well as regular trainings from Scott and Barry.

And don’t forget to register for our biannual international conference, “The Heart and Soul of Change 4: Delivering What Works” coming up June 5-7 in Phoenix Arizona. Learn the latest and greatest research as well as the nuts and bolts about implementing CDOI in whatever setting you may work. Register now at http://www.ti-sbh.org/displayconvention.cfm.

For example, Morten Anker, (who I like to call the outcome prince of Norway) will be presenting the incredible results of his 600 couple feedback study. He is presenting with ISTC Associate and CDOI partner in crime, Jacqueline Sparks about using client feedback to tailor services with couples and families. Hope to see you there.

2007-11-28T04:57:00.000-08:00

Coming soon: the long awaited "members only" subscription service--get the latest from Barry and Scott's research projects before they are published; one hour personal Q & A or training from Scott and Barry per month; interviews with CDOI movers and shakers; and more...stay tuned for details.

Morten Anker's (with Barry and Jacqueline) feedback study with 600 couples in Norway is coming to a close and the results are incredible. The feedback group achieved well over double the effectiveness of the non-feedback group--with therapists serving as their own control.

Welcome

2007-11-12T21:20:00.000-08:00

Welcome to the TalkingCure Blog. Barry and Scott will be posting their latest findings here soon. Meanwhile, checkout the new issue of the Psychotherapy Networker magazine for a feature article by Scott Miller, Mark Hubble and Barry Duncan - Supershrinks - What's the secret of their success?