I just had the great privilege to meet Nora Bateson, the daughter of Gregory Bateson, and Betty Alice Erickson, the daughter of Milton Erickson in Bruges. It was quite an incredible experience to say the least—these two very profoundly insightful and talented women of two of the most influential people of their generation. Betty Alice (named after Alice in Alice in Wonderland) is a masterful story teller in own right. She picked up her father’s trade 20 years ago after raising her family and now does training in hypnosis, storytelling, etc. She also just completed an edited book about her father called “An American Healer.” In addition to her great accounts of her father, she told a couple of metaphoric stories at the end of the day and there was not a dry eye in the room. Besides all that, she was quite delightful and full of fun.

Nora Bateson just completed a documentary film about her father which is not only a beautiful honoring of a father by a devoted daughter, an invaluable account of his impact on many fields, but also a magnificent statement of the interconnectedness of all living things—all embedded in a finely crafted cinematic experience. Nora is a truly gifted speaker and filmmaker, as well as an articulate spokesperson for systemic ideas. She was also was full of life and had a sparkling sense of humor. Check out the film at: http://www.anecologyofmind.com/Home_Page.php

This all came about via my association with the Korzybski Institute (a largely solution focused group with a decided existential twist called the Bruges model) which trains many therapists across Europe but mainly in the Netherlands, Switzerland, and Belgium. A fascinating man, Luc Isabaert, is the director. Luc is a wise and very knowledgeable person about almost everything from Bateson to Belgium Beer (which I capitalize because it is a national treasure)! I am now a trainer for Luc and Korzybski which led to my invitation to this “think tank” session following my kick off training course in Amsterdam which will continue in Bruges and other training sites in May. The theme of the think tank was my old friend, the therapeutic alliance, and the participants ranged from anthropologists, logicians, and organizational consultants to psychiatrists and family therapists. The discussion was fascinating although it was a bit outside of the pragmatic world in which I live and therefore a bit more academic at times than my taste. It brought back make many memories for me because my dissertation was a theoretical one (an option in my program) about systems theory and paradox. I had not thought about these ideas for some time and it was particularly fun to see how they still influence my thinking. And of course, the participants were brilliant and interesting so I spent much of time marveling at it all. And Bruges is absolutely unbelievable, a very well preserved 14th century crown jewel of Belgium. Check out the Institute at: http://www.korzybski.com/index.php?lang=en

Here is my presentation at the think tank about the alliance:

It just makes a lot of sense for mental health and substance abuse professionals, as Bob Bohanske, Project Leader, asserts in the new edition of the Heart and Soul of Change, to formally partner with consumers and the recovery movement in total. According to SAMSHA:

Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

Client based outcome feedback (click here for more information or here for free client based outcome and alliance measures) or consumer driven outcomes management gives recipients of our services a real voice in their own care, not just lip service. Therapists and clients could be allies in ensuring that services are recovery oriented (National Consensus Conference on Mental Health Recovery and Mental Health Systems Transformation, 2004)—a shift from professional interventions based on diagnostic labels and prescriptive treatments to individually tailored, consumer-directed services that at their core require clients’ active participation:

The 10 Fundamental Components of Recovery
Self-Direction: Consumers lead, control, exercise choice over, and determine their own path of recovery by optimizing autonomy, independence, and control of resources to achieve a self-determined life. By definition, the recovery process must be self-directed by the individual, who defines his or her own life goals and designs a unique path towards those goals.
Individualized and Person-Centered: There are multiple pathways to recovery based on an individual’s unique strengths and resiliencies as well as his or her needs, preferences, experiences (including past trauma), and cultural background in all of its diverse representations. Individuals also identify recovery as being an ongoing journey and an end result as well as an overall paradigm for achieving wellness and optimal mental health.
Empowerment: Consumers have the authority to choose from a range of options and to participate in all decisions—including the allocation of resources—that will affect their lives, and are educated and supported in so doing. They have the ability to join with other consumers to collectively and effectively speak for themselves about their needs, wants, desires, and aspirations. Through empowerment, an individual gains control of his or her own destiny and influences the organizational and societal structures in his or her life.
Holistic: Recovery encompasses an individual’s whole life, including mind, body, spirit, and community. Recovery embraces all aspects of life, including housing, employment, education, mental health and healthcare treatment and services, complementary and naturalistic services, addictions treatment, spirituality, creativity, social networks, community participation, and family supports as determined by the person. Families, providers, organizations, systems, communities, and society play crucial roles in creating and maintaining meaningful opportunities for consumer access to these supports.
Non-Linear: Recovery is not a step-bystep process but one based on continual growth, occasional setbacks, and learning from experience. Recovery begins with an initial stage of awareness in which a person recognizes that positive change is possible. This awareness enables the consumer to move on to fully engage in the work of recovery.
Strengths-Based: Recovery focuses on valuing and building on the multiple capacities, resiliencies, talents, coping abilities, and inherent worth of individuals. By building on these strengths, consumers leave stymied life roles behind and engage in new life roles (e.g., partner, caregiver, friend, student, employee). The process of recovery moves forward through interaction with others in supportive, trust-based relationships.
Peer Support: Mutual support—including the sharing of experiential knowledge and skills and social learning—plays an invaluable role in recovery. Consumers encourage and engage other consumers in recovery and provide each other with a sense of belonging, supportive relationships, valued roles, and community.
Respect: Community, systems, and societal acceptance and appreciation of consumers —including protecting their rights and eliminating discrimination and stigma—are crucial in achieving recovery. Self-acceptance and regaining belief in one’s self are particularly vital. Respect ensures the inclusion and full participation of consumers in all aspects of their lives.
Responsibility: Consumers have a personal responsibility for their own self-care and journeys of recovery. Taking steps towards their goals may require great courage. Consumers must strive to understand and give meaning to their experiences and identify coping strategies and healing processes to promote their own wellness.
Hope: Recovery provides the essential and motivating message of a better future— that people can and do overcome the barriers and obstacles that confront them. Hope is internalized; but can be fostered by peers, families, friends, providers, and others. Hope is the catalyst of the recovery process. Mental health recovery not only benefi ts individuals with mental health disabilities by focusing on their abilities to live, work, learn, and fully participate in our society, but also enriches the texture of American community life. America reaps the benefits of the contributions individuals with mental disabilities can make, ultimately becoming a stronger and healthier Nation.

Resources
www.samhsa.gov

Also check out a great video about recovery at
http://promoteacceptance.samhsa.gov/action/partnersInRecovery.aspx

And speaking of recovery, check out the next webinar:

From Illness to Recovery: Consumer Voice and Choice
A sharp departure from customary discourse on mental illness, recovery-driven services shift away from professional-directed treatment based on diagnostic labels and prescriptive practices to individually tailored, consumer-authored plans. After telling her personal story of recovery, Dr. Ashcraft asserts that moving from illness toward recovery means that counseling professionals must be both responsible and responsive to their customer base and directly involve clients in decision making. This webinar calls for recovery-focused services based on the heart and soul of change—services that recognize clients as the primary movers of change, that require the unique tailoring of intervention to their preferences, and that call for relationships that are collaborative and respectful. Dr. Ashcraft also discusses how to successfully integrate peers into your workforce: peer training and preparation, worksite preparations for a smooth integration of peers, performance improvement approaches for peer work, and evaluation of peer services.

Lori Ashcraft, Ph.D., CPRP is the Executive Director of Recovery Opportunities Center based in Phoenix, Arizona with Peer Support training, consulting and system development operating in 30 states and three countries. Dr. Ashcraft recently served as a professor for the University of Arizona teaching psycho-social rehabilitation and managing one of eight SAMHSA funded employment demonstration programs. Her latest book, Offering Wellness, provides insight to the “whole person” wellness and Recovery approach.

Title: Dr. Lori Ashcraft–From Illness to Recovery: Consumer Voice and Choice

Date: Wednesday, March 10, 2010

Time: 12:00 PM – 1:00 PM CST

Join the members site to enjoy this upcoming webinar here

People have asked me about my appearance on Oprah for many years. It was way back in 1992 just after I published my first book (with my best friend Joe Rock), a self help book called Overcoming Relationship Impasses. (That book, now called “The Lone Changer,” is available as a download at http://heartandsoulofchange.com/resources/bookstore/)

It has always been a source of amusement for me that people are so interested in my brief moment in the spotlight. No matter what I put in my bio, the first thing that is commented on is my Oprah appearance. So in deference to an interest that has mightily stood the test of time, here are snippets of my Oprah debut in the world of TV media. But before you look at it let me say a few words in my defense. I was a full time private practitioner with zero media experience, and I was scared half out of my wits. They called on a Monday and asked me to be there for a Wednesday taping. So I flew up after my last client on Tuesday and checked into a very fancy Chicago hotel, The Drake. I didn’t have a clue about what I was doing. I knew a lot about the book, and a fair amount about working with couples, but nothing about how to handle this situation. The producers for the show, a young and extremely talented  group, were exceptionally helpful and had really done their homework. They really knew the book and asked me very good questions to prepare me for what might happen.  They told me that I had to be very assertive, even aggressive at times (not exactly my style!) and the last thing they wanted me to be was a wallflower. They noted that Oprah would intentionally provoke me, in a nice way, to comment on the action as it unfolded. I was freaked to say the least and rued the day that I ever thought to write a self help book! So here’s the deal: feel free to laugh but not in my face; and please don’t tell me how young I looked (the subtext being how old I look now!)

And one more thing: People often ask me about Oprah. What was she like? She was warm, friendly, and the consumate professional. I have nothing but good things to say about her and her staff. BTW, I have improved (thank goodness) on the TV front. Check out my TV interviews regarding the book What’s Right With You, including a friendly debate with a psychiatrist, at http://www.whatsrightwithyou.com/resources.htm

The bookstore is now open and has all my books including the just published 2nd Edition of The Heart and Soul of Change. More books of interest to the mission of the Project will be added periodically. Full length videos will also soon be featured. Webinars and slideshows are avaliable too. If you have been following the blog and this site, you know that the concept of “recovery” is thematic and a vital part of client directed, outcome informed (CDOI) ideas and practices (http://heartandsoulofchange.com/training/cdoi-members/what-is-cdoi/). I am very happy to say that the theme of recovery also applies to the bookstore. Folks in recovery are running the bookstore and the more products that are sold, the more hours can be offerred. Thanks to Mary Haynes for making this happen and for her ongoing commitment to the values of recovery.

Finally, I am very happy to announce that Anne-Grethe Tuseth is joining our team as a Project Leader. Anne-Grethe is the Leader of the KOR (CDOI) network in Norway and is a long time advocate of CDOI. She first brought me to Norway ten years ago and has been a mover and shaker of the ideas ever since. She orchestrated the first book written about CDOI by others than the developers, was instrumental in translating the Heroic Clients, Heroic Agencies manual into Norwegian, and has been a leader in training others and disseminating  the ideas. In short, Anne-Grethe is a powerful addition to an already incredible group. Find out more about the Project Leaders as well as the CDOI community at http://heartandsoulofchange.com/community/

Just back from an incredible conference of consumers and providers, the 20th annual Children Come First event with the wonderful name: Ready, Set, Relationship! This was the continuing efforts of a group of dedicated individuals, called Wisconsin Family Ties, almost all of whom are parents of special needs children, to give families the support, encouragement, and resources they need to survive and thrive in tough times. They embrace the values of consumer strengths and wisdom as well as the power of change that resides in human relationships. I can’t really say enough about them nor can I express how moved I was to experience their commitment to what they are doing. The director, Hugh Davis, was nothing short of inspirational. He gave up a lucrative career in corporate America to try to make a difference with families who are under exceptional pressures from within because of a special needs child and from without from a system oriented more toward investigation and punishment than helping folks succeed. Constantly fighting an uphill battle for funding, they are making a significant difference in the lives of hundreds of children and families.

Check them out at: http://www.wifamilyties.org/

This is one of the great gifts that I am privileged to receive in my travels, the inspiration of meeting people who have been called to try to make a difference for others. It is heartening to say to least, that people like Family Ties exist. If I become jaundiced at times in my thoughts about we do, these experiences quickly remind me of not only the goodness of people, but also the good of what psychosocial services can accomplish.

On another note, I am doing a workshop in the Twin Cities on February 5th hosted by Rebecca Chesin, another person trying to make a difference in the community. If you are in the Twin Cities area, I would appreciate your support of Rebecca’s efforts. Rebecca recently compiled a list of individuals and agencies who are using client directed, outcome informed practices and is going to expand this idea into an online directory soon. Check out the workshop and the list at:

http://www.timeforclarity.com/cdoitest.html

Finally, another mover and shaker of these ideas is Eric Kueler of Mental Health Pros. Mental Health Pros offers therapists “21st Century tools to optimize psychotherapy for clients.” The 21st Century tools include MyOutcomes, online articles, assessments, multimedia workshops, videos, Lunch and Learn teleseminars, as well as online journaling for clients, practice newsletters, and more.

Check out Mental Health Pros out at: http://mentalhealthpros.com/mhp/ An e-brochure is available at http://mentalhealthpros.com/mhp/pdf/MHPbrochure.pdf

Eric recently interviewed me about the evolution of CDOI ideas and research.

Check it out: Interview with Eric (Download)

Please let me know what you thinking about the blogs. I appreciate your feedback.

Those of you who are CDOI Members: http://heartandsoulofchange.com/training/cdoi-members/  know that I just did a webinar of the same title as this blog. For the first time, members were able to download the actual PowerPoint slides from the presentation so that they could influence the decision makers where they work. Here are the slides in pdf format: 

GoodBadUglyWebinarSlides

Here is a brief video I did that covers the main points:

And here is a narrative account excerpted from new book, On Becoming a Better Therapist:
The good news is that the efficacy of psychotherapy is very good—the average treated person is better off than about 80% of the untreated sample (Duncan, Miller, Wampold, & Hubble, 2010), translating to an effect size (ES) of about 0.8. Moreover, these substantial benefits apparently extend from the laboratory to everyday practice. For example, a real world study in the UK (Stiles, Barkham, Twigg, Mellor-Clark, & Cooper, 2006) comparing cognitive behavioral therapy (CBT), psychodynamic therapy (PDT), and person centered therapy (PCT) as routinely practiced reported a pre-post ES of around 1.30. In short, there is a lot to feel proud about our profession: psychotherapy works.

But there’s more to the story. The bad news is two-fold: First, drop outs are a significant problem in the delivery of mental health and substance abuse services, averaging at least 47% (Wierzbicki & Pekarik, 1993). When drops outs are considered, a hard rain falls on psychotherapy’s efficacy parade, both in randomized clinical trials (RCT) and in clinical settings. Second, despite the fact that the general efficacy is consistently good, not everyone benefits. Hansen, Lambert, and Foreman (2002), using a national data base of over 6000 clients, reported a sobering picture of routine clinical care in which only 20% of clients improved as compared to the 57-67% rates typical of RCTs. Whichever rate is accepted as more representative of actual practice, the fact remains that a substantial portion of clients go home without help.

And the ugly: Explaining part of the volatile results, variability among therapists is the rule rather than the exception. Not surprisingly, although rarely discussed, some therapists are much better at securing positive results than others. In fact, therapist effectiveness ranges from 20-70%! Moreover, even very effective clinicians seem to be poor at identifying deteriorating clients. Hannan et al. (2005) compared therapist predictions of client deterioration to actuarial methods. Though therapists were aware of the study’s purpose, familiar with the outcome measure used, and informed that the base rate was likely to be 8%, they accurately predicted deterioration in only one out of 550 cases; psychotherapists did not identify 39 out of the 40 clients who deteriorated. In contrast, the actuarial method correctly predicted 36 of the 40.

So despite the overall efficacy and effectiveness of psychotherapy, drop outs are a substantial problem, many clients do not benefit, therapists vary significantly in effectiveness, and are poor judges of client deterioration. Most of us provide an invaluable service to our clients, but sadly most of us don’t know how effective we really are—we don’t know who will drop out or who will ultimately not benefit or even deteriorate. Do you know how effective you are? With drop outs considered, how many of your clients leave your office absent of benefit? Which clients in your practice now are at risk for drop out or negative outcome?

And what is the answer to these problems? You know! Practice based evidence. Continuous client feedback individualizes psychotherapy based on treatment response, provides an early warning system that identifies at risk clients thereby preventing drop-outs and negative outcomes, and suggests a tried and true solution to the problem of therapist variability—namely that feedback necessarily improves performance and quickens the pace of your development.