Making Therapy Better

Why haven’t psychotherapy outcomes improved in decades, despite hundreds of new treatment models and thousands of new randomized controlled trials?In this special episode of the Making Therapy Better podcast, renowned psychotherapy researchers Bruce Wampold and Scott Miller discuss how the field’s obsession with inventing and testing treatment methods may have distracted us from strengthening the relational skills that we know drive better treatment outcomes. Bruce and Scott explore why therapy outcomes have plateaued, what makes some therapists consistently more effective than others, and how clinical training must evolve to focus on measurable interpersonal skills.Bruce Wampold, Ph.D. is Emeritus Professor at the University of Wisconsin–Madison and among the most influential psychotherapy researchers alive today. Scott Miller, Ph.D. is the founder of the International Center for Clinical Excellence and a pioneer in improving clinical training through deliberate practice and measurement-based care.----The Making Therapy Better podcast is brought to you by CarePaths EHR, an electronic health records system designed to help you improve your therapy outcomes. (https://www.carepaths.com)----Follow the Making Therapy Better project:- Website: (http://www.makingtherapybetter.com)- Instagram: (https://www.instagram.com/making_therapy_better)- Facebook: (https://www.facebook.com/makingtherapybetter)- Twitter: (https://twitter.com/therapybetter)- LinkedIn: (https://www.linkedin.com/groups/9223245/)----The Making Therapy Better podcast is produced and edited by Kevin Riordan.Intro/outro music is by DELOSound and is free for use under the Pixabay Content License.----

Zac Imel, PhD is a professor and Director of clinical training in the counseling department at the University of Utah as well as co-founder and Chief Psychotherapy Science officer at Lyssn.io, an AI-powered assessment platform for behavioral health and human services. He has had over 50 papers published in academic journals, with a particular interest in assessing and improving the quality of mental health services in a variety of settings.In this episode, Zac talks to Bruce about his work at Lyssn.io, and how they have used natural language processing to analyze psychotherapy and crisis counseling interactions. Bruce and Zac discuss how cutting edge statistical models are revolutionizing psychotherapy research by allowing for faster analysis of larger sample sizes than ever before. Bruce asks Zac to speculate on how this technology could be used to help therapists improve over the course of their careers and what else he thinks the future holds in terms of the applications of artificial intelligence to mental health services.Follow Making Therapy Better onInstagram: https://www.instagram.com/making_therapy_better/Facebook: https://www.facebook.com/makingtherapybetterTwitter: https://twitter.com/therapybetterLinkedIn: https://www.linkedin.com/groups/9223245/The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major" http://www.makingtherapybetter.comMaking Therapy Better is sponsored by CarePaths https://www.carepaths.com

Daisy Singla, PhD is a clinical psychologist, associate professor in the Department of Psychiatry at the University of Toronto, and senior scientist with the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health. She has led some of the largest clinical psychotherapy trials in the world, exploring methods for increasing access to mental health services in diverse cultures and settings around the world. She has received awards from the American Psychological Association and the Society Psychotherapy Research, and in 2018 she became the youngest ever recipient of the Pragmatic Clinical Study Award. In this episode, Daisy talks to Bruce about her work to increase access to mental health services in low-income communities around the world, including in rural India and Uganda. She explains how the task sharing model makes it possible to leverage the expertise of mental health professionals along with motivated trainees from local communities to scale up evidence-based treatments in high need areas. She also describes the training and supervision models they employ and offers her insights on how what she’s learned through this work can be applied in North America. Follow Making Therapy Better onInstagram: https://www.instagram.com/making_therapy_better/Facebook: https://www.facebook.com/makingtherapybetterTwitter: https://twitter.com/therapybetterLinkedIn: https://www.linkedin.com/groups/9223245/The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major" http://www.makingtherapybetter.comMaking Therapy Better is sponsored by CarePaths https://www.carepaths.com

Michael Garrett MD is professor emeritus of Clinical Psychiatry at SUNY Downstate Medical Center in Brooklyn, and previously served as medical director of the Department of Psychiatry at North Central Bronx Hospital, and Deputy Director of Psychiatry at Bellevue Hospital Medical Center in Manhattan. He is the author of Psychotherapy for Psychosis: Integrating Cognitive-Behavioral and Psychodynamic Treatment, which won Second Place in the American Journal of Nursing Book of the Year Award, Psychiatric and Mental Health Nursing Category. His clinical and academic work has focused on better understanding the experience of psychosis and how it can be effectively treated with psychotherapy.In this episode, Bruce talks to Michael about his experience working with clients exhibiting schizophrenia and other psychotic symptoms. Michael explains his understanding of psychosis as originating from a combination of biological predispositions and environmental factors and describes how his integration of both cognitive behavioral and psychodynamic approaches has helped numerous patients who would be considered untreatable by anything other than medication under the previous paradigm. He shares his hopes for the future of psychotherapeutic interventions for psychosis while recognizing that the field is still in the very early stages of understanding how to treat these extremely difficult cases.Follow Making Therapy Better on Instagram: https://www.instagram.com/making_therapy_better/ Facebook: https://www.facebook.com/makingtherapybetter Twitter: https://twitter.com/therapybetter LinkedIn: https://www.linkedin.com/groups/9223245/The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major" http://www.makingtherapybetter.com Making Therapy Better is sponsored by CarePaths https://www.carepaths.com

Jerome is a Professor of Social Work at New York University as well as a member of the American Academy of Social Work and Social Welfare, and has sat on editorial boards for the Clinical Social Work Journal and Evolutionary Psychology. He is the author of more than 300 publications appearing in journals in psychology, philosophy, psychiatry, psychoanalysis, and social work, and a number of books, including The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder, which was named Best Psychology Book of 2007 by the Association of American PublishersIn this episode, Bruce and Jerome talk about the history of the DSM and psychiatric diagnosis, and Jerome’s working definition of mental disorder as a harmful deviation from biologically designed functioning. They also touch on the fact that a large portion of people who benefit from psychotherapy are not actually suffering from a diagnosable disorder. Jerome criticizes the current system that requires a diagnosis for insurance reimbursement and the difficult ethical situation this forces clinicians into. Finally, they discuss more generally the problems caused by the medicalization of mental health care and how to move forward.Follow Making Therapy Better onInstagram: https://www.instagram.com/making_therapy_better/Facebook: https://www.facebook.com/makingtherapybetterTwitter: https://twitter.com/therapybetterLinkedIn: https://www.linkedin.com/groups/9223245/The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major"http://www.makingtherapybetter.comMaking Therapy Better is sponsored by CarePaths https://www.carepaths.com

Nancy McWilliams, PhD is emerita visiting professor of Psychology at Rutgers University and a former president of the American Psychological Association’s Division of Psychoanalysis. She is the author of several books including Psychoanalytic Diagnosis, and Psychoanalytic Psychotherapy: a Practitioner’s Guide. She is the recipient of numerous awards, including the Rosalee Weiss Award, the Laughlin Distinguished Teacher award, and awards for Leadership, Scholarship, and International Academic Excellence from the APA Division of Psychoanalysis. She also maintains a private practice in Lambertville, New Jersey.In this episode, Nancy talks to Bruce about why she favors a psychoanalytic approach to treatment, and how this perspective informs her thinking about diagnosis and supervision. They discuss why psychoanalytic therapy is relevant to lived experiences of therapists and clients rather than simply an interesting historical artifact, as well as the place it might hold in the evolving landscape of mental health care.Follow Making Therapy Better onInstagram: https://www.instagram.com/making_therapy_better/Facebook: https://www.facebook.com/makingtherapybetterTwitter: https://twitter.com/therapybetterLinkedIn: https://www.linkedin.com/groups/9223245/The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major"http://www.makingtherapybetter.comMaking Therapy Better is sponsored by CarePaths https://www.carepaths.com

Dr. Raison is a professor of psychiatry and human ecology at University of Wisconsin-Madison, director of Clinical and Translational Research for Usona Institute, and Director of Research on Spiritual Health for Emory Healthcare. In addition, Dr Raison founded the Center for Compassion Studies at the University of Arizona. His research has focused on novel mechanisms involved in the development and treatment of major depression and on the physical and behavioral effects of compassion training. Recently, Dr. Raison has taken a leadership role in the development of psychedelic medicine, particularly as a treatment for depression. He has received numerous awards, including the Raymond Pearl Award from the Human Biology Association, and being named one of the most influential researchers in the world by Web of Science. His most recent book is The New Mind-Body Science of Depression. In this episode, Charles and Bruce talk about depression as a mind/body phenomenon, and as an evolutionarily adaptive response. Charles shares his thoughts on the present and future of psychedelic-assisted therapy and presents a number of different treatment models and frameworks for understanding why psychedelics are so effective at treating depression for some people. Follow Making Therapy Better on Instagram: https://www.instagram.com/making_ther... Facebook: https://www.facebook.com/makingtherap... Twitter: https://twitter.com/therapybetter LinkedIn: https://www.linkedin.com/showcase/917... The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major" http://www.makingtherapybetter.com Making Therapy Better is sponsored by CarePaths https://www.carepaths.com

Steven is a professor of psychology at Vanderbilt University. He has over 300 publications to his name and is the recipient of numerous awards, including, in 2020, the American Psychological Association’s Distinguished Scientific Award for the Applications of Psychology. He has served as Editor of the journal Cognitive Therapy and Research, and president of the Association for Behavioral and Cognitive Therapies. His research focuses on the treatment and prevention of depression, with a particular emphasis on cognitive therapy in comparison to antidepressant medications.In this episode, Bruce talks to Steven about the evolutionary origins of depression and what we know about the most effective treatments for depression and their mechanisms of action. Steven also presents some surprising new data that challenges the long-held belief that the combination of psychotherapy and medication is more effective in the treatment of depression than either one on its own. Follow Making Therapy Better onInstagram: https://www.instagram.com/making_ther...Facebook: https://www.facebook.com/makingtherap...Twitter: https://twitter.com/therapybetterLinkedIn: https://www.linkedin.com/showcase/917...The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major"http://www.makingtherapybetter.comMaking Therapy Better is brought to you by CarePaths https://www.carepaths.com

Ed received his doctorate in anthropology from UC Santa Barbara, after which he worked at the Institute for Theoretical Biology in Berlin. He is currently a professor of evolutionary anthropology and director of the Bioanthropology Lab at Washington State University Vancouver. His research focuses on evolutionary medicine and finding evolutionary explanations for the origins of substance use and other mental health issues. His work challenges the notion that depression is caused by a dysfunction of the brain and argues that it is likely an adaptive response passed down through natural selection.In this episode, Bruce talks with Ed about his theories and how they can affect the way we view clinical practice.Follow Making Therapy Better onInstagram: https://www.instagram.com/making_ther...Facebook: https://www.facebook.com/makingtherap...Twitter: https://twitter.com/therapybetterLinkedIn: https://www.linkedin.com/showcase/917...The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major"www.makingtherapybetter.comMaking Therapy Better is sponsored by CarePaths https://www.carepaths.com

Barrett Griffith is CEO of CarePaths, where he has served for over five years, previously as a developer and then as CTO. He has two decades of experience in the tech industry, with much of that time in healthcare IT.Maureen Hart, PhD and Geoff Gray, PhD are both psychologists with years of clinical and managerial experience who saw the potential for technology to improve the quality of mental health care. Together they started CarePaths over twenty years ago as an electronic health records system which now includes practice management and outcomes measurement tools. In 2022 they teamed up with Professor Wampold to launch Making Therapy Better, an educational initiative including a blog, webinar and this podcast, coinciding with the release of Automated Measurement Based Care by Bruce Wampold, PhD, a feature of the new CarePaths Connect Digital Front Door and Mobile app for patients. Their hope is to improve mental health outcomes by providing therapists with reliable information on the benefits and practice of MBC as well as effective and affordable tools for implementing it.In the final episode of Season 1, Bruce talks with the CarePaths team about the founding of their company and the origins of the Making Therapy Better project. They also review some of the most important themes from the first eleven episodes of the podcast and discuss what's in store for Season 2.Follow Making Therapy Better on Instagram: https://www.instagram.com/making_ther... Facebook: https://www.facebook.com/makingtherap... Twitter: https://twitter.com/therapybetter LinkedIn: https://www.linkedin.com/showcase/917...The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major"www.makingtherapybetter.comSponsored by CarePaths EHR and Measurement Based Care

Catherine Eubanks, PhD is co-director of the Center for Alliance-Focused Training, and professor of clinical psychology at Adelphi University. She is a fellow of the American Psychological Association and received the Outstanding Early Career Achievement Award from the Society for Psychotherapy Research in 2015. Dr. Eubanks helped to develop the Rupture Resolution Rating System and is coauthor of Therapist Performance under Pressure: Negotiating Emotion, Difference and Rupture. She also recently released Rupture and Repair in Psychotherapy as part of the APA Video Series.In this episode, Bruce and Catherine discuss the importance of a good working therapeutic alliance, particularly how to recognize and repair ruptures in the alliance, both big and small. They identify the most common markers of alliance ruptures, and talk about how clinical supervisors can work with therapists in training to better recognize these markers. They also talk about supervision of supervisors, and other applications of the alliance rupture framework outside of psychotherapy.Learn more about Catherine's work at: https://www.therapeutic-alliance.org/References:Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16(3), 252–260. https://doi.org/10.1037/h0085885Stiles, W. B., Glick, M. J., Osatuke, K., Hardy, G. E., Shapiro, D. A., Agnew-Davies, R., Rees, A., & Barkham, M. (2004). Patterns of alliance developmentand the rupture-repair hypothesis: Are productive relationships U-shaped orV-shaped? Journal of Counseling Psychology, 51, 81–92. http://dx.doi.org/10.1037/0022-0167.51.1.81Safran, J. D., & Muran, J. C. (1996). The resolution of ruptures in the therapeuticalliance. Journal of Consulting and Clinical Psychology, 64, 447–458.http://dx.doi.org/10.1037/0022-006X.64.3.447Follow Making Therapy Better on Instagram: https://www.instagram.com/making_therapy_better/ Facebook: https://www.facebook.com/makingtherapybetter Twitter: https://twitter.com/therapybetter LinkedIn: https://www.linkedin.com/showcase/91731994The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major"www.makingtherapybetter.comSponsored by CarePaths EHR and Measurement Based Care

Jonathan Shedler, Phd is a clinical professor of psychiatry at the University of California, San Francisco (UCSF) and faculty member at the San Francisco Center for Psychoanalysis. He is author of numerous scientific and scholarly articles, and his article The Efficacy of Psychodynamic Psychotherapy won worldwide acclaim for firmly establishing psychoanalytic therapy as an evidence-based treatment. He has more than 25 years’ experience teaching and supervising psychologists, psychiatrists, and psychoanalysts.In this episode Jonathan and Bruce talk about what constitutes meaningful psychological change and whether or not randomized clinical trials of eight to sixteen sessions are actually relevant to real-world psychotherapy. Jonathan also discusses some of the evidence for psychodynamic therapy as an effective long term psychological intervention.Find out more about Jonathan and his work at https://jonathanshedler.com/References:Ormel J, Hollon SD, Kessler RC, Cuijpers P, Monroe SM. More treatment but no less depression: The treatment-prevalence paradox. Clin Psychol Rev. 2022 Feb;91:102111. doi: 10.1016/j.cpr.2021.102111. Epub 2021 Dec 11. PMID: 34959153. https://pubmed.ncbi.nlm.nih.gov/34959153/Beutel, M., Rasting, M., Stuhr, U., Ruger, B., & LeuzingerBohleber, M. (2004). Assessing the impact of psychoanalyses and long-term psychoanalytic psychotherapies on health care utilization and cost. Psychotherapy Research, 14, 146-160.The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major"www.makingtherapybetter.comSponsored By CarePaths EHR and Measurement Based Care

Edward R Jones, PhD is a clinical psychologist with years of executive leadership experience in the behavioral healthcare industry, including Vice President roles at Pacific Care Behavioral Health and Value Options. He has worked as a healthcare consultant in connection with both established and start-up companies. In recent years he has focused on health and wellness services, digital health services, and consultation to employers on the economic value of health and productivity.In this episode, Bruce and Ed talk about the future of behavioral healthcare, and how a new model of trained therapists integrated into the primary care system could help improve access to mental health services, as well as some of the potential pitfalls of the new age of digital therapeutics.The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major"www.makingtherapybetter.comSponsored by CarePaths EHR and Measurement Based Care

Terri Moyers, PhD is a Professor in the Psychology Department at the University of New Mexico. Her research has focused on the active ingredients of empirically supported interventions for substance use treatments, particularly motivational interviewing. She also has an active line of research investigating therapist characteristics that support more favorable client outcomes. Dr. Moyers has more than 30 peer-reviewed papers in these areas, and has been a keynote speaker and workshop teacher in 11 countries.William R. (Bill) Miller, PhD is Emeritus Distinguished Professor of Psychology and Psychiatry at the University of New Mexico. Fundamentally interested in the psychology of change, he has published 65 books for public and professional audiences including texts on the method of motivational interviewing that he first described in 1983.Together, they are the authors of Effective Psychotherapists: Clinical Skills that Improve Client OutcomesIn this episode, Bruce talks with Terri and Bill about empathy as one of the eight skills that they have identified in their book as important for successful therapists. They discuss different understandings of empathy and how it relates to motivational interviewing. They also address the questions of whether empathy is an inherent trait or an acquired skill, whether it can lead to burnout, and the differences between empathy and compassion.The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major"www.makingtherapybetter.comSponsored by CarePaths EHR and Measurement Based Care

Helene Nissen-Lie is a professor of clinical psychology at the University of Oslo and a practicing psychologist. She participates in a number of research projects in Norway as well as internationally, including collaborations with the University of Sheffield and the University of Chicago. She has published over 50 papers and articles, and her research interests include therapist effects, the therapeutic alliance, mechanisms of change in psychotherapy, and outcomes research, among many others.In this episode, Bruce talks to Helene about her research and her surprising finding that therapists who expressed more professional self-doubt, which they both agree may be better thought of as "professional humility" end up with better outcomes for their clients. They also talk about some of the applications of measurement-based care and the differences between the Norwegian and American systems of mental-health care.The intro and outro music is the Borromeo String Quartet performing Beethoven's "String Quartet No. 3 in D Major"www.makingtherapybetter.comSponsored By CarePaths EHR and Measurement Based Care