Psychotherapy - SWEET INSTITUTE - Continuing Education for Mental Health Professionals

Target Fixation: A Metaphor for Goal Achievement

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Wed, 19 Jul 2023 22:33:22 +0000

Mardoche started to get interested in cycling. As he bikes, he started to appreciate more and more something so relevant to the work we do, every day, as clinicians. It is what we refer to in science as “Target Fixation.” What is “Target Fixation”? Target fixation is also known as “eye-steering.” It is a psychological effect that can influence our direction of travel, particularly when riding a bicycle or motorcycle.[1] Why does this happen? Here are the three main reasons why: Visual Attention[2]: Our visual attention is closely linked to our body’s movement. When we focus our eyes on a specific object or point, our attention becomes fixated on that target. As a result, our body naturally tends to move in the direction we are looking. Balance and Proprioception[3]: When riding a bike, our body relies on a combination of visual cues, balance, and proprioception to maintain stability and control. Looking in a particular direction can subtly shift our body’s balance and affect our steering input, causing the bike to lean or turn in that direction. Note that proprioception is awareness of body position. In other words, awareness plays a key role in maintaining such stability and control. Unconscious Steering Input: The act of looking in a specific direction can trigger subtle unconscious movements in our hands, arms, and upper body. These small steering adjustments, often imperceptible to us, contribute to the bike naturally following the direction of our eyes. Target fixation influences our steering and the control of the bike’s movement, not just through the above three mechanisms. Rather, also by affecting other factors, including: Our body positioning Our weight distribution Our intentional steering inputs Awareness of target fixation is key; and by consciously directing our gaze where we want to go and practicing good riding techniques, we can improve our ability to control the bike effectively and navigate safely. Now, how is this relevant to the work we do? Well, everything we do with our clients is goal-based, whether we are aware of that or not. As a result, goal achievement is key to the work we do with our patients. This is despite the fact that we, clinicians, have not been formally trained in the area of goal achievement. Now, what is the relationship between target fixation and goal achievement? Let us look: Goal achievement is a fundamental aspect of growth, development, and success. It involves: Setting clear objectives Charting a path Making progress toward desired outcomes Interestingly, the phenomenon of target fixation, often observed in activities like cycling or motorcycling, as discussed above, can serve as a powerful metaphor for understanding and achieving our goals and guide our patients and clients to do the same. Let’s explore how target fixation relates to goal achievement and the lessons it offers along the way. The Power of Focus[4]: In target fixation, the direction of our eyes and focus influence our path of travel. Similarly, in goal achievement, a clear focus on our desired outcome plays a pivotal role. By setting specific goals and maintaining unwavering attention on them, we increase our chances of reaching them. Like a cyclist intently staring at a target, our focused attention directs our efforts, decisions, and actions toward the realization of our goals. Harnessing the Unconscious Mind: Target fixation triggers subtle unconscious movements in our body, guiding us in the direction we are looking. In goal achievement, our unconscious mind also plays a significant role[5]. When we deeply internalize our goals and maintain an optimal mindset, our unconscious mind becomes aligned with our objectives. It drives us to take action, make choices, and seize opportunities that bring us closer to our desired outcomes, often without us consciously realizing it. Overcoming Distractions and Obstacles: During target fixation, excessive fixation on obstacles rather than the desired path can lead to accidents or deviations. Similarly, in goal achievement, distractions, and obstacles can divert our attention and impede progress[6]. By staying focused on our target and cultivating resilience, we can navigate around obstacles and remain on track. We learn to acknowledge distractions without losing sight of our ultimate destination. Balance and Adaptability: In target fixation, balance is crucial for maintaining control and staying on course. Likewise, in goal achievement, finding balance in our efforts, resources, and priorities is essential. Balancing dedication with self-care, perseverance with flexibility, and short-term milestones with a long-term vision, ensures sustained progress and adaptability[7]. It enables us to adjust our approach when needed without losing sight of our ultimate goal. Celebrating Milestones: During target fixation, as a cyclist reaches intermediate targets, they experience a sense of accomplishment and motivation to keep going. Similarly, in goal achievement, acknowledging and celebrating milestones along the way provides a boost of motivation and reinforces progress. By recognizing and appreciating each step taken towards our goals, we cultivate a positive mindset and the drive to continue forward. Target fixation serves as a powerful metaphor for goal achievement, teaching us the importance of focus, harnessing the unconscious mind, overcoming obstacles, maintaining balance, and celebrating milestones. By applying these lessons to our pursuit of goals, we can maximize our chances of success. As we fix our gaze on our desired outcomes, remain adaptable, and steer clear of distractions, we empower ourselves to navigate the path to achievement with determination, resilience, and unwavering focus. Isn’t this an idea worth sharing with our colleagues, our mentees, and more importantly with our patients and clients? And, please come and engage in experiential learning, through the SWEET Model, by attending one or more of the following seminars this week: Social Work Code of Ethics Mastering Genograms Cognitive Distortions and Our Clients Mastering Case Formulation The Psychotherapy Certificate Course (Self-Study) Also, join us for our upcoming CBT for PTSD Virtual Conference. [1] Bobrova, E. V., et al. “Comparative analysis of the dynamics of human postural control during fixation and pursuit of a visual target.” Biophysics 52 (2007): 248-252. [2] Samiei, Manoosh, and James J. Clark. “Target Features Affect Visual Search, A Study of Eye Fixations.” arXiv preprint […]

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How to Become Wise: The Supertherapist’s Ten Reflections on Wisdom

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Thu, 01 Jun 2023 10:36:52 +0000

The Supertherapist knows all too well that wisdom means to be integrated with the Source of Wisdom in them. They also know that the process of being integrated with the Source of Wisdom involves: Unlearning Relearning Learning again In this process, Supertherapists: Remove blocks, in form of patterns Gain knowledge, which is different from perception or just information Go through an experiential process culminating in understanding They then learn to develop: Sound judgment Wisdom Discernment Here are the ten reflections of Supertherapists on Wisdom and becoming wise: Allowing Understanding Actively allowing learning and knowledge in various areas of life Reading books Engaging in meaningful conversations Exploring different perspectives Staying curious about ourselves, others, and the world around them Embracing Life Experiences Learning from our own experiences and reflecting upon them Embracing both successes and failures as opportunities for growth and self-integration Extracting valuable lessons from each experience to enhance our understanding of life Practicing Critical Thinking[1] Developing the ability to think critically and analyzing information objectively Questioning assumptions, limiting beliefs and schemas Evaluating evidence, and considering alternative viewpoints Avoiding hasty judgments and striving for a balanced and rational approach Cultivating Open-Mindedness Being open to new ideas, perspectives, and possibilities Avoiding rigid thinking and embracing intellectual flexibility Allowing ourselves to consider different viewpoints, even if they challenge our existing beliefs Seeking Guidance from Mentors Seeking out mentors or wise individuals who can provide guidance and share their wisdom with us Learning from others’ experiences, insights, and advice Knowing that others’ guidance can be part of our process of mastering how to navigate challenges and gain valuable insights from and through life Practicing Self-Reflection[2] Taking time for introspection and self-reflection Exploring our thoughts, emotions, and beliefs Regularly evaluating our own actions, motivations, and values Understanding that self-reflection helps deepen self-awareness and promotes personal growth Learning from Others Observing and learning from the experiences and wisdom of others Engaging in meaningful conversations, listening actively, and asking questions Being open to learning from people of different ages, backgrounds, and perspectives Cultivating Empathy[3] Developing the ability to understand and empathize with others Seeking to understand others’ experiences, emotions, and perspectives Understanding that empathy helps broaden our understanding of the human condition and enhances our ability to make wise decisions Practicing Mindfulness[4] Cultivating mindfulness by being fully present in the moment and aware of our thoughts, emotions, and sensations Understanding that mindfulness helps us observe and respond to situations with clarity and wisdom Embracing Humility[5] Recognizing our own limitations and embracing a humble attitude Avoiding excessive pride or arrogance. For we know that they hinder the growth of wisdom Understanding that humility allows us to: Be open to learning Consider different viewpoints Accept that we don’t have all the answers; unless we are fully integrated with our Source of Wisdom Now unto you: Many of these reflections are yours. Others are very much familiar to you; while still others are still a challenge. Here, at SWEET, we have thousands of online seminars that can help you in your process of becoming wise. Click the link below to select some courses, and let us continue to be empowered and model for our patients and clients to do the same. Schema Therapy for Clinicians: Mondays from 8-9pm (EDT) Philosophy and Mental Health: Monday, 10:30-11:30pm Super Memory Skills for Clinicians: Wednesdays from 7-8pm (EDT) Writing Skills for Clinicians: Thursdays from 10:30-11:30pm (EDT) Spiritual Tools for Clinical Outcomes: 2nd and 4th Saturday, 2-3pm Please also join us for our upcoming CBT Virtual Conference on CBT for Substance Use, Friday, June 16, 2023 [1] Krupat, Edward, et al. “Thinking critically about critical thinking: ability, disposition or both?.” Medical education 45.6 (2011): 625-635. [2] Gerace, Adam, et al. “‘I think, you think’: Understanding the importance of self-reflection to the taking of another person’s perspective.” Journal of Relationships Research 8 (2017): e9. [3] Hardee, James T. “An overview of empathy.” The Permanente Journal 7.4 (2003): 51. [4] Irving, Julie Anne, Patricia L. Dobkin, and Jeeseon Park. “Cultivating mindfulness in health care professionals: A review of empirical studies of mindfulness-based stress reduction (MBSR).” Complementary therapies in clinical practice 15.2 (2009): 61-66. [5] Huynh, Ho Phi, and Amy Dicke-Bohmann. “Humble doctors, healthy patients? Exploring the relationships between clinician humility and patient satisfaction, trust, and health status.” Patient Education and Counseling 103.1 (2020): 173-179.

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25 Exercises of Supertherapists

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Sun, 28 May 2023 16:26:51 +0000

In two previous articles entitled, 25 Practices of Supertherapists and 25 Additional Practices of Supertherapists, we have outlined a total of 50 practices that elevate Supertherapists. In this article, we are outlining 25 exercises that truly make the difference in the lives of Supertherapists. Let us read on and enjoy. Supertherapists learn to take a step back with each doubt to examine whether it is fear or a feedback mechanism from their Source of Wisdom They understand that everyone and everything around them are a Source of Wisdom and they allow themselves to learn from them They learn that they become most alive when they are doing what will benefit both them and others, understanding that the more people will benefit the more alive they become They are curious about their life. Instead of reacting to life, they use each and every aspect of it as an opportunity They continuously pay attention to where they are operating from and use every single opportunity to shift They continuously work on developing a healthy relationship with their past They continuously work on developing a healthy relationship with their present, understanding that thinking about the future is always a rehearsal of their past They draw inspiration from others’ success instead of resenting them They take “losses” as an opportunity to remind themselves that Consciousness is that part of ourselves that we do not see and that is always present They practice neutrality, understanding the Best Interest Principle They work on remaining open-minded, adopting the Beginner’s Mind[1], and making use of the Wise Mind[2] They work on keeping in mind what truly matters They work on being aware of their limiting beliefs and they practice Belief Substitution They engage in critical thinking[3], learning to think for themselves, and applying first principles, as often as possible They learn to be aware of their fear and they work on replacing it with awareness, every time They know they have nothing to prove, understanding that appearances are short-lived and what is True eventually reveals itself They learn to stay confident about how things are going to turn out, understanding that all it takes is doing the best one can and leaving up the rest up to Life As part of paying attention to each of the 7 Areas of Life, they practice taking care of themselves, including eating well, exercising, and resting They understand that only in the context of our contribution to a community do our achievements really become meaningful They understand that wanting to be seen as smart is really a function of Imposter Syndrome[4] They learn the value of being honest with themselves, understanding that refusing to acknowledge our unhealthy patterns serves no one They understand that it is best to have fewer, deeper friendships than to have many superficial ones They learn to stand on the shoulders of giants They learn to work on expressing their authenticity[5] They learn the art and science of forgiving and they continuously work on forgiving themselves, forgiving others, knowing that all they are really forgiving is their thoughts and meaning given to things Once again: Which ones of these 25 exercises are yours? Which ones of them are foreign to you? Which ones would you like to start implementing right away? When would you like to start implementing them? What do you need to get started? Below is a list of series happening at the Institute that you may find to be helpful and relevant to these 25 additional practices. Which ones can you commit to attend? See below and see you soon: Philosophy and Mental Health: Monday, 10:30-11:30pmAddiction Mental Health:2nd and 4th Wednesday, 8-9pm Geriatric Mental Health:1st & 3rd Wednesday, 8-9pm Child and Adolescent Mental Health Series:1st & 3rd Saturday, 2-3pm Spiritual Tools for Clinical Outcomes:2nd & 4th Saturday, 2-3pm Ethics, Law, and Mental Health Series: Every Friday, 1-2pm Please also join us for our upcoming CBT Virtual Conference on CBT for Substance Use, Friday, June 16, 2023 [1] McKenzie-Edwards, Emma. “Are we enabling the next generation to thrive?.” London Journal of Primary Care 9.6 (2017): 81-82. [2] Alexander, Ronald. Wise mind, open mind: Finding purpose and meaning in times of crisis, loss, and change. New Harbinger Publications, 2009. [3] Feltham, Colin. Critical thinking in counselling and psychotherapy. Sage, 2010. [4] Mullangi, Samyukta, and Reshma Jagsi. “Imposter syndrome: treat the cause, not the symptom.” Jama 322.5 (2019): 403-404. [5] Erskine, Richard G. “Vulnerability, authenticity, and inter-subjective contact: Philosophical principles of integrative psychotherapy.” International Journal of Integrative Psychotherapy 4.2 (2013): 1-9.

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25 Practices of Supertherapists

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Thu, 11 May 2023 12:56:07 +0000

Our identity, for example, being a Supertherapist, is a result of our habits. Our habits, in turn, are the result of our behaviors. A behavior is how we do things. It is our practice, our exercise. It is what we do in combination with how we feel, our focus, attitude, and belief. As you embark on your journey as a Supertherapist, here are 25 Practices of Supertherapists to reflect on. Which ones catch your attention the most? Read on… Daily reflection on the work they do[1] They often ask: “What went as expected? What could I have done differently? What am I going to do differently next time? They consult with themselves, first They are clear on what they are doing and why they are doing it They have a framework and a system for everything they do They have a How; yet remain flexible to allow room for flexibility and improvisation They know there is always time for everything; and they are responsible with how they use their time They are conscious of how they use their time. They are present and mindful They know when to consult, who to consult, and how to consult[2] They set time aside to read, to discuss cases, and to write They have solid skills in clinical interviewing, the art and science of questioning, and in mental health evaluation They have solid skills in establishing rapport, in engaging their patients, and in establishing trust and safety They have solid skills in doing a History of Present Illness, a History of Mental Health Symptoms, and in Symptom Contextualization They have solid skills in doing a Case Formulation, a Diagnostic Formulation, and in Differential Diagnosis They have solid skills in doing a cultural assessment, a spiritual assessment, and in formulating a comprehensive treatment plan[3] They hone their skills and their craft with much dedication They are continuously working on knowing themselves. They know they have blind spots; and that the best way to uncover them is by going inside, be it through introspection, inquiry, or meditation They know that the ultimate way for patients to end their suffering is through integration. This means becoming connected with their source of wisdom more often than not They know one best way to help their patients is by maintaining a safe place for them to unlearn, relearn, and learn again[4] They know one best way for their patient to learn is by being a model for them[5] They know that all forms of treatment have their place and time. They then become acquainted with as many of them as possible; and they develop at least a working knowledge of the different methods and systems involved in evaluating and treating patients They have developed the wisdom to understand that people will claim to discover new theories, which are already well-known principles that are slightly restated They remain up-to-date and use the latest practice guidelines. However, they remain flexible enough to always put their patients first They set time aside to learn skills like public speaking, writing, speed reading, memory skills, and critical thinking. They know the more they have the more they can give and they cannot give what they do not have They have developed such a high physical and spiritual intelligence[6] to know when to rest just a little bit more, when to take some time off, and when to return to the world with an exponentially fuller force Now, unto you: Which of these 25 practices is yours? Which ones of them are foreign to you? Which ones would you like to start implementing right away? When would you like to start implementing them? What do you need to get started? Below is a list of series happening at the Institute that you may find to be helpful and relevant to these 25 practices. Which ones can you commit to attending? See below and see you soon: Speed Reading for Clinicians, Mondays from 7-8pm (EDT) Super Memory Skills for Clinicians, Wednesdays from 7-8pm (EDT) Writing Skills for Clinicians, Thursdays from 10:30-11:30pm (EDT) Public Speaking for Clinicians, Tuesdays from 10:30-11:30pm (EDT) Also, join us for our virtual conference on CBT for Behavior Change on Friday, May 19, 2023 from 9-1pm [1] McBeath, Alistair. “The motivations of psychotherapists: An in‐depth survey.” Counselling and Psychotherapy Research 19.4 (2019): 377-387. [2] Rønnestad, Michael Helge, et al. “The professional development of counsellors and psychotherapists: Implications of empirical studies for supervision, training and practice.” Counselling and Psychotherapy Research 19.3 (2019): 214-230. [3] Gilbert, Paul. “Psychotherapy for the 21st century: An integrative, evolutionary, contextual, biopsychosocial approach.” Psychology and Psychotherapy: Theory, Research and Practice 92.2 (2019): 164-189. [4] Tsai, Mavis, et al. “Creating safe, evocative, attuned, and mutually vulnerable therapeutic beginnings: Strategies from functional analytic psychotherapy.” Psychotherapy 56.1 (2019): 55. [5] Bellows, Karen F. “Psychotherapists’ personal psychotherapy and its perceived influence on clinical practice.” Bulletin of the Menninger Clinic 71.3 (2007): 204-226. [6] Al Eid, Nawal A., Boshra A. Arnout, and Ayed A. Almoied. “Leader’s spiritual intelligence and religiousness: Skills, factors affecting, and their effects on performance (a qualitative study by grounded theory).” Journal of Public Affairs 21.1 (2021): e2129.

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Supertherapists and the Trolley Problem

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Sun, 07 May 2023 14:10:20 +0000

The Trolley Problem[1] can help us brainstorm on decision-making in ethics in mental health. It was first invented by Philippa Foot[2], over half a century ago, in 1967. Since then, a series of experts have built upon it through different scenarios to test moral intuitions for those specialized in ethics, for the general public, and for professionals in fields like ours. While there are several iterations of the Trolley Problem, the most basic is as follows: A driver loses control of his trolley. There are 5 people tied to the track and they are going to be killed. The driver has the option to divert the trolley to an alternate track where only one person is tied. That would then result in one person being killed versus five. What would you do if you were the driver? Would you continue on the track where 5 people would be killed? Or, would you divert the trolley to the alternative track where one person would be killed? To answer this question, we will use a point of reference, which for us consists of the four pillars of medical ethics, known as the Four Main Principles: Non-maleficence – which is to do no harm[3] Beneficence- which means doing what is in the patient’s best interest[4] Autonomy – means respecting the patient’s choice[5] Justice â€“ means equity and fairness Inquiries: Are these four main principles all created equal? Is one ever more important than the others? If so, which one? First “Do No Harm” may be one of the most common phrases in medicine, at large, and in mental health, in particular. And, this may be another way to introduce the primacy of the principle of non-maleficence. This means, under usual circumstances, the principle of nonmaleficence tends to prevail over the other thee. Simply put, when dealing with ethical dilemmas, relying on the primacy of the non-maleficence principle may be a safe rule of thumb. Yet, is it that simple? Is it that straightforward? How does that really play itself in practice? The Trolley Problem with its varying scenarios shows us that ethical decisions are not always clear-cut. This is because it depends on which theory is being used to look at the dilemma. There are three major approaches to ethics to which several major ethical theories relate: Virtue Theory which is treating concepts of moral virtue as central[6] Consequentialism treats the concept of goodness of outcomes of an action as central[7] Deontology makes the concept of moral duty central[8] From these three major approaches, the following theories derive and are very relevant to the work we do as Supertherapists. We have: Kantian principles, which are related to Deontology Utilitarianism, which is related to Consequentiality The doctrine of double effect, which is related to Virtue Theory; and Contemporary virtue ethics, which is related to Virtue Theory In subsequent articles, we are going to elaborate on the above aspects of ethics in mental health. This is because operating from principles is one of the secrets of Supertherapists. While waiting for the next article on this series, we invite you to join us for our Ethics, Law, and Mental Health Series, which started on Friday, May 5th, and runs every week. We also invite you to register for one or more of our 19 special series at SWEET. These series are designed to give you the skills you need in each and every single area of mental health: Neuroanatomy Made Simple Business Skills for Clinicians Speed Reading for Clinicians Schema Therapy for Clinicians Medical First Aid for Clinicians Philosophy and Mental Health Public Speaking for Clinicians Super Memory Skills for Clinicians Geriatric Mental Health Addiction Mental Health Basic Biostatistics for Clinicians Writing Skills for Clinicians Ethics, Law, and Mental Health Basic Neurology for Clinicians Optimal Aging Child & Adolescent Mental Health Spiritual Tools for Clinicians Research Skills for Clinicians [1] Thomson, Judith Jarvis. The Trolley Problem. The Yale Law Journal, vol. 94, no. 6, 1985, pp. 1395â€“415. JSTOR, https://doi.org/10.2307/796133. Accessed 4 May 2023. [2] Wikimedia Foundation. (2023, February 10). Philippa Foot. Wikipedia. Retrieved May 4, 2023, from https://en.wikipedia.org/wiki/Philippa_Foot [3] Andersson, Gunnar BJ, et al. “Do no harm: the balance of beneficence and non-maleficence.”Spine 35.9S (2010): S2-S8. [4] Pellegrino, Edmund D. “For the patient’s good: The restoration of beneficence in health care.” (1988). [5] Deci, Edward L., and Richard M. Ryan. “The support of autonomy and the control of behavior.”Â Journal of personality and social psychologyÂ 53.6 (1987): 1024. [6] Statman, Daniel. “Introduction to virtue ethics.”Virtue ethics: A critical reader” (1997): 1-41. [7] Driver, Julia.Â Consequentialism. Routledge, 2011. [8] Paquette, Michael, Erich J. Sommerfeldt, and Michael L. Kent. “Do the ends justify the means? Dialogue, development communication, and deontological ethics.”Â Public Relations ReviewÂ 41.1 (2015): 30-39.

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Treatment Planning By Supertherapists

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Thu, 27 Apr 2023 13:44:02 +0000

Let us start with the following 10 inquiries: What is Treatment Planning? How do you currently think about Treatment Planning? What does Treatment Planning mean to you? What comes to mind when you hear or say the term “Treatment Planning”? What does the term “Treatment Planning” evoke for you? What are your current best practices regarding Treatment Planning? How satisfied are you with the current state of affairs when it comes to Treatment Planning? How successful have your Treatment Planning practices been for your clients? What will it take to make a major change in this area? What does it take to implement such a change? Supertherapists use principles to guide them. Effective Treatment Planning is based on principles. Below are five principles that Supertherapists use to guide their treatment plans. Treatment Planning: The 5 Principles: Team Approach: Supertherapists know that it takes a village. They know that each member of the treatment team has a role. They know that it is not about degree or background; rather it is about working together to do the best with, for, and by their patients.[1] Collaboration: Supertherapists know that fresh eyes make a difference. They also know that their best collaborator is their patient. And they know that the best way to have a successful treatment plan is to make their patient their chief collaborator.[2] Framework: Supertherapists use and rely on a framework. They are effective and efficient because they build a framework and then allow the framework to build their work. In other words, they do not need to be thinking about how to make the same decision each time they have to make it. In this vein, a framework that becomes handy for them when it comes to formulating and implementing an effective treatment plan is the bio-psycho-social-cultural formulation.[3] Guidance: Supertherapists use principles to guide them. They use a framework to build their work upon. And they consistently rely on patient feedback to adjust accordingly. Supertherapists do not just assume and then act. Rather, they check what they think with their patients and then act accordingly. In other words, consulting with their patients is their primary guiding principle.[4] Patient-Centered: Supertherapists stand on the shoulders of clinicians like Carl Rogers, who is one of the founders of the humanistic approach in psychology, one of the founding fathers of psychotherapy research, and is considered the most influential psychotherapist in history, by some standards, and even more influential than Sigmund Freud, in this regard. Patient-centered care is one of Rogers’s best gifts to Supertherapists, who, in turn, use it as another key guiding principle for their treatment planning and their work, in general.[5] Which of the above 5 principles would you like to implement in your practice? Stay tuned for additional insights into how Supertherapists function. Maybe you are already one of them, and you are finding all this reading rather satisfying. Regardless, as you wait for the next article in this series, feel free to join us for one of our 12 series. Neuroanatomy Made Simple Addiction Mental Health Spiritual Tools for Clinical Outcomes Geriatric Mental Health Ethics, Law, and Mental Health Series Speed Reading for Clinicians Medical First Aid for Clinicians Super Memory Skills for Clinicians Research Week for Clinicians Optimal Aging Series Child and Adolescent Mental Health Series [1] Moulder, Patricia A., Anne M. Staal, and Marjorie Grant. “Making the interdisciplinary team approach work.”Â Rehabilitation Nursing JournalÂ 13.6 (1988): 338-339. [2] Woody, Sheila R., et al.Â Treatment planning in psychotherapy: Taking the guesswork out of clinical care. Guilford Press, 2004. [3] Boschen, Mark J., and Tian PS Oei. “A cognitive behavioral case formulation framework for treatment planning in anxiety disorders.”Â Depression and AnxietyÂ 25.10 (2008): 811-823. [4] Lambert, Michael J., and Kenichi Shimokawa. “Collecting client feedback.” (2016). [5] Rathert, Cheryl, Mary D. Wyrwich, and Suzanne Austin Boren. “Patient-centered care and outcomes: a systematic review of the literature.”Â Medical Care Research and ReviewÂ 70.4 (2013): 351-379.

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The Use of Scales in Mental Health

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Thu, 20 Apr 2023 10:14:26 +0000

We have written a series of articles on Supertherapists. In the first one, entitled, Becoming a Supertherapist, some of the inquiries are related to success rates, the tools we use to evaluate success, and to measure our own progress, and that of our patients. In our second article entitled, 7 Revelations to Becoming a Supertherapist, we discuss (1) how the best and most competent appraiser for our patients’ outcome is our patient, (2) how our patient’s assessment of us is not always accurate, and (3) how the assessment method used on our patients can make or break. We also discuss how the best way to obtain the most accurate level of assessment of us from our patients is through the use of systematized measures. This may clearly show how part of the secret to becoming a Supertherapist lies in a mastery of understanding and using measures. What is a measure? A measure is a scale, and a scale can be defined as follows[1]: A system of ordered marks at fixed intervals used as a reference standard in measure A standard of measurement or judgment; a criterion A progressive classification, as of size, amount, importance, or rank In healthcare, in general, and in the field of mental health, in particular, we have an overwhelmingly high number of scales. From measuring mood disorders[2] to measuring anxiety[3]; from measuring ADHD[4] to measuring personality type[5]; and from measuring suicide[6] to measuring violence[7]. Choosing among the high number of available choices can be rather daunting. We might decide to solve this problem by choosing the best one for each scenario. But what does it mean to choose the best one? What criteria are used to determine whether this scale is better compared to that one? As a Supertherapist, we are going to make use of scales to obtain objective, valid, and reliable feedback from our patients. To ensure this is done well enough, let us go ahead and talk about scales. Let us start by looking at features or characteristics of what we consider to be the best possible scales. Many of them will be stated in different ways to facilitate the learning around this. Features or Characteristics of What We Consider to be the Best Possible Scales: We know a scale is an optimal one because: The optimal question is asked. The questions being used match the needs that are being sought to fulfill. The scale is practical to administer. The expenses related to administering and using the scale are low. This is in regard to time, money, and other types of resources. It is efficient to administer the scale. The scale is bias-free at its best. The scale truly measures what it claims to measure (test validity) (For example, the scores have appropriate correlations with the outcome variables as well as other scales). The scores are consistent when readministered to the same individual even under other circumstances (Test-retest reliability). The scores are consistent when readministered by a different clinician to the same individual even under other circumstances (inter-rater reliability). The norms are adequate and appropriate. In subsequent articles, we are going to elaborate on the above features and characteristics of scales. This is because, as already mentioned, you are going to obtain feedback from your patients, the feedback needs to be valid and reliable, and for this, you will benefit from having a basic understanding of the psychometrics of scales. While waiting for the next article on this series, here’s what you can do: Be one of the first 100 clinicians to send your thoughts and you may earn a free 6-month one-on-one coaching session with SWEET. Click below to register for one or more of our 12 series at SWEET. These series are designed to give you the skills you need in each and every single area of mental health: Neuroanatomy Made Simple Addiction Mental Health Spiritual Tools for Clinical Outcomes Geriatric Mental Health: 1st & 3rd Wednesday Ethics, Law, and Mental Health Series Speed Reading for Clinicians Medical First Aid for Clinicians Super Memory Skills for Clinicians Research Week for Clinicians Optimal Aging Series Child and Adolescent Mental Health Series [1] Publishers, H. C. (n.d.). The American Heritage Dictionary entry: Scale. American Heritage Dictionary Entry: scale. Retrieved April 19, 2023, from https://ahdictionary.com/word/search.html?q=scale [2] Mood disorder rating scales. NCMD. (n.d.). Retrieved April 19, 2023, from https://mood-disorders.co.uk/resources/rating-scales [3] Julian LJ. Measures of anxiety: State-Trait Anxiety Inventory (STAI), Beck Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety (HADS-A). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11(0 11):S467-72. doi: 10.1002/acr.20561. PMID: 22588767; PMCID: PMC3879951. [4] ADHD rating scales. ADHD Institute. (2022, January 18). Retrieved April 19, 2023, from https://adhd-institute.com/assessment-diagnosis/rating-scales/ [5] Nunes A, Limpo T, Lima CF, Castro SL. Short Scales for the Assessment of Personality Traits: Development and Validation of the Portuguese Ten-Item Personality Inventory (TIPI). Front Psychol. 2018 Apr 5;9:461. doi: 10.3389/fpsyg.2018.00461. PMID: 29674989; PMCID: PMC5895732. [6] Ghasemi P, Shaghaghi A, Allahverdipour H. Measurement Scales of Suicidal Ideation and Attitudes: A Systematic Review Article. Health Promot Perspect. 2015 Oct 25;5(3):156-68. doi: 10.15171/hpp.2015.019. PMID: 26634193; PMCID: PMC4667258. [7] Dahlberg LL, Toal SB, Swahn M, Behrens CB. Measuring Violence-Related Attitudes, Behaviors, and Influences Among Youths: A Compendium of Assessment Tools, 2nd ed., Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2005.

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21 More Secrets of Supertherapists

Mardoche Sidor, MD and Karen Dubin, PhD, LCSW — Sun, 16 Apr 2023 12:48:06 +0000

In a previous article, entitled, The First 21 Secrets of Supertherapists, we outlined exactly that – 21 secrets that Supertherapists know that ordinary therapists do not. This current article introduces 21 more secrets. Let us go ahead and have fun. Secret #22: Supertherapists pay close attention to their baseline outcomes at all times.[1] Secret #23: Supertherapists are persistent. Secret #24: Supertherapists make small but consistent improvements each time they receive feedback.[2] Secret #25: Supertherapists obtain regular, timely, and frequent feedback from their patients and do so systematically.[3] Secret #26: Supertherapists rarely, if ever, attribute failure to external or uncontrollable factors. Secret #27: Supertherapists spend more time thinking about strategies that may be more effective. Secret #28: Supertherapists rarely attribute patients’ failure to engage to patient denial, resistance, or lack of motivation. Secret #29: Supertherapists stay away from explanations that blame the patient and excuse the clinician.[4] Secret #30: Supertherapists are always willing to engage in deliberate practice. Secret #31: Supertherapists are self-motivated. Secret #32: Supertherapists devote time, energy, and resources to achieve the highest possible outcomes for each of their patients. Secret #33: Supertherapists engage in deliberate practice multiple times a day. Secret #34: Supertherapists engage in continuing education that targets the development of skill sets specific to their individual needs based on the ongoing feedback they receive from their patients.[5] Secret #35: Supertherapists pursue excellence in every one of their clinical encounters. Secret #36: Supertherapists hold themselves accountable at all times.[6] Secret #37: Supertherapists know that their patients are looking for value, that they deserve it, and they are working each day to provide their patients just that and nothing less. Secret #38: Supertherapists know and understand that they are apprentices and that mastery is a moment-by-moment process and never a destination.[7] Secret # 39: Supertherapists always keep each patient’s outcome in mind. Secret # 40: Supertherapists go beyond just seeing their patients be “better off.” Secret # 41: Supertherapists know and understand very well that success leaves clues, and they are willing to pay attention to these clues and act accordingly. Secret # 42: Supertherapists know that the single most determinative factor in patient outcome is who delivers the treatment. By now, you have been introduced to a total of 42 secrets of Supertherapists. There are more secrets to come, and we will soon be elaborating on each of them. We will also create a mechanism by which you will be able to embody these secrets in the most effortless way possible. It will all be part of a process. We will get there. For now: What do you hear so far? Which of these 42 secrets of Supertherapists speak to you the most? Which ones catch your attention the most? What would you like to do about that? When would you like to do that? What is the next step? Stay tuned for the subsequent articles in this series to continue to learn about the characteristics of the Supertherapists, their secrets, and how to implement them in your own practice. Meanwhile, here’s what you can do: Be one of the first 100 clinicians to send your thoughts on the above inquiries, and you may earn a free 6-month one-on-one coaching session with SWEET. Email us at contact@sweetinstitute.com, Subject Line: 6 Month One-one-One Coaching Click here to register for one or both of our upcoming Certificate Courses Loneliness Certificate Course: Click to join us [1] Stein, David M., and Michael J. Lambert. “On the relationship between therapist experience and psychotherapy outcome.” Clinical Psychology Review 4.2 (1984): 127-142. [2] Okiishi, John C., et al. “An analysis of therapist treatment effects: Toward providing feedback to individual therapists on their clients’ psychotherapy outcome.” Journal of clinical psychology 62.9 (2006): 1157-1172. [3] Lambert, Michael J. “Emerging methods for providing clinicians with timely feedback on treatment effectiveness: An introduction.” Journal of Clinical Psychology 61.2 (2005): 141-144. [4] Waller, Glenn, and Hannah Turner. “Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track.” Behaviour research and therapy 77 (2016): 129-137. [5] Jameson, Penny, Michael Stadter, and James Poulton. “Sustained and sustaining continuing education for therapists.” Psychotherapy: Theory, Research, Practice, Training 44.1 (2007): 110. [6] Sparks, Jacqueline A., et al. “Teaching accountability: Using client feedback to train effective family therapists.” Journal of Marital and Family Therapy 37.4 (2011): 452-467. [7] Jennings, Len, and Thomas M. Skovholt. “The cognitive, emotional, and relational characteristics of master therapists.” Journal of counseling psychology 46.1 (1999): 3.

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