greatest hits

www.heartandsoulofchange.com 6/10/2010

1

Psychotherapy Research’sGreatest Hits


The Most Important Findings

of the Last 30 Years

The Most Important Findings

of the Last 30 Years

Barry Duncan,Barry Duncan, Psy.DPsy.D.. www.heartandsoulofchange.comwww.heartandsoulofchange.com954.721.2981 www.whatsrighwithyou.com954.721.2981 www.whatsrighwithyou.com

[email protected]@comcast.net


2


3



The Four Greatest Hits

The Two Greatest Disasters

The Four Greatest Hits

The Two Greatest Disasters



Number 4

The Dodo Bird Verdict

Number 4

The Dodo Bird Verdict


4

The Dodo VerdictThe Dodo Verdict

••With few exceptions, partisan studiesWith few exceptions, partisan studiesdesigned to prove the unique effectsdesigned to prove the unique effectsof a given model have found noof a given model have found nodifferencesdifferences——nor has recent metanor has recent meta--analyses…analyses…The Dodo VerdictThe Dodo Verdict——thethemost replicated finding in themost replicated finding in thepsychological literaturepsychological literature

“Everybody has won and all“Everybody has won and allmust have prizes.”must have prizes.”

Rosenzweig, S. (1936). Some implicit common factors in diverse methods in psychotherapy.Journal of Orthopsychiatry, 6, 412-15.Wampold, B.E. et al. (1997). A meta-analysis of outcome studies comparing bona fidepsychotherapies: Empirically, "All must have prizes." Psychological Bulletin, 122(3), 203-215.

The Treatment of DepressionThe Treatment of DepressionCollaborative Research Project (TDCRP)Collaborative Research Project (TDCRP)

••Considered to be the most sophisticated comparativeConsidered to be the most sophisticated comparativeclinical trial ever conducted:clinical trial ever conducted:

••Four approaches (CBT, IPT, Drug, Placebo).Four approaches (CBT, IPT, Drug, Placebo).

Elkin, I. Et al. (1989). The NIMH TDCRP: General effectiveness of treatments. Archives of GeneralPsychiatry, 46, 971-82.

••NoNo difference in outcome between approachesdifference in outcome between approaches••TheThe client’sclient’s rating of the alliance at the second sessionrating of the alliance at the second sessionthe best predictor of outcome across conditions.the best predictor of outcome across conditions.••Tx model accounted for (0Tx model accounted for (0--2% of the variance…2% of the variance…


5

••The largest study ever conducted on the treatment ofThe largest study ever conducted on the treatment ofproblem drinking:problem drinking:

••Three different treatment approaches studied (CBT, 12Three different treatment approaches studied (CBT, 12--step,step,and Motivational Interviewing).and Motivational Interviewing).

••NONO difference in outcome between approaches.difference in outcome between approaches.

Project MATCH Group (1997). Matching alcoholism treatment to client heterogeneity.Project MATCH Group (1997). Matching alcoholism treatment to client heterogeneity. Journal of Studies on Alcohol, 58Journal of Studies on Alcohol, 58, 7, 7--29.29.Babor, T.F., & Del Boca, F.K. (eds.) (2003).Babor, T.F., & Del Boca, F.K. (eds.) (2003). Treatment matching in Alcoholism.Treatment matching in Alcoholism. Cambridge University Press: Cambridge, UK.Cambridge University Press: Cambridge, UK.Connors, G.J., & Carroll, K.M. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation aConnors, G.J., & Carroll, K.M. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation andndoutcome.outcome. Journal of Consulting and Clinical Psychology, 65Journal of Consulting and Clinical Psychology, 65(4), 588(4), 588--98.98.

••The client’s rating of the therapeutic alliance the bestThe client’s rating of the therapeutic alliance the bestpredictor of:predictor of:

••Treatment participation;Treatment participation;••Drinking behavior during treatment;Drinking behavior during treatment;••Drinking at 12Drinking at 12--month followmonth follow--up.up.

Project MATCH and the AllianceProject MATCH and the Alliance

••600 Adolescents marijuana users:600 Adolescents marijuana users:••Significant coSignificant co--morbidity (3morbidity (3--12 problems).12 problems).

••Two arms (dose, type) and one ofTwo arms (dose, type) and one ofthree types of treatment in each arm:three types of treatment in each arm:

••Dose arm: MET+CBT (5 wks),Dose arm: MET+CBT (5 wks),MET+CBT (12 wks), Family SupportMET+CBT (12 wks), Family SupportNetwork (12 wks)+MET+CBT;Network (12 wks)+MET+CBT;••Type arm: MET/CBT (5 wks), ACRT (12Type arm: MET/CBT (5 wks), ACRT (12weeks), MDFT (12 wks).weeks), MDFT (12 wks).

The Dodo Also Rules Family TherapyThe Dodo Also Rules Family TherapyCannabis Youth Treatment ProjectCannabis Youth Treatment Project

Approach accounted for 0% of the variance in outcome. Ratings of theApproach accounted for 0% of the variance in outcome. Ratings of thealliance predicted: Premature dropalliance predicted: Premature drop--out; Substance abuse and dependencyout; Substance abuse and dependencysymptoms postsymptoms post--treatment, and cannabis use at 3 and 6 month followtreatment, and cannabis use at 3 and 6 month follow--up.up.


6

Tired of RCTs…The Dodoin the Real World

Tired of RCTs…The Dodoin the Real World

1999 study of 2000 providers and over20,000 clients; 13 different orientationsincluding CBT, SFBT, family therapy,medication, and eclectic…

2006 study of 1309 clients compared sixgroups: CBT, PCT or PDT only, and one ofthese plus one additional approach(integrative, supportive, art)

NO DIFFERENCE! In the UK study, allgroups made marked improvement (ES =1.36). Approach and purity accounted fortiny proportions of variance (1% & 0.5%.

1999 study of 2000 providers and over20,000 clients; 13 different orientationsincluding CBT, SFBT, family therapy,medication, and eclectic…

2006 study of 1309 clients compared sixgroups: CBT, PCT or PDT only, and one ofthese plus one additional approach(integrative, supportive, art)

NO DIFFERENCE! In the UK study, allgroups made marked improvement (ES =1.36). Approach and purity accounted fortiny proportions of variance (1% & 0.5%.

Stiles, W. B., Barkham, M., Twigg, E., Mellor-Clark, J., & Cooper, M. (2006). Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapiesas practised in UK National Health Service settings Psychological medicine 36, 555-566.

Brown, J., Dreis, S., & Nace, D.K. (1999). What really makes a difference in psychotherapy outcome? Why does managed care want to know? InM.A. Hubble, B.L. Duncan, and S.D. Miller (Eds.). The heart and soul of change: What works in therapy.. Washington, D.C.: APA Press, pp. 389-406.

Implications of the Dodo Bird VerdictImplications of the Dodo Bird Verdict

All approaches work becauseAll approaches work becauseof factors common to all:of factors common to all:

Of theOf the client’sclient’s abilitiesabilities

Client resources transcendClient resources transcendmodel differencesmodel differences

Time better spent recruitingTime better spent recruitingwhat clients already have thanwhat clients already have thanassessing what they needassessing what they need


7

40.0%40.0%

30.0%30.0%

15.0%15.0%

15.0%15.0%

Lambert, M. (1986). Implications of Psychotherapy Outcome Research for Eclectic Psychotherapy.In J. Norcross (Ed.) Handbook of Eclectic Psychotherapy. New York: Brunner/Mazel.

Factors Accounting forFactors Accounting forSuccessful OutcomeSuccessful Outcome

Spontaneous RemissionSpontaneous Remission

Client/ExtratherapeuticClient/Extratherapeutic

Common FactorsCommon FactorsRelationshipRelationship

Placebo/Hope/ExpectancyPlacebo/Hope/Expectancy

Models/TechniquesModels/Techniques

Client/Extratherapeutic Factors (87%)

Treatment Effects13%

Feedback Effects15-31%

Alliance Effects38-54%

Model/Technique8%

Model/Technique Delivered:Expectancy/AllegianceRationale/Ritual (GeneralEffects)

30-?%

Therapist Effects46-69%


8

DysfunctionDisorderDisabilityDiseaseDeficitDamagedNot Reliable or ValidNone ever related to

outcome

The Killer D’s ofThe Killer D’s of

Client DiminishmentClient Diminishment

Until lions have theirUntil lions have theirhistorians, tales ofhistorians, tales ofhunting will alwayshunting will alwaysglorify the hunter.glorify the hunter.

African Proverb

Clients Are the Lions of Change


9



Number 3

The Power of the

Alliance

Number 3

The Power of the

Alliance

Duncan, B., Miller, S., & Sparks, J. (2004). The Heroic Client. San Francisco: Jossey-Bass

Relationship FactorsRelationship Factors

The Alliance:The Alliance:

•• Relational BondRelational Bond•• Agreement onAgreement on goals• Agreement on tasksAgreement on tasks

Seven TimesSeven Times the Impact ofthe Impact ofModel/Technique…AccountsModel/Technique…Accountsfor Most of Therapistfor Most of TherapistVarianceVariance

3838--54%54%


10

The Alliance:The Alliance:OverOver 10001000 Research FindingsResearch Findings

Quality of the alliance morepotent predictor of outcome thanorientation, experience, orprofessional discipline-- recallTDCRP, MATCH, CYT.

Clients rarely report negativereactions before deciding toterminate.

Same holds true for youth andfamily therapy

••Increasingly, the relationship isIncreasingly, the relationship isviewed as merely “setting the stage”viewed as merely “setting the stage”for the “real” treatment:for the “real” treatment:

••Confronting distorted thoughts;Confronting distorted thoughts;••Recovering forgotten memories;Recovering forgotten memories;••Asking special questions;Asking special questions;••Tapping on or waving fingers in front of theTapping on or waving fingers in front of theface…but the data say:face…but the data say:

••The alliance deserves farThe alliance deserves farmoremore RESPECT…RESPECT…

Research into PracticeThe Alliance

Research into PracticeThe Alliance

Duncan, B. (2010). On becoming a better therapist. Washington, DC: APA.


11

Molly:Molly:A Client ExampleA Client Example

Goals,Goals,Meaning orMeaning or

PurposePurpose

Means orMeans orMethodsMethods

Client’s View of theClient’s View of theTherapeutic RelationshipTherapeutic Relationship

Client’sClient’sTheory of ChangeTheory of Change

Psychotherapy Research’sGreatest Hits: The Alliance

Psychotherapy Research’sGreatest Hits: The Alliance



Number 2

The Predictive Power

of Early Change

Number 2

The Predictive Power

of Early Change


12

Psychotherapy Research’sGreatest Hits : Project Match

Psychotherapy Research’sGreatest Hits : Project Match

Babor, T.F., & DelBoca, F.K. (eds.) (2003).Babor, T.F., & DelBoca, F.K. (eds.) (2003). Treatment Matching in AlcoholismTreatment Matching in Alcoholism. United Kingdom: Cambridge, 113.. United Kingdom: Cambridge, 113.

Cannabis Youth Treatment ProjectCannabis Youth Treatment Project

Psychotherapy Research’sGreatest Hits: Early Change

Psychotherapy Research’sGreatest Hits: Early Change

ApproachApproach DoseDose

http://www.chestnut.org/LI/Posters/CYT_%20MF_APA.pdfhttp://www.chestnut.org/LI/Posters/CYT_%20MF_APA.pdf


13

Early Change Predicts…Early Change Predicts…

In a study of more than 2000 therapists,Brown found that if no improvementoccurred by the sixth visit, then noimprovement was likely over the entirecourse of treatment.

Clients who worsened by the third visitwere twice as likely to drop out thanthose reporting progress.

Variables such as diagnosis, severity, andtype of therapy were, “not . . . asimportant [in predicting eventualoutcome] as knowing whether or not thetreatment being provided [was] actuallyworking.”

In a study of more than 2000 therapists,Brown found that if no improvementoccurred by the sixth visit, then noimprovement was likely over the entirecourse of treatment.

Clients who worsened by the third visitwere twice as likely to drop out thanthose reporting progress.

Variables such as diagnosis, severity, andtype of therapy were, “not . . . asimportant [in predicting eventualoutcome] as knowing whether or not thetreatment being provided [was] actuallyworking.”

ImplicationsImplications

Feedback about outcome is essentialfor clinical decision making.

Do not need to know what tx to usefor a given diagnosis as much aswhether the current relationship is agood fit and providing benefit, and,if not, to adjust early to maximizethe chances of success.

Feedback about outcome is essentialfor clinical decision making.

Do not need to know what tx to usefor a given diagnosis as much aswhether the current relationship is agood fit and providing benefit, and,if not, to adjust early to maximizethe chances of success.


14



Number 1Client Feedback

Dramatically Improves

Effectiveness

and Efficiency(more than anything else)

Number 1Client Feedback

Dramatically Improves

Effectiveness

and Efficiency(more than anything else)

Psychotherapy Research’sGreatest Hits: Client Feedback

Psychotherapy Research’sGreatest Hits: Client Feedback

One study of 6224 clients, Miller,Duncan et al (2006) providedtherapists with real-time feedbackregarding the client’s experienceof the alliance and progress.

This “practice-based evidence” notonly resulted in higher retentionrates but also doubled the overalleffect size of services offered(baseline ES = .37 v. final phaseES = .79; p < .001). Downloadthese measures for free…

One study of 6224 clients, Miller,Duncan et al (2006) providedtherapists with real-time feedbackregarding the client’s experienceof the alliance and progress.

This “practice-based evidence” notonly resulted in higher retentionrates but also doubled the overalleffect size of services offered(baseline ES = .37 v. final phaseES = .79; p < .001). Downloadthese measures for free…


15

The Revolutionary BenefitsThe Revolutionary Benefits

As incredible as the results appear, they areentirely consistent with other findings.

Lambert et al. (2003) reported that thoserelationships at risk which received formalfeedback were better off than 65% of thosewithout feedback (Average ES = .39!).

Whipple et al. (2003) found that clientswhose therapists had access to outcome andalliance info were less likely to deteriorate,and twice as likely to achieve change.

Obtained without any attempt to controltreatment process.

As incredible as the results appear, they areentirely consistent with other findings.

Lambert et al. (2003) reported that thoserelationships at risk which received formalfeedback were better off than 65% of thosewithout feedback (Average ES = .39!).

Whipple et al. (2003) found that clientswhose therapists had access to outcome andalliance info were less likely to deteriorate,and twice as likely to achieve change.

Obtained without any attempt to controltreatment process.

Effects on EfficiencyCancellations, No Shows, LOS

Effects on EfficiencyCancellations, No Shows, LOS

Claude (2004) compared the ave. # ofsessions, canc., no shows, and % of long-term cases before and after OM. Sample:2130 closed cases seen in a public CMHC.

Ave. # of sessions dropped 40% (10 to 6)while outcomes improved by 7%; canc. andno show rates were reduced by 40% and25%; and % of long term null casesdiminished by 80% (10% to 2%).

An estimated savings of $489,600. Such costsavings did not come at the expense of clientsatisfaction with services—during the sameperiod satisfaction rates improvedsignificantly.

Claude (2004) compared the ave. # ofsessions, canc., no shows, and % of long-term cases before and after OM. Sample:2130 closed cases seen in a public CMHC.

Ave. # of sessions dropped 40% (10 to 6)while outcomes improved by 7%; canc. andno show rates were reduced by 40% and25%; and % of long term null casesdiminished by 80% (10% to 2%).

An estimated savings of $489,600. Such costsavings did not come at the expense of clientsatisfaction with services—during the sameperiod satisfaction rates improvedsignificantly.


16

Psychotherapy Research’sGreatest Disasters


Number 2

Diagnosis

Number 2

Diagnosis

“I have found littlethat is good abouthuman beings. In myexperience, most ofthem are trash.”--Sigmund Freud, M.D.

DiagnosisDiagnosis


17

Sicker With Each Passing YearSicker With Each Passing Year

DSM IDSM II DSM

IIIDSM

III RDSM

IV

66111

206

261

397

0

50

100

150

200

250

300

350

400

DSM 1952 - 1994

Educate the People: You Are SickEducate the People: You Are Sick

Now "free mental health check ups”like National Depression Day orNational Anxiety Day.

Largely funded by drug companies andsponsored by MH prof. org—should betelling.

Cultivated a curious change.Unhappiness not shaped by diverseforces. No, problems are becausepeople are diseased, disordered,dysfunctional, disabled, and havedeficits…the Killer Ds

Now "free mental health check ups”like National Depression Day orNational Anxiety Day.

Largely funded by drug companies andsponsored by MH prof. org—should betelling.

Cultivated a curious change.Unhappiness not shaped by diverseforces. No, problems are becausepeople are diseased, disordered,dysfunctional, disabled, and havedeficits…the Killer Ds


18

Mental Health Screening TestMental Health Screening Test

1. Lift your right foot off thefloor and make clockwisecircles.

2. Now, while doing this, drawthe number "6" in the airwith your right hand.

3. If your foot changesdirection, you need drugs ortherapy or both.

1. Lift your right foot off thefloor and make clockwisecircles.

2. Now, while doing this, drawthe number "6" in the airwith your right hand.

3. If your foot changesdirection, you need drugs ortherapy or both.

If drug txs for mental “disorders”were books, they would berunaway bestsellers.

Last year, more than 150 millionpres. were written for anti-dep.—more than $14 billion spent; 20million pres. for Ritalin,surpassing the amount spent forantibiotics!

And the Message Works!


19

DiagnosticDiagnostic DysDys--OrderOrder

Poor ReliabilityPoor Reliability

Unknown ValidityUnknown Validity

Does not predict LOS or outcomeDoes not predict LOS or outcome

Little help in treatment selectionLittle help in treatment selection

Surveys consistently find thatSurveys consistently find thattherapists do not like it or find ittherapists do not like it or find itusefuluseful

Kirk, S.A., & Kutchins, H. (1992). The selling of DSM: The rhetoric of science in psychiatry. New York: AldineDuncan, B., Miller, S., & Sparks, J. (2004). The Heroic Client. San Francisco: Jossey-Bass.



Number 1

EvidenceBasedPractice

Number 1

EvidenceBasedPractice


20

Evidence Based PracticeEvidence Based Practice

The intent here is not todemonize EBP—anyapproach can be just theticket for a particular client—but rather expose itslimitations because it is oftenwielded as a mandate forcompetent and ethicalpractice. Such edicts aregross misrepresentations ofthe data and blatant misusesof the evidence.

The intent here is not todemonize EBP—anyapproach can be just theticket for a particular client—but rather expose itslimitations because it is oftenwielded as a mandate forcompetent and ethicalpractice. Such edicts aregross misrepresentations ofthe data and blatant misusesof the evidence.

Psychotherapy Research’sGreatest Disasters: EBPPsychotherapy Research’sGreatest Disasters: EBP

Rosenzweig, S. (1936). Some implicit common factors in diverse methods in psychotherapy.Rosenzweig, S. (1936). Some implicit common factors in diverse methods in psychotherapy. Journal ofJournal ofOrthopsychiatry, 6Orthopsychiatry, 6, 412, 412--15.15.

Wampold, B.E. et al. (1997).Wampold, B.E. et al. (1997). A metaA meta--analysis of outcome studies comparing bona fide psychotherapies: Empirically,analysis of outcome studies comparing bona fide psychotherapies: Empirically,"All must have prizes.""All must have prizes." Psychological Bulletin, 122Psychological Bulletin, 122(3), 203(3), 203--215.215.

••Dodo Verdict highlights fatalDodo Verdict highlights fatalflaw: Efficacy over placebo orflaw: Efficacy over placebo orTAU is not efficacy over otherTAU is not efficacy over otherapproaches; and unremarkableapproaches; and unremarkable;;

••The differences which have beenThe differences which have beenfound:found:

••Do not exceed what would be expected byDo not exceed what would be expected bychance;chance;••Accounts for 1% of the variance.Accounts for 1% of the variance.••And as a mandateAnd as a mandate


21

A Mountain of ManureA Mountain of Manure

The “Evidence” ofEvidence Based Practice

The “Evidence” ofEvidence Based Practice

Must always ask,“Whose” evidence is it?and

“What kind” ofevidence is it? (Is itjust efficacy overplacebo?)

Because…

Must always ask,“Whose” evidence is it?and

“What kind” ofevidence is it? (Is itjust efficacy overplacebo?)

Because…


22

—notable for

what is

concealed

rather than

what is

exposed.

—notable for

what is

concealed

rather than

what is

exposed.

Superiority Claims:Superiority Claims:Like Bikini WearLike Bikini Wear

Bikinis and Allegiance:Whose Evidence Is It?Bikinis and Allegiance:Whose Evidence Is It?

At least 40% of anyobserved effect isattributable to the beliefin (allegiance to) theapproach by theresearchers

Even meagerEven meagerdifferences disappeardifferences disappearwhen researcherwhen researcherallegiance isallegiance iscontrolled…controlled…

At least 40% of anyobserved effect isattributable to the beliefin (allegiance to) theapproach by theresearchers

Even meagerEven meagerdifferences disappeardifferences disappearwhen researcherwhen researcherallegiance isallegiance iscontrolled…controlled…


23

Bikinis and Unfair Comparisons:What Kind of Evidence Is It?

Bikinis and Unfair Comparisons:What Kind of Evidence Is It?

Is the study really a fair contest?

E.g., CBT v PDT

TAU: Pet approach of theresearcher, handpicked andtrained therapists with specialsupervision (reduced caseloads)will always outperform TAU.

The exorbitant cost better spenton reducing caseloads, supportingther. with sup., feedback aboutoutcome, and training in models oftheir choice.

Is the study really a fair contest?

E.g., CBT v PDT

TAU: Pet approach of theresearcher, handpicked andtrained therapists with specialsupervision (reduced caseloads)will always outperform TAU.

The exorbitant cost better spenton reducing caseloads, supportingther. with sup., feedback aboutoutcome, and training in models oftheir choice.

Smoke and MirrorsSmoke and Mirrors

Dialetical BT for “BPD”

Of 382 eligible by dx, only25 (6.5%) thought it was forthem; 25% of thosedropped out before programstarted; another 25%dropped out.

For those remaining, waseffective, but once again,not fitting the hype or theexpense of implementation

And the conclusion…

Dialetical BT for “BPD”

Of 382 eligible by dx, only25 (6.5%) thought it was forthem; 25% of thosedropped out before programstarted; another 25%dropped out.

For those remaining, waseffective, but once again,not fitting the hype or theexpense of implementation

And the conclusion…


24

EBP Is A HumbugEBP Is A Humbug

APA Definition of EBPAPA Definition of EBP

Evidence-based practice isthe integration of the bestavailable research withclinical expertise in thecontext of clientcharacteristics, culture,and preferences(American Psychologist,May 2006).

Evidence-based practice isthe integration of the bestavailable research withclinical expertise in thecontext of clientcharacteristics, culture,and preferences(American Psychologist,May 2006).


25

APA RecommendationsAPA Recommendations

Clinical decisions should be made incollaboration with the client,based on the best clinically relevantevidence, and with consideration forthe probable costs, benefits, andavailable resources and options

Services are most effectivewhen responsive to the client’sspecific problems, strengths,personality, socioculturalcontext, and preferences.

The application of researchevidence always involvesprobabilistic inferences. Therefore,ongoing monitoring of clientprogress and adjustment oftreatment as needed are essential.

Clinical decisions should be made incollaboration with the client,based on the best clinically relevantevidence, and with consideration forthe probable costs, benefits, andavailable resources and options

Services are most effectivewhen responsive to the client’sspecific problems, strengths,personality, socioculturalcontext, and preferences.

The application of researchevidence always involvesprobabilistic inferences. Therefore,ongoing monitoring of clientprogress and adjustment oftreatment as needed are essential.

Final Thoughts: The Borg?Final Thoughts: The Borg?

No--need not be warringfactions; Captain Picard notreally fighting the Borg

EBP is a worthy endeavor--butbroaden the definition (APA)

Evidence based on 40 yearsof outcome research and theknown predictors of success

And the best evidence of all—the feedback about fit andprogress we get from clients

No--need not be warringfactions; Captain Picard notreally fighting the Borg

EBP is a worthy endeavor--butbroaden the definition (APA)

Evidence based on 40 yearsof outcome research and theknown predictors of success

And the best evidence of all—the feedback about fit andprogress we get from clients


26

No One Approach WorksNo One Approach WorksBetter than Another...theBetter than Another...theClient Is The Lion of ChangeClient Is The Lion of Change

No One Approach WorksNo One Approach WorksBetter than Another...theBetter than Another...theClient Is The Lion of ChangeClient Is The Lion of Change

The Alliance Predicts Outcome…The Alliance Predicts Outcome…Early Change Predicts Outcome…Early Change Predicts Outcome…Using Client Feedback, or PBE,Using Client Feedback, or PBE,Improves Effectiveness andImproves Effectiveness andEfficiencyEfficiency

The Alliance Predicts Outcome…The Alliance Predicts Outcome…Early Change Predicts Outcome…Early Change Predicts Outcome…Using Client Feedback, or PBE,Using Client Feedback, or PBE,Improves Effectiveness andImproves Effectiveness andEfficiencyEfficiency

Psychotherapy Research’sGreatest Hits: SummaryPsychotherapy Research’s

Greatest Hits: Summary

greatest hits

Education