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Deliberate Practice with Scott D. Miller
Episode 22nd September 2022 • Embark Sessions • Embark Behavioral Health
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In this episode, Rob interviews Scott D. Miller, the founder of the International Center for Clinical Excellence, about his personal story and what drove him to pursue coaching other clinicians about feedback informed treatment. Rob and Scott discuss surfing, Scott’s relationships throughout his career, deliberate practice, and how it applies to clinicians today. Related Blogs https://bit.ly/how-to-find-a-good-therapist https://bit.ly/group-therapy-know-your-options https://bit.ly/equine-therapy-teen-mental-health Resources Staying on Top and Keeping the Sand Out of Your Pants: A Surfer's Guide to the Good Life: Miller, Scott, Hubble, Mark, Houdeshell, Seth, Byrne, John: 9780757300332: Amazon.com: Books Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness on JSTOR Connect with Embark on Social Media: Have a question for our experts? We want to hear from you! Submit your questions to: askatherapist@embarkbh.com About Rob Rob Gent, M.A. LPC, is the Chief Clinical Officer and one of the founding members of Embark Behavioral Health. Rob has been with the company for 15 years and has led the Embark organization in clinical development and growth of numerous programs. He is the lead developer of the proprietary CASA Developmental Framework, which is pervasive throughout Embark’s programs. Through his dedication to advancing clinical development, practice, and research, he has become a nationally recognized expert in the field. His specialization in clinical development is enhanced by his therapeutic expertise and has yielded such accomplishments as the development of; The CASA Developmental Framework, Vive Family Intensive Program, Calo Preteens, Canine Attachment Therapy-Transferable Attachment Program, and other specialized programs. Rob’s dedication has led him to pursue his Ph.D in Psychology with an emphasis on development and attachment. He remains passionate about neurological, psychological, and physiological development and continues to focus on advancing research and the effectiveness of therapeutic interventions. He resides in Tempe, Arizona, with his wife and two boys.

Transcripts

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Welcome, everybody to our Sessions Podcast. I'm Rob Gent,

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Chief Clinical Officer of Embark. Just super elated and

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privileged to have our guest today is Scott D. Miller. We

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could sing his accolades all day long, but, really Scott, thank

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you so much for joining us. Well, welcome to the podcast. I

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know I'm looking forward to us doing some work later on in the

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year with you. But yeah, so thank you for joining us.

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It's my pleasure.

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Great.

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So just a little bit about Scott, Scott and his colleagues

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have significantly influenced and dare I say, transformed the

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way that psychotherapy and psychotherapists assess

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effectiveness for client outcomes. Him and his colleagues

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have used the data and develop methodology to inform therapist

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how to become more effective. How am I doing with that Scott?

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That's good.

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Great, awesome. Yes, Scott is widely known for his expertise.

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He's, he's widely known for his speaking and teaching ability,

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he has a ton of resources. And he's got has been doing this for

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a while and has made it his purpose and his mission. And

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he's certainly known for his profound critical thought if you

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guys have read his resources and his books, you'll know that his

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his team and him have done their due diligence to think

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critically about everything, and really look at the data and help

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us as therapists and as clients really make some movement. So we

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could talk about all that. But what I wanted to do is have a

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personal conversation with Scott to get to know his story. Is

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that ok?

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Awesome. Well, I've got to be honest, I'm looking into Scott,

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Yeah, sure.

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and I've known about him over the years as a psychotherapist,

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and knowing this thing, what is feedback-informed treatment?

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Let's look at the data. What are we really doing? And personally,

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I've bought his book a few of his books early on. And then

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recently, his new book "Better Results: Using Deliberate

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Practice." And of course, being in charge if we want to do

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better supervision and deliberate practice came

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screaming out at me. And like, yeah, what can we do? What is

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this thing we call deliberate practice? So that initially

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caught my attention. And then this is where I have to be

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honest. Scott's book called "Staying on Top and Keeping the

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A Surfer's Guide to the Good Life"

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is what really roped me in Scott.

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Well, I know from one surfer to the next how important a part of

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my life Surfing has been.

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Well, me and Scott briefly got a chance to talk about it. And it

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from that conversation, I was hooked because from one server

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to the next, we had a wonderful conversation about, oh, how long

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where have you from? I grew up in California. So did I, we had

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this wonderful engagement. So we've had a little bit of

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correspondence regarding that. So kindred spirits, Scott.

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That's right. It was really enjoyable to catch up around

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that. Usually I'm asked about psychotherapy research, you and

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I got the chat about surfspots, around California. And as you

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said, I grew up I think, during the heyday, the best time to

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have surfed and maybe I'm gonna offend somebody by saying that,

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but

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I don't care.

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The late 60s, early 70s. The beaches weren't crowded. You

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could go out in the morning in the late afternoon. And the

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waves were great. It was it was a phenomenal childhood,

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actually.

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Well, so appreciate that. Yeah. Remind me, Scott it was Southern

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California, correct?

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It was Southern California. Yeah. And we used to -- gas I

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think was, I'm embarrassed to say, it was under $1 a gallon.

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And it took us about maybe 20 minutes to drive from our home

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to the beach, we usually surfed in Newport Beach. And nowadays,

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that drive would probably take about 75 to 90 minutes to get

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from my home down down to the beach, but we would beg for

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money, my friends and I would drive down surf in the morning,

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sit at the Crab Cooker and eat clam chowder and eat breadsticks

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because that's what we could afford. And then we would go

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back out in the late afternoon, after all, what we disparagingly

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referred to as "tourists" went home and we would have sort of

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free freedom to do what we wanted on the waves without

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worrying about running our boards into somebody.

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Well, it's got to bring back a lot of memories for me just I'm

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laughing about the Crab Cooker. I've spent my time there and

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they've recently redone it. They built another one inland

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somewhere so that's great.

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They did,

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as good but maybe it's just the atmosphere. The environment was

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so cool inside and that just was a place to walk down in your

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board shorts and tank top and get some lunch and really on the

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cheap. I am probably reminiscing too much, Rob, but i think a

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bowl of clam chowder was a buck. And you could eat as many

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breadsticks and these little bread balls as a as you wanted

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and, you know, filled you up and then you could go back and serve

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again once they took the flags down. You could go up and surf

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from about four four o'clock on without without hindrance with

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the with the sunbathers and swimmers.

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Yeah, so great, Scott. Now you need to have $50 in your pocket

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to do that exact same thing.

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Yeah,

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that's exactly right.

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You pay for parking, and those little bread balls are super

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expensive now.

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Yeah.

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Really great. Scott. Thank you. Well, I know you're currently

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stationed in Chicago, is that correct?

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That's right. I've lived here since about 1993-94.

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Okay, terrific. And I imagine that's kind of a central

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location to get wherever you need to in the country pretty

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fast.

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You know,

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it's really facilitated my career, which right up into the

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pandemic, I was gone every week, I was on the road somewhere in

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the United States, in Asia or in Europe, traveling, teaching and

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consulting. And so being in Chicago meant that I could get

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anywhere in the states in a maximum of about four hours, I

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could get to Europe in eight, I could get to Australia and Asia

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in about 14 with a direct flight. So it really was a great

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place to be. And all of that was very serendipitous. A wave came

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by, so to speak, happened to be woman named Karen. And we hit it

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off. She lived here. I was working in Milwaukee at the

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time. And I decided I would move here to be with her. And it's

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really been a great it's really been a great move.

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Yeah, terrific. Terrific. That's great to hear. Scott, you're

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surfing probably suffers a little bit, being in Chicago.

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You know,

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they do surf here. It's not the same and wind surfing is really

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quite big south on the south part of like Michigan, given the

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winds and there are some tributaries outside of Lake

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Michigan that people do a lot of parasailing and such. But board

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surfing, it's not going to be like it is in any of the beaches

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or in Hawaii.

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Yeah. Well, I wonder if the foiling has taken off a little

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bit.

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I don't know.

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The foil boards are quite the big thing. Now you get a mix of

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surfing and foiling. It's really fascinating. I'm sure they're

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doing that there. But so great, Scott. So if you don't mind,

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let's shift gears. It's interesting that you're in

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Chicago. Now you've had this amazing career, if we don't

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mind, kind of taking a step back. Where, Where did that

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story really, really begin for you?

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The story of?

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The story of you, right? Growing up in Southern California. I

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know I want to touch in, you've got this amazing story about

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being a Mormon and a chance to read that book. I'm just

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curious, like, what does it really start off? Any siblings,

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what are your parents like?

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Well, I think I had a pretty uneventful and normal childhood

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had a great family, parents and two brothers. I was right in the

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middle. When I went away to college. And in my house, my

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father was a high school, or rather, an elementary school

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principal his entire life. Education was really an

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important thing in my household. If you did well, in school, you

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could do just about anything else. They were very tolerant

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and forgiving people. So I knew college was in my future on the

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radar. I left after graduating from Glendora High School moved

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to go to college. And while I was there originally I was going

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to be an accountant. And I sometimes joke that that's

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because my mother thought that at least I would be near money.

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I don't think she had any belief that I would be rich, but at

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least I could count other people's dough. I went for a

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year and I met a professor, his name (no relationship) was Hal

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Miller he was a student from of Skinner's from Harvard. And

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really, I wanted to be Hal Miller. He was so interesting,

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so provocative, so free thinking. And so I became a

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research assistant as an undergraduate. At one point, he

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said because he was a an experimental psychologist, and I

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thought that I would go and do a traditional teaching rap, become

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a professor. He thought otherwise. He said that you

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unless you scored on the top on your GREs, you got the best

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university context that you are pretty much destined to make

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very little money, and to have a long and difficult career

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publishing, seeking grants, etc. And he thought that I was well

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suited for clinical work. So he sent me over to talk to another

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professor. His name was Michael Lambert. And Michael Lambert,

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really changed the arc of my life. He was a clinical

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psychologist. He was very interested in what made

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treatment work. And particularly interested in identifying cases

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that are at risk for deterioration. And Michael and I

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remained friends to this particular day, even though I

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graduated from my undergraduate school in 1980. So from there, I

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went with his help and advice to graduate school. And I've been

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driven by really one chief question. And that was, "how

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could I be effective?" And that's what's been the guiding

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influence during my entire career. I wasn't interested in

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specializing in one population or the next or particular

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technique or not, I really want -- and that's because I think I

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was a very anxious clinician. When I was in the room with

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people, I could definitely sense just how much they were

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struggling. In my own personal life, I've not really struggled

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in the way that many of the people who came to see me as a

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practicum student or an intern seem to be struggling. I wanted

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somebody to tell me what was it I was supposed to do in that

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room. And I have to say, quite often, I felt like I had been

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ripped off in graduate school, I must have missed the day where

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they taught the secret about how all this works. In addition,

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many of my fellow students around me, seemed much more

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confident about how this was supposed to work. So that's

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still a driving influence in my professional career. It's what's

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driven really all, with very few exceptions, all of my

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publications, all of the teams that I've been a part of over

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the last 30 plus years of my career.

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Wow, thanks for that. Scott. It sounds like you had some

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significant mentors in your life early on.

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It's amazing. And if I had any advice for anybody who was

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heading down the academic route, I would say, relationships are

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much more important than books. Books are definitely important,

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videos that you want to learn from also important. But the

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people that I met along the way, and that are still important

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relationships to me, I mentioned one, Michael Lambert, who was a

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pivotal person. Harold Miller, Hal Miller is I knew him was

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another. Bruce Wampold who was my stats professor, in my first

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year of my graduate program, he and I still collaborate on

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publications. That's been an amazing and important resource.

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Scott, as a therapist, I'm so intrigued by the story,

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hopefully many of us can resonate, because you have this

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experience of the numbers being analytical, trying to search for

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some real knowable, reliable, valid data in life. And then, us

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as therapists, we tend to be high emotional, wanting to

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connect, and it sounds like here, you are really trying to

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bridge that gap between those two things.

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I suppose I have tried to bridge that particular gap, the

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research literature, it's interesting is massive. And yet

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most of us practitioners rely on someone to interpret it for us,

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someone who might have an ideological slant to their work.

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I think, as well, however, that many of us are looking for what

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to do. Truth be told, when I say that even after 30 years when

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I'm sitting in the room with a person who's struggling, and I'm

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thinking in my head, even though my exterior certainly

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communicates confidence, that I wonder what the hell I should do

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here. I guess another thing for me is that much of what our

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field has taught, simply didn't ring true in the room. So there

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were lots of theories about what I was supposed to do, whether

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they were psychoanalytic, which they were for me in the

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beginning, or more recently, cognitive behavioral traditions.

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But all of that still seems not to really capture the essence of

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the work that we do. And plus, I've been really struck by

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research which indicates and this is a very controversial

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thing, which is surprising to me. It's not even taught

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nowadays in graduate school. There is no difference in

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outcome between these various and competing treatment

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approaches. So what clinicians tend to do or what the field

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tends to do is either align with one or pick and choose and make

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some amalgamation that is used with clients on an ongoing

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basis. That's all perfectly fine until you confront literature

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which indicates that therapist outcomes are no better, that is

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experienced therapists, outcomes are no better than students

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outcomes. It's it's also a challenge when you look at the

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data that shows that clinicians do not improve with time and

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experience in the in the field, even though they think they do.

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So whether it's emotions or thoughts or models, etc. For me,

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the focus, again, comes back to how can I reliably show that the

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work I'm doing is helping more people? And that's why our team

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has really been at the forefront of saying, "why not measure your

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results and be sure?" And I promise you, it's going to be

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quite humbling, as you do that, because you're going to find out

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very quickly that your mother was wrong about you. You're

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you're not special. The average clinician, get this, multiple

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studies now show the average clinicians thinks that they are

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more effective than 80% of their peers. Well, just think about

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that, that sort of like self esteem on crack or something, it

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really doesn't line up with the data. So whether again, it's

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emotions, or thinking or models or math, what we have to do is

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know our work and know how effective we are not just with

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this person in front of us, not with them just saying "Oh, yes,

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I've been helped." Not with our model saying we're practicing in

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a theoretically or technically correct way. But when we crunch

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the numbers, they show that in fact, we're helping people.

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And you have, and I can't emphasize this enough, that

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you've provided so much of your work has been about providing

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the resources to be able to effectively do that, as a

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clinician.

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So let me rewind,

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Well, thanks for that. Now, we we do make some very simple

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There's a lot in there. I know.

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tools available on my website, we've done that since the

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measures were developed back in the late 90s. The turn, right at

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the turn of the millennium. And believe me this, this was a

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journey for me professionally, I didn't start here, I tried to

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follow what the data said. So anybody who's knows my history,

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That's the fire-- No, no, it's so wonderful. Thank you, Scott,

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as a practitioner knows that I moved from sunny Southern

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California to Milwaukee, Wisconsin, because I was in

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pursuit of a job. And also somebody who would give me

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direct specific guidance about what to do in the therapy room.

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I had the distinct honor and privilege of going to work at

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the Brief Family Therapy Center, where Steve de Shazer and Insoo

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Berg worked. And together, we worked on the Solution-Focused

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Therapy model. And believe me, I got a lot more confidence in the

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room, I could do SFBT in my sleep backwards and forwards and

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in multiple languages. What what happened though, was researchers

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came and they studied our clients. And they came back

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eventually to us. And they said, there's good news and bad news.

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The good news was that what we did worked, the bad news was it

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didn't work anything any better than anything else. So there we

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were right back to the dilemma. Because if you want to improve,

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you have to know what your data say, and then look into the

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abyss, you have to look for where your traditional beliefs

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and practices fall short. So we left that formed a different

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team. And we began looking for ways to figure out how could we

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be more effective. And in time, that led me back to two mentors

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of mine first, Michael Lambert and another one, Lynn Johnson.

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Michael was suggesting that well, we may never find the

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because just as a clinician, I'm trying to reflect on well, I

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"right" way to do treatment, this technique for that

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particular problem. But what we can know, right now is whether

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or not we're helping this client, by simply measuring.

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Lynn Johnson developed a measurement tool that allowed us

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to assess one of the key contributors to success:

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establishing a good therapeutic alliance. And here's what's key.

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That therapeutic relationship therapists' views of that

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relationship have historically correlated very low with the

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clients' experience of the relationship. As a result, if

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you're in supervision with me, I don't really care what you think

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of the relationship, because your view isn't predictive of

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whether the client stays in treatment, or gets better. What

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I really care about is soliciting that information from

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the client, and seeing if I can close the gap between what I'm

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thinking and experiencing and what the client wants from me.

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So together we've called that feedback-informed treatment, non

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theoretical, non ideological, doesn't matter whether you're a

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want to ask a few questions. One is, is to sort of reflect on and

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psychoanalytic in orientation, or you dig CBT or Acceptance and

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Commitment Therapy, we can all measure our results at that

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moment with our client. By doing so, we can also identify those

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clients where we're not having an impact or making a connection

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that improves probably what is the number one predictor of

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treatment results which is therapists responsiveness to

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individual differences. So that's what feedback-informed

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care is really all about.

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say, so what you're saying, Scott is, is that my perception

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of the relationship with the client is not connected to the

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outcomes as far as the client's perception of the relationship.

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Right, it's their view that's going to predict whether there

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stay or not. About one quarter of the people we work with drop

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out without experiencing any improvement. So a lot of those

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folks are dropping out. Because there isn't a sort of love

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connection, there isn't a sense of felt empathy on the client's

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part. So I really -- and given the historically low

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correlations in the research between therapists' view of the

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relationship and clients' view of the relationship, I really

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think I have to try to solicit that from them. And keep my

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ideology out of it, that it's a distortion, that it's a sign of

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their pathology, however, they may view it. If I want to

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rearrange the furniture, I have to be inside the client's house.

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Boy, that's a great analogy. So I can't help it ask, what is

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your hypothesis on? You've worked with so many therapists,

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and I think the trends are saying is that we, as

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therapists, tend to overrate our perception of success. We tend

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to boil in all of this stuff. Scott, in all your experience,

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why do you think that is? Why do you think that the therapist

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naturally we are inclined to tell ourselves that we're more

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effective than 80% of that? What do you think that happened?

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I think this is the result of a number of things. But it's

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really related to our latest work on deliberate practice. So

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this is simply the way we operate as a species, when we

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approach a new activity, whether for example, it's learning

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therapy, or driving a car. Initially, if you can remember

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back to your first experiences with a client, or even role

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playing in a practicum context with another student, you were

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highly conscious of everything that you did every move you

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made, how long you had eye contact, how you're breathing,

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whether your legs were crossed, or your arms folded, you were

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aware of all of those things. In time, as you're trying to master

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therapy, those things become automatic. This is the language

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of deliberate practice, the more automatic they become, the more

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seamless they seem. And if there aren't major errors, like in

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driving a big car accident, or say in learning to walk, you're

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constantly falling down. If that doesn't happen, then we begin to

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assume a greater and greater ability than is actually the

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case. So I think the reason why we do that is that it's simply

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human nature, we become proficient at an activity and

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the absence of large, gross and catastrophic errors causes us to

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assume more ability than actually exists. And there's a

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big problem with that. Automaticity, combined with that

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assumption, leads to a lack of learning. After all, why would

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you need to learn anything new, because you're already doing it

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relatively well? In addition, our continuing education system,

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the way it's structured, and organized facilitates that kind

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of belief. It doesn't challenge us. In fact, the data indicate

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that attending a continuing education workshop likely

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reinforces false assumptions therapists have about the

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breadth and depth of their skills and abilities. Think

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about that for a second. So

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What you're

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saying is sacrilege. Oh my gosh, right? I mean, most people

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feel--

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respects, for average people coming through our door, it

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In many

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doesn't make any difference. If you're driving to the grocery

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store every day, you know, it probably doesn't make any

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difference. You don't have to be Mario Andretti in order to get

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there, or some other highly skilled driver. However, since

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we're seeing clients year after year, the more automatic our

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thinking and skill execution is, the narrower that ability

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becomes with time and experience, the only way to

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countervene that is to begin to get feedback. So I have to

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measure and begin to show you where, in fact, your abilities

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break down. So for example, that you're not you're not in line

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with your client about goals, or their sense of identity and

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preferences or about what exactly they were hoping for

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from you in the interaction, feeding that back on an ongoing

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basis, has a very predictable impact on automaticity. It makes

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us aware again, of our behavior in the room, which gives us the

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ability to exercise influence over our behaviors. That is a

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very disruptive process. So people really don't like

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deliberate practice. They're infatuated with the concept

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right now, which we introduced to the field back in 2007. In an

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:

What's the Secret to Their

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:

Success?", you can get that online, just type in the title

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:

for free from my website, for example. And lots of people like

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:

that idea. But the reality of it is very different. There is a

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:

reason there are so few Olympic athletes. Because it's not

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because of their natural ability. It's because pushing

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your performance a bit over time, every day is painful, and

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disruptive and time consuming. And being proficient most of the

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time is good enough.

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So how have you sort of been speaking to the average

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therapist talking about maybe the word dissonance or pressure

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between that comfort zone? And that place of objectivity, where

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we're looking at feedback, we're able to step out of our ego,

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:

because even reading your books, especially your recent one, I'm

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:

thinking, "wow, this was an ego pitch to me," right? I mean,

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"oh, I'm married to my modality, I'm married to my intervention.

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I've spent so much time and trying to master this particular

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thing." And you're telling me "no, no, that's less than what

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:

your modality interventions less than 1% of the variance in this

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outcome, client change. And Rob, your best chance of really

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making change is looking at the feedback." And that's really

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hard to do. How do most of us therapists wrestle with that

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whether we're conscious or pre consciously aware of? This is an

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ego pinch? I mean, this is really

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hard.

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Yeah, I guess I would say that, I truly believe in the depths of

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my soul, that, that therapists are a pretty smart group of

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people. And I've noticed that when I simply give them the

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information about this, when I start to say, when I start to

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acknowledge experiences in the consulting room, like I did

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earlier and say, "Geez, you know, I'm not sure I know what

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to do with this particular person" that a lot of people

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raise their hand and say, "I have that experience multiple

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times per week." There are a few people on the margins who are

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ideological zealots, "I do CBT. And that CBT solves all

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:

problems." Or "EMDR is the thing that cures truamas." I see those

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people and mostly I see them on social media, frankly. The

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average therapist in the room with a client, I think, does an

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honest effort to try to figure out how to accommodate to

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clients. But to me, that's a little bit like a physician,

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trying to guess your blood pressure. By looking at you. Can

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it be done? Yeah, it you can actually be trained to look for

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small signs. But it's much easier to put a cuff on and let

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the technology do it for you. So one step in this process, once

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you get beyond is I think as I say, therapists are a smart

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group, I just have to let them know about this, most of them

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can identify their next question is, "well, what do I do? What do

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I do about this?" I say "you got to start to measure." And from

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here, therapists really need support. Because you're going to

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get lots of information, and you're not going to know what to

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do with it at the moment, you're going to see a client who's

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telling you that, that in fact, they don't experience you as

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aligned or empathizing with them or working on what they think is

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important. And it's not as easy as simply saying, well, I'll do

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what the client says. So there needs to be a supportive

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community around clinicians that are also using measures

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integrating client feedback into their care. Once you do that,

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there's a whole nother step. And that's the step to deliberate

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practice, which means now, I'm not just trying to improve my

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responsiveness in the moment, which is a big challenge. Our

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clients are, thank goodness, increasingly diverse, they don't

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all look like me anymore. That therapy is having broad ranging,

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finally, a broad reach in our field. So that next step after

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that big challenge, is to begin to look for the holes in my

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clinical work. Where is it I fall short? So does it happen to

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be with certain problems, depression versus substance

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abuse, people of a certain gender identification versus

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others? Is it because during certain times of the day, I'm

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more on than at other times of the day? I'm looking for those

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leverage points. Again, that takes time and cognitive effort.

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If you're seeing six to eight clients a day, the last thing

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you're going to want to do when you get home, is spend time

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looking at your data and trying to develop strategies. Heck, I

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meet therapists nowadays that are so busy, they don't even

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read what they wrote in their clinical notes about the last

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visit before they meet with their client for the current

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visit. So that means that the ability to do deliberate

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practice spending the time mining our data, looking for

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those small objectives, getting the coaching that we might need

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a round that particular objective from knowledgeable

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experts in the field, that's going to really even be a bigger

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challenge. And so once again, community is really going to be

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important. Second thing that's important is having a system. So

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anybody who's successful at deliberate practice, they don't

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have a goal to deliberately practice. They have a system,

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for example, that's automatic, they do it at the same time

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every day. In fact, I think it's the creator, what is his name,

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:

Scott Adams, who created the cartoon Dilbert, he says, if you

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set goals, you are always in a state of pre success failure.

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If you simply have a system -- "I will do deliberate practice

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every morning from seven until 7:30." You can measure your

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success by whether you follow through on that particular

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objective. So having a system makes it much easier to

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continue. And last but not least what we call the census

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community, you need a group of people who are going to support

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you, because deliberate practice is difficult. And the amount of

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progress can be glacial. But the studies that we do have so far,

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and they're limited, but we do have a few suggest think about

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this, that when therapists engage in measurement of their

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results, and then deliberate practice, the improvement they

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they achieve in overtime, is about the same that you see in

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Olympic athletes over time. It's small and consistent over time.

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So we're not talking about dramatic differences. But small,

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consistent differences over time that end up in the long run,

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helping many more clients, which, as I say, has been my

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objective since I was a graduate student.

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Slow and steady wins the race.

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In the case of deliberate practice, that's absolutely and

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slow and steady also means you need a cheerleading section, and

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the right coaches telling you to move one foot in front of the

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other and to keep going absolutely,

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Boy, Scott, I really appreciate this push towards creating a

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system and more importantly, having these coaches I always

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like the definition of a coach, a coach highlights what we just

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can't see. Right?

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Yeah, that's exactly right.

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In our own performance. I mean, and how many of us, "Hey, I've

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been doing this for X amount of years, I slipped into this

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automated way. And like it or not, my perception, my

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experience in therapy might be just reinforcing to my own

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stuff."

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It absolutely will be. And I'd say once again, let's look to a

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group that really does push themselves on an ongoing basis.

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That's Olympic athletes, most Olympic athletes nowadays, and I

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would say professional athletes in basketball, football, etc.

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They don't have one coach. So I'm a big fan of female ice

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skating. Mostly because for me, the combination of absolute

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athleticism with grace is like a combination that I find hard to

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look away from. These female figure skaters have a coach for

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equipment, they have a coach for dress, they have a coach for

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upper body strength for lower body strength, for choreography,

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it, it goes on and on and on. What do therapists have? O ne

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supervisor, and usually it's low hanging fruit, meaning that it's

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the person next door or the person that you got assigned to.

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So I say don't do that. And I Not that I need to serve as an

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example. But again, from the time I was an undergraduate,

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actually, I simply asked people for help. So I had a

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conversation with BF Skinner back in the 80s. It would have

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been early 80s. When I had a challenging undergraduate

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course, well, was probably more about 1979, actually. And we had

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this ongoing correspondence. How did it start? I called him on

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the phone. He was amazingly friendly and you won't know

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unless you pick up the phone. So I guess what I'm saying is,

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don't just look for the person next door. Access to solid

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teachers is one of the distinguishing characteristic

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Successful deliberate practice. By achieving small gains and

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performance, it must open the door to newer, better, more

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knowledgeable teachers.

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You're really driving the point home for me, Scott right now is

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to just really, if we see it more objectively, just have the

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courage to reach out beyond our immediate supervision reach. I

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mean, just like you're saying, I called BF Skinner up on the

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phone. I mean, who would think to do that? Right? I mean,

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that's amazing.

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All they can say is no and I have been I have been turned

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down by, by by some people, but I find most of these people if I

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can find an avenue to reach them, have been amazingly

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willing to talk with me.

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That's tremendous. I guess my question is, Have you always

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been so objective, or it hasn't been a journey moving from into

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this really objectivity because I'm seeing this interesting

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relationship that for you, it's, the more objective I can be, the

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more rewarding that is, in some way.

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I wouldn't call what I do objective, I would maybe call it

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quantifiable. Numbers are easy to make comparisons between my

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internal sense can often be misleading the numbers tell no

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lies once I begin to crunch those numbers and look at the

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difference between then. And now. The other thing I think I

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am is driven, seated opposite people. That I'm not helping

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bugs me. It bugs me deeply, I have a hard time letting it go.

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And I've never felt my anxiety has never been mollified by

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attributing the difficulty to the client. So they're in

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denial, they're resistant. They, they have X disorder, etc. It's

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not a very it's personally a very unsatisfying, X experience

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to me, I wanted to know, what more could I do? How can I have

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a greater impact? How can I be have them be more engaged, so

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that their lives can be better by the time they leave? Do I

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succeed all the time? Absolutely not. But that's my growth edge.

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That's, that's where I can learn something. Otherwise, I'm just

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doing what everybody has done. And what I've always done,

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Can you put your finger on where that drive came from? For you?

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I think this is a in nowadays, in our current sort of

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postmodern society, it's going to sound very old fashioned. I'm

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interested in the truth. I'm not interested in anything but the

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truth. And that is, unfortunately, not there isn't a

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direct route to that. So it means struggling.

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Well, and that somewhat flies in the face of our cultural sort of

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cliches of truth is relative.

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Yeah, and it may be contextually relative, and it's certainly

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relative in the in the person's life. So that means I'm going to

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have to bend to accommodate other people's way of being in

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the room that is in a service of a larger truth, which is

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connection, and relationship is what leads to engagement. And

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engagement is the number one predictor of treatment outcome.

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So I don't see necessarily a a contradiction between those two

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things. Because I think that I, well, if that's just been the

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driving influence, I don't know what more to say.

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Well, I'm hearing and I'm just appreciate this so much that

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truth and engagement can go together. They don't need to be

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separate are conflicting, is what you're saying. So

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I initially I was taught in a very analytic way, I then went

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and started working in a very solution focused way. And that

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was the truth. We viewed, every person who came in had

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unexplored exceptions and unimagined miracles. That was

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just the nature of the work. Was it the truth that that's what

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really made a difference? No. What really made a difference

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was the clients left the room hopeful and expecting something

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different? And that could be accomplished by any host of

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means. Not just solution focused, but a host of other

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ways of working. So for example, we just finished a study where

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we were looking at people who went to see psychics. Did you

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know psychics have outcomes that are on par with therapist

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outcomes? And in some cases even better? Well, I think it's

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because they accommodate clients points of view in the service of

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engagement. Am I telling everybody to run out and buy a

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deck of tarot cards and a crystal ball? I think that would

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be been far too literal. What it really means is searching for

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that greater truth. That indicates what is it that really

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helps people?

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Yeah.

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And thanks to your book, I remember reading that about the

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psychics and I was like, "Oh my gosh." Again, it's that wanting

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to quantify and feeling value in that quantification of that. One

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question I did have is that I noticed early on in your career,

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especially a Brief Solution-Focused focusing on

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therapy, you worked with addicts or alcoholics and underserved

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population.

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Yeah.

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How did that impact your trajectory? Or what was that

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like for? Scott, I'm

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wondering.

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Well, beginning to work with this group of folks was really

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an accident. I went back from my second year of graduate school,

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thinking that I would pick up with my assistantship that paid

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for part of my college and housing that I had the prior

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year, I went in to see the professor, a very interesting

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guy named Tom Kale. And Tom said, "What are you doing here?"

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I said, "Well, I've come back start to my my assistantship."

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He goes, "Well, I didn't think you wanted to." I said, "Well,

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why would you think that?" "Well, you didn't apply again."

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I said, "I didn't know I had to apply." I was I was at pressure

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to find work very quickly. And I took a job as a case manager at

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Weaver County Drug and Alcohol. Another very formulaitve

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experience. It was about an hour north of where I was going to

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university in Salt Lake City. And there I met a supervisor,

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Vern Vetter, who was a really amazing guy, very helpful

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person. And that's where I got to work with this population of

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folks, people with substance use issues and concerns. And I just

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thought it was great. I thought it was fantastic. And I didn't

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see a whole lot of difference between the struggles they had

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and the struggles everyone else had. So writing about that, in

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the 1980s and 90s, when the dominant view was the Johnsonian

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Intervention Model. And AA and we were saying, "Well, you know,

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you really need to do that." Wow, was that was that

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controversial.

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Very, yeah.

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But it was very clear that while AA and the Johnsonian model,

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plus, so help some that the need was far greater, and that many

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people didn't get the help they needed from those. And that's

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what I wanted to do. I wanted to figure out how to help more

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people. So that's in part what led me to get hired at the FTC

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in Milwaukee was Steven ensue. They were looking for somebody

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because the population of folks they were working with at the

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time, many of them, including homeless population, they had a

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project going, had problems with substances. And so I was just

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bringing my experience to the center when I started there.

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And when I really appreciated you saying, "Hey look, it

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doesn't matter the population. Are we willing to look at

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outcomes feedback-informed treatment, and and look at the

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effectiveness and this regardless of the population?"

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and your knowledge about drugs and the lives of people who are

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Sure

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who who struggle because of those things. That knowledge is

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important, I think, not because it gives you some expert

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technique, but because it allows you to convey that you get it

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that you understand the person and the situation that they find

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themselves in. So I would never poopoo needing to learn a bit

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about drugs and alcohol, but especially the lived experience

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of the folks that have those particular concerns and are

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coming to you for help. But to claim that somehow this

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technique or that technique for this population will make you

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more effective. I just don't see the evidence of that. And plus,

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I think it's the the the really the wrong approach to take. The

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question isn't what approach will help solve drug and alcohol

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problems? The question is, how can I engage this person who

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happens to have those as problems? What can I do? And

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believe me, I'm willing to do almost anything to keep them

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engaged long enough that their life wellbeing and substance use

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improve?

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Yeah.

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So it's got correct me if I'm wrong, but I am hearing a

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tremendous amount of compassion and empathy. And it's paired up

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with this sense of, they're not mutually exclusive, but some how

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they complement each other, is what you're saying.

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Well, how are you going to improve your empathic engagement

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with somebody if you don't know when you're not doing it?

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Or when they're experiencing it?

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Yeah. Is that Yes, exactly. So that's that's the whole nature

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of this recursive feedback process. I've got to get the

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feedback from from the person. And very often that reveals

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small blind spots of mine. That that I can then work with a

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coach, talk it through roleplay deliberately practice in an

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effort to widen my abilities to connect.

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A mentor, right?

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I would say a coach.

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Yeah, I would say a coach. I think mentors are fine. You

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Seek out coaching.

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know, Michael, and Bruce and Lynn Johnson, all of these

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people have been important mentors. But they're also very

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good at saying, "This is not what I know, best. So let's get

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you to somebody else." That's what Hal Miller did. You know,

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"thinking about you moving forward? I think you had to go

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talk to Mike Lambert." It changed my life. Mike Lambert

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talking to me about which graduate school to go to and

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saying, "here's a person who is on the cutting edge of

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statistical analysis, maybe think about going to that

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particular graduate school program." Lynn Johnson was the

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person who said, "have you read Steve de Shazer's and Insoo

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Berg's work? Have you read it?" At the time I hadn't. "Well, you

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ought to read it." That led me lo and behold, I reached out to

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Insoo. And I had been up to Nebraska to interview at the

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time with Bill O'Hanlon.

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Oh, wow, wow.

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I just met him at a conference. I said, "Can I come talk to

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you?" He said, Yeah, I send an email to Insoo, or maybe it was

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a call I can't remember. And I said, "Hey, I'm gonna go

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interview after for a job after graduate school in Omaha,

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Nebraska." That's where Bill was at the time. And she said, Well,

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she says, "before you agree to go work there, make sure you

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come see us." So this was all just about picking up the phone.

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Now. There were I, I don't want to make it sound all all rosy,

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because when I moved from Southern California, to

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Milwaukee, there were costs. So I went from a high paying job to

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a job that paid nearly nothing. But my student loans and

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outstanding debt were the same. I was leaving behind a

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relationship because the person that I was with at the time,

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really could think of no good reason to live after Palm

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Springs, moving to Milwaukee, Wisconsin. So there were there

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were costs I don't mean to imply as such. But that comes back to

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my sort of driven nature. I was really interested in getting

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better, and doing so by continuously questioning, what

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was the truth about this?

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And then where does vision play a role for you because I am

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hearing this ability to delay gratification to have some sort

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of vision. You use the term "driven," I'm just, I wonder if

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those those words are part of Scott Miller, too?

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That is what's gratifying to me. So I don't think I've delayed

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gratification as much as I identify gratification with

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improving my skills or abilities. And believe me, I

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fall short in every way possible as a clinician still. But I find

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that process of exposing areas where I might improve, deeply

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gratifying. That next objective, the next time that I call

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somebody on the phone and say here's what I'm trying to solve

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an address. So for example, K. Anders Ericsson is the

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researcher who coined the term "deliberate practice." And I had

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read somebody else's book, a general book about deliberate

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practice that had mentioned Ericsson's work, I went and read

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most of it. And then I picked up the phone, and I called him. And

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I said, "we're really needing some coaching to do some

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research that's never been done in the field on this subject, as

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applied to psychotherapy improvement as a

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psychotherapist." Anders Ericsson said, "Sure." Shocking.

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Yeah.

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So and he coached us for several years, right up to the first

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year of the pandemic, and unfortunately died, not from

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COVID, during the summer of 2020. It's a huge loss. And by

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that time, we've been working with him for close to seven

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years now. So yeah.

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Wow.

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Having the courage to reach out. I'm really quite inspired. Thank

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you, Scott, for that. I gotta --

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My pleasure.

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Yeah. Well, I wanted to ask, there's so much to uncover, I'd

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love to do a part two, because there's so much resource I was

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just really blown away just even by looking at the ORS and the

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SRS, and you've set up primers and manuals and how to do this

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and you've you've made it almost seamless for an organization or

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a therapist by themselves, an outpatient therapist, whatever,

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to really engage in this process that you've described.

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You know,

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together with a team of great people. Cynthia Maeschalck,

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Susanne Bargmann, Brooke Mathewes, these, Mark Hubble,

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these folks have made all of that possible. And it's

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interesting because I think we share that common if there is a

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vision, it's that common interest in how can we how can

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we get better? And I want to cut to the chase and get to the

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truth cut through all the folderol that is commonly

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characteristic of our field, the the ideological commitments that

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don't have an empirical payoff, that's, that's they share that

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they share that passion.

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What a wonderful support system in a team, you've, you have with

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you. Just two more questions, Scott, I know you've published

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over 28 books, and countless speaking engagements, and you've

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just have all these resources, you've had such an amazing

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career. I don't know if you can boil it down. But when you think

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about all that, what aspect of that has been most rewarding for

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you?

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I think it's eight or nine books actually not 20. You know, there

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are several 100 research articles that have been been

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published. And, you know, I spent my life on the road. So

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hundreds and hundreds of presentations. The most

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rewarding project is the one I'm working on right now. And it's

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always that way. It's the being on the learning edge that is

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rewarding. And actually, once the book is done, I hate to say

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this, I'm no longer interested in the subject. So I'm on to

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sort of the next little area that we're trying to make clear,

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shine a light on and then resolve that next objective.

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Wow,

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I really appreciate that. One of my patent questions that I love

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to ask, what part of your story is untold?

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I think I've been very fortunate that people have been willing to

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follow me on this journey. I mean, the team of people I work

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with, and as well as the 10s of 1000s of people I've met over

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the last 30 years while I'm training that people sit in the

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audience and listen and ask questions and challenge. They

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email me. They comment on blog posts, so I don't feel like

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there's anything that is, that is un -- What did you say? What

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did you call it?

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Untold

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Untold ,that's, that's important, really. I like sushi.

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Well, I want to just communicate such a great appreciation,

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because much like you, it took an email from me and Scott

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Miller is a real person, you responded to me, we were able to

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connect and just so appreciative of our time together, Scott. So

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wonderful to learn about you and all that you've done in your

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practice. I really, really appreciate you.

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Thanks very much for that, Rob, for this opportunity to speak to

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you and to the people who listen to your podcast.

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Yeah, great. I do want to make a little plug if it's, you're

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going to be at the Evolution of Psychotherapy Conference

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That's right

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in December, and then you'll be one of the key presenters there.

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And you'll be actually working with me, we're doing a pre

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conference event, which I'm super excited about. So the

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listeners can look, look into that and get to experience more

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of Scott D. Miller.

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Would love to see you at either or both.

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Oh, fantastic. Well, Scott, thank you so much. Again,

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appreciate for your time.

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