Welcome, everybody to our Sessions Podcast. I'm Rob Gent,
Speaker:Chief Clinical Officer of Embark. Just super elated and
Speaker:privileged to have our guest today is Scott D. Miller. We
Speaker:could sing his accolades all day long, but, really Scott, thank
Speaker:you so much for joining us. Well, welcome to the podcast. I
Speaker:know I'm looking forward to us doing some work later on in the
Speaker:year with you. But yeah, so thank you for joining us.
Speaker:It's my pleasure.
Speaker:Great.
Speaker:So just a little bit about Scott, Scott and his colleagues
Speaker:have significantly influenced and dare I say, transformed the
Speaker:way that psychotherapy and psychotherapists assess
Speaker:effectiveness for client outcomes. Him and his colleagues
Speaker:have used the data and develop methodology to inform therapist
Speaker:how to become more effective. How am I doing with that Scott?
Speaker:That's good.
Speaker:Great, awesome. Yes, Scott is widely known for his expertise.
Speaker:He's, he's widely known for his speaking and teaching ability,
Speaker:he has a ton of resources. And he's got has been doing this for
Speaker:a while and has made it his purpose and his mission. And
Speaker:he's certainly known for his profound critical thought if you
Speaker:guys have read his resources and his books, you'll know that his
Speaker:his team and him have done their due diligence to think
Speaker:critically about everything, and really look at the data and help
Speaker:us as therapists and as clients really make some movement. So we
Speaker:could talk about all that. But what I wanted to do is have a
Speaker:personal conversation with Scott to get to know his story. Is
Speaker:that ok?
Speaker:Awesome. Well, I've got to be honest, I'm looking into Scott,
Speaker:Yeah, sure.
Speaker:and I've known about him over the years as a psychotherapist,
Speaker:and knowing this thing, what is feedback-informed treatment?
Speaker:Let's look at the data. What are we really doing? And personally,
Speaker:I've bought his book a few of his books early on. And then
Speaker:recently, his new book "Better Results: Using Deliberate
Speaker:Practice." And of course, being in charge if we want to do
Speaker:better supervision and deliberate practice came
Speaker:screaming out at me. And like, yeah, what can we do? What is
Speaker:this thing we call deliberate practice? So that initially
Speaker:caught my attention. And then this is where I have to be
Speaker:honest. Scott's book called "Staying on Top and Keeping the
Sand Out of Your Pants:A Surfer's Guide to the Good Life"
Sand Out of Your Pants:is what really roped me in Scott.
Sand Out of Your Pants:Well, I know from one surfer to the next how important a part of
Sand Out of Your Pants:my life Surfing has been.
Sand Out of Your Pants:Well, me and Scott briefly got a chance to talk about it. And it
Sand Out of Your Pants:from that conversation, I was hooked because from one server
Sand Out of Your Pants:to the next, we had a wonderful conversation about, oh, how long
Sand Out of Your Pants:where have you from? I grew up in California. So did I, we had
Sand Out of Your Pants:this wonderful engagement. So we've had a little bit of
Sand Out of Your Pants:correspondence regarding that. So kindred spirits, Scott.
Sand Out of Your Pants:That's right. It was really enjoyable to catch up around
Sand Out of Your Pants:that. Usually I'm asked about psychotherapy research, you and
Sand Out of Your Pants:I got the chat about surfspots, around California. And as you
Sand Out of Your Pants:said, I grew up I think, during the heyday, the best time to
Sand Out of Your Pants:have surfed and maybe I'm gonna offend somebody by saying that,
Sand Out of Your Pants:but
Sand Out of Your Pants:I don't care.
Sand Out of Your Pants:The late 60s, early 70s. The beaches weren't crowded. You
Sand Out of Your Pants:could go out in the morning in the late afternoon. And the
Sand Out of Your Pants:waves were great. It was it was a phenomenal childhood,
Sand Out of Your Pants:actually.
Sand Out of Your Pants:Well, so appreciate that. Yeah. Remind me, Scott it was Southern
Sand Out of Your Pants:California, correct?
Sand Out of Your Pants:It was Southern California. Yeah. And we used to -- gas I
Sand Out of Your Pants:think was, I'm embarrassed to say, it was under $1 a gallon.
Sand Out of Your Pants:And it took us about maybe 20 minutes to drive from our home
Sand Out of Your Pants:to the beach, we usually surfed in Newport Beach. And nowadays,
Sand Out of Your Pants:that drive would probably take about 75 to 90 minutes to get
Sand Out of Your Pants:from my home down down to the beach, but we would beg for
Sand Out of Your Pants:money, my friends and I would drive down surf in the morning,
Sand Out of Your Pants:sit at the Crab Cooker and eat clam chowder and eat breadsticks
Sand Out of Your Pants:because that's what we could afford. And then we would go
Sand Out of Your Pants:back out in the late afternoon, after all, what we disparagingly
Sand Out of Your Pants:referred to as "tourists" went home and we would have sort of
Sand Out of Your Pants:free freedom to do what we wanted on the waves without
Sand Out of Your Pants:worrying about running our boards into somebody.
Sand Out of Your Pants:Well, it's got to bring back a lot of memories for me just I'm
Sand Out of Your Pants:laughing about the Crab Cooker. I've spent my time there and
Sand Out of Your Pants:they've recently redone it. They built another one inland
Sand Out of Your Pants:somewhere so that's great.
Sand Out of Your Pants:They did,
Sand Out of Your Pants:as good but maybe it's just the atmosphere. The environment was
Sand Out of Your Pants:so cool inside and that just was a place to walk down in your
Sand Out of Your Pants:board shorts and tank top and get some lunch and really on the
Sand Out of Your Pants:cheap. I am probably reminiscing too much, Rob, but i think a
Sand Out of Your Pants:bowl of clam chowder was a buck. And you could eat as many
Sand Out of Your Pants:breadsticks and these little bread balls as a as you wanted
Sand Out of Your Pants:and, you know, filled you up and then you could go back and serve
Sand Out of Your Pants:again once they took the flags down. You could go up and surf
Sand Out of Your Pants:from about four four o'clock on without without hindrance with
Sand Out of Your Pants:the with the sunbathers and swimmers.
Sand Out of Your Pants:Yeah, so great, Scott. Now you need to have $50 in your pocket
Sand Out of Your Pants:to do that exact same thing.
Sand Out of Your Pants:Yeah,
Sand Out of Your Pants:that's exactly right.
Sand Out of Your Pants:You pay for parking, and those little bread balls are super
Sand Out of Your Pants:expensive now.
Sand Out of Your Pants:Yeah.
Sand Out of Your Pants:Really great. Scott. Thank you. Well, I know you're currently
Sand Out of Your Pants:stationed in Chicago, is that correct?
Sand Out of Your Pants:That's right. I've lived here since about 1993-94.
Sand Out of Your Pants:Okay, terrific. And I imagine that's kind of a central
Sand Out of Your Pants:location to get wherever you need to in the country pretty
Sand Out of Your Pants:fast.
Sand Out of Your Pants:You know,
Sand Out of Your Pants:it's really facilitated my career, which right up into the
Sand Out of Your Pants:pandemic, I was gone every week, I was on the road somewhere in
Sand Out of Your Pants:the United States, in Asia or in Europe, traveling, teaching and
Sand Out of Your Pants:consulting. And so being in Chicago meant that I could get
Sand Out of Your Pants:anywhere in the states in a maximum of about four hours, I
Sand Out of Your Pants:could get to Europe in eight, I could get to Australia and Asia
Sand Out of Your Pants:in about 14 with a direct flight. So it really was a great
Sand Out of Your Pants:place to be. And all of that was very serendipitous. A wave came
Sand Out of Your Pants:by, so to speak, happened to be woman named Karen. And we hit it
Sand Out of Your Pants:off. She lived here. I was working in Milwaukee at the
Sand Out of Your Pants:time. And I decided I would move here to be with her. And it's
Sand Out of Your Pants:really been a great it's really been a great move.
Sand Out of Your Pants:Yeah, terrific. Terrific. That's great to hear. Scott, you're
Sand Out of Your Pants:surfing probably suffers a little bit, being in Chicago.
Sand Out of Your Pants:You know,
Sand Out of Your Pants:they do surf here. It's not the same and wind surfing is really
Sand Out of Your Pants:quite big south on the south part of like Michigan, given the
Sand Out of Your Pants:winds and there are some tributaries outside of Lake
Sand Out of Your Pants:Michigan that people do a lot of parasailing and such. But board
Sand Out of Your Pants:surfing, it's not going to be like it is in any of the beaches
Sand Out of Your Pants:or in Hawaii.
Sand Out of Your Pants:Yeah. Well, I wonder if the foiling has taken off a little
Sand Out of Your Pants:bit.
Sand Out of Your Pants:I don't know.
Sand Out of Your Pants:The foil boards are quite the big thing. Now you get a mix of
Sand Out of Your Pants:surfing and foiling. It's really fascinating. I'm sure they're
Sand Out of Your Pants:doing that there. But so great, Scott. So if you don't mind,
Sand Out of Your Pants:let's shift gears. It's interesting that you're in
Sand Out of Your Pants:Chicago. Now you've had this amazing career, if we don't
Sand Out of Your Pants:mind, kind of taking a step back. Where, Where did that
Sand Out of Your Pants:story really, really begin for you?
Sand Out of Your Pants:The story of?
Sand Out of Your Pants:The story of you, right? Growing up in Southern California. I
Sand Out of Your Pants:know I want to touch in, you've got this amazing story about
Sand Out of Your Pants:being a Mormon and a chance to read that book. I'm just
Sand Out of Your Pants:curious, like, what does it really start off? Any siblings,
Sand Out of Your Pants:what are your parents like?
Sand Out of Your Pants:Well, I think I had a pretty uneventful and normal childhood
Sand Out of Your Pants:had a great family, parents and two brothers. I was right in the
Sand Out of Your Pants:middle. When I went away to college. And in my house, my
Sand Out of Your Pants:father was a high school, or rather, an elementary school
Sand Out of Your Pants:principal his entire life. Education was really an
Sand Out of Your Pants:important thing in my household. If you did well, in school, you
Sand Out of Your Pants:could do just about anything else. They were very tolerant
Sand Out of Your Pants:and forgiving people. So I knew college was in my future on the
Sand Out of Your Pants:radar. I left after graduating from Glendora High School moved
Sand Out of Your Pants:to go to college. And while I was there originally I was going
Sand Out of Your Pants:to be an accountant. And I sometimes joke that that's
Sand Out of Your Pants:because my mother thought that at least I would be near money.
Sand Out of Your Pants:I don't think she had any belief that I would be rich, but at
Sand Out of Your Pants:least I could count other people's dough. I went for a
Sand Out of Your Pants:year and I met a professor, his name (no relationship) was Hal
Sand Out of Your Pants:Miller he was a student from of Skinner's from Harvard. And
Sand Out of Your Pants:really, I wanted to be Hal Miller. He was so interesting,
Sand Out of Your Pants:so provocative, so free thinking. And so I became a
Sand Out of Your Pants:research assistant as an undergraduate. At one point, he
Sand Out of Your Pants:said because he was a an experimental psychologist, and I
Sand Out of Your Pants:thought that I would go and do a traditional teaching rap, become
Sand Out of Your Pants:a professor. He thought otherwise. He said that you
Sand Out of Your Pants:unless you scored on the top on your GREs, you got the best
Sand Out of Your Pants:university context that you are pretty much destined to make
Sand Out of Your Pants:very little money, and to have a long and difficult career
Sand Out of Your Pants:publishing, seeking grants, etc. And he thought that I was well
Sand Out of Your Pants:suited for clinical work. So he sent me over to talk to another
Sand Out of Your Pants:professor. His name was Michael Lambert. And Michael Lambert,
Sand Out of Your Pants:really changed the arc of my life. He was a clinical
Sand Out of Your Pants:psychologist. He was very interested in what made
Sand Out of Your Pants:treatment work. And particularly interested in identifying cases
Sand Out of Your Pants:that are at risk for deterioration. And Michael and I
Sand Out of Your Pants:remained friends to this particular day, even though I
Sand Out of Your Pants:graduated from my undergraduate school in 1980. So from there, I
Sand Out of Your Pants:went with his help and advice to graduate school. And I've been
Sand Out of Your Pants:driven by really one chief question. And that was, "how
Sand Out of Your Pants:could I be effective?" And that's what's been the guiding
Sand Out of Your Pants:influence during my entire career. I wasn't interested in
Sand Out of Your Pants:specializing in one population or the next or particular
Sand Out of Your Pants:technique or not, I really want -- and that's because I think I
Sand Out of Your Pants:was a very anxious clinician. When I was in the room with
Sand Out of Your Pants:people, I could definitely sense just how much they were
Sand Out of Your Pants:struggling. In my own personal life, I've not really struggled
Sand Out of Your Pants:in the way that many of the people who came to see me as a
Sand Out of Your Pants:practicum student or an intern seem to be struggling. I wanted
Sand Out of Your Pants:somebody to tell me what was it I was supposed to do in that
Sand Out of Your Pants:room. And I have to say, quite often, I felt like I had been
Sand Out of Your Pants:ripped off in graduate school, I must have missed the day where
Sand Out of Your Pants:they taught the secret about how all this works. In addition,
Sand Out of Your Pants:many of my fellow students around me, seemed much more
Sand Out of Your Pants:confident about how this was supposed to work. So that's
Sand Out of Your Pants:still a driving influence in my professional career. It's what's
Sand Out of Your Pants:driven really all, with very few exceptions, all of my
Sand Out of Your Pants:publications, all of the teams that I've been a part of over
Sand Out of Your Pants:the last 30 plus years of my career.
Sand Out of Your Pants:Wow, thanks for that. Scott. It sounds like you had some
Sand Out of Your Pants:significant mentors in your life early on.
Sand Out of Your Pants:It's amazing. And if I had any advice for anybody who was
Sand Out of Your Pants:heading down the academic route, I would say, relationships are
Sand Out of Your Pants:much more important than books. Books are definitely important,
Sand Out of Your Pants:videos that you want to learn from also important. But the
Sand Out of Your Pants:people that I met along the way, and that are still important
Sand Out of Your Pants:relationships to me, I mentioned one, Michael Lambert, who was a
Sand Out of Your Pants:pivotal person. Harold Miller, Hal Miller is I knew him was
Sand Out of Your Pants:another. Bruce Wampold who was my stats professor, in my first
Sand Out of Your Pants:year of my graduate program, he and I still collaborate on
Sand Out of Your Pants:publications. That's been an amazing and important resource.
Sand Out of Your Pants:Scott, as a therapist, I'm so intrigued by the story,
Sand Out of Your Pants:hopefully many of us can resonate, because you have this
Sand Out of Your Pants:experience of the numbers being analytical, trying to search for
Sand Out of Your Pants:some real knowable, reliable, valid data in life. And then, us
Sand Out of Your Pants:as therapists, we tend to be high emotional, wanting to
Sand Out of Your Pants:connect, and it sounds like here, you are really trying to
Sand Out of Your Pants:bridge that gap between those two things.
Sand Out of Your Pants:I suppose I have tried to bridge that particular gap, the
Sand Out of Your Pants:research literature, it's interesting is massive. And yet
Sand Out of Your Pants:most of us practitioners rely on someone to interpret it for us,
Sand Out of Your Pants:someone who might have an ideological slant to their work.
Sand Out of Your Pants:I think, as well, however, that many of us are looking for what
Sand Out of Your Pants:to do. Truth be told, when I say that even after 30 years when
Sand Out of Your Pants:I'm sitting in the room with a person who's struggling, and I'm
Sand Out of Your Pants:thinking in my head, even though my exterior certainly
Sand Out of Your Pants:communicates confidence, that I wonder what the hell I should do
Sand Out of Your Pants:here. I guess another thing for me is that much of what our
Sand Out of Your Pants:field has taught, simply didn't ring true in the room. So there
Sand Out of Your Pants:were lots of theories about what I was supposed to do, whether
Sand Out of Your Pants:they were psychoanalytic, which they were for me in the
Sand Out of Your Pants:beginning, or more recently, cognitive behavioral traditions.
Sand Out of Your Pants:But all of that still seems not to really capture the essence of
Sand Out of Your Pants:the work that we do. And plus, I've been really struck by
Sand Out of Your Pants:research which indicates and this is a very controversial
Sand Out of Your Pants:thing, which is surprising to me. It's not even taught
Sand Out of Your Pants:nowadays in graduate school. There is no difference in
Sand Out of Your Pants:outcome between these various and competing treatment
Sand Out of Your Pants:approaches. So what clinicians tend to do or what the field
Sand Out of Your Pants:tends to do is either align with one or pick and choose and make
Sand Out of Your Pants:some amalgamation that is used with clients on an ongoing
Sand Out of Your Pants:basis. That's all perfectly fine until you confront literature
Sand Out of Your Pants:which indicates that therapist outcomes are no better, that is
Sand Out of Your Pants:experienced therapists, outcomes are no better than students
Sand Out of Your Pants:outcomes. It's it's also a challenge when you look at the
Sand Out of Your Pants:data that shows that clinicians do not improve with time and
Sand Out of Your Pants:experience in the in the field, even though they think they do.
Sand Out of Your Pants:So whether it's emotions or thoughts or models, etc. For me,
Sand Out of Your Pants:the focus, again, comes back to how can I reliably show that the
Sand Out of Your Pants:work I'm doing is helping more people? And that's why our team
Sand Out of Your Pants:has really been at the forefront of saying, "why not measure your
Sand Out of Your Pants:results and be sure?" And I promise you, it's going to be
Sand Out of Your Pants:quite humbling, as you do that, because you're going to find out
Sand Out of Your Pants:very quickly that your mother was wrong about you. You're
Sand Out of Your Pants:you're not special. The average clinician, get this, multiple
Sand Out of Your Pants:studies now show the average clinicians thinks that they are
Sand Out of Your Pants:more effective than 80% of their peers. Well, just think about
Sand Out of Your Pants:that, that sort of like self esteem on crack or something, it
Sand Out of Your Pants:really doesn't line up with the data. So whether again, it's
Sand Out of Your Pants:emotions, or thinking or models or math, what we have to do is
Sand Out of Your Pants:know our work and know how effective we are not just with
Sand Out of Your Pants:this person in front of us, not with them just saying "Oh, yes,
Sand Out of Your Pants:I've been helped." Not with our model saying we're practicing in
Sand Out of Your Pants:a theoretically or technically correct way. But when we crunch
Sand Out of Your Pants:the numbers, they show that in fact, we're helping people.
Sand Out of Your Pants:And you have, and I can't emphasize this enough, that
Sand Out of Your Pants:you've provided so much of your work has been about providing
Sand Out of Your Pants:the resources to be able to effectively do that, as a
Sand Out of Your Pants:clinician.
Sand Out of Your Pants:So let me rewind,
Sand Out of Your Pants:Well, thanks for that. Now, we we do make some very simple
Sand Out of Your Pants:There's a lot in there. I know.
Sand Out of Your Pants:tools available on my website, we've done that since the
Sand Out of Your Pants:measures were developed back in the late 90s. The turn, right at
Sand Out of Your Pants:the turn of the millennium. And believe me this, this was a
Sand Out of Your Pants:journey for me professionally, I didn't start here, I tried to
Sand Out of Your Pants:follow what the data said. So anybody who's knows my history,
Sand Out of Your Pants:That's the fire-- No, no, it's so wonderful. Thank you, Scott,
Sand Out of Your Pants:as a practitioner knows that I moved from sunny Southern
Sand Out of Your Pants:California to Milwaukee, Wisconsin, because I was in
Sand Out of Your Pants:pursuit of a job. And also somebody who would give me
Sand Out of Your Pants:direct specific guidance about what to do in the therapy room.
Sand Out of Your Pants:I had the distinct honor and privilege of going to work at
Sand Out of Your Pants:the Brief Family Therapy Center, where Steve de Shazer and Insoo
Sand Out of Your Pants:Berg worked. And together, we worked on the Solution-Focused
Sand Out of Your Pants:Therapy model. And believe me, I got a lot more confidence in the
Sand Out of Your Pants:room, I could do SFBT in my sleep backwards and forwards and
Sand Out of Your Pants:in multiple languages. What what happened though, was researchers
Sand Out of Your Pants:came and they studied our clients. And they came back
Sand Out of Your Pants:eventually to us. And they said, there's good news and bad news.
Sand Out of Your Pants:The good news was that what we did worked, the bad news was it
Sand Out of Your Pants:didn't work anything any better than anything else. So there we
Sand Out of Your Pants:were right back to the dilemma. Because if you want to improve,
Sand Out of Your Pants:you have to know what your data say, and then look into the
Sand Out of Your Pants:abyss, you have to look for where your traditional beliefs
Sand Out of Your Pants:and practices fall short. So we left that formed a different
Sand Out of Your Pants:team. And we began looking for ways to figure out how could we
Sand Out of Your Pants:be more effective. And in time, that led me back to two mentors
Sand Out of Your Pants:of mine first, Michael Lambert and another one, Lynn Johnson.
Sand Out of Your Pants:Michael was suggesting that well, we may never find the
Sand Out of Your Pants:because just as a clinician, I'm trying to reflect on well, I
Sand Out of Your Pants:"right" way to do treatment, this technique for that
Sand Out of Your Pants:particular problem. But what we can know, right now is whether
Sand Out of Your Pants:or not we're helping this client, by simply measuring.
Sand Out of Your Pants:Lynn Johnson developed a measurement tool that allowed us
Sand Out of Your Pants:to assess one of the key contributors to success:
Sand Out of Your Pants:establishing a good therapeutic alliance. And here's what's key.
Sand Out of Your Pants:That therapeutic relationship therapists' views of that
Sand Out of Your Pants:relationship have historically correlated very low with the
Sand Out of Your Pants:clients' experience of the relationship. As a result, if
Sand Out of Your Pants:you're in supervision with me, I don't really care what you think
Sand Out of Your Pants:of the relationship, because your view isn't predictive of
Sand Out of Your Pants:whether the client stays in treatment, or gets better. What
Sand Out of Your Pants:I really care about is soliciting that information from
Sand Out of Your Pants:the client, and seeing if I can close the gap between what I'm
Sand Out of Your Pants:thinking and experiencing and what the client wants from me.
Sand Out of Your Pants:So together we've called that feedback-informed treatment, non
Sand Out of Your Pants:theoretical, non ideological, doesn't matter whether you're a
Sand Out of Your Pants:want to ask a few questions. One is, is to sort of reflect on and
Sand Out of Your Pants:psychoanalytic in orientation, or you dig CBT or Acceptance and
Sand Out of Your Pants:Commitment Therapy, we can all measure our results at that
Sand Out of Your Pants:moment with our client. By doing so, we can also identify those
Sand Out of Your Pants:clients where we're not having an impact or making a connection
Sand Out of Your Pants:that improves probably what is the number one predictor of
Sand Out of Your Pants:treatment results which is therapists responsiveness to
Sand Out of Your Pants:individual differences. So that's what feedback-informed
Sand Out of Your Pants:care is really all about.
Sand Out of Your Pants:say, so what you're saying, Scott is, is that my perception
Sand Out of Your Pants:of the relationship with the client is not connected to the
Sand Out of Your Pants:outcomes as far as the client's perception of the relationship.
Sand Out of Your Pants:Right, it's their view that's going to predict whether there
Sand Out of Your Pants:stay or not. About one quarter of the people we work with drop
Sand Out of Your Pants:out without experiencing any improvement. So a lot of those
Sand Out of Your Pants:folks are dropping out. Because there isn't a sort of love
Sand Out of Your Pants:connection, there isn't a sense of felt empathy on the client's
Sand Out of Your Pants:part. So I really -- and given the historically low
Sand Out of Your Pants:correlations in the research between therapists' view of the
Sand Out of Your Pants:relationship and clients' view of the relationship, I really
Sand Out of Your Pants:think I have to try to solicit that from them. And keep my
Sand Out of Your Pants:ideology out of it, that it's a distortion, that it's a sign of
Sand Out of Your Pants:their pathology, however, they may view it. If I want to
Sand Out of Your Pants:rearrange the furniture, I have to be inside the client's house.
Sand Out of Your Pants:Boy, that's a great analogy. So I can't help it ask, what is
Sand Out of Your Pants:your hypothesis on? You've worked with so many therapists,
Sand Out of Your Pants:and I think the trends are saying is that we, as
Sand Out of Your Pants:therapists, tend to overrate our perception of success. We tend
Sand Out of Your Pants:to boil in all of this stuff. Scott, in all your experience,
Sand Out of Your Pants:why do you think that is? Why do you think that the therapist
Sand Out of Your Pants:naturally we are inclined to tell ourselves that we're more
Sand Out of Your Pants:effective than 80% of that? What do you think that happened?
Sand Out of Your Pants:I think this is the result of a number of things. But it's
Sand Out of Your Pants:really related to our latest work on deliberate practice. So
Sand Out of Your Pants:this is simply the way we operate as a species, when we
Sand Out of Your Pants:approach a new activity, whether for example, it's learning
Sand Out of Your Pants:therapy, or driving a car. Initially, if you can remember
Sand Out of Your Pants:back to your first experiences with a client, or even role
Sand Out of Your Pants:playing in a practicum context with another student, you were
Sand Out of Your Pants:highly conscious of everything that you did every move you
Sand Out of Your Pants:made, how long you had eye contact, how you're breathing,
Sand Out of Your Pants:whether your legs were crossed, or your arms folded, you were
Sand Out of Your Pants:aware of all of those things. In time, as you're trying to master
Sand Out of Your Pants:therapy, those things become automatic. This is the language
Sand Out of Your Pants:of deliberate practice, the more automatic they become, the more
Sand Out of Your Pants:seamless they seem. And if there aren't major errors, like in
Sand Out of Your Pants:driving a big car accident, or say in learning to walk, you're
Sand Out of Your Pants:constantly falling down. If that doesn't happen, then we begin to
Sand Out of Your Pants:assume a greater and greater ability than is actually the
Sand Out of Your Pants:case. So I think the reason why we do that is that it's simply
Sand Out of Your Pants:human nature, we become proficient at an activity and
Sand Out of Your Pants:the absence of large, gross and catastrophic errors causes us to
Sand Out of Your Pants:assume more ability than actually exists. And there's a
Sand Out of Your Pants:big problem with that. Automaticity, combined with that
Sand Out of Your Pants:assumption, leads to a lack of learning. After all, why would
Sand Out of Your Pants:you need to learn anything new, because you're already doing it
Sand Out of Your Pants:relatively well? In addition, our continuing education system,
Sand Out of Your Pants:the way it's structured, and organized facilitates that kind
Sand Out of Your Pants:of belief. It doesn't challenge us. In fact, the data indicate
Sand Out of Your Pants:that attending a continuing education workshop likely
Sand Out of Your Pants:reinforces false assumptions therapists have about the
Sand Out of Your Pants:breadth and depth of their skills and abilities. Think
Sand Out of Your Pants:about that for a second. So
Sand Out of Your Pants:What you're
Sand Out of Your Pants:saying is sacrilege. Oh my gosh, right? I mean, most people
Sand Out of Your Pants:feel--
Sand Out of Your Pants:respects, for average people coming through our door, it
Sand Out of Your Pants:In many
Sand Out of Your Pants:doesn't make any difference. If you're driving to the grocery
Sand Out of Your Pants:store every day, you know, it probably doesn't make any
Sand Out of Your Pants:difference. You don't have to be Mario Andretti in order to get
Sand Out of Your Pants:there, or some other highly skilled driver. However, since
Sand Out of Your Pants:we're seeing clients year after year, the more automatic our
Sand Out of Your Pants:thinking and skill execution is, the narrower that ability
Sand Out of Your Pants:becomes with time and experience, the only way to
Sand Out of Your Pants:countervene that is to begin to get feedback. So I have to
Sand Out of Your Pants:measure and begin to show you where, in fact, your abilities
Sand Out of Your Pants:break down. So for example, that you're not you're not in line
Sand Out of Your Pants:with your client about goals, or their sense of identity and
Sand Out of Your Pants:preferences or about what exactly they were hoping for
Sand Out of Your Pants:from you in the interaction, feeding that back on an ongoing
Sand Out of Your Pants:basis, has a very predictable impact on automaticity. It makes
Sand Out of Your Pants:us aware again, of our behavior in the room, which gives us the
Sand Out of Your Pants:ability to exercise influence over our behaviors. That is a
Sand Out of Your Pants:very disruptive process. So people really don't like
Sand Out of Your Pants:deliberate practice. They're infatuated with the concept
Sand Out of Your Pants:right now, which we introduced to the field back in 2007. In an
article called "Super Shrinks:
:What's the Secret to Their
article called "Super Shrinks:
:Success?", you can get that online, just type in the title
article called "Super Shrinks:
: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,
article called "Super Shrinks:
: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,
article called "Super Shrinks:
:"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.
article called "Super Shrinks:
: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
article called "Super Shrinks:
: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.
article called "Super Shrinks:
:Slow and steady wins the race.
article called "Super Shrinks:
: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.
article called "Super Shrinks:
: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.
article called "Super Shrinks:
:Very, yeah.
article called "Super Shrinks:
: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.