Seth Bernstein, Ph.D.
* Time-Limited Therapy: A Necessary Evil In The Era of Managed Care? challenges the idea that longer treatment is necessarily better treatment. Considerable research shows that "the most significant gains in treatment happen during the first six to eight sessions."
* Effect of time-limited psychotherapy on patient dropout rates, American Journal of Psychiatry 1990;147:1341-1347. The authors conducted an archival study of 149 new clinic patients at a large community mental health center. The dropout rate for time-limited psychotherapy (32%) was about one-half the dropout rate for patients in brief (67%) and long-term (61%) individual psychotherapy.The difference in dropout rates could not be explained by patient demographic or diagnostic variables nor by therapist characteristics measured in the study. The results suggest that setting a specific time limit on individual psychotherapy at the outset of treatment increases the likelihood that clients will see the work through to its conclusion.
Developed by Scott Miller and Barry Duncan, this model of treatment involves a client completing a brief outcome survey before every session. There is scientific evidence to support the effectiveness of doing this. The main purposes of this activity are to start each session with a discussion of the client's progress towards achieving treatment goals AND to discuss how the client is feeling about his or her relationship with the therapist.
While working at the Accountable Behavioral Health Alliance, I developed an outcomes measurement tool based on the Outcome Rating Scale (ORS) developed by Miller and Duncan. I called it the Oregon Change Index (OCI). It is used by therapists in Oregon and other states. I use this tool in my private practice today.
A strength-based approach to mental health care has been established as an evidence-based practice for the treatment of adults and children with serious mental illnesses. Here is a summary of the principles of this approach from Recovery and Strengths Based Practice:
The strengths based approach to recovery could be described as agnostic, and need not be in dispute with, or subscribe to, any particular model or theory of mental health. Instead the strengths based approach seeks to answer some quite different questions such as:
• Why do people survive the problems of life at all?
• What resources do people draw on that would account for their resilience?
• Why do a significant majority of people diagnosed with mental health problems not just survive, but often live well despite their problems?
• What are the protective factors that support recovery?
• What meaning do individuals ascribe to their experiences, their suffering, and their triumphs?
Taking a strengths based approach involves moving away from a focus on deficits and therefore represents a paradigm shift. Assumptions on “treatment” are challenged and the role of the service user is transformed from passive recipient of treatment into an active collaborator. The goal is to have clients direct their own recovery.
* The Harvard Mental Health Newsletter has a good article that both summarizes TTM and the treatment implications for using it in mental health treatment. (TTM was originally developed for chemical dependency treatment.)