The two big questions that I have had in starting Psych 406 are does counselling actually work (can people actually change)? and which approach is best? When I mentioned to a colleague of mine and practicing counsellor that I was taking this course, he suggested that I have a look at the work of Scott D. Miller. I picked up a copy of Dr. Scott D. Miller’s book, The Heart and Soul of Change ( http://www.scottdmiller.com/), and also listened to an interview with Scott D. Miller at http://shrinkrapradio.com/66-what-really-works-in-therapy/

Interestingly, Miller’s analysis of the effectiveness of clinical counselling suggests that the particulars of a clinician’s approach do not have a significant impact on the success of counselling. This claim, of course, is quite controversial.

Below, I have laid out in point form the basic components of Miller’s research and findings.

• He argues that the medical model is unhelpful. Diagnosis and symptom clustering does not necessarily guarantee a desirable outcome.
• Mental health therapy is struggling as a field because:
  • A lack of confidence in the outcome of treatment is the primary reason why clients stop or refuse to return to therapy.
  • Clinicians are overly focused on how they work, and not enough on outcomes.
  • Diagnostic groupings predict very little in terms of change. (we need to change the policies and language of mental health practice)
  • Of clinician burnout: over 60% of clinician time is spent with paperwork. Suggested solutions often include even more paperwork (this is reminiscent of education, where I work as a teacher).

However, Miller argues that, despite these problems, therapy works (he claims to show an 80% success rate for clinical therapy…a better success rate than some fields of medicine). But successful therapy is, for him, less about correct diagnosis or techniques, than about the client-therapist relationship, flexibility, and other factors.

Factors that do matter in treatment:

1. A good client-clinician relationship
2. Clinician Openness: Allowance for client feedback (to shape treatment) and commitment to outcome.
3. Clinician Flexibility: therapists need to choose whichever approach best fits them and the client
4. Belief: therapists have to believe in the effectiveness of their approach.
5. Extraneous Factors: what the client brings to therapy.

Miller does not go as far as to say that a correct therapeutic approach or use of medication is irrelevant. He simply argues that these are only effective within an effective therapist-client relationship.

Some thoughts:

• Miller’s claims about an 80% success rate for clinical counselling is certainly encouraging.
• A successful Client-therapist relationship should see positive change within a few weeks, or it isn’t working. If it isn’t working, therapy may need to be adjusted, or changed completely.
• What matters is “does the client like the therapy, and are they getting better?”
• Comparisons can be made between Carl Roger’s Client-Centred Therapy, but, in a sense, Miller seems to go even farther.
• Certainly, Miller’s findings highlight the usefulness of a course like Psych 406, as successful clinicians are eclectic in their approaches to helping clients.

I would certainly welcome any thoughts any of you might have regarding this topic. Thank you!