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I’ve been thinking hard about the so-called “Dodo Bird Verdict“.

The verdict, based on a character from Lewis Carroll’s “Alice’s Adventures in Wonderland” states that every psychotherapeutic theory is equal, and no one theory reigns supreme.  In the words of Carroll’s Dodo (after judging a foot race):  ”Everybody has won and all must have prizes.” This verdict asserts that there are common factors among therapists which, if adhered to, will result in successful therapy no matter what model or technique the therapist applies to treatment.

I’ve recently been involved with a group called the International Center for Clinical Excellence (ICCE).  Scott D. Miller, it’s founder, used to be one of the most ardent proponent of the Dodo Bird Verdict.  In fact, in one of my recent posts entitled “What REALLY Causes Change in Teens“, I outline the common factors of therapy that Miller introduced me to.  The common factors are:  1) things that happen outside of the therapy office; 2) the client’s orientation toward hope for change; 3) the strength of the client-therapist relationship; and 4) the therapist’s applied technique.

These four key common factors give us a descriptive sense of what is similar across the vast world of psychotherapy success. However, it is not a model of therapy in and of itself.  In other words, if we were to focus our efforts around strictly enhancing the four common factors in our work with clients, we would find that we never improve beyond where we are today.  Why?

The “Red Queen Principle” bears the answer.  Again taken from a character in Carroll’s book, the Red Queen tells Alice, “It takes all the running you can do, to keep in the same place.”  Evolutionary theorists use these words from the Red Queen to elucidate the Red Queen Principle.  The Principle explains the necessity of all organisms to adapt or become extinct.  In other words, if a predator does not adapt, but its prey does adapt, then eventually the predator will cease to exist.  For example, if rabbits become faster and foxes don’t, then foxes will eventually become extinct.  The Red Queen Principle states that while groups of organisms must do “all the running [they] can do” just to keep up with other organisms and avoid extinction, individual organisms within those groups often exceed the evolutionary advances of the group.  For example, one fox may become exceedingly fast and cunning and it will pass those genes on to its offspring.

So what does this have to do with therapy?

Well, if the common factors are true of every successful treatment outcome, then it doesn’t really matter which model of therapy you use, does it?  It would follow that every therapist who focused on those factors would have similar successful outcomes, wouldn’t they?  But research shows that this simply isn’t true.  Some therapist are vastly more skilled at inching their clients toward health than other therapists.  Why?  What is different about these “supershrinks“?  (Click on the “supershrinks” link. Read the article.  You won’t regret it. In fact, it may change your life.)

The difference, according to Miller, lies in the work of K. Anders Ericsson.  Internationally renowned as the “expert on expertise”, Ericsson’s research shows that the truly great in any field have things in common – they improve themselves through deliberate practice.  And they do much more deliberate practice than other relatively “good” performers – up to as much as 10,000 hours more!

Expert therapists know where they are weak.  This means that they are measuring themselves constantly.  They are following up with their clients.  They are soliciting feedback.  They know exactly what they need to improve upon. And then they act to improve it.

In evolutionary terms, supershrinks adhere to the Red Queen Principle.  They far exceed the psychotherapeutic advances of their time.  They adapt and improve and reach and stretch far more than groupings of their “adequate” peers.

The truly excellent are humble enough to know they are limited, smart enough to seek feedback, passionate enough to act on that feedback, and stubborn enough to engage in deliberate practice over and over and over again.

Looks like I have some work to do.  How about you?

It’s been another fantastic few days of Family Weekend at New Haven, the residential treatment center where I work. It’s my favorite time! I love being with each family in group sessions as they work on their issues. It’s an honor.

These weekends always cause me to wonder: What is it that really causes change in struggling teens?

Scott Miller, Ph.D., (www.scottdmiller.com) and his colleagues have researched this topic ferociously over the past decade. They’ve studied over 6,000 research articles. What they came up with surprised me at first. After I thought about it for a while, though, it began to make sense.

Miller says that 40% of change is attributable to “extra-therapeutic” factors. These are things that happen outside of the therapy office. Unforeseen changes in the economy, in families, and in the environment can spur people to change. I call these things “acts of God”.

The next 30% of change can be attributed to a person’s orientation toward hope and change. Do they believe they can change? Do they have hope the change can last?

15% of change is due to the relationship the client has with the therapist.

The last 15% can be narrowed down to the therapist’s particular skill and style.

This has important implications for treatment.

Extra-therapeutic Factors
For example, the residential staff, shift changes, room changes, cats, horses, activities off-campus, intensive days, family weekends, campouts, hikes, family phone calls, and so forth, are our attempt to have some effect on the “extra-therapeutic” factors. John Stewart calls this “shotgun therapy”. We try a lot of different things to see if we can get through to a girl. Like a father said this weekend in a group session, “New Haven will even throw ‘the book’ out if it will work for a kid.”  This doesn’t mean we run around willy-nilly, of course.  We just try a lot of things until something works.

Hope
We try to focus on strength rather than condemning weakness. We fiercely protect a person’s ability to choose – it’s our effort to foster an internal locus of control. When a person takes me by the hand and expresses kindness to me and confidence in me – even challenges me – I am more likely to rise to the occasion because he or she has faith in me. That give me hope. Our experiential therapy approach is designed to give students successful experiences that they can point to later, when they feel down.

Relationship with the Therapist
I require each therapist to measure how well each student connects with that therapist. Every session, every student rates how well she felt the therapist did during the session. We make sure that the student/therapist relationship is a match.

Skill and Style
I welcome a wide range of skills and styles of therapy here, as long as the therapists we hire are able to be effective during family therapy. It’s my feeling that family therapy which encourages every member of the family to do his/her part is the most effective way to ensure that the change in the adolescent lasts.

So how well are you doing at taking advantage of the extra-therapeutic factors?  How effective are you at instilling hope in those who feel hopeless?  How much influence are you able to marshall, because of the relationship you have with those you serve?  Do you possess the set of skills necessary to help the client who is seated in front of you?