Ummannaq, Greenland

About MeEducation

BSW - University of Maryland – Baltimore CountyMSW[AP] - Charles Sturt University

Run a small adventure therapy program in SAAwarded Australian Postgraduate Award by CSU

Australian Association for Bush Adventure Therapy

Co-Adventuring with At-Risk Youth• The Business of It All – Consumers, Professionals, & Service Delivery• Finding What Works – Research & Practice• Feedback & Continuous Quality Improvement

1976 in Australia

1976 in Psychology & Social Work• Smith & Glass conduct meta-analysis of therapy outcomes• Clients are better off than 75% of people who do not engage• No difference in outcomes between types of interventions provided

2017: What’s changed?• No improvement in outcomes. • Dropouts average at 47%• No one type of intervention has proved itself superior• Supershrinks: Some therapists achieve better outcomes than others• No evidence to support that we get better with experience

Therapeutic Factors

Quality of Participation• Relationship improves Engagement• Engagement predicts Outcome

Adventure Therapy Specific Ingredients • Time in Nature• New Environment• Away from Home• Fun / Engaging• Hard Skills (i.e. Navigation)• The Metaphor of Survival• Relationship to Team Leader• Peer / Social Environment• Team initiatives

• Climbing / Abseiling• Group Responsibilities• Self Sufficiency • Time for Reflection• Exercise (i.e. Hiking)• Healthy Sleep Patterns • Nutrition• Journaling / Worksheets• Time Spent Problem Free

The Importance of Feedback• Participant ratings of experience are better than our guess• Tailor-Fitting Our Programs • Reduces the likelihood of participants getting worse under our care• Critical to effective follow-up

Session ORS SRS

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ORS/SRS - Youth

ORS SRS Collateral ORS

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Creating a Culture of Feedback• Ask participants for ’Task Centered’ Feedback• Thank participants for their feedback• The key is not to measure, the key is to obtain negative feedback• Don’t worry about honesty, worry about engagement• Create an environment for creative suggestions

Attending to your Participants• Make them feel very special• Validate their efforts to solve their problems• Empathy not only for the negative, can we be empathic to the good?• Try not to validate the problem story as often• Create a picture of the participant that is on the move

• Anker, M. G., Duncan, B. L., & Sparks, J. A. (2009). Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77(4), 693-704. • Asay, T. P., & Lambert, M. J. (1999). The empirical case for the common factors of therapy: Quantitative findings. In M. A. Hubble, B. L. Duncan, & S. D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 33-56).

Washington, DC: American Psychological Association.• Baldwin, S. A., Wampold, B. E., & Imel, Z. E. (2007). Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance. Journal of Consulting and Clinical Psychology, 75(6),

842-852. • Bertolini, B., & Miller, S. D. (2012). ICCE manuals of feedback-informed treatment (Vol. 1). Chicago, IL: ICCEPress.• Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research & Practice, 16, 252-260. • Bowen, D. J., & Neill, J. T. (2013). A meta-analysis of adventure therapy outcomes and moderators. The Open Psychology Journal, 6, 28-53. • Brown, J., Dreis, S., & Nace, D. (1999). What really makes a difference in psychotherapy outcome? Why does managed care want to know. In M. A. Hubble & S. D. Miller (Eds.), The heart and soul of change (pp. 389-406). Washington

DC: APA Press.• Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. T., Thurnton, J. A., & Andrews, W. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52(3), 337-345. • Diaz, C., & Drewery, S. (2016). A critical assessment of evidence-based policy and practice in social work. Journal of Evidence-Informed Social Work, 13(4), 425-431. • Draper, S., Bjorklund, E., Hess, J. Z., & Preece, N. (2013). Poison apples, big bad wolves, and other "happy hending" spoilers: Overcoming barriers to enduring change following youth residential treatment. Journal of Therapeutic

Schools and Programs, 4(1), 69-97. • Duncan, B. L., & Miller, S. D. (2007). The Group Session Rating Scale. Jensen Beach, FL: Author.• Duncan, B. L., Miller, S. D., & Sparks, J. A. (2004). The heroic client: A revolutionary way to improve effectiveness through client-directed, outcome informed therapy . San Francisco, CA: Jossey-Bass.• Duncan, B. L., Miller, S. D., & Sparks, J. A. (2007). Common factors and the uncommon heroism of youth. Psychotherapy in Australia, 13(2), 34-43. • Duncan, B. L., Miller, S. D., Sparks, J. A., Claud, D. A., Reynolds, L. R., Brown, J., & Johnson, L. D. (2003). The session rating scale: Preliminary psychometric properties of a "working" alliance measure. Journal of Brief Therapy, 3(1), 3-12. • Fernee, C. R., Gabrielsen, L. E., Andersen, A. J., & Mesel, T. (2017). Unpacking the black box of wilderness tehrapy: A realist synthesis. Qualitative Health Research, 27(1), 114-129. • Gabrielsen, L. E., Fernee, C. R., Aasen, G. O., & Eskedal, L. T. (2015). Why randomized trials are challenging within adventure therapy research: Lessons learned in Norway. Journal of Experiential Education, 39(1), 5-14. • GAO. (2007). Residential treatment programs: Concerns regarding abuse and death in certain programs troubled youth. Retrieved from United States Government Accountability Office: http://www.gao.gov/new.items/d08146t.pdf• Garcia, J. A., & Weisz, J. R. (2002). When youth mental health care stops: Therapeutic relationship problems and other reasons for ending youth outpatient treatment. Journal of Consulting and Clinical Psychology, 70(2), 439-443. • Gillis, H. L., Speelman, E., Linville, N., Bailey, E., Kalle, A., Oglesbee, N., . . . Jensen, J. (2016). Meta-analysis of treatment outcomes measured by the YO-Q and Y-OQ-SR comparing wilderness and non-wilderness treatment programs.

Child and Youth Care Forum, 45, 851-863. • Hannan, C., Lambert, M. J., Harmon, C., Nielsen, S. L., Smart, D. W., Shimokawa, K., & Sutton, S. W. (2005). A lab test and algorithms for identifying clients at risk for treatment failure. . Journal of Clinical Psychology, 61(2), 155-163. • Hubble, M. A., Duncan, B. L., Miller, S. D., & Wampold, B. E. (2010). Introduction. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapyq (2nd ed.).

Washington DC: American Psychological Association.

References

• Lambert, M. J. (2010). Yes, it is time for clinicians to routinely monitor treatment outcome. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart & soul of change (2nd ed., pp. 239-266).• Lambert, M. J. (2013). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield's handbook of psychotherapy and behavior change (6th ed., pp. 169-218). Hoboken, NJ: Wiley.• Lambert, M. J., & Bergin, A. E. (1994). The effectiveness of psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed., pp. 143-189). New York: Wiley.• Littell, J. H. (2010). Evidence-based practice: Evidence or othodoxy? In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (2nd ed.).

Washington DC: American Psychological Association.• Miller, S. D. (2011). Psychometrics of the ORS and SRS. Results from RCTs and Meta-analyses of Routine Outcome Monitoring & Feedback. The Available Evidence. Retrieved from

http://www.slideshare.net/scottdmiller/measures-and-feedback-january-2011• Miller, S. D., Hubble, M. A., Chow, D. L., & Seidel, J. A. (2013). The outcome of psychotherapy: Yesterday, today, and tomorrow. Psychotherapy, 50(1), 88-97. • Miller, S. D., Hubble, M. A., Chow, D. L., & Seidel, J. A. (2015). Beyond measures and monitoring: Realizing the potential of Feedback-Informed Treatment. Psychotherapy, 52(4), 449-457. • Miller, S. D., Hubble, M. A., & Duncan, B. L. (2008). Supershrinks: What is the secret of their success? Psychotherapy in Australia, 14(4), 14-22. • Orlinsky, D. E., Grawe, K., & Parks, B. K. (1994). Process and outcome in psychotherapy - noch einmal. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change. (4th ed., pp. 270-378). New

York: Wiley.• Quirk, K., Miller, S. D., Duncan, B. L., & Owen, J. (2012). Group Session Rating Scale: Preliminary psychometrics in substance abuse group interventions. Counselling and Psychotherapy Research, 1-7. • Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103. • Smith, M. L., & Glass, G. V. (1976). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32(9), 752-760. • Smith, S. (2002). What works for whom: The link between process and outcome in effectiveness research. Australian Social Work, 55(2), 147-155. • Sparks, J. A., & Muro, M. L. (2009). Client-directed wraparound: The client as connector in community collaboration. Journal of Systemic Therapies, 28(3), 63-76. • Tilsen, J., & McNamee, S. (2015). Feedback informed treatment: Evidence-based practice meets social construction. Family Process, 54(1), 124-137. • Tilsen, J., & Nylund, D. (2008). Psychotherapy research, the recovery movement and practice-based evidence in psychiatric rehabilitation. Journal of Social Work in Disability & Rehabilitation, 7(3), 340-354. • Tryon, G. S., Collins, S., & Felleman, E. (2006, August). Meta-analysis of the third session client-therapist working alliance. Paper presented at the 112th Annual Convention of the American Psychological Association, New

Orleans, LA. • Wampold, B. E. (1997). Methodological problems in identifying efficacious psychotherapies. Psychotherapy Research, 7(1), 21-43. • Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. Hillsdale, NJ: Lawrence Erlbaum.• Wampold, B. E. (2010). The research evidence for common factors models: A historicaly situated perspective. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering

what works in therapy (2nd ed.). Washington, DC: American Psychological Association.• Wampold, B. E., Mondin, G. W., Moody, M., & Ahn, H.-n. (1997). The flat earth as a metaphor for the evidence for uniform efficacy of bona fide psychotherapies: Reply to Crits-Christoph (1997), and Howard et al. (1997).

Psychological Bulletin, 122, 226-230.

References