#66 – What Really Works in Therapy with Scott D. Miller, Ph.D.


Scott D. Miller, Ph.D., is a noted author, psychologist, and workshop presenter. He’s a therapist, lecturer and trainer on client-directed, outcome-informed clinical work and other time-sensitive therapeutic approaches. For three years, he co-directed Problems to Solutions, Inc.–a clinic specializing in the treatment of the homeless and other traditionally under served populations. Most recently, Dr. Miller co-founded the Institute for the Study of Therapeutic Change and works pro-bono at a clinic dedicated to serving the under served. He is the author of many papers and seven books including: The Heroic Client in 2000 and The Heart & Soul of Change in 1999.


One Comment

  1. PC Leong
    Posted January 20, 2013 at 12:16 pm | Permalink

    Having read Escape from Babel, this show is a perfect complement to the central points made in that book. I’m looking forward to reading The Heroic Client next.

    Miller laments that “We are using as criteria for success things that have no bearing on success of the case…diagnosis, and treatment approach, and treatment plan; these things are largely unrelated to outcome…and yet there are other things that do predict (the success of therapy), that we just seem to ignore…” Well, I think that’s because to take those things seriously into account will be too threatening to the profession – for individual counsellors/therapists as well as the host of vested interests that surround the field.

    I know this interview was conducted some years back, but I’ll put my question out anyway. When might this ‘the customer is always right’ approach be contraindicative for the well-being of the client, therapist and the relationship, and implicitly the outcome? One example might be the fine line between working with the client and colluding with them to not actually be working at an effective outcome, which leads to the question of what is and how to define effective outcome. While I agree that the client’s definition should prevail, I think there are times when perhaps it shouldn’t…or no? Besides contexts dealing with addictions, say, what about when clients say one thing and mean/do another? I suspect many who are in private practice do practice the ‘go with what the client wants’ anyway, though some may perhaps be driven more by the business model, than the ‘what’s in the client’s interests’ consideration that Miller is advocating.

    I’m not sure about privileging outcome over process entirely. That’s like throwing the baby out with the bathwater…because I think outcomes could be seen as different points along the continuum of work in progress. I think an important aspect of the success of the work depends on the client staying long enough for some semblance of effective outcome to manifest, which is very much influenced by the relationship as perceived by the client. Allowing for external reasons why clients might leave (lack of financial resources, leaving the area and the like), clients give their feedback by voting with their feet; they simply do not come back. Miller’s efforts that are aimed at fine-tuning the feedback options can make a difference, and in that, I applaud the idea.

    I like Miller’s take on wanting to bring some “customer service mentality” focus to the field. I agree, though I’m not sure it’s such a radical notion. Within the particular context of the therapeutic alliance, customer service is significantly informed by genuineness, empathy, etc. I think one effective way to bring a customer-service mentality might be to encourage (mandate?) mental health professionals to have counselling/therapy themselves. Having experienced therapy myself, I can attest to its effects on personal growth, as well as look at it with the lens of an informed consumer who has personal experience of being at the receiving end of good vs not-so-good therapy. Hmm, or maybe not…I’m thinking of analysts who have been analyzed themselves and who are not good therapists.

    In any case, being a novice therapist, all this talk about the effectiveness of the work I’ll be embarking on is fascinating and holds me in thrall.


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