The Tilting Mill

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Disrupting Therapy

As a profession, psychotherapy is largely stagnant, inflexible, ineffective, and unprofitable. We need disruption.

Here are 10 questions which might prove constructively disruptive for our field:

1) How can we provide therapy at a drastically reduced cost and still be profitable?

2) How can we more effectively match clients and their difficulties with the most appropriate therapist and therapeutic approach?

3) As a profession, what are our core strengths and how do we market them effectively? Put another way, how do we show – convincingly – that what we offer is valuable?

4) Identifying problems and solutions is not the issue; the difficulty lies in affecting change. Though it is undoubtedly essential, our central concern should not be understanding but motivation. What are the fundamentals of inspiring change and growth?

5) Advances in pharmacology will continue to grow, likely at an increased rate. What can we offer that pharmaceuticals do not and will never be able to provide?

6) Let’s be humble. What can we learn from our younger siblings – PsyDs, MFTs, Life/Executive Coaches, Clinical Social Workers, School Counselors, HR? Let’s find the really excellent therapists, regardless of their degree, and see what we can learn from them.

7) How do we apply our strength as researchers? We should look to the influence of “big data” on the financial, political, and business worlds.

8) How can we more effectively utilize technology? 

9) How do we go beyond psychopathology? What about psychonormality or positive psychology?

10) Why are there so many strange people in our profession? We can’t hope to reach a larger audience, expand the scope of our work, or make significant progress in our larger goals if on an individual level most of us are perceived as “odd,” “strange,” “out of touch,” or “socially awkward.” Without sacrificing quality, we need less weird and more cool.

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The Psychology of Summer: Why the Season Makes Us Lazy

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Maria Konnikova:

There’s a limit, however, to heat’s ability to boost our mood: when temperatures reach the kind of summer highs that mark heat waves all over the world, the effect rapidly deteriorates. In a 2013 study of perceived well-being, the economist Marie Connolly found that on days when the temperature rose above ninety degrees, the negative impact on happiness levels was greater than the consequences of being widowed or divorced.

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Angela Duckworth on Grit, one of the more intriguing new psychological constructs being studied and theorized about.

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Becoming an Expert: 10,000 Hours May Not Be Enough

A former professor of mine, Sian Beilock, writing for Psychology Today:

I have to admit, the 10,000 hour rule is an appealing one. It implies that almost anyone can become an expert if they work hard enough. As Hambrick says, deliberate practice is so popular because it has “meritocratic appeal.”  The data, however, tell a somewhat different story. Yes, hard work is extremely important, but it’s not everything. Whether it’s genes, motivation, one’s ability to handle failure, all of the above or something else altogether, we have to owe up to the fact that factors other than practice contribute to achieving greatness. Only then will we be best able to identify areas we are most likely to excel in and have the best chance of rising to the top.

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Do ADHD Drugs Improve Kids' Grades?

Shirley Wang, for the Wall Street Journal:

Stimulants used to treat ADHD like Ritalin and Adderall are sometimes called "cognitive enhancers" because they have been shown in a number of studies to improve attention, concentration and even certain types of memory in the short-term. Similar drugs were given to World War II soldiers to improve their ability to stay alert while scanning radars for enemy aircraft.

However, a growing body of research finds that in the long run, achievement scores, grade-point averages or the likelihood of repeating a grade generally aren't any different in kids with ADHD who take medication compared with those who don't.

One way to look at this is to ask, 'why is the drug's primary effect not working like we thought it did?'

Together, these findings suggest that medication alone isn't enough to improve academic performance. The medicine may help with focus, but it doesn't help with deciding what to focus on, experts say. Rather, it needs to be coupled with skills training, such as learning how to organize or prioritize.

The medication's ability to improve concentration and attention may even backfire when it comes to studying.

Martha Farah, a cognitive neuroscientist at the University of Pennsylvania who sits on the American Academy of Neurology committee that is drafting new treatment guidelines, recalls a student saying that after she takes her medication, she heads to the library. If she keeps her head down and studies, she gets very absorbed in her work and accomplishes a tremendous amount. But if a friend stops by, she becomes equally engrossed in the chat. Many students report they find themselves absorbed in cleaning their rooms rather than studying.

Sure having attention isn't necessarily enough. You also need to direct it appropriately. But I wonder if there are still other factors at play here? Specifically, are there non-pharmacological side effects to taking ADHD medication which might be hindering academic performance? 

What does a child learn and internalize about themselves when they're told that they need to take medicine in order to do better in school?