EVOLUTION 

OF COGNITIVE BEHAVIOR THERAPY: A PERSONAL AND

PROFESSIONAL JOURNEY WITH DON MEICHENBAUM

Donald Meichenbaum, Ph.D.

Research Director of   the Melissa Institute for Violence Prevention, Miami

www.melissainstitute.org

roadmaptoresilience.wordpress.com

Email Address: [email protected]
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TABLE  OF CONTENTS
PAGE

Biographical Sketch 3

Treatment of individuals with addictive disorders Endorsement statements 4

The nature of the challenge for psychotherapists 5

How to spot "Hype" in the field of psychotherapy 11

        
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BIOGRAPHICAL SKETCH

Donald Meichenbaum, Ph. D, is Distinguished Professor Emeritus, from the University of

Waterloo, Ontario from which he took early retirement 25 years ago.  Since then he has been the
Research Director of the Melissa Institute for Violence Prevention and the Treatment of Victims
of Violence in Miami. (Please visit www.melssainstitute.org). Dr. Meichenbaum is one of the
founders of Cognitive behavior therapy and  in a survey of clinicians, he was voted "one of  the
ten most influential psychotherapists of the 20th century." He has received a Lifetime
Achievement  Award from the Clinical Division of the American Psychological  Association.
He was the Honorary President of the Canadian Psychological Association. He has presented in
all of the Canadian Provinces, in all 50 U.S. states, and internationally. He has published
extensively and has authored several books including Roadmap to resilience that he has made
available as  a website for FREE (Please visit  roadmaptoresilience.wordpress.com). His most
recent article " How to spot HYPE in the field of psychotherapy " was chosen the best article in
the filed of psychotherapy. His latest book "Treating individuals with addiction disorders: A
strengths-based workbook for patients and clinicians" is being published by Routledge Press.   
He celebrated his 80th birthday publishing "The evolution of cognitive behavior therapy: A
personal and professional journey with Don Meichenbaum" (Routledge Press).

WHY YOU SHOULD ATTEND DON MEICHENBAUM'S WORKSHOP

 
 "I'm writing to express my deep appreciation for your work, style, and influence, I have all of
your books and frequently cite your articles. I am a sponge when it comes to your interventions
and overall approach to therapy.
 
Please let me tell you how I have made a gift of your work to others. I own a large private
practice. I have 90 therapists and interns working with me and we see thousands of clients every
year. After I attended your workshop, I was so motivated that I decided to implement your model
into the daily work we do with clients. I have been teaching your philosophy, using your
handouts and books. I changed the way we keep our progress notes to reflect your Case
Conceptualization Model and now require every therapist to complete a Case Conceptualization
form for each case.

As a therapist, I want to comment on how much I appreciate the ease of using the online version
of your Roadmap to resilience book (roadmaptoresilience.wordpress.com).   It's so user friendly. 
I am able to go to the fitness areas and ask what area my patient might like to discuss.  Equally, it
is possible to go to the Appendices and take a look at the checklists or the topics and move
forward from there.  It is really brilliantly done.  My client has said that he really likes working
with Roadmap to Resilience and after having the opportunity to explore the online book in
greater depth I'm certain I will use it with other clients.  

It is a very generous gift for you to have shared your book in this way at this time.  I thank you
very much.  
(NOTE: The FREE Roadmap to resilience website in the first month has had 19,000 visitors
from 113 countries worldwide). 
TREATING INDIVIDUALS WITH ADDICTIVE DISORDERS:
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A STRENGTHS -BASED WORKBOOK FOR PATIENTS

AND CLINICIANS (Routledge, Taylor and Francis Press, 2020)

Don Meichenbaum is not only one of the foremost psychotherapy scholars of our lifetimes;
in keeping with his book’s theme, he is an excellent "story-teller." This Patient Workbook
provides a wealth of practical, user-friendly, and evidence-informed coping tools that
addicted individuals can use in their journey of recovery. Meichenbaum’s workbook is a
refreshing new approach to treating addiction, and an antidote to the ever-present hype in
the addiction field.  Highly recommended!
 
Scott O. Lilienfeld, Ph.D., Samuel Chandler Dobbs Professor, Emory University, Atlanta,
Georgia Editor, Clinical Psychological Science
 
This is a valuable workbook that provides concrete explanations and recommendations for
people who struggle with addictive behaviors. Dr. Meichenbaum has vast experience in
field of mental health and is considered a world-renowned expert. He certainly
understands that the skills needed for overcoming addictions go well beyond “Just say no.”
He focuses on cognitive, behavioral, interpersonal, general coping, and life skills in
accessible, conversational ways – and his vivid case examples (“Recovery Voices”) are
particularly helpful. I highly recommend this workbook to anyone seeking relief from
addictive behaviors, as well as those professionals who help people with addictions.

Bruce Liese, Ph.D., A.B.P.P., Clinical Director, Corrin Logan Center for Addiction
Research And Treatment; Professor of Family Medicine and Psychiatry, University of
Kansas, Kansas City

This book offers an excellent combination of hope and inspiration, useful factual
information, and actual skill instruction and the language needed to achieve and maintain
recovery. There is also valuable attention to managing interpersonal problems and to the
use of cultural strengths and spiritual-religious resources. I expect that both therapists and
their clients/patients will want to have a copy for their frequent reference. Strongly
recommended!
Michael F. Hoyt, Ph.D., author of Brief Therapy and Beyond; editor of Therapist Stories of
Inspiration, Passion, and Renewal; and co-editor of Single-Session Therapy by Walk-In or
Appointment.
 

THE NATURE OF THE CHALLENGE FOR PSYCHOTHERAPISTS

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Donald Meichenbaum

1. There has been no improvement in treatment outcomes in the field of psychotherapy over
the last 30 years, as reflected by changes in Effect Sizes (ES) and by meta-analytic
studies (Budd & Hughes, 2009; Hunsley & D. Guilio, 2002).

2. The dropout rate from psychotherapy averages between 20% and 47% for adult patients.
The dropout rate for children and adolescents ranges from 28% to 85%.

3. Some 30% to 50% of adult patients do not benefit from psychotherapy. In the treatment
of patients with Substance Abuse Disorders, the relapse rate is 75%, no matter what
substance is being used.

4. The deterioration rate among adult patients in psychotherapy is 5% to 10%. Those

patients who deteriorate in psychotherapy account for 60% to 70% of the total
expenditure of mental health care costs.

5. Psychotherapists routinely fail to successfully identify patients who are not progressing.
Such patients who are deteriorating are at most risk of dropping out and having negative
treatment outcomes (Lambert, 2007; Lambert & Shimokawa, 2011).

6. Psychotherapists lack knowledge and usually do not seek treatment outcome data and as
a result have a tendency to overestimate their effectiveness. There is a need to check-in
with patients on a regular basis regarding the quality of the therapeutic relationship and
their progress (Sperry & Carlson, 2013).

7. The Partners for change Management System which is a SAMHSA National Registry
evidence-based program provides a session-by-session tool kit for obtaining real-time
patient feedback. Also see Lambert’s OQ-45 measure (Duncan, 2010; Lambert 2007).

8. Psychotherapists need to focus on early changes and monitor and bolster patient progress.
There is a dose-response relationship between early improvement and treatment outcome
of patients who are engaged in treatment:

a) 30% of them improve by the second session;

b) 50%-60% evidence improvement by session 7;
c) 70%-75% by 6 months;
d) 85% by the end of the year.
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Sudden gains in symptom reduction contributes to improved therapeutic alliance, and in

turn, to a “positive spiral” of change. Early improvement and patient progress predicts
positive treatment outcomes (Tang & DeRebeis, 2005).

9. With experience psychotherapists treatment effectiveness does not improve. What does
change with experience is the psychotherapists’ confidence in their competence and
effectiveness (Wampold, 2001).

10. For example, a study by Branson et al. (2015) provided 43 psychotherapists with 300
hours of training in CBT. They tracked outcomes in 1247 patients and found that the 300
hours of training significantly improved adherence to CBT protocols, but the extensive
training did not result in better treatment outcomes, relative to untrained
psychotherapists. The CBT therapists were no more effective following training than
before. There was little support of a general association between CBT competence and
patient outcome. Moreover, Webb et al. (2010) have reported that the psychotherapists’
strict adherence to evidence-based treatment manuals is not related to treatment
outcomes. In fact, “loose compliance” that is tailored to the patients’ individual needs and
preferences may be the best treatment approach (See doi.10.1016/jbrat.2015.03.002 for
the Branson et al. study).

11. There is substantial variation in outcomes between providers with similar training and
experience. Some psychotherapists are more “expert” in achieving better treatment
outcomes and “lasting changes” in their patients.

Patients of effective psychotherapists improve at a rate of at least 50% higher and their
drop-out rate is at least 50% lower than the less effective psychotherapists (Norcross,
2002; Skovholt & Jennings, 2004).

12. A variety of studies have shown that the difference in effectiveness of individual
psychotherapists, within a given treatment, accounts for a larger proportion of variance
than the variance accounted for between various treatments. The person and his/her
clinical skills are more important than the specific treatment being implemented in
contributing to treatment outcomes (Sperry & Carlson, 2013).

13. The person of the psychotherapist is more important than the psychotherapists’
theoretical orientation, years of experience, and discipline or professional affiliation
(Horvath et al. 2011).

14. Over 90% of the differences in treatment outcome between more and less effective
psychotherapists is attributable to differences in their ability to establish, maintain and
monitor on a regular basis, the quality of the therapeutic alliance and patient progress
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toward achieving the collaboratively-generated treatment goals. For example, in DBT

with Borderline Personality Disorder patients, those patients who perceived their
therapist as both affirming and protective had longer lasting changes and were less self-
injurious (Thoma et al., 2015).

15. Caution and humility is warranted even when considering the most widely endorsed
evidence-based intervention of Cognitive behavior therapy (CBT). For example, consider
the following findings:

a) CBT has not been found to be more effective than most other treatment approaches
such as interpersonal and supportive psychotherapy. Tolin (2010) did report that CBT
was more effective than psychodynamic approaches, especially for the treatment of
patients with anxiety and depressive disorders.

b) However, Thoma et al. (2015) reported that the more methodically rigorous that the
randomized control study of CBT with depressed patients, the poorer the treatment
outcomes. Moreover, there were “allegiance” effects, with those who most advocate
CBT approach, the better the outcome results. Earlier studies of CBT were more
effective than more recent CBT treatment outcome studies (Thoma et al., 2015).

c) CBT has not been found to work through the proposed mechanism of change in
several studies (Muse & McManus, 2013).

d) Dismantling studies do not find specific ingredients as being critical to the benefits of
CBT.

e) Critical psychotherapeutic skills related to the therapeutic alliance and that are not
directly related to the specific protocols contribute the largest proportion of variance
in accounting for treatment outcomes (Baardseth et al., ).

16. A common finding in psychotherapy research has been the inability to detect differences
when active, bona-fide psychotherapists as compared with specific treatment approaches
(Wampold, 2011). Wampold argues that psychotherapy works in large part through
general mechanisms of “remoralization” (ala the work of Jerome Frank), as patients
develop a sense that they have value and can be effective in their lives as a result of the
healing relationship with their psychotherapists (Wampold et al., 1997).

17. When comparing various Acronym-based psychotherapeutic approaches for treating

patients with PTSD and Complex PTSD, there are no significant differences between the
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varied treatments. Whether the acronym-therapy approach is DTE, CPT, EMDR, DBT,
ACT, SIT and the like, there are “no winners of the race” (Meichenbaum, 2013).

18. The psychotherapists’ effectiveness is in terms of the patient treatment outcomes tends to
plateau over the course of their careers in the absence of a concerted effort to improve as
a result of “deliberate practice”. (See Meichenbaum’s recent papers on “Nurturing
therapeutic mastery” and “The psychotherapeutic relationships as a common factor:
Implications for trauma therapy.” Please visit www.melissainstitute.org and Click
Resilience Resources to access other Meichenbaum papers.)

REFERENCES

Baardseth, T.P., Goldberg, S.B. et al. (2013). Cognitive-behavioral therapy versus other
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therapies. Redux, Clinical Psychology Review, 33, 398-405.

Branson, A., Shafran, R. & Myles, P. (2015). Investigating the relationship between competence

and patient outcome with cognitive behavior therapy. Behavior Research and Therapy,

68, 19-26. (doi.10.1016/jbrat.2015.03.002)

Budd, R. & Hughes, L. (2009). The Dodo Bird verdict - - controversial, inevitable and important.

Clinical Psychology and Psychotherapy, 16, 510-522.

Duncan, B. (2010). On becoming a better therapist. Washington, DC: American Psychological

Association.

Horvath, A., Del, R., Fluckiger & Symonds, D. (2011). Alliance in individual psychotherapy.

Psychotherapy, 48, 9-16.

Hunsley, J. & D. Giulio, G. (2002). Dodo bird, phoenix or urban legend? The question of

psychotherapy equivalence. Scientific Review of Mental Health Practice, 1.

Kingdon, D. & Dimech, A. (2008). Cognitive and behavioral therapies: The state of the art.

Psychiatry, 7, 217-220.

Lambert, M.J. (2007). What we have learned from a decade of research aimed at improving

outcome in routine care. Psychotherapy Research, 17, 1-14.

Lambert, M.J. & Shimokawa, K. (2011). Collecting client feedback. Psychotherapy, 218, 72-79.

Meichenbaum, D. (2013). The therapeutic relationship as a common factor: Implication for

trauma therapy. In D. Murphy & S. Joseph (Eds.) Trauma and the therapeutic

relationship. Basingstoke, UK: Palgrave MacMillan.

Muse, K. & McManus, F. (2013). A systemic review of methods for assessing competence in

cognitive behavior therapy. Clinical Psychology Review, 33, 484-499.

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doi.10.1016/j.cpr.2013.01.010

Norcross, J. (Ed.). (2002). Psychotherapy relationships that work: Therapist contributions and

responsiveness to patients. New York: Oxford Press.

Skovholt, J.M. & Jennings, J. (2004). Master Therapists: Exploring expertise in Therapy and

counseling. Boston, MA: Allyn & Bacon.

Sperry, L. & Carlson, J. (2013). How master therapists work. New York: Routledge.

Tang, T.Z., DeRubeis, R. et al. (2005). Cognitive changes, critical sessions, and sudden gains in

cognitive behavior therapy for depression. Journal of Consulting and Clinical

Psychology, 73, 168-172.

Thoma, N., Oilecki, B. & McKay, D. (2015). Contemporary cognitive behavior therapy: A

review of theory, history and evidence. Psychodynamic Psychiatry, 43, 423-462.

Tolin, D.F. (2010). Is cognitive-behavioral therapy more effective than other therapies. A meta-

analytic review. Clinical Psychology Review, 30, 710-720.

Wampold, B.E., Mondin, G.W. et al. (1997). A meta-analysis of outcome studies comparing

bona-fide psychotherapies: Empirically “all must have prizes.” Psychological Bulletin,

122.

Wampold, B.E. (2001). The great psychotherapy debate: Models, methods and findings.

Mahwah, NJ: Erlbaum.

Webb, C.A., DeRubeis, Hollon, S.D. et al.(2013). Convergence and divergence in the delivery of

cognitive therapies in two randomized clinical trials. Behavior Research and Therapy, 51,

490-498.

HOW TO SPOT “HYPE” IN THE FIELD OF PSYCHOTHERAPY: A CONSUMER’S

CHECKLIST
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Donald Meichenbaum, Ph.D.

Distinguished Professor Emeritus
University of Waterloo, Ontario

Research Director
Melissa Institute for Violence Prevention
Miami, Florida

www.melissainstitute.org
www.roadmaptoresilience.wordpress.com

Email Address
[email protected]

CHARACTERISTICS OF “HYPE” IN THE FIELD OF PSYCHOTHERTAPY

Your attendance at this conference reflects your interest in increasing your knowledge
and your clinical strategies and skills to help your patients achieve better treatment outcomes.
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Such concerns are timely given the research findings in the field of psychotherapy on the marked
variability in effectiveness across psychotherapists. The most effective psychotherapists average
50% better outcomes and 50% fewer dropouts than psychotherapists in general (Wampold,
2017).  One of the characteristics of more "expert" psychotherapists is their penchant for
maintaining a critical attitude apropos of Paul Meehl’s (1973), admonition of "Why he does not
attend case conferences," and the presence of “SELF-DOUBT.” Research indicates that
psychotherapists self-reported self-doubt predicted treatment outcomes- more doubt about their
skill in helping patients (e.g., "Lacking confidence that you might have about a beneficial effect
on a patient." and "Unsure about how best to deal effectively with a patient."), had better
treatment outcomes, particularly if they also had a positive sense of self. Consistent with the
article by Nissen-Lie et al. ( 2015) entitled  " Love yourself as a person, doubt yourself as a
therapist " , the present Psychotherapy Consumer Checklist is designed to plant the seed of self-
doubt and nurture a healthy sense of "HUMILITY ",  and hopefully improve treatment
outcomes. What follows is a Checklist of “Psychotherapy Beware Signals.”

1. Advocates for a therapeutic approach state that their treatment is “revolutionary” and offer
outlandish unsubstantiated claims for its superiority (Over 90% improvement rates). “Simple, but
powerful” treatment approach. “A breakthrough treatment.”

2. Make claims that you can learn from a “master”, “leading expert” or “guru” and use marketing
terms like “powerful”, “transformative”, “unique and ultimate training," “life-changing benefits”,
“deep psychological healing”, and moreover, assure that your “complete satisfaction is
guaranteed.”

3. Advocates use Acronyms (Acronym Therapies) and “psycho-babble” to sell their treatment
approach.

4. Claim that the treatment approach could be applied successfully with patients who have a wide
variety of psychiatric and physical conditions, and across multiple age groups without any
clinical trial demonstrations. Advocates often imply that their treatment approach “fits all”
(“One size fits all”).

5. Claims that treatment approach is “evidence-based”, scientifically proven, because it has met
the criteria of two randomized controlled trials, but they do not report Effect Sizes, nor provide
details about the exclusionary criteria of the patients. “Cherry-pick” the patients. Also, does not
report on the attrition and drop-out rates, follow-up data. Advocates often broadly and
subjectively define “evidence” (e.g. “I saw it work with my clients, and that is my evidence”.)

6. Advocates state that “Over X number of studies have consistently demonstrated efficacy and
superiority”, without citing or critiquing these studies.

7. Compare proposed treatment to “weak” comparison groups. Does not compare treatment to
“bona-fide” comparison groups that are intended to be effective (See Wampold et al., 1997).
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8. Compares the proposed treatment versus a reduced, or weaker version of the comparative
treatment. For example, see Foa et al. (1999) comparison of Prolong Exposure versus Stress
inoculation training (SIT), where the third application phase of SIT was omitted.

9. Do not report on possible “allegiance effects” of who conducted the controlled outcome studies.
Moreover, the cited supportive studies that were initially conducted yielded more effective results than
later conducted studies. (“Strike while the iron is hot”, and when the enthusiasm for the new therapeutic
approach is highest.) See the provocative informative article by Lehrer (2010) of the "decline
effect” in research attempts to replicate clinical trials. For example, the efficacy of antidepressant
medication has gone down as much as threefold in recent decades.  Effect Sizes from studies
from treatment studies drop off.  He observes that the researcher's belief can act as a kind of
blindness. 
10. Do not independently determine if the treatment rationale offered to the alternative treatment
and control groups is judged as being as credible and believable as for the advocated treatment.
This can lead to differences in expectancy effects across groups.

11. Do not highlight the role of non-specific treatment factors, such as therapeutic alliance,
expectancy effects, and other placebo considerations. For example, does not include any
measures of the ongoing quality of the therapeutic alliance, such as the Therapeutic Alliance
Scales, or the Quality of Relationship Measures, or the session-by-session treatment-informed
feedback (Prescott et al., 2017).

12. Does not include a critical account of the scientific validity, or theoretical basis, for the
effectiveness of the proposed treatment. Offers little scientific basis for the proposed change
mechanisms for the treatment. See controversy over so-called “energy –based” treatments such
as Tapping, Eye Movements, Magnetic fields, Meridian band techniques and the like. The
intervention may work, but it has little to do with the proposed treatment model. The proposed
treatment may do better than no treatment, or weak control and comparison groups because of
non-specific factors, such as placebo effects.

13. Advocates use “neuro-babble” and “neuro-networks” and reductionism (often with colored
versions of the brain) to explain the treatment approach. They resort to a dubious neurological
basis for the explanation of their treatment approach.

14. Advocates fail to discuss criticisms of their treatment approach. They fail to mention the
results of dismantling studies that question the basis of their treatment approach.

15. Advocates tell their patients that “If this treatment does not help you, then nothing else will.”
They convey an expectancy that reinforces treatment outcomes.

16. Advocates promote advance training, sell paraphernalia, tapes that go along with their
treatment approaches. They require that trainees sign statements that they will not share
treatment protocols with others. “Commercialism is rampant.”
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17. Advocates are very defensive and “thin-skinned” about their approach. They often question
the motives and background of those who have questioned the efficacy, theoretical basis of their
treatment approach. They fail to question what they are proposing and readily dismiss skeptics.
They may disregard “inconvenient truths” and offer “alternative facts”, thus, holding onto
debunked theories.

18. The advocates of their treatment approach rely on the endorsements of a leaders in the field.
For example, some therapists in the trauma field cite Bessel van der Kolk as an advocate and
endorser of their treatment approach.

19. Advocates establish a coterie of trainers and an International organization to promote the
treatment. Advocates use public media (television, blogs, print) and they over sell their treatment
approach. Advocates are “slick salespersons,” setting up clinics, training settings, and
conferences.

20. The advocates will provide a Certificate that you have taken the training and can call yourself
an X therapist. Offers to put you on a referral list of Certified X practitioners.

HOW MANY OF THESE 20 ITEMS DOES YOUR TREATMENT APPROACH

INCORPORATE?

REFERENCES

Foa, E.B., Dancu, C.V. et al. (1999). A comparison of exposure therapy, stress inoculation training and
their combination for reducing PTSD in female assault victims. Journal of Clinical and
Consulting Psychology, 59, 715-723.
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Lehrer, J. (2010). The truth wears off: Is there something wrong with the scientific method? The New
Yorker. (https://www.newyorker/com/magazine/2010/12/13/the-truth-wears-off).
Meehl, P.E. (1973). Why I do not attend case conferences. Psychodiagnosis Selected Papers. (pp. 225-
302). Minneapolis: University of Minvits Press.
Nissen-Lie, H.A., Ronnestad, M.H. et al. (2015). “Love yourself as a person, doubt yourself as a
therapist?” Clinical Psychology and Psychotherapy (doi:10.1002/cpp.1977).
http://www.dgapractice.com/documents/meehl_case_conferences_adapted.pdf
Prescott, H.D., Mareschalack, C.C., & Miller, S.D. (eds.). (2017). Feedback informed treatment in
clinical practice. Washington, DC: American Psychological Association.
Wampold, B.E. (2017). What should we practice? In T. Rousmaniere, R.K. Goodyear, S.D. Miller &
B.E. Wampold (Eds.). The cycle of excellence (pp. 49-65). New York: Wiley.
Wampold, B.E., Modin, G.W. et al. (1997). A meta-analysis of outcome studies comparing bona-fide
psychotherapies: " All must have prizes." Psychological Bulletin, 122, 203-215 

For a copy of the published version of this article, please go to:

Meichenbaum, D. & Lilienfeld, S. (2018). How to spot HYPE in the field of psychotherapy:
 A 19 item Checklist. Professional Psychology, 49, 22-30.

This article was chosen as the best article in the field of psychotherapy by the Journal Contemporary
Psychotherapy. You can access a copy of this article by visiting the Melissa Institute website,
www.melissainstitute.org

Click on Resilience resources and go to the Section "Ways to improve psychotherapy outcomes". It is

the third article down.

Thank you for your interest,   

Don Meichenbaum