England to enter new lockdown; UK virus cases pass 1 million
Covid numbers fall 30% in Oct, first monthly drop since March
Health insurers are starting to roll back coverage for telehealth – even though demand is way up due to COVID-19
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How to Render Beef Tallow
I almost never hear of people cooking with beef tallow, even in Primal circles. I hear about lard, duck fat, ghee, butter, olive oil, and avocado oil, but rarely tallow. Hey, those are all great, delicious fats, and they deserve their prestige, but I like sticking up for the little guy. I like an underdog. In this case, of course, the little guy comes courtesy of a big cloven-hoofed ungulate.
Another reason to try tallow: those of you experimenting with the carnivore diet will want to mix up your cooking fats here and there. Each one has a different nutritional profile.
Here’s how to do it.
Instantly download your quick reference Guide to Cooking Fats and Oils
How to Render Beef Tallow
To render beef tallow, you need to get your hands on some raw beef fat.
It’s called suet, and the best stuff for rendering is going to be solid and firm. Most suet comes from the tissue surrounding the kidneys and the loins, but any hard beef fat will do. What I did was buy steak and roast trimmings from a butcher. Grass-fed and grass-finished is best, but if you can’t find that, look for clean, organic meat. It should be inexpensive. If you can find a good butcher that deals with grass-fed meat, I’d imagine buying the fat trimmings is still fairly inexpensive and completely worth the extra effort.
I don’t know whether my batch was suet or not (I suspect there was at least a bit, judging from the thick, hard pieces that felt like cold butter when you sliced into them), and it did look a little ragged and hastily thrown together, but it was still fat. I wasn’t going to let a little uncertainty slow me down, for I was armed with the knowledge that fat can always be rendered.
Instructions
Using a chef’s knife, trim off any leftover tissue (it will be red or hard) and cut the fat into cubes. I’d read tons of contradictory information about particle size, with some recipes calling for larger, 1-inch cubes and others claiming finely diced or shredded fat got the best yield. When I rendered pre-shredded buffalo kidney fat, I went for shredded. So this time, I opted for cubes so I can test both ways. Shredding and cubing both work just fine.
So, after trimming the fat completely and removing all attached muscle meat and bloody tissue (this step is crucial, because meat and blood will only burn and ruin the purity of your tallow), I ended up with small cubes. Tiny bits of red are fine. You’ll end up straining later.
Dry rendering vs. wet rendering method
Here, I could choose to dry-render over the stove in a high quality pot, or do a wet-render and get the potentially purest tallow by boiling and then separating fat from water. I’d read about several different ways to render fat, but I chose two that seemed to make the most sense. The wet-render sounded tempting, if a bit messy and time-consuming, but I eventually passed on it. I settled on doing the traditional dry-render over super low heat on the stove top. I used enameled cast-iron pots and about a pound of cubed fat in each.
Stove top dry render method
The stove top fat started rendering almost right away, even with just a tiny flicker of a flame doing the heating. After about 20 minutes, the first sign of “cracklins”began to show: light brown shriveled up pieces of (former) fat bubbling around inside the newly rendered fat. I was initially worried that I was going too fast too soon, but that wasn’t the case. The cracklins were great, and they never burned. The fat remained pure and clear.
I used a fine mesh strainer and it was completely sufficient. The result was pure, delicious tallow that turned white in the fridge and was easy to scoop. If you look really closely, you can see some specks at the bottom of the jars, but you’d really have to look for them.
From my experience, both methods work equally well. If you like stay in the kitchen and tend to your dishes, go with the stove top method. As long as you keep an eye on it and keep the fat from sticking to the bottom, your fat will render much faster this way. If you want to go do other stuff while it renders, use the oven method. Other than keeping the heat low and occasionally popping in for a quick stir and scrape, you can pretty much set the clock and forget about the rendering.
Anyone ever use the wet-render method? Got any tips for my next batch of tallow? Let me know!
The post How to Render Beef Tallow appeared first on Mark's Daily Apple.
SARS-CoV-2 Spike Proteins Disrupt the Blood-Brain Barrier, Potentially Raising Risk of Neurological Damage in COVID-19 Patients
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FDC launches stronger versions of its generic Covid drug, Favipiravir, in India
Regeneron pauses drug trial on sickest
Gilead’s Covid drug is mediocre. It will be a blockbuster anyway.
Positive Outlook Predicts Less Memory Decline: A new study found that people who feel enthusiastic and cheerful—what psychologists call “positive affect”—are less likely to experience memory decline as they age
Positive Outlook Predicts Less Memory Decline: A new study found that people who feel enthusiastic and cheerful—what psychologists call “positive affect”—are less likely to experience memory decline as they age
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Covid cases & deaths in India down to 50% of mid-Sept peak
Delhi: 60% ventilator beds full, but good recovery rate a boost
Centre asks states to form committees for smooth Covid-19 vaccination drive
Andhra govt to invest over Rs 17,000 crore on health infrastructure across state
Andhra govt to invest over Rs 17,000 crore on health infrastructure across state
from Top Health News | Latest Health & Healthcare Industry Information and Updates: ET HealthWorld : ETHealthworld.com https://ift.tt/2TJA11X
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Under pressure, WHO plans Covid-19 vaccine insurance scheme for poor nations
New insights into autoimmune disease: According to new research, novel insights into a pathway that restrains the immune response opens up new avenues for treating inflammatory and autoimmune conditions
Hard physical work significantly increases the risk of dementia: Men in jobs with hard physical work have a higher risk of developing dementia compared to men doing sedentary work, new research reveals
New insights into autoimmune disease: According to new research, novel insights into a pathway that restrains the immune response opens up new avenues for treating inflammatory and autoimmune conditions
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Hard physical work significantly increases the risk of dementia: Men in jobs with hard physical work have a higher risk of developing dementia compared to men doing sedentary work, new research reveals
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Maharashtra: ICMR urges states to ramp up testing ahead of winter
New Zealand votes to legalize euthanasia for terminally ill people
Medicago to supply up to 76 Million doses of its plant-derived Covid-19 Vaccine Candidate : PMI
Hospital Bills for Uninsured COVID Patients Are Covered, but No One Tells Them
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Active Covid cases in India fall below 6 lakh
Dumbbell Squat to Overhead Press
This is the dumbbell squat to overhead press.
The post Dumbbell Squat to Overhead Press appeared first on Under Armour.
October 29, 2020 at 09:30PM https://ift.tt/3mzHmh1 https://ift.tt/1ilzca6High Knee Drop Lunge
This is the high knee drop lunge.
The post High Knee Drop Lunge appeared first on Under Armour.
October 28, 2020 at 07:30PM https://ift.tt/2TCEu6E https://ift.tt/1ilzca6Picking a Cooking Oil
What is the healthiest oil to cook with?
The post Picking a Cooking Oil appeared first on Under Armour.
October 27, 2020 at 07:30PM https://ift.tt/2JkQYht https://ift.tt/1ilzca6What It Took for This Obese Doctor to Take His Own Health Advice
Kevin turned to food for comfort as he dealt with the death of his father. He chose a healthier path when his sister was diagnosed with cancer.
The post What It Took for This Obese Doctor to Take His Own Health Advice appeared first on Under Armour.
October 26, 2020 at 09:30PM https://ift.tt/2Yo4vXa https://ift.tt/1ilzca6Clamshell
This is the clamshell.
The post Clamshell appeared first on Under Armour.
October 23, 2020 at 07:30PM https://ift.tt/31SwS4o https://ift.tt/1ilzca6PTSD Interacts with Klotho Gene, May Cause Premature Aging in the Brain: Genetics and the environment (including psychiatric stress) may contribute to the pace of cellular aging, causing some individuals to have a biological age that exceeds their chronological age
[link] [comments] https://ift.tt/eA8V8J October 29, 2020 at 10:31PM https://ift.tt/1R552o9
Media Multitasking Disrupts Memory, Even in Young Adults: Simultaneous TV, texting and Instagram lead to memory-sapping attention lapses
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How to Deal with the Pressure of Never Having Enough Time (and Why It’s Total BS)
If you’ve read Tim Ferris’ 4-Hour Workweek, you can just jump to the end of this post. For everyone else, I invite you to take a closer look at your relationship with time. Especially those of you who are too busy to spend, oh, I don’t know, 5 or so minutes reading this.
Somehow, “I’m busy” has become the new “I’m fine” in response to being asked how you are. I get it thought — I know you actually ARE busy, but stay with me here.
Whenever I’m working with new clients, they’ll typically tell me they don’t have time to sit down for a satiating, nutrient-dense breakfast, so they just grab a “quick toast and coffee.” Or they have too much going on and can’t get to bed on time. It’s not just a once-in-a-while-thing either. It’s day after day after day.
Sound like your life? If so, let me ask you this: why do some people seem to effortlessly crush their to-do lists and others find theirs growing out of control?
Seriously, There’s Not Enough Time
I never like to say “We all have the same 24 hours in the day,” because that logic is fundamentally flawed, and can come off sounding privileged. In truth, all of us are filling our 24 hours in different ways depending on our jobs, lives, families, hobbies, obligations, and unique life goings-on.
Sometimes I choose to be busy during my 24 hours because I have lots of things that are important to me — family, friends, my clients, my home life, my role at the Primal Health Coach Institute. And *usually* I like that because I enjoy my work and I like being productive.
I’m choosing to be busy because it leaves me feeling fulfilled. The problem arises when it leaves you feeling like a victim, like you can’t keep up, or like you just want to bury your head in the sand.
Lack of Time = Lack of Priorities
It all comes down to priorities. If better health or a leaner waistline was really important to you, you’d make it a priority. Unfortunately, if you’re like most people, you unknowingly put other, less important priorities in their place (everything from stewing over a mean comment on social media to worrying how you’re going to get it all done).1
Whenever you catch yourself having an I-don’t-have-enough-time moment, remember that what you’re spending your time on is a choice — and you always have options. This is the perfect time to take a step back and ask yourself these four questions:
- What’s important here?
- What’s not important?
- Am I wasting time on things that aren’t important?
- What else could I be doing with my time?
Go ahead and do this exercise with me for a sec. Get out a piece of paper (or the notes section on your phone) and jot down your daily schedule. What time do you typically get up? When do you go to bed? How much time do you spend at work? On social media? With your family? Daydreaming? Running errands? Working on your health?
Looking at your list, what are the three things you spend the most time on?
Like it or not, those three things are your priorities. How you spend your day reflects what you believe to be the most important. If that’s not sitting well with you — or you feel like you have an equal amount of priorities (even though that’s not actually possible), you’re in a good place to start making change.
Because when you learn to eliminate your non-priorities, you free up time to focus on what does matter to you.
How Do You Eliminate Non-Priorities?
It starts by taking things off the table that aren’t important or urgent. Research shows that having too many options can lead you to waste time attending to details that don’t matter or avoid a task altogether. In this experiment, a Columbia University professor set up a booth selling jams at a local farmers market. Every few hours she alternated between offering 24 jams and 6 jams. She found that 60% of the customers visited the booth when there was the larger assortment, however more people actually made purchases when there were fewer options.2
Not only that, when faced with tasks of mixed urgency and importance, participants in this study prioritized to-dos that were time-sensitive over ones that were less urgent but had a greater reward3 Researchers found that the effect was even more prominent in people who describe themselves as busy, adding that they were more likely to select an urgent task with a lower reward because they were fixated on the clock and “getting it done”.
But how do you determine what’s urgent and important? Enter the Eisenhower Matrix, named for the 34th U.S. President, Dwight D. Eisenhower. It’s a prioritization framework (used by everyone from athletes to CEOs) that helps you eliminate time wasters in your life.
And in case you need proof that Eisenhower knew what he was talking about, during his two terms in office, he signed into law the first major piece of civil rights legislation since the end of the Civil War, he ended the Korean War, oh and he created NASA.
Eisenhower recognized that having a solid grasp of time management means you’ve got to do things that are important andurgent — and eliminate all the rest.
- Important tasks get you closer to your goal, whether it’s wearing a smaller pant size or not feeling ravenous all day.
- Urgent tasks are ones that demand your immediate attention, like a deadline or showing up on time for an appointment.
Once you’ve got that straight, you can overcome the tendency to focus on the unimportant tasks and instead, do what’s essential to your success, whatever that looks like for you.
Let’s Put the Matrix into Action
Using the questions below, you’ll be able to get a good handle on your priorities, evaluating which are urgent, which are important, and which can be delegated to someone else — or ditched altogether.
1. Does it have consequences for not taking immediate action and does it align with your goals?
ACTION STEP: DO IT. This is a task that’s both urgent and important, which means it’s a priority. And getting it done first will take a lot of pressure off your plate. Examples are:
- Completing a project for work
- Deep breathing when you’re stressed
- Responding to certain emails
2. Does it bring you closer to your goals, but doesn’t have a clear deadline?
ACTION STEP: SCHEDULE IT. This is a task that’s important, but not urgent. Since it’s easy to procrastinate here, scheduling time to attend to it is your best bet. Examples are:
- Working out
- General self-care
- Spending time with your family
3. Does it need to get done within a certain timeframe, but doesn’t require your specific skill set?
ACTION STEP: DELEGATE IT. This is a task that’s urgent, but not important — at least not important for you to do, specifically. Sure, it needs to get done, but you could probably pass off this task off to someone else, which frees up your time. Examples are:
- Making sure the kids are ready for school
- Shopping for groceries for the week
- Meal prepping
4. Does it not have a deadline or get you closer to your goals?
ACTION STEP: DELETE IT. This is a task that’s not important or urgent. And it’s a huge time suck! It’s the kind of “task” that makes you wonder where all your time went. Using a browser blocker like Freedom can help a ton. Examples are:
- Scrolling your social media feed
- Playing online games
- Worrying, obsessing, and stressing out about things that don’t matter
Bonus Tip: Figure out what time of day you’re the most focused. When do you tend to get a lot accomplished? Are you a morning person? A night owl? Knowing when you’re the most productive can help you get stuff done with less effort.
Now tell me what you think. Have you tried these strategies? What’s worked for you?
References
- https://www.marksdailyapple.com/what-it-means-overwhelmed/
- https://faculty.washington.edu/jdb/345/345%20Articles/Iyengar%20%26%20Lepper%20(2000).pdf
- https://academic.oup.com/jcr/article-abstract/45/3/673/4847790
The post How to Deal with the Pressure of Never Having Enough Time (and Why It’s Total BS) appeared first on Mark's Daily Apple.
Talking to your doctor about an abusive relationship
When Jayden called our clinic to talk about worsening migraines, a medication change was one potential outcome. But moments into our telehealth visit, it was clear that a cure for her problems couldn’t be found in a pill. “He’s out of control again,” she whispered, lips pressed to the phone speaker, “What can I do?”
Unfortunately, abusive relationships like Jayden’s are incredibly common. Intimate partner violence (IPV) harms one in four women and one in 10 men in the United States. People sometimes think that abusive relationships only happen between men and women. But this type of violence can occur between people of any gender and sexual orientation.
Experiencing abuse can be extremely isolating, and can make you feel hopeless. But it is possible to live a life free from violence. Support and resources are available to guide you towards safety — and your doctor or health professional may be able to help in ways described below.
What is intimate partner violence?
Intimate partner violence (IPV) isn’t just physical abuse like kicking or choking, though it can include physical harm. IPV is any emotional, psychological, sexual, or physical way your partner may hurt and/or control you. This can include sexual harassment, threats to harm you, stalking, or controlling behaviors such as restricting access to bank accounts, children, friends, or family.
If this sounds like your relationship, consider talking to your doctor or health care professional, or contact the National Domestic Violence Hotline at 800-799-SAFE.
What does a healthy relationship look like?
Media images show us uniformly blissful relationships, but perfect relationships are a myth. This culture can make it difficult for us to recognize unhealthy characteristics in our own relationships. Respect, trust, open communication, and shared decisions are part of a healthy relationship. You should be able to freely participate in leisure activities or see friends without fear of your partner’s reaction. You should be able to share your opinions or make decisions without fear of retaliation or abuse. Sexual and physical intimacy should include consent — meaning that no one uses force or guilt to compel you to do things that hurt you or make you feel uncomfortable.
How can a health professional help me?
Health professionals like doctors or nurses can take a history and assess how the abuse may be affecting your health, well-being, and safety. Trauma from IPV can cause visible symptoms, like bruises or scars, as well as more subtle symptoms, like abdominal pain, headaches, trouble sleeping, or symptoms of traumatic brain injury. Health professionals can also provide referrals to see specialists, if needed.
With your consent, health professionals can take a detailed history, examine you, and document the exam findings in your confidential medical record. Let them know if you are concerned that your partner will view your medical record, so measures can be taken to keep it confidential. This documentation can help to strengthen a court case if you decide to pursue legal action in the future.
Additionally, you may be at risk for pregnancy or certain sexually transmitted infections (STIs). A health professional can perform tests for STIs or pregnancy and offer birth control options. Some forms of birth control are less easily detected by your partner, like an IUD, or a contraceptive implant or injection.
Health professionals can help you develop a safety plan if you feel unsafe. They can also help connect you with social services, legal services, and specially trained advocates. If you would like, health professionals can also connect you with law enforcement to file a report.
What is a sexual assault exam?
If you have experienced sexual assault within 120 hours (five days), you may be offered a sexual assault medical examination. This exam is voluntary. It is performed by a trained health professional and may include a full body exam, including your vagina, penis, or anus. It may also include taking blood, urine, or body surface samples and/or photographs that could be used during an investigation or legal action. You may be prescribed medication that could prevent infections or a pregnancy. You can click here to learn more about the sexual assault exam.
What can I expect if I talk to a health care professional about IPV?
Health professionals should listen to you supportively and without judgement. While not all health professionals are trained in trauma-informed care, it is your right to be treated with respect and empathy to help you feel safe and empowered. You should not be pressured to do anything you don’t want to do. And this shouldn’t change the care you receive. You have the right to decline any care you are not comfortable with. You get to decide how you want to proceed after you share information with your healthcare professional, whether that means seeking out legal support, making a safety plan to leave the relationship, or choosing to stay in the relationship and be connected to ongoing support. And you can choose not to share information about abuse at all.
Will the conversation be private and confidential?
These discussions should occur with you and your health professional in a private space. If your abusive partner accompanies you to your appointment, your health professional may ask them to leave the examination room for a period of time so that you have the privacy to talk openly. You can also ask to speak with the health professional alone.
In most cases, discussing your experiences with your health professional is confidential under HIPAA. All states have laws that protect children, elders and people with disabilities from abuse of any kind. Your health professional is obligated in certain circumstances to report abuse, such as violence against a minor or vulnerable adult. However, only a few states require health professionals to report intimate partner abuse.
Where can I find more resources on IPV?
Want to learn more about IPV and how to seek help?
If you or someone you know you is at risk, call the National Domestic Violence Hotline at 800-799-SAFE (7233) or 800-787-3224. This hotline is for anyone, regardless of race, sex, ethnicity, gender identity, sexual orientation, religion, or ability.
If you are unable to speak safely, you can visit thehotline.org or text LOVEIS to 22522. They are available 24/7 by phone or with a live chat, and can work with you to find help in your area.
- RAINN (national resource for sexual assault and violence)
- Love Is Respect (national resource for dating violence)
- WomensLaw.org (legal information for women experiencing domestic violence)
- LGBT National Help Center (LGBTQ+ resources, including chat and peer counseling).
The post Talking to your doctor about an abusive relationship appeared first on Harvard Health Blog.
387: Ask Katie Anything: Protein, Supplements, Sleep, Parenting, and Shoes
You all ask so many great questions that I like to do a solo episode once in a while to answer some of the things on your mind. Of course I’m not a doctor, but I am a mom who’s been totally immersed in health for the last 15 years! I try to answer most …
Continue reading 387: Ask Katie Anything: Protein, Supplements, Sleep, Parenting, and Shoes...
October 29, 2020 at 04:30PM Wellness Mama® https://ift.tt/2hMTHxr https://ift.tt/eA8V8JCentre introduces new law through ordinance to tackle air pollution in Delhi-NCR
Therapist or Patient: Who’s in Charge?
Let’s talk about psychotherapy. Why hasn’t it changed much in the last century? And if a patient isn’t getting well, is it the fault of the patient, the therapist or the therapy itself? In today’s podcast, Gabe and psychologist Barry L. Duncan discuss the idea of holding therapists more accountable when the patient isn’t getting better.
Join us for a great discussion that sheds new light on how we should be treating mental health issues.
SUBSCRIBE & REVIEW
Guest information for ‘Barry L. Duncan- Therapist or Patient’ Podcast Episode
Barry L. Duncan, Psy.D. . is CEO of Better Outcomes Now and a psychologist, trainer, and researcher with over 17,000 hours of face-to-face experience with clients. Dr. Duncan is the developer of the clinical process of the evidence based practice, the Partners for Change Outcome Management System (PCOMS), a process that ensures that clients are privileged and therapy is accountable. Barry has over one hundred publications, including 18 books addressing client feedback, consumer rights, and the power of relationship in any change endeavor. Because of his self-help books (the latest is What’s Right With You), he has appeared on Oprah, The View, and several other national TV programs.
About The Psych Central Podcast Host
Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, Mental Illness is an Asshole and other Observations, available from Amazon; signed copies are also available directly from the author. To learn more about Gabe, please visit his website, gabehoward.com.
Computer Generated Transcript for ‘Barry L. Duncan- Therapist or Patient’ Episode
Editor’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to the Psych Central Podcast, where guest experts in the field of psychology and mental health share thought-provoking information using plain, everyday language. Here’s your host, Gabe Howard.
Gabe Howard: Hello, everyone, and welcome to this week’s episode of The Psych Central Podcast, I’m your host Gabe Howard and calling into the show today, we have Dr. Barry L. Duncan. Dr. Duncan is the CEO of Better Outcomes Now and a psychologist, trainer and researcher. His self-help books, the latest is What’s Right With You, have led to appearances on Oprah, The View and several other national TV programs. Dr. Duncan. Welcome to the show.
Barry L. Duncan, Psy.D.: It’s great to be here again. Thanks for having me.
Gabe Howard: Today we’re going to discuss holding therapists accountable and their need to evolve. Now, as a person living with bipolar disorder, I can tell you that patients are always encouraged to change our way of thinking and to evolve. But in some ways, therapy hasn’t really changed all that much in the 20 years that I’ve been involved. Now, I’ve been involved as a patient. But Dr. Duncan, what are your overall thoughts on that?
Barry L. Duncan, Psy.D.: Well, I think you’re right on the money with that, I mean, as a profession, we really haven’t changed a heck of a lot in the last hundred years in a lot of ways. I mean, there’s a lot of these models and techniques. In fact, there’s over four hundred models and techniques now. But a lot of things about psychotherapy have not changed, like, for example, who’s in charge and how the hierarchy works and who calls the shots and how collaborative it is. And all of those things are pretty much the same as it’s always been. And that’s why we do need for therapists and the field itself to evolve to be a bit more accountable than it’s been in its last hundred years.
Gabe Howard: It’s interesting to me that you say it really hasn’t evolved in the last hundred years because everything’s evolved in 100 years. I can’t hang on to a cell phone for more than six months before it’s considered outdated old technology. So for something to last a hundred years, was it just perfect or are we really using this antiquated method that isn’t giving us our best results?
Barry L. Duncan, Psy.D.: There had been an evolution of different models and techniques and ways of understanding people’s problems and way of treating people’s problems. The only problem with that is that no one approach now developed is any more effective than the approaches developed 50 years ago.
Gabe Howard: Gotcha.
Barry L. Duncan, Psy.D.: All approaches work about equally well. That means, then, that psychotherapy as a treatment endeavor has not improved. It was as effective 50 years ago as it is right now. That’s the disconcerting part, and that is because we have not been results oriented. We haven’t been accountable to the client, the consumer or the patient, whatever you want to call that person sitting in the room with you, we haven’t been accountable to what they think would be a successful conclusion to the therapy.
Gabe Howard: And is that who you think that therapist should be accountable to?
Barry L. Duncan, Psy.D.: Yes, it would be totally accountable to their perception of their own benefit, their perception of their experience of the therapy itself, rather than feeding the therapist, the provider, the psychiatrist, a psychologist, whoever they’re seeing, instead of fitting their viewpoint of how the therapy should go, how the patients should wind up, it should be taken from the construction, the perception of the person receiving the treatment.
Gabe Howard: Do you get a lot of pushback when you say that, because I know people living with mental illness or even people with mental health concerns, we often feel like whenever things go well, it’s because we have a great therapist. And whenever things go poorly, it’s because we’re not listening to our great therapist. That’s our world. But you’re over on the other side. Do your colleagues like you saying this publicly?
Barry L. Duncan, Psy.D.: Actually, a lot of them do, but there’s a portion that don’t like that arrangement where they blame the client when there’s no change and take credit when there is, I would like for that to be spun around completely, 180 there. And when there is change that the client take credit for making the changes because they’re the ones doing it. And when there’s no change, it’s about the treatment model and how the treatment model interacted. Is the right fit for the person receiving it rather than putting the blame on the client’s shoulders, which is what psychotherapy has done since the beginning. Right. When there’s no change, it’s because of the client’s psychopathology. Think about how we organize our profession. If you change, it’s because I’m so super brilliant and I’m a great practitioner, if you don’t change well, you are quite sick. This is going to take more time, more effort, more drugs, more therapy. That’s been the kind of mentality. I think that kind of story is reaching its end at this point. And people are starting to realize that they’re far more fruitful ways of going about this.
Gabe Howard: A lot of my listeners don’t know this, but whenever we set up a guest on the show, we always ask the guests to submit some questions because they know the questions that they get asked most of all. And I can’t know everything as much as I tell my wife that I do. And one of the questions that you submitted, I think it might be my favorite question ever. The question is, what does the death of George Washington have to do with our topic today, Dr. Duncan?
Barry L. Duncan, Psy.D.: Actually, it is the perfect story for our situation today, because here’s what happened to little George after he retired from the presidency, right? Right. His Mount Vernon estate every morning. And on a cold, blustery December day in 1799, he got back from his ride and he got a sore throat and a cough. And so, they put him to bed and they summoned the area physicians. The first physician got there and administered the standard of care of the day, and Washington’s condition grew worse. The second physician got there, re-administered the standard of care of the day and Washington lost consciousness. And then finally, the third physician arrived later that night, re-administered the standard of care to an unconscious George Washington, and by the next morning, George was dead. Now, what was that standard of care? It was bloodletting. And while medical historians quibble over whether or not the bloodletting hastened his demise or outright killed him, the fact of the matter is that they continue to apply the same treatment despite direct evidence from the patient that it clearly was not working and making it worse. And that’s exactly what people do today. They will continue to administer the same treatment to a client despite direct evidence that the treatment isn’t working. That code creates chronicity in clients. It causes them to get worse over time. We used to call that bloated files syndrome. It was more about the person who’d been in so many unsuccessful treatments, more so about that than about the person themselves. The people began to have a mentality about themselves, that they’re untreatable, they’re too sick, they’ll never get better rather than having it look to the outside and saying, gosh, maybe the treatments I’ve been getting or not what I am needing and let me try different people, different treatments to see if I can get to a better place.
Gabe Howard: I think that this leads to patients just giving up. I hear the word quackery a lot. I hear that they the therapist just wanted to talk to me and it didn’t do any good. And you hear a lot of terms to describe therapists from the disgruntled. Do you think that part of that disgruntled-ness comes from what you’ve just described?
Barry L. Duncan, Psy.D.: Absolutely. People become disgruntled when there’s no change and when they see no possibility for change or no hope for change, one of the factors that makes treatment beneficial for people is that it inspires hope. A very famous psychiatrist, Jerome Frank, had a very nice perspective on this. And he thought that when people come to treatment, they are demoralized by their lives and they believe that every day is going to be just as miserable as today. But what therapy does is, in his words, re-moralizes or gives them the possibility that’s not true. And then that inspires people to catalyze them into action. And then they do things to make meaningful changes in their lives when it’s not helping. Therapy can make you quite disgruntled and start to believe that you’re unchangeable, which is the worst conceivable outcome.
Gabe Howard: So this begs the question, Dr. Duncan, how do we get therapy, which, as you stated, hasn’t really changed all that much in the last hundred years? How do we get them all to change?
Barry L. Duncan, Psy.D.: There has been a movement within psychotherapy, this called systematic client feedback, and Michael Lampert is the pioneer of this. And he had this idea that why not measure in each encounter with a client’s believe they’re benefiting from their therapy and then those clients who aren’t benefiting will be identified so that the therapist can then do something different with them? That’s a great idea. But there’s a more radical side that really appealed to me. And that was that don’t make it an expert kind of a process. Don’t make it to where it just gives information to the therapist. Why not let it be a collaborative process that’s done together with the client and the provider and have that process of monitoring outcome to see whether or not the person is benefiting and then collaboratively figuring out what else can be done and or to move them on to greener pastures with somebody else, if indeed they can’t collaboratively come up with different ideas to be beneficial to the client. The relationship is called the Therapeutic Alliance, which if the alliance isn’t good, it’s very unlikely for anything good to happen in the therapy. We also check in with people in each and every encounter about how was this experience for you today? Are we talking about the right stuff, the approach that we’ve taken to address your goals? Do you really think that’s going to be helpful to you? So we check that out with these two four item scales.
Barry L. Duncan, Psy.D.: It takes less than five minutes. And when you do that, you identify the consumers who aren’t benefiting. Because an important thing we know, Gabe, is that who is providing the service accounts for most of the change of any treatment being administered. Now, what that means is that it doesn’t matter whether your psychodynamic or your cognitive behavioral, who you are as a person accounts for much more how change happens with clients than the models and techniques that you use. If that isn’t in line with the clients, the best thing you could do is to fire yourself and let the person see someone else.
Gabe Howard: Let’s step away from therapy for a moment and even step away from mental health treatment and into physical health treatment or just patients versus doctors. There’s a huge movement in America right now for patients voices to be heard. And again, I want to be very clear. This isn’t a therapy relationship or even a mental health relationship. This is all of patients feel that they are not being partnered with. And when I say all of patients, they don’t have the downside of having the discrimination or the stigma of being out of their mind or crazy or not thinking straight or we need to do this for their own good, because after all, they can’t advocate for themselves because they’re sick. And I point that out because if it’s happening over on the quote unquote, physical health side, meaning for somebody with cancer, for example, what hope does the mental health side have? Because we’re much easier to ignore? Can you talk on that for a moment? Because I know that many patients are like, look, even in the best of circumstances, we’re not believed.
Barry L. Duncan, Psy.D.: From a medical point of view, it’s really the same dynamic that exists, you have an expert and the patient who needs the help of the expert. What you find is that relationship and medical treatment is also predictive of eventual outcomes, even with biological markers has been a recent research in the last five years that when patients believe they have a good relationship and good communication with their medical provider, they get better outcomes and even biological marker better outcomes. So the same processes could be helpful in medical care. In fact, my colleagues and I have developed measures for primary care docs, so the same dynamics exists there. So we validated our measures in primary care science and our next step is to actually try and see if it improves outcomes. Once we started measuring outcomes and doing this collaborative process with clients and psychotherapy to solicit their views and whether they’re benefiting and solicit their views of how the experience of therapy was going. We then started doing randomized clinical trials, which is the language of science, where you compare clients who didn’t have the support of their treatment and clients who did. And we’ve done eight randomized clinical trials now and it doubles overall treatment outcomes for those clients who have systematic client feedback as part of their therapy.
Gabe Howard: I don’t know why we separate mental health and physical health out, but for the purposes of this conversation, moving it out of the physical health realm and into the mental health realm, patients know that we have to be involved. We see a therapist one hour a week and then all the other hours or hours. Essentially, if we don’t participate in therapy, it does not work. We know that hard stop. You cannot send an unwilling person to therapy and expect it to do any good. They’ll just sit there and ignore you for an hour and then go off and do whatever they want. So knowing that is an absolute fact, why do you think you’re getting any pushback whatsoever? Is there I’m going to use a mean word. Is there just an arrogance among therapists that they can convince people who don’t want to listen, to listen, or is it just deeper than that?
Barry L. Duncan, Psy.D.: I think there’s certainly an arrogance there, but I think that there’s I call organizational apathy toward doing anything, that it’s a change. We like to work the way we’ve always worked. That’s always worked for us before. They see it as adding to what they’re already doing. A lot of therapists believe that they are overworked and underpaid. The master’s in social work and master’s in counseling are the two lowest paid master’s degrees in the United States. It’s different in Europe, but here in the US, it’s a very low paid master’s degree. People feel up against it a lot of times. And so when they’re asked to do more, know someone comes in from the outside and said, this is the greatest thing since sliced bread and it improves outcomes and decreases dropouts. It’s a way to be collaborate with people like. Oh yeah, I heard that was the last paradigm shift. So people tend to hunker down. Implementation is a long term process for people and it takes training and use and supervision. And I basically tell people when I’m implementing an agency that about twenty five to thirty three percent of therapists will say, I really like this, I’m going to do it. I see the benefit from it right away. But then everybody else has to be brought along. And most people learn from their own experience. So they need to have the experience of it being useful to them before they’ll completely buy in.
Barry L. Duncan, Psy.D.: Arrogance is certainly part of it. And there’s that, that this is an old old idea, back and from the beginning, the sanctity of the closed room, nobody else in there except me and the client, no outside influences. And this is this private time. And I don’t want to let anybody else or anything else in and doing any measurement process or formally soliciting the client’s voice. It’s not what I’m about. The really sad part is that a lot of therapists and this is the arrogance or believe that they know what the client needs and wants without ever asking them. That’s the part that drives me crazy. They think they already know the answer. You did an RCT in Norway, and the person I was working with, Morten Anker, he is a good friend of mine. He did a survey of the therapists before we did the trial and there were ten therapists. And he asked them, do you think that getting systematic client feedback about the client’s view of benefit and their view of the alliance? Do you think that will improve your effectiveness? All ten said no. We already know whether people are benefiting. We already know whether we have a good alliance with people. And guess what happened? Only one of the ten was correct because nine out of ten improved their effectiveness with this systematic feedback from the client.
Gabe Howard: Stay tuned and we’ll be right back after these messages.
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Gabe Howard: Welcome back, everyone. We’re here with Dr. Barry L. Duncan, discussing how to hold therapists accountable and their need to evolve. Dr. Duncan, is that you’re met with this resistance and you are able to overcome it, but what do you say? There’s this knee jerk reaction in me to say, hey, I told you that this would be better for your patients. Why are you arguing with me? But I know as an advocate, yelling at people doesn’t ever work. So I’m curious as to your method, because, as you said, you’re overcoming years of thinking and people’s ways of doing things.
Barry L. Duncan, Psy.D.: Yes, we’ve implemented many places. In fact, we have one point five million administrations of our measures in our database, so there are many people doing it there. Thirty thousand registered users on our website. But there is this kind of initial response. And I first started training people. I was shocked that they didn’t say, wow, this is such a great idea. We’re going to do this right away because it identifies our people who are benefiting in mixed therapy, more collaborative and honoring the client’s voice and all of these values that people are always reporting that they have, that when push came to shove, they wouldn’t actually do it. And I was shocked by that. I had to develop ways of inspiring people rather than mandating people do this. And what really got me into it was it’s about social justice and client privilege and making sure that we level the playing field with clients and we got them engaged and involved. But other people get on board for other reasons. It identifies the people who are likely to drop out before they drop out. It improves effectiveness. It’s been proven in real world settings to raise the bar of everybody’s performance. It involves the known predictors of how people change. My kind of go-to in helping win people over is to show them the work. Therapists really like to see the work itself, because then I go from being a talker about it to showing them.
Barry L. Duncan, Psy.D.: And I, of course, releases from my clients and anonymize the videos. But I show them the actually doing this with people and people’s comments about liking being involved in the process, liking being involved in all of the decisions, liking how transparent the process is and getting better, recapturing some people that would have otherwise not benefited. I have a video that’s very popular with therapists where it’s a client who I was not successful with. I really wanted to be successful with her. I really liked her. She was a great young person, couldn’t have wanted her to work through her struggles more, but I was not the right fit for whatever reason. And then I do a consult with one of my colleagues who took over therapy, and then she changed quite rapidly. So the message is that we all have clients who don’t benefit and there’s nobody that’s one hundred percent effective, the very best therapist on the planet, or about two thirds effective, which means that one third of their clients do not benefit, that if we identify who those third are, we can either change up what we’re doing or we can get them in front of somebody else. That is a better fit. In the old days before I started doing this, I think I would eventually figure out that I wasn’t being helpful to people, but they may have dropped out by the time I figured it out.
Gabe Howard: Right, and then you can’t refer them.
Barry L. Duncan, Psy.D.: They can’t be referred, and it means they walk away saying therapy wasn’t helpful rather than saying therapy with Barry wasn’t helpful and it could be helpful with somebody else, with different ideas, different trainings, different kind of personality, whatever. It got me to the end of right away with people from the second or third encounter saying, does it look like things happened? What do you think we should do about that? And that conversation is really cool because it does comment on the partnership. And we can get to maybe if there is something that’s holding us back, have a frank conversation about it and move on, or we need to change approaches altogether or think about it in a different way.
Gabe Howard: Dr. Duncan, is there any downside to holding therapists accountable and to your method? We’ve talked a lot about the positives, but let’s be fair. Does the pendulum swing back the other way?
Barry L. Duncan, Psy.D.: There could be potential downsides, for example, if the payers, managed care companies, insurance companies use this as the sole decision to throw people out of their you reach maximum gain, no more sessions for you rather than that being. This is information, the decisions made between the client, the therapist, about when therapy should end or when it should be cut back or what have you. It also could be a downside if management decided to use it in a punitive way. For example, to say you’re your therapist, Gabe, and I say to you, well, we measure outcomes here with this system. And if you don’t attain 60 percent effectiveness with your clients, you’ll be reprimanded. Or if you get 60 percent, I’ll give you a raise. That would be a really horrible consequence. So in all of my contracts and all of my agreements, I spell those things out that it can’t be used that way. It can’t be used to reward or punish therapists. It can’t be used as the sole determinant, whether a person continues in therapy or not, because, again, those decisions are far more collaborative than that, than a number from a scale. But the number from the scale, it’s our insurance policy in that it keeps us honest so that we have those conversations with. And one thing that I really is troubling to me as I look at therapy across many organizations and many therapists, is that therapy can devolve into a place where there’s only a processing of the client’s life.
Barry L. Duncan, Psy.D.: It’s just an ongoing commentary on what’s happened that week with no thematic connection to a change that is being tried for. That winds up happening because it’s a much easier thing for people to do rather than being accountable for making a meaningful difference in people’s lives. And that’s why measuring outcomes is very important. You can prevent that. I do implementation a lot of agencies that wind up doing supervision and I’ll say, what are you working on? And I’ll say he’s been through a lot. And this is a place where you can come and get support and say, so what’s the end game to providing support? This is the only place that he can get that. I said, wouldn’t it make sense to have a discussion about a goal that he could get support in his real world because you’re not going to invite him home for Thanksgiving dinner? Right.
Gabe Howard: All right.
Barry L. Duncan, Psy.D.: We’re not really a support system. Not really. We’re temporary support system for people. We hope that they can get support systems in their natural world and that we are not a replacement for those things. And that’s what happens. A lot of time therapy can become replacement. And we’re not that kind of relationship. And those lines can get really blurred when those circumstances when you’re not accountable to person, to clients and first to there being some results that come from it, we can have these endless process oriented, support oriented therapies now in saying that there’s nothing wrong with process or support, but there shouldn’t be that change component. That’s a part of it.
Gabe Howard: Dr. Duncan, as both a patient and a mental health advocate, I like anything that improves outcomes for patients because that’s me. I want outcomes to improve. I do believe that therapists want outcomes to improve as well. It’s just we’ve always done it this way. Why do we need to change? Change is scary. It’s the kind of thing that you often go to therapy for.
Barry L. Duncan, Psy.D.: Absolutely. You know, one of my favorite agencies of working with, they’re called Wesley Community Action, and they have a big poster in their waiting room and it says, We pledge to have as much courage as the people that we serve. We have to be courageous ourselves as therapists to make changes that we know are for the better, rather than saying the way we’ve always done them, because that’s where our comfort zone is. And we ask clients to make changes all the time. We ourselves aren’t willing to do it. Sad commentary on us, basically, but it takes courage to do things that are different. It’s hard for some therapists to get feedback that therapy is not helping. OK? Wouldn’t you rather know? It’s not helping them believing that it does and then the client drops out. You don’t know why some therapists are squeamish about getting direct feedback about the relationship. Those are incredible things for people to say to you because they’re trusting you enough that there won’t be some negative consequence by their being candid with you. And that’s exactly what we want clients to be with us is as candid as possible. It’s a gift when clients say things negative to you, because if you can work through that with them, it will build the alliance even stronger and the client will be more likely to benefit from the service.
Gabe Howard: I like that, I like that a lot, Dr. Duncan, do you have any last words or comments on the topic? And also where can people find you online?
Barry L. Duncan, Psy.D.: BetterOutcomesNow.com is the Web site, BetterOutcomesNow.com and there’s a section called Resources and there’s all kinds of free resources there, articles, videos about a lot of the stuff we talk about there, brief videos about. Lots of free stuff, in fact, 253 downloads are on the website.
Gabe Howard: Wow, lots of cool stuff.
Barry L. Duncan, Psy.D.: And something I’d like to leave you with is if you were a client in therapy, if you would like for that therapy to be accountable, it would be a nice thing to bring up to your therapist. And you could tell your therapist that he or she can download the measures for free from the website. BetterOutcomesNow.com and watch a video and could learn how to use them quite readily. They want to go so far as to read a book. They can do that too. In my book, What’s Right With You, which is written for a general audience, I recommend that you monitor the progress of your own therapy. Even if your therapist says that you do it, you monitor your own progress so that you have a sense from session to session whether or not you are gaining. And of course, that book tells you how to do that. There’s also stuff online that would help you how to do that. That’s a free download.
Gabe Howard: And advocating for yourself as a patient is something that, well, Gabe Howard, Psych Central and pretty much every organization that I’m involved with highly recommend. Steer your own bat. I think that’s really the bottom line. When we wait for stuff to happen to us, we’re not really in control. And when we advocate for ourselves with our doctors, our medical teams and even in our own families, workplaces and general society, I think it really does impact our outcomes, our mental health and, of course, our overall lives.
Barry L. Duncan, Psy.D.: Absolutely.
Gabe Howard: Thank you, Dr. Duncan, and thank you to all of our listeners for listening. My name is Gabe Howard and I am the author of Mental Illness Is an Asshole, which is available on Amazon. Or you can get a signed copy for less money over a gabehoward.com and I’ll even throw in stickers from the show. Remember, we have a super secret Facebook page over at PsychCentral.com/FBShow. I recommend that you sign up for that. If you have any topic ideas, please, please, please send them to me at show@PsychCentral.com. Wherever you downloaded this podcast, please, please subscribe. Use your words and tell other people why they should subscribe. Ratings are powerful and remember, you can get one week of free, convenient, affordable, private online counseling any time anywhere simply by visiting BetterHelp.com/PsychCentral. We’ll see everyone next week.
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