Clinical Practice
Posts on the clinical work itself — assessments, modalities, ethics, and the craft of doing therapy well.
← Back to all postsWhat 'Evidence-Based' Actually Means in Therapy
Every therapist claims to be evidence-based; few can explain it. Here's the real definition, why it matters, and how to spot who actually practices it.
Burnout and the Drift Toward Easy Therapy
Therapist burnout doesn't just hurt the therapist — it pushes clinical work toward supportive therapy that's easier to deliver but less effective for clients.
Trauma-Focused CBT vs. EMDR: The Evidence
Two leading trauma treatments, often pitted against each other. Here's what the research shows about how they compare — and what matters more.
The ROI of Evidence-Based Therapy
Effective therapy isn't just clinically superior — it's more cost-effective: fewer sessions, less disability, better long-term outcomes.
How to Use a DBT Diary Card in Session
A practical guide to reviewing the DBT diary card at the start of session — the target hierarchy, chain analysis hand-off, and reinforcing skills use.
Paper vs. Digital DBT Diary Cards: Which Should You Use?
The clinical trade-offs between paper and digital DBT diary cards — compliance, retrospective bias, trend visibility — and when each one is the right call.
The DBT Diary Card for Teens (DBT-A): A Clinician's Guide
How the DBT diary card adapts for adolescents in DBT-A — the Walking the Middle Path module, age-appropriate language, and confidentiality with parents.
Behavioral Activation for Depression
Depression makes you withdraw, and withdrawal makes it worse. Behavioral activation breaks the cycle — one of the most effective treatments we have.
Exposure Therapy: Why Avoidance Keeps You Stuck
Avoidance is the engine of anxiety. Exposure therapy is the most effective treatment we have — and the most underused. How it works and why.
Therapeutic Alliance Is Not Enough
A strong therapeutic relationship predicts better outcomes. But alliance alone doesn't produce change — here's what the research says about the other half.
CBT vs. Talk Therapy: What the Evidence Says
CBT has decades of research behind it. Traditional talk therapy has decades of tradition. What the evidence actually says about effectiveness.
The PHQ-9 Isn't Just a Screener — It's a Treatment Tool
The PHQ-9's real power is in repeated measurement, not intake. How to use it to track treatment response, catch deterioration, and guide care.
Why Good Therapists Work Themselves Out of a Job
An effective therapist's goal is to become unnecessary. Here's why that matters — and why the profession's incentive structure makes it hard.
Red Flags Your Therapist Isn't Evidence-Based
Not all therapy is created equal. Here are warning signs that your therapist may not be using methods backed by research — and what to do about it.
The Case for Measurement-Based Care
Measurement-based care doubles the odds of reliable improvement and halves the rate of deterioration. Here's what the evidence actually says.
Common Factors: Relationship and Structure
The common factors model shows that therapeutic alliance and structured methods both drive outcomes. What the research says and why it matters.
Acceptance and Change: What DBT Gets Right
DBT's core dialectic of acceptance AND change separates effective therapy from comfortable therapy. Why the balance matters and how therapists drift.
GAD-7 Scoring & Interpretation: A Therapist's Guide to the Anxiety Scale
How to score and interpret the GAD-7: the 0–21 scale, severity bands, reliable change, and using anxiety data to guide treatment.
PCL-5 Scoring & Interpretation: A Therapist's Guide to the PTSD Checklist
How to score and interpret the PCL-5 (PTSD Checklist for DSM-5): cluster math, severity bands, reliable change, and using it as an ongoing trauma tool.
Clinical Alerts: Spot Risk Before the Session
A client's PHQ-9 jumped from 9 to 17 between sessions. Would you know before they walked in? Clinical alerts catch what session-to-session observation misses.
Custom Assessment Forms: When You Need One (and When You Don't)
Most of what therapists build a custom form for is already covered by a validated assessment or a Diary Card. How to tell which tool you need.
What Is Measurement-Based Care?
Measurement-based care improves therapy outcomes by 2-3x, yet fewer than 20% of therapists use it. Here's what MBC is, why adoption is low, and how to start.
How to Talk to Clients About Their Assessment Scores
Sharing assessment scores with clients improves outcomes and the alliance. Practical scripts and framing for making score conversations natural.
Building a Safety Plan in Therapy: A Step-by-Step Guide
A step-by-step guide to building a safety plan with clients using the Stanley-Brown framework — what to cover, common mistakes, and tools that help.
Set Up Outcome Tracking in 15 Minutes
Set up outcome tracking for your whole caseload in 15 minutes. Step-by-step guide to choosing assessments, assigning them to clients, and reading the data.
Using Diary Cards in DBT: A Digital Approach
Paper DBT diary cards get lost and can't be analyzed over time. Here's how digital diary cards improve compliance, enable trend tracking, and save session time.
Between-Session Assessments: Better Outcomes
Clients who complete assessments between sessions have better outcomes, more consistent attendance, and richer clinical data. Evidence and how-to.
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