Tag: Psychiatrist

What is Improving Access to Psychological Therapies?

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Introduction

Improving Access to Psychological Therapies (IAPT) is a National Health Service (England) initiative to provide more psychotherapy to the general population.

It was developed and introduced by the Labour Party as a result of economic evaluations by Professor Lord Richard Layard, based on new therapy guidelines from the National Institute for Health and Care Excellence as promoted by clinical psychologist David M. Clark.

Brief History

Richard Layard, a labour economist at the London School of Economics, had become influential in New Labour party politics and was appointed to the House of Lords in 2000. He had a particular interest in the happiness of populations and mental health; his father, John Layard, was an anthropologist who had survived suicidal depression and retrained as a Jungian psychologist after undergoing psychoanalysis by Carl Jung. In 2003 Richard Layard met the clinical psychologist David M. Clark, a leading figure in Cognitive Behavioural Therapy who was running the Centre for Anxiety Disorders and Trauma (with Anke Ehlers and Paul Salkovskis) at the Institute of Psychiatry and Maudsley Hospital. Clark professed to high rates of improvement from CBT but low availability of the therapy despite NICE guidelines now recommending it for several mental disorders.

Layard, with Clark’s help, set about campaigning for a new national service for NICE-recommended treatments, particularly CBT. One key argument was that it would be cost-effective and indeed eventually pay for itself by increasing productivity and reducing state benefits such as Disability Living Allowance and Incapacity Benefit (which had seen rising claims since their introduction by John Major’s Conservative Party in 1992 and 1995 respectively). The plan was accepted in principle by the newly re-elected Labour government in 2005 and gradually put into practice directed by Clark. Layard names several others as having helped gain the initial political traction for the initiative – MP Ed Miliband, psychiatrist Louis Appleby (then National Director for Mental Health), David Halpern (psychologist), psychiatrist David Nutt, MP Alan Milburn (married to a psychiatrist) and eventually the Prime Minister Gordon Brown.

In 2006 the Mental Health Policy Group at the LSE published ‘The Depression Report’, commonly referred to as the Layard Report, advocating for the expansion of psychotherapy on the NHS. This facilitated the development of IAPT initiatives, including two demonstration sites (pilot studies) and then training schemes for new types of psychological practitioner. The programme was officially announced in 2007 on World Mental Health Day. Some mental health professionals cast doubt on the claims early on. In the official publication of the British Psychological Society in 2009, experienced clinical psychologists John Marzillier and Professor John Hall strongly criticised IAPT’s promoters for glossing over both the data gaps acknowledged in the NICE reports and the complexity of the multiple issues typically affecting people with mental health problems and their ability to sustain employment; they were met with much agreement as well as angry criticism. One researcher cited the UK initiative as the most impressive plan to disseminate stepped-care cognitive behaviour therapy. But the plan appears not to have worked, Davis (2020) in the Journal of Evidence Based Mental Health, noted that 73% of IAPT clients receive low intensity therapy first (guided self help, computer assisted CBT or group psychoeducation) but only 4 % are transferred to high intensity therapy and the first transition appointment is the least well attended.

Aims

The aim of the project is to increase the provision of evidence-based treatments for common mental health conditions such as anxiety and depression by primary care organisations. This includes workforce planning to adequately train the mental health professionals required. This would be based on a ‘stepped care’ or triage model where ‘low intensity’ interventions or self-help would be provided to most people in the first instance and ‘high intensity’ interventions for more serious or complex conditions. Outcomes would be assessed by standardised questionnaires, where sufficiently high initial scores (a ‘case’) and sufficiently low scores immediately after treatment (below ‘caseness’), would be classed as ‘moving to recovery’. The NICE (National Institute for Health and Clinical Excellence) therapy guidelines presume reliable diagnosis. IAPT therapists do not make formal diagnoses. This calls into question IAPT’s claimed fidelity to the NICE guidelines, particularly as it does not monitor therapists treatment adherence.

Evaluation

Initial demonstration sites reported outcomes in line with predictions in terms of the number of people treated (especially with ‘low intensity’ interventions such as ‘guided self-help’) and the percentages classified as recovered and as in more employment (a small minority) to ten months later. It was noted that the literature indicates a substantial proportion of patients would recover anyway with the passage of time or with a placebo – in fact the majority of those whose condition had lasted for less than six months, but only a small minority of those whose condition had been longer-lasting.

There has been some debate over whether IAPT’s roll-out may result initially in low quality therapy being offered by poorly trained practitioners.

Beacon UK benchmarked IAPT performance across England for 2011-2012 and reported that 533,550 people accessed (were referred to) IAPT services – 8.7% of people suffering from anxiety and depression disorders – with around 60% entering treatment sessions. Most local IAPT services did not reach the target of a 50% ‘recovery’ rate.

In 2012-2013, 761,848 people were referred to IAPT services. 49% went into treatment (the rest either assessed as unsuitable for IAPT or declined), although around half of those dropped out before completing at least two sessions. Of the remainder, 127,060 people had pre-treatment and post-treatment mental health questionnaires submitted indicating ‘recovery’ – a headline rate of 43%. A report by the University of Chester indicated that sessions were costing three times more to fund than the original Department of Health estimates.

For 2014-2015 there were nearly 1.3 million referrals to IAPT, of which 815,665 entered treatment. Of those, 37% completed sufficient sessions, with 180,300 showing a ‘reliable recovery’ (on anxiety and depression questionnaires completed before and immediately after treatment) – which was just over one in five of those who entered treatment, just under half of those who completed enough sessions. Opinion on IAPT remained divided. The number of trained IAPT therapists did not appear to have met the government’s target of 6000, resulting in high caseloads. Some complained of seeing more ‘revolving door’ patients and excess complexity of cases, while the NHS has acknowledged problems with waiting times and recovery rates. However Norman Lamb, who championed IAPT within the coalition government 2010-2015, disagreed with picking faults with such an extensive and world-leading advance in evidence-based treatment. Others lauded the success in rising numbers of referrals, but warned of the failure to improve recovery rates. It was noted that both antidepressant prescribing and psychiatric disability claims have continued to rise.

In 2017 fewer than half of the Clinical Commissioning Groups met the target (15.8%) for the number of people who should be accessing talking therapies. There has been no publicly funded independent audit of IAPT . A study of 90 IAPT cases assessed with a ‘gold standard’ diagnostic interview revealed that only the tip of the iceberg recovered, in the sense of losing their diagnostic status. The results were identical whether or not the person was treated before or after personal injury litigation.

In July 2021 55,703 appointments out of the total 434,000 which went ahead involved one or more practitioners who did not have an accredited IAPT qualification. There are about 2000 psychological wellbeing practitioners in the service, with another 1,200 trainees. They are supported by high intensity therapists and counsellors of which there are about 4,000 with 700 trainees.

Updates

In December 2010, Paul Burstow, Minister for Care Services, announced an extension to the IAPT project to include Children and Young Peoples services. The government pledged £118m annually from 2015 to 2019 to increase access to psychological therapies services to children and young people.

When the programme officially started in 2008 it was only for working age adults, but in 2010 it was opened to all ages.

In 2015 Clark and fellow clinical psychologist Peter Fonagy, writing in response to wide-ranging criticism from child and adolescent psychiatrist Sami Timimi, stated that IAPT now has increasing support for the non-CBT modalities recommended by NICE for depression: counselling, couples therapy, interpersonal psychotherapy and brief psychodynamic therapy; and for Children and Young People (CYP-IAPT) more systemic family therapy, interpersonal therapy and parenting therapy is on the way. Timimi described the changes as still “light” on relational/collaborative therapy compared to the ‘technical model’ derived from ’eminence-based’ NICE guidelines via inadequate diagnostic categories.

A Payment by Results system is being developed for IAPT, whereby each local Clinical Commissioning Group can reward each local provider according to various targets met for the service and for each client – particularly for how much change in scores on the self-report questionnaires. The March 2021 issue of the British Journal of Clinical Psychology has highlighted the considerable controversy over IAPT’s claims of success, Scott( 2021) and Kellett et al., (2021) have responded with their own commentary ‘The costs and benefits of practice-based evidence: Correcting some misunderstandings about the 10-year meta-analysis of IAPT studies’.

On This Day .. 12 January

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People (Births)

  • 1896 – David Wechsler, Romanian-American psychologist and author (d. 1981).
  • 1914 – Mieko Kamiya, Japanese psychiatrist and psychologist (d. 1979).
  • 1941 – Fiona Caldicott, English psychiatrist and psychotherapist.

David Wechsler

David Wechsler (12 January 1896 to 02 May 1981) was a Romanian-American psychologist. He developed well-known intelligence scales, such as the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Intelligence Scale for Children (WISC).

Wechsler is best known for his intelligence tests. He was one of the most influential advocates of the role of non-intellective factors in testing. He emphasized that factors other than intellectual ability are involved in intelligent behaviour. Wechsler objected to the single score offered by the 1937 Binet scale. Although his test did not directly measure non-intellective factors, it took these factors into careful account in its underlying theory. The Wechsler Adult Intelligence Scale (WAIS) was developed first in 1939 and then called the Wechsler-Bellevue Intelligence Test. From these he derived the Wechsler Intelligence Scale for Children (WISC) in 1949 and the Wechsler Preschool and Primary Scale of Intelligence (WPPSI) in 1967. Wechsler originally created these tests to find out more about his patients at the Bellevue clinic and he found the then-current Binet IQ test unsatisfactory. The tests are still based on his philosophy that intelligence is “the global capacity to act purposefully, to think rationally, and to deal effectively with [one’s] environment”.

The Wechsler scales introduced many novel concepts and breakthroughs to the intelligence testing movement. First, he did away with the quotient scores of older intelligence tests (the Q in “I.Q.”). Instead, he assigned an arbitrary value of 100 to the mean intelligence and added or subtracted another 15 points for each standard deviation above or below the mean the subject was. While not rejecting the concept of general intelligence (as conceptualized by his teacher Charles Spearman), he divided the concept of intelligence into two main areas: verbal and performance (non-verbal) scales, each evaluated with different subtests.

A Review of General Psychology survey, published in 2002, ranked Wechsler as the 51st most cited psychologist of the 20th century.

Mieko Kamiya

Mieko Kamiya (神谷 美恵子, Kamiya Mieko, 12 January 1914 to 22 October 1979) was a Japanese psychiatrist who treated leprosy patients at Nagashima Aiseien Sanatorium.

She was known for translating books on philosophy. She worked as a medical doctor in the Department of Psychiatry at Tokyo University following World War II. She was said to have greatly helped the Ministry of Education and the General Headquarters, where the Supreme Commander of the Allied Powers stayed, in her role as an English-speaking secretary, and served as an adviser to Empress Michiko. She wrote many books as a highly educated, multi-lingual person; one of her books, titled On the Meaning of Life (Ikigai Ni Tsuite in Japanese), based on her experiences with leprosy patients, attracted many readers.

Fiona Caldicott

Dame Fiona Caldicott, DBE, FMedSci (12 January 1941 to 15 February 2021) was a British psychiatrist and psychotherapist who also served as Principal of Somerville College, Oxford. She was the National Data Guardian for Health and Social Care in England until her death.

On This Day … 02 January

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People (Deaths)

  • 2016 – Frances Cress Welsing, American psychiatrist and author (b. 1935).

Frances Cress Welsing

Frances Luella Welsing (née Cress; 18 March 1935 to 02 January 2016) was an American psychiatrist and well-known proponent of the Black supremacist melanin theory.  Her 1970 essay, The Cress Theory of Colour-Confrontation and Racism (White Supremacy), offered her interpretation of what she described as the origins of white supremacy culture.

She was the author of The Isis Papers: The Keys to the Colours (1991).

What is the Young Mania Rating Scale?

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Introduction

The Young Mania Rating Scale (YMRS), developed by Vincent E Ziegler and popularised by Robert Young, is an eleven-item multiple choice diagnostic questionnaire which psychiatrists use to measure the presence and severity of mania and associated symptoms.

Background

The scale was originally developed for use in the evaluation of adult patients with bipolar disorder, but has since been adapted for use in paediatric patients. The scale is widely used by clinicians and researchers in the diagnosis, evaluation, and quantification of manic symptomology.

A similar scale was later developed to allow clinicians to interview parents about their children’s symptoms, in order to ascertain a better diagnosis of mania in children. This parent version (P-YMRS) can be completed by a parent or a teacher to determine whether a child should receive further evaluation from a psychologist or psychiatrist. Clinical studies have demonstrated the reliability and validity of the parent version of the scale, which has been found to provide “clinically meaningful information about mood disorders in youth.” The P-YMRS does succeed in identifying most cases of childhood bipolar disorder, but it has an extremely high false positive rate.

On This Day … 22 December

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People (Deaths)

  • 1902 – Richard von Krafft-Ebing, German-Austrian psychiatrist and author (b. 1840).

Richard von Kraft-Ebing

Richard Freiherr von Krafft-Ebing (full name Richard Fridolin Joseph Freiherr Krafft von Festenberg auf Frohnberg, genannt von Ebing; 1840-1902) was a German psychiatrist and author of the foundational work Psychopathia Sexualis (1886).

Krafft-Ebing was born in 1840 in Mannheim, Germany. He studied medicine at the University of Heidelberg, where he specialised in psychiatry. He later practiced in psychiatric asylums. After leaving his work in asylums, he pursued a career in psychiatry, forensics, and hypnosis.

He died in Graz in 1902. He was recognised as an authority on deviant sexual behaviour and its medicolegal aspects.

On This Day … 19 December

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People (Births)

  • 1925 – William Schutz, American psychologist and academic (d. 2002).

People (Deaths)

  • 1915 – Alois Alzheimer, German psychiatrist and neuropathologist (b. 1864).

William Schultz

William Schutz (19 December 1925 to 09 November 2002) was an American psychologist.

Schutz was born in Chicago, Illinois. He practiced at the Esalen Institute in the 1960s. He later became the president of BConWSA International. He received his Ph.D. from UCLA. In the 1950s, he was part of the peer-group at the University of Chicago’s Counselling Centre that included Carl Rogers, Thomas Gordon, Abraham Maslow and Elias Porter. He taught at Tufts University, Harvard University, University of California, Berkeley and the Albert Einstein College of Medicine, and was chairman of the holistic studies department at Antioch University until 1983.

In 1958, Schutz introduced a theory of interpersonal relations he called Fundamental Interpersonal Relations Orientation (FIRO). According to the theory three dimensions of interpersonal relations were deemed to be necessary and sufficient to explain most human interaction: Inclusion, Control and Affection. These dimensions have been used to assess group dynamics.

Schutz also created FIRO-B, a measurement instrument with scales that assess the behavioural aspects of the three dimensions. His advancement of FIRO Theory beyond the FIRO-B tool was most obvious in the change of the “Affection” scale to the “Openness” scale in the “FIRO Element-B”. This change highlighted his newer theory that behaviour comes from feelings (“FIRO Element-F”) and the self-concept (“FIRO Element-S”). “Underlying the behaviour of openness is the feeling of being likable or unlikeable, lovable or unlovable. I find you likable if I like myself in your presence, if you create an atmosphere within which I like myself.”

W. Schutz authored more than ten books and many articles. His work was influenced by Alexander Lowen, Ida Pauline Rolf and Moshe Feldenkrais. As a body therapist he led encounter group workshops focussing on the underlying causes of illnesses and developing alternative body-centred cures. His books, “Profound Simplicity” and “The Truth Option,” address this theme. He brought new approaches to body therapy that integrated truth, choice (freedom), (self) responsibility, self-esteem, self-regard and honesty into his approach.

In his books one encounters the concept of energy cycles (e.g. Schutz 1979) which a person goes through or call for completion. The single steps of the energy cycles are: motivation – prepare – act – feel.

Schutz died at his home in Muir Beach, California in 2002.

Influences

While teaching and doing research at Harvard, the University of Chicago, the University of California at Berkeley, and other institutions, Schutz focused on psychology but also studied philosophy – in particular, the scientific method, the philosophy of science, logical empiricism, and research design (with both Hans Reichenbach and Abraham Kaplan). He also worked with Paul Lazarsfeld, the well-known sociologist and methodologist and Elvin Semrad, professor of psychiatry at Harvard Medical School and clinical director in charge of psychiatric residency training at the Massachusetts Mental Health Centre. For Schutz, Semrad was a key figure, “a brilliant, earthy psychoanalyst who became my main mentor about groups.”

An avid student, Schutz also learned T-group methodology (“T” for training) at the National Training Laboratories (NTL) at Bethel, Maine, psychosynthesis, a spiritually oriented technique involving imagery, devised by an Italian contemporary of Freud named Roberto Assagioli, psychodrama with Hannah Weiner, bioenergetics with Alexander Lowen and John Pierrakos, Rolfing with Ida Rolf, and Gestalt Therapy with Paul Goodman. In his own words, “I tried everything physical, psychological, and spiritual – all diets, all therapies, all body methods, jogging, meditating, visiting a guru in India, and fasting for thirty-four days on water. These experiences counterbalanced my twenty years in science and left me with a strong desire to integrate the scientific with the experiential.”

Alois Alzheimer

Alois Alzheimer (14 June 1864 to 19 December 1915) was a German psychiatrist and neuropathologist and a colleague of Emil Kraepelin. Alzheimer is credited with identifying the first published case of “presenile dementia”, which Kraepelin would later identify as Alzheimer’s disease.

On This Day … 15 December

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Events

People (Births)

  • 1911 – Nicholas P. Dallis, American psychiatrist and illustrator (d. 1991).

Nicholas P. Dallis

Nicholas Peter Dallis (15 December 1911 to 06 July 1991), known as Nick Dallis, was an American psychiatrist turned comic strip writer, creator of the soap opera-style strips Rex Morgan, M.D., Judge Parker and Apartment 3-G. Separating his comics career from his medical practice, he wrote under pseudonyms, Dal Curtis for Rex Morgan, M.D. and Paul Nichols for Judge Parker.

Born in New York City, Nick Dallis grew up on Long Island. He graduated from Washington & Jefferson College in 1933 and from Temple University’s medical school in 1938 and married a nurse, Sarah Luddy. He decided to specialise in psychiatry, and after World War II, started a practice in Toledo, Ohio. Allen Saunders was chair at the time of the local mental hygiene centre that invited him there, and in his autobiography, he recalled that Dallis approached him, as a well-known comics writer (Steve Roper and Mike Nomad, Mary Worth), about “his desire to write a comic strip, one tracing the history of medicine. I told him that, commendable as his idea was, such a feature would not succeed. Readers want entertainment, not enlightenment. But a story about a handsome young doctor’s involvement with his patients might be a winner.”

On This Day … 13 December

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People (Deaths)

  • 1931 – Gustave Le Bon, French psychologist, sociologist, and anthropologist (b. 1840).
  • 1955 – Antonio Egas Moniz, Portuguese psychiatrist and neurosurgeon, Nobel Prize laureate (b. 1874).

Gustave Le Bon

Charles-Marie Gustave Le Bon (07 May 1841 to 13 December 1931) was a leading French polymath whose areas of interest included anthropology, psychology, sociology, medicine, invention, and physics. He is best known for his 1895 work The Crowd: A Study of the Popular Mind, which is considered one of the seminal works of crowd psychology.

A native of Nogent-le-Rotrou, Le Bon qualified as a doctor of medicine at the University of Paris in 1866. He opted against the formal practice of medicine as a physician, instead beginning his writing career the same year of his graduation. He published a number of medical articles and books before joining the French Army after the outbreak of the Franco-Prussian War. Defeat in the war coupled with being a first-hand witness to the Paris Commune of 1871 strongly shaped Le Bon’s worldview. He then travelled widely, touring Europe, Asia and North Africa. He analysed the peoples and the civilisations he encountered under the umbrella of the nascent field of anthropology, developing an essentialist view of humanity, and invented a portable cephalometer during his travels.

In the 1890s, he turned to psychology and sociology, in which fields he released his most successful works. Le Bon developed the view that crowds are not the sum of their individual parts, proposing that within crowds there forms a new psychological entity, the characteristics of which are determined by the “racial unconscious” of the crowd. At the same time he created his psychological and sociological theories, he performed experiments in physics and published popular books on the subject, anticipating the mass-energy equivalence and prophesising the Atomic Age. Le Bon maintained his eclectic interests up until his death in 1931.

Ignored or maligned by sections of the French academic and scientific establishment during his life due to his politically conservative and reactionary views, Le Bon was critical of democracy and socialism. Le Bon’s works were influential to such disparate figures as Theodore Roosevelt and Benito Mussolini, Sigmund Freud and José Ortega y Gasset, Adolf Hitler and Vladimir Lenin.

Antonio Egas Moniz

António Caetano de Abreu Freire Egas Moniz GCSE GCIB (29 November 1874 to 13 December 1955), known as Egas Moniz, was a Portuguese neurologist and the developer of cerebral angiography. He is regarded as one of the founders of modern psychosurgery, having developed the surgical procedure leucotomy – ​better known today as lobotomy – for which he became the first Portuguese national to receive a Nobel Prize in 1949 (shared with Walter Rudolf Hess).

He held academic positions, wrote many medical articles and also served in several legislative and diplomatic posts in the Portuguese government. In 1911 he became professor of neurology in Lisbon until his retirement in 1944.

On This Day … 06 December

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People (Births)

  • 1890 – Dion Fortune, Welsh occultist, psychologist, and author (d. 1946).

People (Deaths)

  • 1961 – Frantz Fanon, Martinique-French psychiatrist and author (b. 1925).

Dion Fortune

Dion Fortune (born Violet Mary Firth, 06 December 1890 to 06 January 1946) was a British occultist, ceremonial magician, novelist and author. She was a co-founder of the Fraternity of the Inner Light, an occult organisation that promoted philosophies which she claimed had been taught to her by spiritual entities known as the Ascended Masters. A prolific writer, she produced a large number of articles and books on her occult ideas and also authored seven novels, several of which expound occult themes.

Fortune was born in Llandudno, Caernarfonshire, North Wales, to a wealthy upper middle-class English family, although little is known of her early life. By her teenage years she was living in England’s West Country, where she wrote two books of poetry. After time spent at a horticultural college she began studying psychology and psychoanalysis at the University of London before working as a counsellor in a psychotherapy clinic. During the First World War she joined the Women’s Land Army and established a company selling soy milk products. She became interested in esotericism through the teachings of the Theosophical Society, before joining an occult lodge led by Theodore Moriarty and then the Alpha et Omega occult organisation.

She came to believe that she was being contacted by the Ascended Masters, including “the Master Jesus”, and underwent trance mediumship to channel the Masters’ messages. In 1922 Fortune and Charles Loveday claimed that during one of these ceremonies they were contacted by Masters who provided them with a text, The Cosmic Doctrine. Although she became the president of the Christian Mystic Lodge of the Theosophical Society, she believed the society to be uninterested in Christianity, and split from it to form the Community of the Inner Light, a group later renamed the Fraternity of the Inner Light. With Loveday she established bases in both Glastonbury and Bayswater, London, began issuing a magazine, gave public lectures, and promoted the growth of their society. During the Second World War she organised a project of meditations and visualisations designed to protect Britain. She began planning for what she believed was a coming post-war Age of Aquarius, although she died of leukaemia shortly after the war’s end.

Fortune is recognised as one of the most significant occultists and ceremonial magicians of the early 20th century. The Fraternity she founded survived her and in later decades spawned a variety of related groups based upon her teachings. Her novels in particular proved an influence on later occult and modern Pagan groups such as Wicca.

Frantz Fanon

Frantz Omar Fanon (20 July 1925 to 6 December 1961), also known as Ibrahim Frantz Fanon, was a French West Indian psychiatrist and political philosopher from the French colony of Martinique (today a French department).

His works have become influential in the fields of post-colonial studies, critical theory and Marxism. As well as being an intellectual, Fanon was a political radical, Pan-Africanist, and Marxist humanist concerned with the psychopathology of colonisation and the human, social, and cultural consequences of decolonisation.

In the course of his work as a physician and psychiatrist, Fanon supported Algeria’s War of independence from France and was a member of the Algerian National Liberation Front.

For more than five decades, the life and works of Frantz Fanon have inspired national-liberation movements and other radical political organisations in Palestine, Sri Lanka, South Africa, and the United States. He formulated a model for community psychology, believing that many mental-health patients would do better if they were integrated into their family and community instead of being treated with institutionalised care. He also helped found the field of institutional psychotherapy while working at Saint-Alban under Francois Tosquelles and Jean Oury.

Fanon published numerous books, including The Wretched of the Earth (1961). This influential work focuses on what he believed is the necessary role of violence by activists in conducting decolonisation struggles.

On This Day … 05 December

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People (Births)

  • 1901 – Milton H. Erickson, American psychiatrist and author (d. 1980).

Milton H. Erickson

Milton Hyland Erickson (05 December 1901 to 25 March 1980) was an American psychiatrist and psychologist specialising in medical hypnosis and family therapy.

He was founding president of the American Society for Clinical Hypnosis and a fellow of the American Psychiatric Association, the American Psychological Association, and the American Psychopathological Association. He is noted for his approach to the unconscious mind as creative and solution-generating.

He is also noted for influencing brief therapy, strategic family therapy, family systems therapy, solution focused brief therapy, and neuro-linguistic programming.