The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles, is sure to have trouble.
~ Josh Kaufman, Personal MBA
As a field, we were obsessed with methods, approaches, tools, theoretical orientations, and schools of thought. Money poured into establishing treatment efficacy differences have not yield much fruit; therapists investment in time, effort and money to train in specific models have not demonstrated improvement in our results.
I suspect that one of our key mistakes is a failure to learn first principles, instead of methods.
In a previous post, I talked about the iterative cycle that we can take in our professional development (click HERE to revisit it, and download the free infographic).
Here’s something that I’ve recently revisited that struck a chord:
“The theorists can only build his theories about what the practitioner was doing yesterday.
Tomorrow the practitioner will be doing something different because of these theories.”
~Gregory Bateson, 1951/68.
Most good theories that we develop in our practice derives after the fact, not before.
In a previous post, I advocated the need to go beyond seeking the help from one individual.
It is up to you to Build a Portfolio of Mentors. It doesn’t happen to you; it’s what you do to make these mentorship work.
There are at least four types of mentors you can seek out.
1. Formal Mentors:
Seek out people that inspire you.
When I first reached out to Scott Miller, I didn’t think he would respond, let alone agreed to guide me in my development. Fast forward a decade later, he still is my someone that I turn to for guidance, even as we collaborate in our writings and teachings.
Another person I sought after at the tail end of my masters in 2005, was a highly perceptive and personable therapist, Juliana Toh who was teaching us systemic therapy. This was the ONE module that made all the difference to me. Near the end of the course, I asked Juliana if a few of us can connect with her for ongoing supervision. She agreed. And this set up another decade’s worth of consultation with her. Priceless. (One of the common practices she had that I adopted was for us to bring in taped-sessions).
2. Informal Mentors:
Seek out colleagues, friends, in and outside of your organisation to connect on a routine basis.
Tell them that you’d like some guidance in some particular area of your work. Buy them lunch during your once a month meeting.
Use these meetings as a check-in, a pit-stop, or even a form of accountability for the stuff that you are working on.
3. Seek Consultation as a Team:
While formal and informal mentors may not typically be a paid service (besides, I don’t think your friend should accept your money), another form of highly valuable professional guidance you can obtain is to seek consultation as a organisation.
This is typically more economical in cost. It is also beneficial if the agency wants to implement new changes in their organisation, and the leaders aim for everyone to be on board.
Consultations are much more powerful and effective, as compared with sending the team to a 1-2 day workshop. The reason is that ongoing routine consultations are aimed at a more SPECIFIC and SUSTAINING manner. Workshops typically ignite interest but fail to fan the flame.
So if you are a leading a team and them to a workshop, make sure you have a clear committed plan ahead on how to sustain the interest of implementing these new ideas.
I spend much of my time mentoring practitioners and consulting with agencies. Even though I offer a special extra value of connection in between, only a minority of people ask me questions between our consultations.
If you seek out a consultant, you shouldn’t feel afraid to bother them in between the formal consultations. That’s because most of the important challenges surface in-between!
In one agency, after an initial training they had with me, they had planned for the ongoing consultations to be once every three months. While they were trying to integrate the use of outcome measures into their daily clinical practice, several of the clinicians were struggling on how to introduce the measures. Thankfully, one of them emailed me on how to address this issue, as the next consult was 8 weeks away. And I provided them some tips and resources as they rolled out the implementation.
4. Instrumental Mentors:
Books and reading materials can be your “Instrumental Mentors,” if you approach this with a mindset of “Just-in-time” learning mentality.
Therapists complain that they do not have enough time to read, given their unending workload. “Just-in-time” learning can help to speed up the learning process but being highly focused and targeted with what you read.
I’m currently enrolled in an online learning course with Scott H Young, called Rapid Learning. One of the things he advocated is to treat each thing that you are learning as a PROJECT. I think it’s a brilliant idea. It gives a handle, and projects can be broken down into parts with an overarching specific goal, along with a deadline, milestones and a week-by-week breakdown of how you plan to accomplish it.
Here’s some examples: if you find yourself struggling with dealing with your client who has high self-criticism, you might persue reading materials from Leslie Greenberg’s work in emotion focused therapy.
If you are working with a couple who are struggling with rekindling their sex life, you might turn to Ester Perel’s work.
If you are working with a family who is facing power struggles with their teenage daughter, you might turn to Salvador Minuchin’s work in structural family therapy.
The key to using Instrumental Mentors via a just-in-time learning approach is to develop your FOCUS.
Here’s how:
1. Block out 30mins to an hour per week within your work hours (yes, you heard me right. Keep it at work, because this form of deep work DIRECTLY addresses your clinical work);
2. Identity the ONE THING that you need to work on at this stage.
3. Read with a just-in-time learning mentality, which means you have to read with the SPECIFIC OBJECTIVE in mind (and avoid Facebook during this blocked out time, AT ALL COST).
4. Keep a learning log. I’m sure I’m not alone; all of us have experienced this thing called Professional Amnesia. That is, we learn something so important at one point in time, but we forget these perennial learning, and instead, get enamored by what’s new and shiny.
By keeping a learning log, you can (and should) revisit them. I’ve been using a free Simplenote to archive my weekly learnings over the past five years. Every so often, I’d open the app, look at a past learning title and test myself, if I can recall what I learned in the past. I’m often shocked at the experience of Professional Amnesia. “Did I write that?”
(I love simplenote. It’s by the creators of wordpress-the platform I use for my website. I’ve used several note taking apps. Evernote has a ton more features, and I use evernote more for web clippers. On the other hand, What I love most about Simplenote is the constrain. You can’t change the font or font size, you can muck around with the formatting, etc [unless you use markdown symbols]. And that’s really helpful to capture your learning ideas down quickly. PLUS, it’s super quick to retrieve your notes, especially if you tag them. I tag my weekly learning log as “TherapyLearnings”. It all syncs across platforms and devices seamlessly. All that… for free!
This is also a good way to stave off our allure towards the timely things, and return to the time-less matters that count.
Don’t forget that the people who write those inspiring materials are also actual human beings. Reach out to them if they spark something in you. Email them, chat with them. Seek them out to be your formal mentors, or seek consultation with them as a team. The world is no longer divided into authors and readers. Every true author is an avid reader, and every reader is capable of becoming an author. So let’s connect.
FINAL TIPS:
1. “Show Your Work”: If you seek out a paid mentor/supervisor/consultant, make sure you do not just “talk about your work.” Instead, “show your work” with the use of audio/visual recordings, so that your mentor knows your work (eg segments of your therapy recordings + outcomes). What good is gossiping even with a good theory in mind?
2. Before and After: What’s crucial is what you do before and after a mentoring session.
Do the Prep work…
and then…
Do the reflection.
Maximise the sessions and time you devote to the mentorship connection. It’s not just the hour or two that you spend that counts. It’s what you do for the prep, and what you do at the end to pull it all together, so that it sticks.
Afterall…
LEARNING =TRANSFER
Anything worth building requires more than an individual.
There is no doubt, psychotherapists value professional development. After all, we are in the business of human development. We prize growth and change not only in our clients, but in ourselves.But the truth is, we seem to be hopping from one workshop to another, one therapy model to the next, without a clear map of where we are going.More worryingly, we aren’t sure if all these activities actually do translate to improvement in our client outcomes. It feels like we are walking in the dark, and we have no clue if we are getting any better with practice. In theory, we feel like we’ve learned so much. In practice, the needle hasn’t moved in our effectiveness.[1]And deep down, there’s this nagging practice anxiety, AM I any good? Is what I’m doing helping me not only to feel like I’m growing, but actually translating into better outcomes for my clients?
In our attempts to deal with our professional neurosis, we think we need to settle for one or two approaches to psychotherapy, so that we can get better in those ways of thinking and working with our clients.
I argue that this is inadequate.The evidence is clear: Model adherence leads us to no better outcomes. [2]Instead, what I propose in this 5-step “iterative pathway” is to encourage the following:1. To assist practitioners in IDENTIFYING where they are at in their journey of professional development, and2. To encourage dynamic MOVEMENT in their exploration.The second point requires some explanation. Gleaning from various domains, developmental psychologist Daniel Stern points out the importance of developing forms of vitality.[3]Here I’ve made a distinction between Forms of Lifelessness and Forms of Vitality:
In this 5-Step Iterative Pathway of a Psychotherapist’s Professional Development, I propose for movement and a sense of directionality. (click here or the image to download a full-sized pdf of the INFOGRAPHIC). I’d spell out what these 5 steps are and provide you with some quick tips along the way. (Click here to download the Infographic for yours to keep.)
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STEP 1: GO BROADLike any introduction, educators generally encourage students to study the breath of different theoretical orientations in psychotherapy. This is an entree stage. Taste and see. Stay curious as you explore the landscape of our field.
This video series is expensive. But I highly recommend it (If you have a university library access, check if your institution is subscribed to Alexander Street Press. There are tons of counseling related video streaming in ASP database, including this one. Judith Beck, Les Greenberg and Nancy McWilliams also worked with a male client, demonstrating their approach.)
b. psychotherapy.net (go to the Approach section and see the various videos)
c. Check out David Van Nuys, Ph.D. Shrinkrap radioDr Dave has been my instrumental mentor in exposing me to the other facets of psychotherapy I wouldn’t have known.
STEP 2: GO NARROWOnce you’ve a taste of the exuberant and diverse field of psychotherapy in Step 1: GO BOARD, zoom in on a vital few that you have a natural gravitation towards.Remember, especially at this stage, be “un-wedded” to the ideas that you gravitate towards. Many truths can co-exist. Treat your system of belief as a working hypothesis; ready to be proven wrong.
TIPS:
1. Read, any books on psychotherapy that you are drawn to. Don’t settle for what a textbook says. Pursue the source further. Hunt down what the authors cite. Chase the source and discover the roots.
Reflect on how these theories links with your beliefs about the psyche and human development.I vividly recall reading about Carl Rogers person centered work in some textbook, and thought nothing much about it. Everything changed when I pursued his writings in the two books A Way of Being, and On Becoming a Person. Somehow, watered down Rogers work to unconditional positive regard, congruency and empathy, just didn’t cut it.
In fact, if you watch closely any of his therapy sessions, Rogers is strategically brilliant and sensitive in his craft.
2. Watch and Listen:Watch, your favorite master therapist in action.
After you’ve familiarised yourself with the landscape of psychotherapy (STEP 1: GO BROAD), and steeped yourself in a few schools of thought that whet your appetite (STEP 2: GO NARROW), explore other territories outside of psychotherapy.Join the dots with your existing knowledge (e.g., arts, science, sports, spiritual/religious traditions, philosophy, computing).For example, music (particularly improvisation) and contemplative practices have been a mainstay for me in thinking about the metaphorical parallels with therapy. Of late, I’ve also found it basic knowledge of computer coding to be an interesting source of how clear pre-meditative thinking can be applied to cognitive and behavioral interventions.
Biologist Steven Jay Gould coined an intriguing term, called exaptation. An exaptation refers to a trait developed for one purpose that is later used for another purpose.
TIPS:
Pick at least 3-5 topics outside of therapy that interests you. Pursue them with depth, AND see how these domains can teach you more about the craft of psychotherapy.
(Warning: A side-effect of Step 3: GO LATERAL is that it can set you off to a different career path.)
STEP 4: GO NARROW (AGAIN)Consolidate and integrate new learnings that you’ve picked up at Step 3: GO LATERAL. Connect them with what you’ve learned in STEP 2: GO NARROW.We know from studies that there’s significant differences between therapist who claim to do the same type of psychotherapy approach. In fact, there’s more therapist differences than orientation differences.[4] Your unique voice and perspective is now emerging.
Interestingly, the words of the great investor and teacher Benjamin Graham is highly relevant here:
“You can get in way more trouble with a good idea than a bad idea, because you forget that the good idea has limits… You’ll know you’re on to something when ideas start to compete with one another — you’ll find situations where Model 1 tells you X and Model 2 tells you Y. Believe it or not, this is a sign that you’re on the right track. Letting the models compete and fight for superiority and greater fundamental truth is what good thinking is all about! It’s hard work, but that’s the only way to get the right answers.”
TIPS:
1. Make time to join the dots: Reflection is key at this stage. Without drawing deliberate links to your work as therapist, these various domains remind EXTERNAL and not integrated into the way you see and do therapy.2. I highly recommend writing down your learnings. Put a date on it. When your future self looks back at these, you will be surprised. Surprise is a good way to encode and re-learn stuff that you’ve forgotten.
STEP 5: GO BACKWe have come full circles. It’s time to return to the fundamentals.We mistake fundamentals as something for the beginners. The accomplished and the enlightened knows that fundamentals are an advanced skill.A true musician knows that at the heart of a song, it’s rhythm, bass, harmony and melody. While we may get enamored by tricks and techniques, a discerning therapist knows that when he or she is in times of difficulty—or simply not sure of how to help a client— a useful heuristic is to examine our fundamentals.The amateur thinks he’s the expert, while the expert thinks like an amateur. This is the cycle of our development.
2. Use the Taxonomy of Deliberate Practice Activities (TDPA) to identify WHAT to work on. (email me daryl@darylchow.com to receive a copy of this)
3. Watch and Listen:
Your Own Session Recordings: Once you’ve used the TDPA to identity the key area to improve on, watch segments of your sessions. Play, Pause, Reflect. What can you do differently to increase the impact for engagement in that particular point in the recording? Employ the help of a peer, a mentor, or consult someone.
~~
The key isn’t to reach enlightenment. Rather, the emphasis is first to know where you are at in the stages of your professional development, and second, is to promote MOVEMENT and clear DIRECTIONALITY in this iterative process.It is motivating when you know where you are, and where to go next. True professional development not only inoculates us from burnout, it also lits a spark of vitality in your life.Now, it’s your turn. can you identify where you are in this iterative process of professional development? Share with us in the comments section below.
Very Best,
Daryl
Footnotes:
[1] Chow, D. (2017). The practice and the practical: Pushing your clinical performance to the next level. Prescott, David S [Ed]; Maeschalck, Cynthia L [Ed]; Miller, Scott D [Ed] (2017) Feedback-informed treatment in clinical practice: Reaching for excellence (pp 323-355) x, 368 pp Washington, DC, US: American Psychological Association; US, 323-355. Miller, S. D., Hubble, M. A., Chow, D. L., & Seidel, J. A. (2015). Beyond measures and monitoring: Realizing the potential of feedback-informed treatment. Psychotherapy. doi:http://dx.doi.org/10.1037/pst0000031
[2] Webb, C. A., DeRubeis, R. J., & Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 200-211. doi:http://dx.doi.org/10.1037/a0018912
[3] Stern, D. N. (2010). Forms of vitality: Exploring dynamic experience in psychology, the Arts, Psychotherapy, and Development. Oxford: Oxford University Press.
[4] Chow, D. (2014). The study of supershrinks: Development and deliberate practices of highly effective psychotherapists. (PhD), Curtin University, Australia.; Wampold, B. E., & Serlin, R. C. (2000). The consequence of ignoring a nested factor on measures of effect size in analysis of variance. Psychological Methods, 5(4), 425-433.
“Pray for one humiliation a day,” says Franciscan Friar Richard Rohr. “And watch your inner reaction to it.”[1]
This is not some Catholic self-flagellating, guilt inducing exercise. Rather, if we see with fresh eyes, every moment of difficulty that we face in a session with you client, presents a gift to you.
These moments areterrible gifts, if we open yourself to deep learning—this sense of moving aside the Ego, and leaning forward towards healing for your client, and for you.
It is terrible because we will feel uncomfortable. The Ego will be bruised, our sense of self will be shaken.
But it is a gift because it has the powerful potential to help us move out of our comfort zone and into our learning zone.[2]
Every difficult moment in therapy is a gift, only if you open yourself to this moment.
But these difficult moments depend entirely on our response. If we reacted from the Ego, a difficult moment is a curse. If we responded humanely to our client and to ourselves, a difficult moment will bless you.
After all, some burdens are a blessing, and some blessings are a burden.
The next time you are faced with a difficult moment in therapy, do not ask, “Why is this horrible situation happening to me?” Instead, go deeper and ask yourself, “What is this difficult moment teaching me?”
Then do the following:
1. Slow: Make haste slowly; slow down your speech (your heart will follow);
2. Ego: Move the ego aside;
3. Lean in: Move towards your client. And stay right there with the other.
That’s how we grow.
p/s: I love to hear in the comments below what sorts of challenges you face in your clinical practice.
MS. TIPPETT: [laughs] “I have prayed for years for one good humiliation a day, and then I must watch my reaction to it,” which sounds so uncomfortable. There’s nothing in me that wants to pray for one good humiliation a day.
FR. ROHR: No, and there isn’t in me either. I just said that to that group of millennials two weeks ago. Some years ago, I started recognizing that I was getting an awful lot of adulation and praise and some people treating me far more importantly than I deserved. And I realized I was growing used to it, that the ego just loves all of this admiration and projection. And a lot of it was projection. And I didn’t want fame and well-knownness and guru status to totally destroy me, and so for me, this became a necessity, that I had to watch how do I react to not getting my way, to people not agreeing with me, to people not admiring me — and there’s plenty of them — and that I actually needed that. And so I do, I still, I ask God for one good humiliation a day, and I usually get it, one hate letter or whatever it might be. [laughs] And then what I have to do, Krista, is I have to watch my reaction to it. And I’ve got to be honest with you, my inner reaction — I’m not proud to tell you — is defensive, is, “That’s not true. You don’t understand me.” I can just see how well-defended my ego is. And of course, even your critics — and I have plenty of them — at least 10 to 20 percent of what they’re saying is usually true. [2] Chow, D. (2017). The practice and the practical: Pushing your clinical performance to the next level. Prescott, David S [Ed]; Maeschalck, Cynthia L [Ed]; Miller, Scott D [Ed] (2017) Feedback-informed treatment in clinical practice: Reaching for excellence (pp 323-355) x, 368 pp Washington, DC, US: American Psychological Association; US, 323-355.
I get the goose bumps when I hear the type of questions discerning therapists raise at my workshops.
Participants reflecting on their questions regarding their professional development
It strikes me every time not only because these are the questions I’ve been pondering about for awhile now, but also because of how universal these questions are.
Here’s what I’m discovering: When we provide a space for a focused inquiry [1], we create an opportunity to ponder, search, reflect. We step into a deeper sense of focus on the right questions, as we resist the urge for a quick answer.
“You know, if you know the answer, but you don’t know the question you are in a bad way. But if you have questions, you will find answers.” ~ Salvador Minuchin, 2000
Here are some of the examples of actual questions psychotherapists, counsellors, and other mental health professionals like you ask:
For songwriters, the perennial pillar is song craft. It is not technical mastery.
A songwriter knows that technical agility at an instrument is not going help him create a better song. It’s easier to identify and work at improving techniques. It’s much harder to improve on their ability to engage with listeners through their songs.
At the time of this writing, in 2017, we commemorate three critically acclaimed albums.
If there are any three records you’d need to hear in your lifetime, it’s these.
Half a century ago, The Beatles released Sgt Pepper’s Lonely Heart’s Club Band. 30 years ago, U2 brought us the follow-up album from The Unforgettable Fire, Joshua Tree. And 20 year ago, Radiohead released Ok Computer. Modern music has never been the same since.
Sgt Pepper would never have had the chance to grow if the Beatles did not take the time away from touring.
The Irish boys from U2 narrowed the focus based on the American landscape in the making of Joshua Tree. Because they made that decision, the album reflected their evolving social consciousness of their time. The album become a timeless piece of art.
Radiohead’s Ok Computer, was spawned from the band’s disillusionment with a relentless touring schedule, resulting in their lives becoming a tour-bus race at the speed of light from one concert venue to the next. They had enough. A break was needed.
(As an aside: It is significant to note that none of these records were the artists’ first albums.)
Consider three lessons we can draw from these landmark albums:
Seek out a portfolio of supervisors, mentors and coaches.
The apprenticeship model of clinical supervision certainly has its merits. It takes us beyond what we read and what we derive from experience in clinical practice. After all, clincial supervision has been defined as the “signature pedagogy” of our field.[1]
However, clinical supervision as we know it, has little tono impact on our actual improvement. If we are to truly develop, and have a deep impact on our clients’ lives, we need to take a more expansive view about this master-apprentice model of professional development.
Instead of enlisting a supervisor for guidance,
we should instead build a portfolio of supervisors, mentors, and coaches.
No one person has all the keys to guide you. It would be unwise to expect to learn everything from one teacher. Instead, we need to first identify areas that we have gaps in our knowledge, and then seek out coaches in that particular domain of expertise.[2]
Do your prep before you approach your guides. Figure out whatyou need to be working on. Make it concrete and write them down. (It’s not enough to just think about them in your head). Date it. When you look back, you get a sense of your evolution.
Remember: Keep one eye on your performance (i.e., client outcomes), and the other on your development (i.e., how you are learning).[3] Enlist the community of guides to make sure you have both eyes focused on where it should be.
Surround yourself with people that can help you become a better version of yourself, not become a mimicry of them.
Your Partner in Crime, Daryl
~
Notes:
[1] Watkins, C. E. (2010). Psychotherapy supervision since 1909: Some friendly observations about its first century. Journal of Contemporary Psychotherapy, 1-11.doi:10.1007/s10879-010-9152-2
[2] Some of these terminologies were borrowed from Dorie Clark’s book, Reinventing You.
[3] Chow, D. (2017). The practice and the practical: Pushing your clinical effectiveness to the next level. In D. Prescott, C. Maeschalck, & S. D. Miller (Eds.), Reaching for Excellence: Feedback-Informed Treatment in Practice: APA.
What if one of the ways of transforming our practice in psychotherapy is to stop calling it talk therapy, but to see it as a performance ritual?
What if we stop talking, and start performing?1
I suspect that if we step beyond therapy models, and see our work as a therapeutic and healing endeavor, we can begin to embrace it is a performance ritual.
In gist, here’s how most therapy goes: Once we create a space and a climate of safety, we dive into the sea of one’s human suffering, and hopefully, in the act of the two or more humans coming together weaving a “believable myth”2(be it addressing cognitive distortions, self-critical markers, past traumas, etc.), growth and change can happen.
The act of two persons working as “of one mind”3 , should not be relegated to a manual’s precription or one (or even two) dogmas. Neither should it be left to “make things up” as we go. Here’s why:
The moment we start to see therapy as a performance, we can break it down into component parts.
Here are some examples:
1. How do you prepare for a session?4
2. How do you begin a session/subsequent session?
3. How do you establish an effective focus with your client?
To those who see therapy as an art form, we can begin to learn to set the stage to enliven the possiblity of deep human interaction, and weave a structure to what seems un-structured to the naive eye. (Even music and theatre improvisers follow a set of rules in their seemingly free-form jams5).
To those who see therapy as more of a science-based pursuit, we can afford to develop some hypothesis for fruitful and – God forbid – playful creation. We can learn to be more responsive6and utilise7 what each person bring of themselves into the therapy room.
Afterall, there is a creative art form in science, and there is a methodical science in art.
Once we see things in component parts, things get more complicated than they seem. Ask a person to rate how well they know about how a toilet flush works, and enquire again after you ask the same person to list out, in detailed step-by-step fashion of how the whole ceramic bowl and flushing systems work, their self-assessment ratings are more than likely to dip.
That said, by breaking things down into its component parts, it allows a devoted practitioner to develop a focused deliberate practice plan to improve at that particular area8.
Question:
What have your identified to work on, that has a leverage on improving your outcomes?
The moment we “stop talking, and start performing,” we invite a different way of seeing our work. We can then invite a host of repetitore that can lit up a fire of engagement in this thing we can psychotherapy.
As musician Frank Zappa says, “The mind is a like a parachute. It doesn’t work if it is not open.”
Enjoy,
Daryl Chow, PhD
Notes:
1. I came around to this term by interviews with Michael Port and Amy Port on the Art of Charm podcasts. Michael Port elaborates further in his book, Steal the Show.
3. Doug Flemons book is titled “Of One Mind.” Though it is primarily about hypnosis, I think it’s a highly relevant read for engaging with someone in therapy.
4. See a brilliant recent 2017 book by Daniel McGinn, Psyched Up
5. I highly recommend Patricia Madison’s Improv Wisdom. For those who are interested in the world of music improvisation, Derek Bailey’sImprovisation is a must-read)
6. see Ben Stilles’s work on Responsivity. E.g., Stiles, W. B., Honos-Webb, L., & Surko, M. (1998). Responsiveness in psychotherapy. Clinical Psychology: Science and Practice, 5(4), 439-458.
7. Utilisation is at the heart of Milton Erickson’s work.
