Frontiers of Psychotherapist Development

At the Bleeding Edge of Development, Reaping Benefit for Our Clients.

Tag: development (page 2 of 2)

What Have You Changed Your Mind About? 

What Have you changed your mind about?

 When thinking changes your mind, that’s philosophy. When God changes your mind, that’s faith. When facts changes your mind, that’s science. 

~ from Editor John Brockman, the Edge book, What Have You Changed Your Mind About? 

Do you know someone who seems to know everything? When you share a new idea with this friend or colleague, they give you that “I-knew-it-all-along” kind of nod and smirk? This person is more likely to be thinking about what they are going to say next, than listening to what you have to say. I have to admit, I find it hard to talk to Mr. “Knew-It-All-Along.” It’s never their intention, but I feel stupid with them.

Here’s a book about a bunch of really big smarts from a variety of fields, who come to the conclusion that what they knew, was wrong, and were willing to change their minds, something which Mr. “Knew-It-All-Along” will find this very hard to do.

In this book, editor John Brockman asked renowned scientists and thinkers around the world this one simple question:

What Have You Changed Your Mind About?: Today’s Leading Minds Rethink Everything (Edge Question Series)

Take this specific example from developmental psychologist, Paul Bloom. (He wrote a brilliant book on the moral development of kids, called Just Babies.) Who would have thought that you can make a case against empathy? Listen to his compelling argument with neuroscientist, Sam Harris podcast before you make up your mind.

(Since the time of this writing, I just realised he’s book on this topic is finally out. It’s called, Against Empathy)

Here are two  of my favorites:

1. The Collaborative Community, by futurist and founding father of the internet, editor at large for Wired magazine and author of The Inevitable Kevin Kelly:

“Much of what I believed about human nature, and the nature of knowledge, has been upended by Wikipedia.”

Kevin Kelly goes on to elaborate about the power force of communities that shaped Wikipedia as we know it today.

2. What Constitutes Life Satisfaction by cognitive scientist and nobel prize winner in economics, Daniel Kahneman: “Conditions that make people satisfied with their life do not necessarily make them happy.” Kahneman makes a compelling argument on this topic. I had to re-read this a few times, at different times to let this one sink in.

The folks at Edge.org are a generous bunch. I just realised the whole damn book is free in their website! [https://www.edge.org/annual-question/what-have-you-changed-your-mind-about-why](Somehow, I found it more compelling to read it in the paperback form. Maybe’s it’s the tactile thing, but I also reckon the layout and the commitment we give to a given book, makes it more focused.)

If this book were to be released in 2015,  past president of the DSM-IV committee, psychiatrist Allen Frances   would have been an important addition to this series  on his change of mind and his outcry of the DSM-V (Check out Dr. Frances’ talk on the recent issue of diagnosis Inflation, and his thought provoking book, Saving Normal).

(Here’s an early article in 2010 by Gary Greenberg on the heated battle of the DSM-V. Well worth the read)

~~~

Now, back to us. Let’s take a moment and ask ourselves: When was the last time you changed your mind?

Do we read new things seeking to be confirmed, or do we open ourselves to be disconfirmed?

Do we hold tentative, or do we end up solidified in our ideas, metaphors, and beliefs about what we know and practice as a psychotherapist?

Once again, “When thinking changes your mind, that’s philosophy. When God changes your mind, that’s faith. When facts changes your mind, that’s science.” My add-on: When you change your own mind, that’s atheism. When someone changes your mind, that’s love.

In relations to our field of mental health/psychotherapy, I would love to hear from you in the comments below, the very same question John Brockman asked six years ago:

 

WHAT HAVE YOU CHANGED YOUR MIND ABOUT? WHY?

Daryl Chow, Ph.D.

 

 

How Do You Get Better At Eliciting Feedback?

 

ask-more-questions

…But what questions should we ask?

In the previous post, we addressed the issue of how to receive feedback.

In this post, we take a step back and address how we can elicit feedback.

But before we dive right in, ask yourself:

Do you really want to know? I used to find myself hesitant to ask for feedback when I know someone was amiss in the session. I’ve learned from my colleagues that this is common. What I learned is to point it out anyway, “You know Tim, I noticed that I might have missed something essential to you today. Am I mistaken? Can you help me figure out what that is, or what we could have explored further on?”

How we convey a sense of openness to the other person’s point of view will determine the type of feedback we get.

When we ask, ”Is everything ok today?” will skew towards a vocal-tic response, “Yeah. All good.”

Where we point the lens, it becomes the foreground. Discuss in advance what you are looking out for. While it may sound counterintuitive at first, take some time to process the following:

High session ratings of engagement by your client is not predictive of good outcomes (e.g., Owen, Miller, Seidel, Chow, 2016). In contrast, highly effective therapists seem to be able to elicit low engagement scores in early sessions. High alliance scores in the first session tells us nothing. The client could be truly happy with the session, or she might not feel safe to tell you how badly you missed her point today.

srs-1srs-2srs-4srs-3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you know the average alliance formation trajectory among your clients? Which of the above fits your pattern?

We’ve also found in our initial Supershrinks study (Chow, 2014; Chow et al 2015. Stay tuned. We are on to some replication studies. More on that next time) that as compared to the average cohort, highly effective therapists are more likely to report being surprised by client feedback. That is, the top performers are more likely to report being surprised by client’s feedback that their counterparts. It does seem to suggest that the highly effective therapists are more willing to be corrected. They have a sense of openness to receive and consider client’s viewpoints, even if it may be contradictory to the therapist existing expectations.

Janet Metcalfe and colleagues suggest that individuals are more likely to correct errors made with initial high confidence than those made with low-confidence, so long as the corrective feedback is given (Barbie & Metcalfe, 2012; Butterfield & Metcalfe, 2001; Butterfield & Metcalfe, 2006; Metcalfe & Finn, 2011). Although it may seem intuitive that deeply held beliefs are more entrenched and are the hardest to change, experimental studies have indicated that individuals are more likely to overwrite their responses and correct their beliefs (Butterfield & Metcalfe, 2001; Butterfield & Metcalfe, 2006), and are more likely to retain the correct answer compared to knowing the correct answer at the outset (Barbie & Metcalfe, 2012).

What? That’s a mouthful. Put it this way. Stand tall, and stand corrected.

Here’s some key points to remember when trying to elicit feedback from your clients at the end of a session:

1. Prime the Recall:

Give a good rationale WHY your client’s feedback about the session is crucial to you;

2. State What This is Not:

For example, “This is not an evaluation tool…You know how we are asked to do feedback surveys at restaurants? This is exactly what it’s not! Simply because those types of feedback, do not effect a change that will impact you. Your meal isn’t going to change because of your feedback. Here in the session, your feedback is important to me as it can help me tailor to fit you specifically…”

3. Juxtapose Open and Close Ended Questions:

Conventional wisdom argue to use open ended question. “What was the session for you?” Most of the time, this is too vague for clients. Instead, ask the specifics. “As you recall out what we talked about, and the exercise we did before we wrapped up, What was helpful to you?” After they share with you a response, follow it up with, “What was not helpful to you?” “…I know it’s tough to give feedback… we don’t normally tell others what we think, but your point of view is very important to me. I won’t take it personally, but I will take it very seriously…. cos’ sometimes, I just can’t see what I can’t see.”

4. Be Specific:

If you want specific feedback, be specific with your questions. “You know Kelvin, I got a feeling that I’ve pushed you too far today, especially when we were attending the issue about your fears. Am i mistaken?”

“What should I do more of?”

And

“What should I do less of?”

5.  The Small of Things:

Say this, “You know as it’s hard to give someone feedback, I just want you to know that even if you think it’s a small or minor issue, please, I would love to hear about it.”

Cite examples: “You know, I once had a client who told me that I was too careful with her, and she wanted me to just be blatant with her. Do you feel that way too?”

As a form of closure, you can ask, “If there’s just one thing, what stands out for you today that you’d like to remember from our session?” Write that down, and begin to form ideas to bridge this into the next session.

Don’t forget to take a gamble on your own to make a prediction of how your client rates the session, before you see their ratings on the alliance measure. (see an older post that I talked about this practice, called Rate & Predict exercise)

All systems balances itself with a feedback loop. It’s up to us to elicit the specifics, and then follow through be an open and warm receiver. It’s abit like receiving presents during this Christmas. Be thankful.

At the time of this writing, I wish each of you a happy new year.

Best,

Daryl Chow, PhD

30th of Dec 2016

 

How Do You Get Better at Receiving Feedback?

 

waitress-funny-service-with-a-smile

“How was your meal sir?”

“Fine, thanks.” I lied.

Five minutes into the meal, the waitress comes back to me. She’s wondering why I haven’t touched my pasta one bit since she last enquired.

“Erm, your meal going ok?”

“Yes, it’s fine.” I feel for the leading question. I smiled, and returned to my conversation with my two friends.

The truth is, the pasta was so salty that I couldn’t continue without numbing my mouth. But I couldn’t be bothered. I was planning to wash it down with a cup of coffee later, and continue my conversation.

This time, she’s bold. She stepped into the fire and asked me again, “Sir, is everything ok?”

I thought to myself, man, she’s persistent. I gotta hand it to her. Maybe I should just tell her.

“Actually, since you asked me for the third time. I have to say,  Frankly, I don’t think I’m a fussy eater, but the pasta is so salty I can’t eat anymore of it.”

In a million years, I couldn’t have guessed her reply. She came up with a one-liner. In fact, it was just two letters.

“Oh,” she said.

Bypassing the awkward silence, she stepped one foot back, and inched away. We couldn’t believe what just happened. I’m a hopeful guy. I waited to see if she might return with  a replacement, indulge me in a tiramisu  cake to sweeten my tooth from the numbing sensation in my mouth, or maybe even waive the cost of that half eaten dish.

None of that happened.

If you ask for feedback, you got to learn to receive it. Period.

Another time, at a phone centre in Singapore, this customer service personnel blatantly said to me, “Bro, everything’s good (with the service) right?”

“Erm,” I said.

“Hey, don’t mind, please give me a good feedback rating here (pointing to the form) please.”

For once I manned up, and said no. It just doesn’t make sense. He was asking for my help, not my feedback. He wasn’t very please with me thereafter.

~~~

Feedback is tough. In the process of writing their book Difficult Conversations: How to Discuss What Matters Most, authors Doug Stone and Bruce Patton realised that most people found it the most difficult giving and receiving critical feedback.

We expect our clients to give us just their honest feedback about the session, and we expect ourselves to enter into potential landmines with open arms. What we really need to learn is the fundamentals of being a good feedback elicitor and receiver, with all the good, the bad and the ugly that comes with it.

Look at your personal library.  Do you own a book that teaches you to be a good receiver of feedback?  I recommend you check out Stone and Patton’s 2014 book “Thanks for the Feedback: The Science and Art of Receiving Feedback Well” It’s not a psychotherapy book. In fact, I think therapists should do their best to read outside of the jargon-laden therapy world to widen your lens and speak a common language.

I once heard a therapist say to a client who was mad at her for making her feeling interrogated with a barrage of questions, “Thank you so much for your feedback. It must take so much courage to say what you said.” On the surface, it sounds ok to say that. It’s polite. It’s what we are taught to say.

Lets face it. Is it easy to take negative feedback from you client? No. Is is pleasant? Hell no. Then I think we should be honest and simple say that. “You know, I must admit, this is hard to take in. I’m trying to digest what you are saying… because this is important… What you are saying is that I’ve interrogated you, bombing you with questions after questions. It’s hard for me to admit… but you are right. Instead of helping you,  I’ve made you feel like a criminal, when you have don’t nothing wrong…. I’m sorry. I’ve let you down today. Again, it’s tough to hear this, but thanks for telling me.”

Supervisors can also highly benefit from digging deep into learning about how to elicit and receive feedback. It’s easy to take for granted the collegial bond, and expect supervisees to vocalise their concerns when the need arises. I argue, that because of the relationship, it can be even harder in a supervisory context than in a therapy.

The authors of Thanks for the Feedback points out three key triggers that can set us off when we receive critical feedback:

  1. Truth Triggers: When something we deny or disagree with. It makes us feel indignant;
  2. Relationship Triggers: Think about how your dad can say something that makes you explode, but when your trusted coach say the exact same thing you take it as good advice. Who matters more than the What, and
  3. Identity Triggers: This gets personal. It shakes the core of you. “We feel overwhelmed, threatened, ashamed, or off balance” by the feedback. (Has that happened to you before? I’m no stranger to this. It hurts.)

Stone and Patton offers some suggestions of dealing with such triggers. For truth triggers, they suggest learning to separate appreciation, coaching, and learning to see your blindspots. For Relationship triggers, they suggest separating the We from What. Finally, for identity trigger, they suggest learning to challenge our pre-existing assumptions and cultivating a growth (vs. fixed) mindset (ala Carol Dweck’s philosophy). (See their book for further elaboration)

That’s all well and good. I think what matters most is not just having these content knowledge, but we need to learn how to explicitly receive and respond to critical feedback.

To whet your appetite, check out Doug Stone’s interview about the book on The Art of Manliness podcast (Ladies, I assure you that you’d find is not an exclusive gender bias podcast). Around the last 10mins of the interview with Brett Mckay, listen to an example Doug gives about men’s lack of attention to women.)

Doug rightly points out,

“One of the most difficult conversations people have is to give and receive negative feedback “

Maybe someone should have taught the waitress on how to follow-through after asking for feedback. She missed a huge opportunity. I don’t blame her. She had the courage but not the skills yet.

Ask, and be ready to receive.

Stay tuned for the next post on the why the difference between performance feedback and learning feedback matters to your development.

Best,

Daryl Chow, Ph.D.

Guess who’s the king of feedback?

jimi-hendrix-1967

 

Why We Need This One Person For Us To Get Better

miles-davis

I play what we can play, not me. I never play what I can play. I’m always playing way over and above what I can play.”

~ Miles Davis

When this guy was in the room, I played better.

We first met Randolf Arriola when I was  about 17 years old. My bandmates and I saved up enough money to go into a recording studio (recall that this was in the late 1990’s when home recording equipment was not yet readily available) to attempt to demo some of our songs. Back then, Randolf was working as an assistant sound engineer with Freddy, who owns this suave  studio*. Frankly, we weren’t so sure we could afford recording there.

Fast forward a few weeks, we abandoned recording at Freddy’s studio. In gist, he made us sound horrible. He said with some confidence, “I can make you sound like Collective Soul.”  We said, “What?”  We collectively didn’t want to sound like them. It was not what we had in mind. We were smothered by bands like the Verve, Radiohead, Led Zeppelin, Jimi Hendrix, etc. Not Collective Soul.

Instead, we bailed out of the formal recording studio and we ended up at Randolf’s tiny room where he lived with his parents in a two-bed room apartment. His bedroom could fit a single bed, a 16 channel mixing, some rack mount stuff, a handful of guitars, and a PC with a monitor. That’s it.

As for the humans, we could fit about 3 to 4 other people in there. Randolf would be sitting on a stool designated for him to face the screen, while the rest of us took turns to sit beside him to review the tracks that we were recording. Forgot about “rockin’ in a free world” and head banging recklessly. There was literally no room for that. With all the equipment around us, we were sardines in a tin can.

We stuck with Randolf for years to come thereafter. He ended up not only becoming our sound engineer and co-producer, he also became our mentor, collaborator, and session guitarist. He was our Brian Eno and Daniel Lanois is to U2, all packed into one person. I mean, this was guy knew every detail about music, from the gears, song craft, repairing instruments, modifying stomp boxes, producing, sound engineer… He was his own company.

The truth is, when he was around us, he raised the bar of our performance. I mean, we were by no means U2 (or collective soul for that matter). The point is that we ended up playing better than we can. (Check out Randolf performing with us at the Esplanade in Singapore 6 years ago).

I believe this came from Randolf’s deep devotion to the craft. And he has this uncanny ability to be so specific about what we can do to push our songs, ourselves, individually and collectively to the next level.

We spent so many nights talking about music, listening to music and riffing about it. I was introduced to a plethora of wide range of music from my bandmates and Randolf.  He personified music. I learned so much about the psychology behind music from him, and how to simplify from the BS and get to the heart of things.

He was critical, but not criticising. He pushed us, but never made us feel small.

Instead, he made us feel like the hero on our hero’s journey.

Combined with some home-brewed 4 and 8 track records we made on our own and Randolf’s tiny home studio recordings, we released an album together. (We were not in the top of the charts,  nor were we expecting to. We just loved music making. In fact, after some time the album got so painful a process that we just wanted to get it out of the way!). In no small ways, it was a  life lesson still embedded in me more than a decade later.

I picked up two key takeaways from my musical journey: 

1. Seek out a few people who can guide me in specific areas,

2.  Stay close to someone who is better than you.

Randolf is a freakin’ brilliant musician in his own right. Watch him do his magic with real-time live looping.

Here’s Randolf featured in TedX:

This speaks to  our work as therapists.

We need a good coach. We need someone who we can help us raise the bar of our performance, and help us become better versions of ourselves (not a copy of the supervisor/coach).

This made me seek out clinicians who are better than me. People who can teach me and guide me. Early on,  I decided that I’m going to be a perpetual student. No shame.

Who do you seek out to raise the bar in your development as a therapist? Do you get specific directives on what you can work on that can leverage on your effectiveness, and not just some theory talk or  vague “case consultation”?

Stay tuned for more on this topic of clinical supervision and coaching. (Or simply signup on the right sidebar for to receive hassle-free updates in your inbox from Frontiers)

You might also be interested in these past posts:

The Scandal of Clinical Supervision: Here’s the Shocker (Part 1 of 2)

The Scandal of Clinical Supervision: How to Resolve It (Part 2 of 2)

Clinical Practice vs. Deliberate Practice: Why Your Years of Experience Doesn’t Get You Better

p/s: My mentor Scott Miller wrote recently on this common topic as well.

*Note: In order to protect his privacy, Freddy is not his real name. Freddy was after all kind enough to entertain a bunch of kids like us in his recording studio.

Love to hear your more from you about who this person who guided you in your personal &/or  professional life.

Til then,

 Daryl Chow, Ph.D.

 

The Tension of Opposites: Clinical Intuition vs. Clinical Data (Part 2 of 2, The Rate & Predict Exercise)

 

In the previous post, I advocated the marriage of our clinical intuition and the use of outcome informed data.

Do not let me convince you. Let your experience convince. Put it to the test. Try them on for size.

fashion-men-vintage-colorful

Here’s how:

I call this the Rate & Predict exercise. There are two parts:

A. Using an Outcome Measure (Outcome Rating Scale, ORS; Clinical Outcome Routine Evaluation, CORE),

1. Rate: After the first session, ask your client to RATE the outcome measure in subsequent sessions;

2. Predict: Before you see your client’s score, PREDICT what they would score. It is important that you write down scores for each of the sub-scales, if any. (for ORS, Individual wellbeing, close relationships, Social, General). This prevents us from falling into the “I knew it all along” hindsight bias effect.

3. Evaluate: Compare and contrast the scores. See what stands out. Talk about the with your client.

B. Using an alliance measure (e.g., Session Rating Scale, SRS),

1. Rate: At the end of the first session, ask your client to RATE how they feel about the level of engagement in the session;

2. Predict: Before you see your client’s score, PREDICT what they would score. It is important that you write down scores for each of the sub-scales (for SRS, level of emotional connection, goals, approach/method, overall).

3. Evaluate: Compare and contrast the scores. See what surprised you. Form your feedback questions from there.

Continue reading

The Pursuit of Excellence is Not the Pursuit of Perfection

the pursuit of perfection vs the pursuit of excellence

“An expert is a person who has made all the mistakes that can be made in a very narrow field.”

-Niels Bohr, Danish physicist and Nobel Prize winner.

The pursuit of getting better at our craft in therapy requires us to make fine distinctions. One of them is to make the distinction between  the pursuit of excellence vs. the pursuit of perfection.

The pursuit of perfection has no room for mistakes. Failing = Failure. The pursuit of excellence treats errors and blunders as grist for the mill. It is where the ordinary magic of growth happens. Failing ≠ Failure.

The pursuit of perfection is rigid, exacting, clinical and cold. The pursuit of excellence is flexible, warm and humanistic in the emotionally charged interpersonal encounter of two persons coming together to co-create a better life for one party. In turn, the giver is moved to be a better person in return as well.

The pursuit of perfection is self-centered. The pursuit of excellance is others-centered. It uses the self in service of the other. It doesn’t use the other to enlarge the self.

The pursuit of perfection sees therapy as a performance. As if held within the judging gaze of another, it’s ego is at stake, thus it confines to it’s comfort zone. The pursuit of excellance seeks to re-form the status quo, seeking to reach beyond our comfort zone.

The pursuit of perfection suffers chronic anxiety. The pursuit of excellence embraces uncertainty, and accepts the uncontrollable force of life circumstances. It treats the turn of each event as teachable moments for the inner life. Its antidote to worry is to believe that the most perfect thing to do is to embrace imperfection.

The pursuit of perfection wears a fixed mindset hat. The pursuit of excellence wears a  growth mindset hat, which promotes receptivity in learning, and learning to take feedback seriously and not personally.

Finally, and perhaps most importantly, the pursuit of perfection thinks it is pursuing excellence.

May we make room for the pursuit of excellence in the new year ahead!

– Daryl Chow, Ph.D.

*imperfect image above hand drawn with Paper & Pencil  on iOS device

#4. Why Our Self-Assessment Might be a Delusion of Reality

 

Homer

It seems that we share more in common with Homer Simpson than we like to admit. Did you know that social psychologists found that in general, people rate themselves as more attractive that they really are?(1)

In my doctoral study of highly effective psychotherapists(2), the results of an area investigated about therapists self-ratings of their Healing Involvement (HI) in therapy left us initially scratching our heads. Orlinsky and Ronnstead(3) describes someone with high HI as someone who views themselves as personally invested, efficacious in relating with the client, affirming, and highly skilling, experiencing flow states in therapy, and employ constructive coping strategies. What we found was a negative relationship between their outcomes performance and HI rating. In other words, therapists who rated high on their HI scores were more likely to be less effective than their peers! How is this possible? Going further, the same group of therapists we studied, half of them rated their current effectiveness as above average. None rated below average. What’s more, these self-assessment of effectiveness ratings did not predictor their actual client outcomes. Continue reading

#1. Therapy Learnings: A Memorable Practice

Image

Memory is the mother of all wisdom.- Aeschylus

 

There are many lessons I’ve learned that I’ve forgotten. Some times, my memory is like an old bookshelf, stock-piled with endless stories, references, and guidebooks, but shelved in such randomness that there is no quick-way to find a particular book.

If I can’t recall an important lesson, what good is it that I’ve have experienced it, but not able to recall it?

About two years ago, this geriatric problem confronted me. I was in my group private practice in Western Australia (SPOT), and I was seeing a young adult male, Jonah, who was depressed over the past two months. After the first two initial sessions, even though I felt that we had a good working rapport – along with his scores on the Session Rating Scale (SRS) indicated good engagement levels, I was daunted by the fact I still didn’t seem to get a sense of who he was. It was this paradox of communicating with him, but not knowing him. At that moment, I didn’t know what more to ask in order for me to get a sense of who he is, and how he was experiencing himself. It was an odd feeling, because I didn’t often run into such a situation relating with a person, what more after a few sessions. Aside from reflecting my disconnect with him, I didn’t know what else to do at that point.

My drive home left me thinking about Jonah. I ruminated, closed to bashing myself (with soft pillows) for not being able to get deeper with this pleasant and friendly client in my therapy office. Then my mind wandered. I felt like listening to the Beatles (Perhaps I wanted some Help!). Sgt Pepper was near at hand. I hit that last track.

It was “A Day in The Life”… That’s it! I’ve learned this before. Several years back, during my post-graduate training, I read Irvin Yalom’s wonderful book, The Gift of Therapy. One of the golden nugget that struck me then was about Asking for a blow-by-blow account of a person’s daily activities. How could I have forgotten this?

At the start of the next session, , that was what I did. I requested for him to share with me the details of what he did the day before, almost an hour-by-hour account. In between his part-time work at the supermarket and swimming training, he was ferried about by his mother. Why was this important? He felt he was not in control of his life, and he also felt bad if he was to tell him mum to back off a little, especially since she has been divorced and alone. Further discussions revealed that he also longed for connection with his mates, but has been plagued with a sense of inferiority (e.g., working in a low paying job, no car).

This session with Jonah struck home on two fronts. The first was that we were able to progress further on improving his life situation. He ended up sitting his mother down and having a talk about needing to move along in his life. The second was for me. I was confronted with the fact that my retrieval memory was like my old bookshelf, messy and disorganised. I needed to get organised.

Since then, on friday afternoons before I pack my bag and head home, I gather my thoughts and spend 3-5 mins, typing out my TherapyLearnings for the week.


Here’s How:

At the end of every typical work week, look at your work calendar to recall all of the clients that you’ve met. Pick one of the cases that strike you the most in that week. Write down one thing that you want to remember about your experience. This could be a lesson that you’ve learned from interacting with that client, a feedback that was given to you, even a mistake that you felt you’ve made? (Did you know that more effective therapists are more likely to elicit negative feedback than less effective counterparts? More on that).

Benefits:

1. You develop your own learnings, bespoke from your own clinical experiences.
2. In a month, you will have 4 learnings. In a year, you will have 48 such gems in your pocket! (well, probably less that 48. I highly encourage holidays).
3. The act of writing it out helps with the consolidation process of the memory, as well as aiding future retrieval. Be forewarned of this pitfall: “Since it’s so important, I will be able to recall it.” For a busy professional, things easily slip us by, and we miss making a pit-stop at the memory bank.


Suggested Format:

You can choose to do this on a notebook that you dedicate to your own TherapyLearnings, or you can choose to do this on apps for portable devices (e.g., tablets, smartphones). Free note taking apps like Evernote and Simplenote are available, and it syncs on multiple devices. Although I use Evernote premium for my web-clippings and other more advanced note-taking, I use Simplenote for my TherapyLearnings. As the name alludes, it is no-frills. Just create a tag therapylearnings for each of your weekly notes. A bonus feature about this is that you can share and collaborate each note with your colleagues in your TherapyLearning Group (more on this below).

Date: ________

Title: A succinct and catchy title helps e.g., A Day in a Life

Learnings: A one-sentence summary of this therapy learnings

Example: Provide a brief snippet of the case that led to this learning, in order to make it more alive and personalised for your future recall.

Keep each TherapyLearning to a maximum of 140 words. Constrains are helpful. For busy professionals, time is a luxury. By self-imposing a word limit (the 140 word limit was borrowed from Twitter), it helps to get the mind to pack a punch, keeps it focused, and makes it doable on a regular basis.

TherapyLearnings Group: I recommend doing this on any individual basis. Complementarily, a TherapyLearnings group can be formed to sharpen this weekly nuggets. A small group size of 4-5 is beneficial. It would typically take 45-60mins for each to share. One tidbit for someone can also be an impactful vicarious learning for the other. Resist the temptation of going into the group without first noting your therapylearnings down. This helps to keep the phenomena of group-think at bay. Walter Lippmann’s quipped, “where all think alike, no one thinks very much.”


Stick-It:

Recall -> Pick one -> Write

Psychotherapy is one of the few professions that practice actually means the real thing. Our task is to predispose ourselves to learn from our ongoing clinical practice. In order to learn, we must develop the ability to have a retrievable memory. This is the hallmark of a memorial life. This is worth remembering.

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