Frontiers of Psychotherapist Development

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

Tag: psychotherapy

The Iterative Pathway of a Psychotherapist’s Professional Development

Click here to download a free INFOGRAPHIC on The Iterative Pathway of a Psychotherapist's Professional Development


  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, and 2. 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:


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  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.)


STEP 1: GO BROAD Screen Shot 2017-09-15 at 4.30.03 PM Like 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.



1. Read a. Theory and Practice of Counseling and Psychotherapy 10th Edition by Gerald Corey  b. Psychotherapy Networker (subscribe to their excellent magazine journal. I’ve been an avid reader for many years.)

2. Watch and Listen: a. Three Approaches to Psychotherapy With a Female Client: The Next Generation With Judith S. Beck, PhD, Leslie S. Greenberg, PhD, and Nancy McWilliams, PhD

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. (go to the Approach section and see the various videos)

c. Check out David Van Nuys, Ph.D. Shrinkrap radio Dr Dave has been my instrumental mentor in exposing me to the other facets of psychotherapy I wouldn’t have known.



STEP 2: GO NARROW Screen Shot 2017-09-15 at 4.30.34 PM Once 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.



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.

Go to Zeig,Tucker & Theisen Alexander Street Press (There’s a free trial) (more post-modern, strength based videos)


Screen Shot 2017-09-15 at 4.30.41 PM 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. 



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) Screen Shot 2017-09-15 at 4.30.48 PM 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.”



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.


1. Read Shinryu Suzuki’s Zen Mind, Beginner’s Mind.



STEP 5: GO BACK Screen Shot 2017-09-15 at 4.30.55 PM We 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.


Return to STEP 1: GO BROAD.



1. Read these blogposts: a. Figure Out the “What” Before the “How” b. Signs That Therapists Are Barking Up The Wrong Tree 

2. Use the Taxonomy of Deliberate Practice Activities (TDPA) to identify WHAT to work on. (email me 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,




[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:

[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:

[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.

How Do You Get Better At Eliciting Feedback?



…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.


















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?”


“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.


Daryl Chow, PhD

30th of Dec 2016


Three Surprising Facts About Psychotherapy You and Your Doctors Need to Know

boy hearing for the first time (w hearing aid)

With the help of a hearing aid, boy hears for the first time.

This is for those who are thinking about seeking help. Maybe you are wondering, unsure of who to go to and what to look out for. Or maybe you just need a reason to give a shot at therapy/counselling before you take a psychotropic drug for your emotional problems.

Click here to find out more: Three Surprising Facts About Psychotherapy You and Your Doctors Need to Know

boy with new pair of shoes_overjoyed

Boy overjoyed with a new pair of shoes

Like the images of the two boys, I hope you get the help you deserve, and experience a renewed sense of joy in your life.

Daryl Chow, PhD

You might also be keen to read from related posts:

Why Our Self-Assessment Might be a Delusion of Reality

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