Frontiers of Psychotherapist Development

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

Tag: work

Our Real Work

Our Real Work

“…In my early professional years I was asking the question: How can I treat, or cure, or change this person? Now I would phrase the question in this way: How can I provide a relationship which this person may use for his own personal growth?” ~Carl Rogers, On Becoming a Person, p.32


What is our real work?

It’s easy to think that the role of a psychotherapist is to treat a person or help our clients change. Indeed, that may be the outcome we hope for. But it’s not the work that we need to put in.

Our real work is not to treat a person. We conflate the outcome we desire with the work that we need to put in, in order to get that outcome.

Our real work is more like a gardener than a builder. 

A builder builds, and when that’s done, the work is done. A gardener lays the ground work, and waits for the seeds to grow. A builder’s work is finite. A gardener’s work is never done. She continues to tend to the plants, nurtures and prunes its branches.


Like a gardener, a therapist real work is in the pre-work. 

It’s what we do outside of the therapy hour,

in order to get better at what we do in the ritual of therapy.

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Stop Talking, and Start Performing.

Stop Talking, and Start Performing


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?

4. How do you deepen the emotional experiencing?

5. How do you close a session with an impact?

…Etc. (See a related post on Figure Out the “What” Before the “How”)

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 responsive6 and 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.


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.”


Daryl Chow, PhD




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.

2. Jerome Frank’s (1993) book, Persuasion and Healing is a seminal read.

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’s Improvisation 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.

8. Here’s a recent chapter I wrote for a recently released edited book. 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. There a chalk full of diverse chapters in this book.

(Please note that the links in the note section are amazon affliate links. That means I get a tiny percentage of the books’ sales.)

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.


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.

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Three Types of Knowledge, and Why This Matters in Psychotherapy

Card trick (smaller)

Information does not equal to transformation.

When I was in secondary school, I had a good friend who seem to morph every time we return from our month-long school holidays. For the rest of us, we came back with grandiose updates about girlfriends – factitious or not – the latest music we’ve heard, and other raving topics. Every cycle of return to school in January and July, most of us were pimple-ridden with awkwardness. Herman had the acne, but was focused and hard-pressed for an audience.

Herman was different. He wasn’t the coolest kid. In fact, he was scrawny, somewhat of an oddball, and didn’t quite fit in. Every holiday that he came back from, he would use us as guinea pigs to test out his latest magic trick. And it was usually a flop. Cards fall of his hands, coins did not reappear as it should. And of course, this was met with testosterone mockery. At least for the start.

But after a few more vacations, we were floored. He almost seemed like he came from an apprenticeship with Houdini. His close-up card tricks became seemingly flawless. He even had our teachers pop in between classes, gasped in amazement.

As it seems, in every class, they would always be at least one smart Alec. This person repeatedly tried to call our Herman’s bluff. “Ah ha!! I saw that. You are cheating!”

What do you expect, smart Alec? Real Magic?

Here’s the thing: as noted by Seth Godin in his book Tribe, citing the great magician Jamy Ian Swiss, it’s easy to figure out how a trick is done, but the real difficult part is to develop the art of doing it. Knowing how a magic trick is done does not make you a magician. (For a good example on this, check out the magic competition TV program, Penn & Teller: Fool Us show).

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