The Reimagining Education in Psychotherapy (REP) Series, Part 2.
… A full knowledge of psychiatric and psychological information, with a brilliant intellect capable of applying this knowledge, is of itself no guarantee of therapeutic skill.
The essential qualifications of the psychotherapist lie primarily…the realm of attitudes, emotions, and insight, rather than in the realm of intellectual equipment.
~ Carl Rogers
Perhaps the chilling part of Carl Rogers statement is not just what he said, but when he said it. While teaching at the University of Rochester, this quote was taken from “The Clinical Treatment of the Problem Child,” written in 1939! Early in his career at aged 37 while working with troubled children, Rogers had the inklings to articulate and foreshadow some of the challenges faced in our approaches to educating psychotherapists in various professional categories (counsellors, psychologists, social workers, marriage and family therapists).
An Over-emphasis on Content Knowledge
As previously described in the differences between the banking model and the kindling models of teaching, much of our formal education relies heavily on the former. And when we are heavy on a banking model, we end up over-emphasising on content knowledge.
Content knowledge simply refers to information, instruction and materials for the student to learn about a given topic.
Content knowledge is necessary, but nowhere close to sufficient. Granted, an undergraduate major in psychology program is not only geared towards teaching students to become a mental health profession. For specific units angled towards the training of someone who is going to become a practitioner, while it is important to have a sound content knowledge in say abnormal psychology, clinical psychopathology, developmental psychology, neuropsychology, it is equally, if not more important to go beyond an objectivistic view and learn about the relational dimension of our meaning making.
The banking model presumes that the job of lecturers is to fill up the learner’s minds with content knowledge. In today’s world, we can better spend time in school kindling a topic—workshopping with cutting-edge examples, developing projects, and experimenting with ideas.
Universities are waking up to this. MIT knows this. That’s why, filed under the Creative Commons license, MIT‘s have unlocked the doors of knowledge swung wide open for anyone who is a motivated and self-directed learner—for free. Wanna sit in Steven Pinker‘s class on evolutionary psychology? Go for it! (It’s for anyone, not everyone. That’s because not everyone will be motivated.)
Information is not education; you wouldn’t bet on inspirational transformation to happen when content knowledge is our only staple.
Wait…What Other Knowledges are There?
Enter the second knowledge…
Content knowledge is focused on “learning to know,” whereas process knowledge is focused on “learning to do.”
Process knowledge is the relational ability to engage in the moment-to-moment interaction between two parties.
Process knowledge requires skills not only in listening, communicating with and understanding another person, but more importantly, it’s about helping the other person feel understood. In such empathic and emotionally charged conversations, the process typically moves the conversation forward, either deeper into the realm of a person’s emotional experiences, and/or leads the conversation in a therapeutic direction.
Process knowledge is perhaps one of the two pillars of what Carl Rogers refers as the heart of “therapeutic skill.”
The use of sound and silence is the hallmark of music. Thomas Merton said,
Music is pleasing not only because of the sound but because of the silence that is in it: without the alternation of sound and silence there would be no rhythm. [2]
The use of listening and words is the hallmark of therapy. Peter Wilberg said,
Listening—being with oneself and others in pregnant silence—is the midwife of speech.[3]
Even outside the field of psychotherapy, relational skills are highly prized in today’s technological society. Yet, a majority of formal education in our field, on the basis of how lessons are taught, imply that teaching content knowledge can either somehow magical transfigure into process knowledge, or it’s something you’ve got to “figure it out” on your own through clinical practice.
Case in point: Most people’s experience of clinical supervision relies heavily on case discussion. Without actually peering into the blackbox and analysing the conversation, we end up discussing about our views, supervisor’s views, and our views about clients’ views. No wonder the evidence in clinical supervision accounts for less than 1% of the variance in client outcomes.
The Final Piece to the Puzzle
The third type of knowledge is what defines the best from the rest.
Conditional knowledge is the ability to know how to approach things differently when the situation, context and person you are relating with changes.
For example, imagine if you have 3 clients who all have similar presentations of anxiety and depression.
1. Your first client who is a 60+ male who recently retired, lost his wife to cancer a year ago;
2. Your second client who is a 20+ female doctoral student who is perfectionistic and self-critical in her approach to her academic work, and
3. Your third client who is a 40+ female with four kids, is conflicted about leaving a domestically violent relationship.
Even though all three clients might have a similar presentation of anxiety and depression, you would sensibly approach therapy differently. The real question about conditional knowledge isn’t about the awareness of needing to adapt to differing contexts, but it’s more about the when and how.
“If [x], then [y]” is a crude and simple way to think about conditional knowledge.
If [x] changes, then your [y] changes.
The second and third types of knowledge are more relational than analytical. Some scholars and argue that such relational knowing should come about more tacitly through clinical experience. While I would agree that tacit knowledge does develop, I believe we should still figure out a way to articulate and teach this skill earlier rather than later in the trajectory of professional development.
Besides, if we do acquire a level of tacit knowledge that is deep and are able do alchemy for our clients, we would see better outcomes for practitioners with more years of experience. This doesn’t seem to be the case (see our research, and Simon Goldberg and colleagues)[4] Moreover, experience is a poor teacher without a deliberate practice plan (see this related post).
I propose that in order for us to reimagine education in psychotherapy (REP), these 3 types of knowledge—content, process, and conditional—can serve as a primary conceptual framework.[5]
Competence in content knowledge can create a false confidence of ability. Meanwhile, analogous to a good music not necessarily needing music theory to make good music, it also begs the question if content knowledge needs to serve as a basis for process and conditional knowledge. Perhaps if schools treat these 3 domains ecologically, and not hierarchical, learners might experience the critical interplay early in their higher education.
I believe that the 3 types of knowledge framework can kindle the flame and help learning come alive for students, and even for teachers. Besides, teachers teach best when they are learning at their own growth edge.
Keys:
Here’s the takeaway:
1. Teach the learner the importance of relating with a person and not just settle for the ability to identity, diagnose, or treat a psychopathology.
2. Create an unrest with content knowledge being necessary and sufficient. It’s not enough to understand. It’s more important to help the other person feel understood.
3. We should not focus solely on content knowledge, but to facilitate the kindling process, the coming to life between the content, process and conditional knowledge.This is where the 3 types of knowledge sing together.
Your Turn:
What has your experience in higher education (undergrad, postgrad, doctoral) been like? Was there a balance of these 3 types of knowledge, or an emphasis in content knowledge?
If you are a student, what are your thoughts around this as you are receiving training in your licensed area?
Share with us in the comments below so that we can learn from you.
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Footnotes:
Image by Matteo Maretto @matmaphotos
[1] Carl Rogers, 1939, p. 284 The Clinical Treatment of the Problem Child (see secured pdf of the book )
[2] Thomas Merton, No Man Is An Island.
[3] Peter Wilberg, The Therapist as Listener: Martin Heidegger and the Missing Dimension of Counselling and Psychotherapy Training.
[4] Chow, D., Miller, S. D., Seidel, J. A., Kane, R. T., Thornton, J., & Andrews, W. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52(3), 337-345. doi:http://dx.doi.org/10.1037/pst0000015; Goldberg, S. B., Rousmaniere, T., Miller, S. D., Whipple, J., Nielsen, S. L., Hoyt, W. T., & Wampold, B. E. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. J Couns Psychol, 63(1), 1-11. doi:10.1037/cou0000131
[5] The original article on “Three Types of knowledge” was posted in Frontiers on Feb 2016. A slant for clinical supervisors can be found at and at psychotherapy.net, “What supervisors Need to Know.” Finally, more related info can be found in the following edited chapter:
Chow, D. (2017). The practice and the practical: Pushing your clinical performance to the next level. In D. S. Prescott, C. L. Maeschalck, & S. D. Miller (Eds.), Feedback-informed treatment in clinical practice: Reaching for excellence (pp. 323-355). Washington, DC, USA: American Psychological Association.
As a student in counselling I’d say that my angst in learning occurs when I only focus on my mind, on the content. Once I feel the knowledge in my body, then what I learn clicks. I think when I started this course I wanted to know everything I could so that I could feel safe knowing that I could handle what came my way. However then I’d find I was caught in my head and working with my clients the same way. My tutors would feed my class and I information as it came up, only convoluting my need to control what might happen and my need to jump ahead and fill my brain with an overabundance of information. Then with supervision and support I learned to trust my own knowledge and experiences. To be fair the whole process is and has been rather confusing sometimes because some of what I’ve learned has been through experience. This is where the classroom is limited and perhaps where schools that are more practical but not as theoretical may have an edge. Rewind two hundred years and consider how we learned way back when? Throw in variables such as cultures and class. University was elitist depending on the culture, and skilled workers perhaps did not hold the kudos? I wonder if because of the history of education we are still trying to package learning in a way that still preserves the elitist smell of academia. Perhaps the skilled labourers had it right all along and the prestige was placed in the wrong place? Why I’m mentioning this is I can see the value in these types of knowledge. My family were farmers for many years in Hungary before my grandfather moved to Canada after WW1. He never had any money. However we learned through experience. We passed on generations of knowledge through our hands. I could never study until I finally learned that I have to learn knowledge by feeling it in my body. I believe this is because of my history. This honors my roots though because I know that those farm hands were right all along and the wisdom of my heritage has helped me learn with my head and heart. In short, awesome post! I get it and would love to see traditional academia overturned so that we can let in some farm air for fresh forms of processing.
Chrissy,
I am deeply appreciative of your comment, especially your sharing of your family’s history. I particularly resonated with the idea of “feeling it in my bones”. That is the hallmark of deep learning.
The problem w our default university process — and it’s elitism — is that it’s plagued w the inability of what educational psychs call, a lack of transfer. Bryan Kaplan provides a thorough review of this in his book The Case Against Education.