The Reimagining Education in Psychotherapy (REP) Series, Part 1.
In the next 2-3 months, I am attempting to conduct a thought experiment and flesh out an idea I’ve been thinking about for a while, through several blogposts on the Frontiers.
If we were given a chance to reimagine education in psychotherapy, how might it look like?
How would we design the learning process?
What needs to change and evolve?
Education Without Translation
In the field of psychotherapy, the ability to handle a variety of interpersonal interactional issues is at the heart of clinical expertise. Yet, the nature of psychotherapy training lacks specific and individualised learning environments to practice these interpersonal domains.
For example, Anderson, Ogles, Patterson, Lambert, and Vameersch found that therapists’ facilitative interpersonal skills (FIS), the ability to perceive, understand and communicate impactfully, accounted for variance of outcomes between therapists.
In a follow-up prospective study, Anderson, Crowley, Himawan, Holmberg, and Uhlin found similar results. However, the researchers noted while FIS scores predicted patient’s alliance and outcome measures, a 2-year relevant doctoral training had no significant effect on client outcomes. Intriguingly, though not statistically significant, untrained therapists had higher alliance ratings! In other words, there is a possibility that a trainee’s ability prior to receiving any training, matters more than the effects of training. While this study pose a logical conclusion of how we should think about the selection process of doctoral studies in psychotherapy related fields, another critical piece to consider is what we are doing in training, as there seems to be a lack of evidence of improved outcomes from formalised education in psychotherapy.
While My Guitar Gently Weeps
The 5 of us live in a 150 square metres apartment. In the middle of out living room, centers an upright piano. My two older sisters plays the piano. They practiced every week. The only thing I am good at playing are my G.I. Joe action figures. My sisters were the smart ones, and I was the “lagging behind little brother.”
I don’t remember the sequence of events, but I somehow ended up in a classical guitar class. Every week, I’d go down to the local community centre at the bottom of a nearby residential apartment to attend lessons, which for some reason was heavily scented with talcum powder.
I stuck around for what seemed like a year or two, but I suspect, in reality, it was only a handful of months. I was consistent with my track record; I gave up on things without much persistence, like how I quit Tae Kwon Do, boy scouts, and soccer.
3 years later, on Sept 1, things took a turn. I am in Secondary 2 (Year 8) and it’s Teachers’ Day, which means that we got to wear what we wanted instead of school uniforms. Also, students came together to perform for our teachers. The truth is, we aren’t so keen on performing for our teachers per say, but more of the fact that some students got to make a ruckus on stage—the very stage that some of us got public canings.
After the performances during the break, I hear this fuzzy, distorted menacing noise, piercing out of the upper secondary class. I took the stairs to the second level, and I see a crowd of students encircling Diony, seated like a modern sage with his electric guitar, which was decorated with stickers and loud neon graffiti-like drawings. The blaring sound was not coming from his guitar; it was coming from his amplifier plugged to his guitar. He was playing Metallica’s “Master of Puppets”. My jaw dropped. I couldn’t move. Is he really playing it? How does he do that wit his fingers? Am I going to cry?? It sounds exactly like in the cassettes.
That was the day when G.I. Joes died, and a new toy was born. The electric guitar.
(It was months later before I saved up enough money to buy a second-hand black Yamaha from a friend).
Diony is untouchable. He is way too cool to teach me, at least that’s what I thought. I am in sheer admiration. Days later, I got to know another senior boy who is eager to impress. I begged him to teach me the song he tried to show-off to me, a Gun N’ Roses number, “One in a Million”. It was what guitarists call a bar-chord song, a tune that requires you to train your lefthand first finger to hold all six strings down the same time—and it would hurt like hell. Even with the classical guitar lesson 3 year ago, I couldn’t even string together 3 simple chords at that stage, let alone play one out of five bar chords in a song.
The stakes got higher. A few weeks later, I got together with 4 other seniors in my school, and out of naivety and hubris, we form a band called Hindenburg (Yes, we were big Led Zeppelin fans). I’m the guitarist. We write our first song together called “Scars,” with 4 chords I mastered. (no bar-chords in this song).
The Banking Model vs. The Kindling Approach to Education
“Tips, tricks and techniques are not at the heart of education—fire is . . . Not merely the facts, not merely the theories, but a deep knowing of what it means to kindle the gift of life in ourselves, in others, and in the world.”~ Parker J. Palmer.
My history with learning the guitar and composing music had a huge impact in the way I thought about how deep learning happens. Turns out, traditional education is often times void of learning that translates. I realised in the “playing in a band” part of my life, lousy as I was in my school grades, learning was possible if I first learned to kindle the flame (It helped that my mom believed that I was a “late bloomer.” I discovered that I was not a poor learner, I was slow learner).
As Plutarch said more than two thousand years ago, “Education is the kindling of a flame, not the filling of a vessel.” 
My education into music ignited, although I had yet to learn any music theory.
There are two different ways to think about how we educate psychotherapists.
The first is a banking model. Traditionally, we teach the theory, study the research, fill it in the learner’s minds, attempting to upload into the learner’s mind with facts and knowledge. Then about 4 years later, we send them off for practical experience and begin the real work. A banking model works more on a top-down direction, or sometimes referred to as deductive reasoning .
The second way is a kindling model. In this approach,we flip the banking model on its head, and start with the action, igniting a deep interest while continuously fanning the flame, and then learn to synthesise, connect the dots and form new conscious knowledge—after the fact. (See Figure 1). Coupled with an apprenticeship philosophy, a kindling model emphasizes more of a bottom-up direction, or sometimes referred to as inductive reasoning (more on this in up-coming posts).
My Counselling and Psychotherapy Unit with Dr. Closs
I hit the jackpot in my undergraduate. In the counselling unit, Dr. Robert Closs device a structure that, to this day, I attribute this first lecture to have a huge influence on the way I think. Each week, we had 3 hours with him. He devoted the first hour or so to the landscape of psychotherapy and its various approaches. After a break, we had about another 1hr and a half of “conversation.” It also happened to be a time in my life, I said to myself, I am not going to be a socially withdrawn individual; I decided to be pro-active.
On the first day, Dr. Closs asked for two volunteers. We had no idea what he had in mind. I raise my hand, along with another student, Candy. “Ok, great,” Dr Closs replies. “Now both of go to this room, and chat with each other for abit. Meanwhile, the rest of us, go behind the one-way mirror, and we’d observe Daryl and Candy as they talk to each other.”
“What??” I had no idea what I signed up for.
Candy, thankfully, is much more socially skilled than I am. She takes the lead, and we ended chatting about her hair color, music, and why we were both interested in psychotherapy. Eventually, we had a blast.
Dr Closs brings the class together, as the rest of the group comes into the pseudo FBI-interrogation room. We debrief. We talk about how we talked. We evaluate what it was like to engage with each other. I was on fire.
Throughout the counselling and psychotherapy unit, Dr. Closs was quick to emphasise that in spite of the various models of therapy we were about to learn, the evidence was consistent that theoretical orientation accounts for very little in treatment outcome. This was the first time I saw references of Michael Lambert, Barry Duncan, Mark Hubble and Scott Miller’s work. (To think I’m co-authoring a book with Mark and Scott in this current day, is just mind-blowing).
Here’s the thing. I don’t believe my experience in higher education should be an outlier. It should be the norm we take more of a kindling model and less of a banking model (see Figure 1), earlier rather than later (and not wait until post-graduate).
Here we can learn what Sal Khan did with the Khan Academy and how he made us rethink how education can look like. As it is popularly now known as the “flipped classroom,” students can learn about the theories outside of the classroom; classrooms can become less of lectures, and more of workshops of sorts, aimed to work through challenges and kindling the flame.
“The Only Reason They Came to School That Day.”
One more example shared by the good people from the Right Questions Institute (RQI) in their newsletter.
“This spring, a science teacher shared what happened when she used the Question Formulation Technique with students facing various challenges to keeping them motivated to learn.
To introduce a lesson on nuclear chemistry, she showed her class a seven-second video about the 1986 Chernobyl disaster. The students had never heard of Chernobyl. They didn’t know what a Geiger counter was. They wondered why an event from 33 years ago still mattered. They were mesmerized.
They had questions.
And they began searching for answers — even watching a documentary about Chernobyl during their own free time.
The teacher wrote: “They came to my class last week and told me the only reason they came to school that day was because of my class. I cannot begin to express in words what that meant to me.”
Think what it means to those students… This is just one example of how our work leads to students getting excited about learning.”
Keys to Action
Kindle the flame with our questions. These questions put the learners on a quest. A quest to figure stuff out. A quest to think deeply and become a deep learner.
Here’s my suggestion to educators in this field:
1. Ignite with the music of therapy. Get students involved as early as possible in actively taking part in the conversational nature of our healing enterprise.
2. Design the psychotherapy classrooms to become more like a social experiment lab and less of lectures. Get students into to play and experiment in the heat of the action.
3. Teach the theories, after the action.
If you like to stay up to date with the Reimagining Education in Psychotherapy (REP) articles and other updates in Frontiers, don’t forget to subscribe.
Image by Roel Dierckens (@roeldickens)
 Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65(7), 755-768. doi:10.1002/jclp.20583
 Anderson, T., Crowley, M. E. J., Himawan, L., Holmberg, J. K., & Uhlin, B. D. (2015). Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome. Psychotherapy Research, 1-19. doi:10.1080/10503307.2015.1049671
 We continued to perform and write songs for more than two decades. The name Hindenburg morphed into Bas Motel, and then finally, we settled on Camra.
 In Radical Presence by Mary Rose O’Reilley
 This quote has also been attributed to others. See quote investigator
 I eventually learned music theory on my own and with the help of some friends in my early 20’s in order to score a piece for a string quartet in two of our recordings. What a radically humbling and enlightening experience to work with classically trained musicians… That’s a different story.
 Watch Sal Khan talk about how he accidentally reinvented education
 Right Questions Institute (RQI) Newsletter, 20th of Jun19.