{"id":5545,"date":"2023-08-25T17:03:00","date_gmt":"2023-08-25T09:03:00","guid":{"rendered":"http:\/\/darylchow.com\/frontiers\/?p=5545"},"modified":"2024-05-03T00:55:21","modified_gmt":"2024-05-02T16:55:21","slug":"what-are-the-most-pressing-problems-in-the-practice-of-psychotherapy","status":"publish","type":"post","link":"https:\/\/darylchow.com\/frontiers\/what-are-the-most-pressing-problems-in-the-practice-of-psychotherapy\/","title":{"rendered":"What are the most pressing problems in the practice of psychotherapy?"},"content":{"rendered":"\n<p class=\"has-medium-font-size\"><strong>What are the most pressing problems in the practice of psychotherapy?<\/strong><\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<p class=\"has-medium-font-size\">There are several issues at hand. For example, it\u2019s a bit of a scandal that, on average, therapists do not get better with experience.<a href=\"https:\/\/darylchow.substack.com\/p\/ff149#footnote-1-136390058\">1<\/a><\/p>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"http:\/\/darylchow.com\/frontiers\/6-visuals\/\" target=\"_blank\" rel=\"noreferrer noopener\"><img decoding=\"async\" src=\"https:\/\/substackcdn.com\/image\/fetch\/w_1456,c_limit,f_auto,q_auto:good,fl_progressive:steep\/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F4a61ee07-d67a-4738-b5ca-5a8befc888a9_2996x1958.png\" alt=\"\"\/><\/a><figcaption class=\"wp-element-caption\"><strong>For more about this, see<\/strong>&nbsp;<strong><a href=\"http:\/\/darylchow.com\/frontiers\/6-visuals\/\">6 Visuals About Our Progress<\/a><\/strong><\/figcaption><\/figure>\n\n\n\n<p class=\"has-medium-font-size\">So what do we do? We invest time, effort and money in getting certified, trained and endorsed in various schools of thought.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">However, formal training has little to no impact on actually improving client outcomes.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">Let me briefly point out 4 relevant studies that has surfaced in the last couple of years.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/substackcdn.com\/image\/fetch\/f_auto,q_auto:good,fl_progressive:steep\/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F389438ca-ba4a-43cd-a23e-82faa5e310da_1036x581.png\" target=\"_blank\" rel=\"noreferrer noopener\"><img decoding=\"async\" src=\"https:\/\/substackcdn.com\/image\/fetch\/w_1456,c_limit,f_auto,q_auto:good,fl_progressive:steep\/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F389438ca-ba4a-43cd-a23e-82faa5e310da_1036x581.png\" alt=\"\"\/><\/a><\/figure>\n\n\n\n<p class=\"has-medium-font-size\">First, one prospective study by Tim Anderson and colleagues noted that a trainee\u2019s interpersonal ability influenced results. However, it was their ability measured&nbsp;<em>prior<\/em>&nbsp;to receiving any training, that predicted actual client outcomes. The 2 years of doctoral training had no significant effect.<a href=\"https:\/\/darylchow.substack.com\/p\/ff149#footnote-2-136390058\">2<\/a><\/p>\n\n\n\n<p class=\"has-medium-font-size\">Second, in a recent 2022 study by Chris Edmondstone and colleagues, they took a step further and asked if there were truly differences from the get-go, before training took place?<a href=\"https:\/\/darylchow.substack.com\/p\/ff149#footnote-3-136390058\">3<\/a><\/p>\n\n\n\n<p class=\"has-medium-font-size\">Here\u2019s what Edmondstone et al. found:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-medium-font-size\">Differences between therapists exists even&nbsp;<em>before<\/em>&nbsp;training took place.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-medium-font-size\">Take a look.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/substackcdn.com\/image\/fetch\/f_auto,q_auto:good,fl_progressive:steep\/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fe294b631-e7b1-418b-be31-9f33d79fc664_4044x2192.png\" target=\"_blank\" rel=\"noreferrer noopener\"><img decoding=\"async\" src=\"https:\/\/substackcdn.com\/image\/fetch\/w_1456,c_limit,f_auto,q_auto:good,fl_progressive:steep\/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fe294b631-e7b1-418b-be31-9f33d79fc664_4044x2192.png\" alt=\"\"\/><\/a><\/figure>\n\n\n\n<p class=\"has-medium-font-size\"><br>Third, David Erekson and colleagues conducted a longitudinal investigation on the impact of psychotherapist training. In essence, there were asking a similar question, \u201cDoes training improve client outcome?&#8221;<a href=\"https:\/\/darylchow.substack.com\/p\/ff149#footnote-4-136390058\">4<\/a><\/p>\n\n\n\n<p class=\"has-medium-font-size\">Here\u2019s what Erekson et al. found:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-medium-font-size\"><strong>Therapists were found to achieve the&nbsp;<\/strong><em><strong>same<\/strong><\/em><strong>&nbsp;amount of change on average in their later stages of training<\/strong><\/li>\n\n\n\n<li class=\"has-medium-font-size\">Findings suggest that as therapists progress through formal stages of training, they&nbsp;<em>do not<\/em>&nbsp;improve in their ability to effect change in their client.<\/li>\n\n\n\n<li class=\"has-medium-font-size\">Granted, some do improve with training. But in essence, psychotherapy training does not have a universal effect.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-medium-font-size\"><br>Finally, Jesse Owen and colleagues studied if trainees in the US improved in their clients\u2019 therapy outcomes over time, or, if it is \u201cAs good as it gets?\u201d<a href=\"https:\/\/darylchow.substack.com\/p\/ff149#footnote-5-136390058\">5<\/a><\/p>\n\n\n\n<p class=\"has-medium-font-size\">Here\u2019s what Owen et al. found:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-medium-font-size\">Trainees improved over time, but only with clients who are less distressed.<\/li>\n\n\n\n<li class=\"has-medium-font-size\">There were no change over time when working with more distressed clients.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-medium-font-size\">Take a look.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/substackcdn.com\/image\/fetch\/f_auto,q_auto:good,fl_progressive:steep\/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fd1b5772c-e4ca-4ad4-9242-37f5a0592370_776x396.png\" target=\"_blank\" rel=\"noreferrer noopener\"><img decoding=\"async\" src=\"https:\/\/substackcdn.com\/image\/fetch\/w_1456,c_limit,f_auto,q_auto:good,fl_progressive:steep\/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fd1b5772c-e4ca-4ad4-9242-37f5a0592370_776x396.png\" alt=\"\"\/><\/a><figcaption class=\"wp-element-caption\">Changes in client outcomes over 50 months<\/figcaption><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">The Most Pressing Issue<\/h2>\n\n\n\n<p class=\"has-medium-font-size\">What do we make of these findings?<\/p>\n\n\n\n<p class=\"has-medium-font-size\">It\u2019s clearly not because of a lack of trying.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">It might not seem like the most pressing issue, but I believe that if we&nbsp;<strong>re-imagine how we conduct clinical supervision<\/strong>, we stand a chance to turn things around.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">At the heart of our work, it is people passing on to people. This apprentice-model is quite a gift. Many of you reading this are clinical supervisors and you are doing your best to guide other therapists.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">You care about this.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">This is why one of the first online courses I\u2019ve created back in 2018 was&nbsp;<strong><a href=\"https:\/\/darylchowcourses.teachable.com\/p\/rcs\">Reigniting Clinical Supervision (RCS).<\/a><\/strong>&nbsp;I didn\u2019t want RCS to be like a poor substitute for live training, or a webinar-recording. So I decided to build this course from the ground up, specifically for someone to learn at their own pace, one bite-sized idea at a time, while journeying with a community of like-minded people.<\/p>\n\n\n\n<figure class=\"wp-block-image\"><a href=\"https:\/\/substackcdn.com\/image\/fetch\/f_auto,q_auto:good,fl_progressive:steep\/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F0e2ac28a-363b-4bbc-a060-1ad0a5545bc6_3264x2448.jpeg\" target=\"_blank\" rel=\"noreferrer noopener\"><img decoding=\"async\" src=\"https:\/\/substackcdn.com\/image\/fetch\/w_1456,c_limit,f_auto,q_auto:good,fl_progressive:steep\/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F0e2ac28a-363b-4bbc-a060-1ad0a5545bc6_3264x2448.jpeg\" alt=\"\"\/><\/a><figcaption class=\"wp-element-caption\">The first sketches of the course design\u2026 and the ambient nerves of putting myself in front of a camera for hours on end.<\/figcaption><\/figure>\n\n\n\n<p class=\"has-medium-font-size\">13 cohort of clinical supervisors from around the globe have gone through RCS so far. And the doors are now open for registration for the 14th cohort. (More details below).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Wait, But Why?<\/h2>\n\n\n\n<p class=\"has-medium-font-size\">Perhaps there are more pressing issues like burnout, lack of clinicians to deliver treatment, access to services and so on. But I would argue if we tweak the way we conduct clinical supervision, this would have a significant ripple on effect.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">People passing on to people. Clinical supervisors passing on to therapists, therapists passing on to clients\u2026<\/p>\n\n\n\n<p class=\"has-medium-font-size\">But first, our default ways of clinical supervision is not without issues. There are some pitfalls to our default ways of conducting clinical supervision.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">More on this below (See #1).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Tapping Into Native Wisdom<\/h2>\n\n\n\n<p class=\"has-medium-font-size\">Given what we know so far from the four studies we\u2019ve highlighted about the impact of training (or the lack of), as well as the differences that is apparent between therapists from the get-go, instead of hyper-fixating on the \u201ccommon-core\u201d skills we need to acquire, it behooves us to tap into what each therapist has to offer, and bring that to the table from the very beginning.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">Let\u2019s call this native wisdom.<a href=\"https:\/\/darylchow.substack.com\/p\/ff149#footnote-6-136390058\">6<\/a><\/p>\n\n\n\n<p class=\"has-medium-font-size\">Native wisdom is located in our&nbsp;<strong>prior knowledge<\/strong>, experiences and relational encounters that consist of both edifying and adverse histories.<br><br>Educational psychologist David Ausubel said,<\/p>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p class=\"has-medium-font-size\">If I had to reduce all of educational psychology to just one principle, I would say this. The most important single factor influencing learning is&nbsp;<strong>what the learner&nbsp;<\/strong><em><strong>already<\/strong><\/em><strong>&nbsp;knows. Ascertain this and teach him accordingly<\/strong>. (emphasis mine).<\/p>\n<\/blockquote>\n\n\n\n<p class=\"has-medium-font-size\">This is relevant to clinical supervisors. Our role is to tap into the&nbsp;<em>existing<\/em>&nbsp;knowledge of each supervisee, and then, help to cultivate this further.<br><br>Much like a gardener.<\/p>\n\n\n\n<p class=\"has-medium-font-size\">Thanks for reading Frontiers of Psychotherapist Development! Subscribe for free to receive new posts and support my work.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">What are the most pressing problems in the practice of psychotherapy?<\/h2>\n\n\n\n<ol class=\"wp-block-list\">\n<li class=\"has-medium-font-size\"><strong>From the Frontiers Archive:&nbsp;<a href=\"http:\/\/darylchow.com\/frontiers\/7mistakes\/\">The 7 Mistakes of Clinical Supervision<\/a><\/strong><a target=\"_blank\" href=\"http:\/\/darylchow.com\/frontiers\/7mistakes\/\" rel=\"noreferrer noopener\"><\/a><\/li>\n\n\n\n<li class=\"has-medium-font-size\"><strong>Interview on Psychotherapy.net:&nbsp;<a href=\"https:\/\/www.psychotherapy.net\/interview\/daryl-chow-reigniting-clinical-supervision\">My conversation with Lawrence Rubin on reigniting clinical supervision<\/a><br>&#8211;&nbsp;<\/strong>For US practitioners, CE credits available.<strong><\/strong><\/li>\n\n\n\n<li class=\"has-medium-font-size\"><strong>Blog from Psychotherapy.net:&nbsp;<a href=\"https:\/\/www.psychotherapy.net\/blog\/title\/it-s-time-for-supervisors-to-help-clinicians-marry-data-with-intuition\">It&#8217;s Time for Supervisors to Help Clinicians Marry Data with Intuition<\/a><br><\/strong><a target=\"_blank\" href=\"https:\/\/www.psychotherapy.net\/blog\/title\/it-s-time-for-supervisors-to-help-clinicians-marry-data-with-intuition\" rel=\"noreferrer noopener\"><\/a><strong><\/strong><\/li>\n\n\n\n<li class=\"has-medium-font-size\"><strong>From the Frontiers Archive:&nbsp;<a href=\"http:\/\/darylchow.com\/frontiers\/the-skills-of-a-supervisor-is-not-the-same-as-a-therapist\/\">The Skills of a Supervisor Is Not the Same as a Therapist<\/a><\/strong><a href=\"http:\/\/darylchow.com\/frontiers\/the-skills-of-a-supervisor-is-not-the-same-as-a-therapist\/\"><\/a><a target=\"_blank\" href=\"http:\/\/darylchow.com\/frontiers\/the-skills-of-a-supervisor-is-not-the-same-as-a-therapist\/\" rel=\"noreferrer noopener\"><\/a><strong>N<\/strong>ot everyone would agree about this, but the distinction is important.<\/li>\n\n\n\n<li class=\"has-medium-font-size\">\u23f8\ufe0f&nbsp;<strong>Words Worth Contemplating:<\/strong><br><strong>One man is no man<\/strong>. \u2014Ancient proverb<\/li>\n<\/ol>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">Reflect:<\/h2>\n\n\n\n<p class=\"has-medium-font-size\">Are you passing on a guiding light?<\/p>\n","protected":false},"excerpt":{"rendered":"<p>What are the most pressing problems in the practice of psychotherapy? There are several issues at hand. For example, it\u2019s a bit of a scandal that, on average, therapists do not get better with&#46;&#46;&#46;<\/p>\n","protected":false},"author":1,"featured_media":5774,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[248],"tags":[],"class_list":["post-5545","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-frontiers-friday-series"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>What are the most pressing problems in the practice of psychotherapy? - Frontiers of Psychotherapist Development<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/darylchow.com\/frontiers\/what-are-the-most-pressing-problems-in-the-practice-of-psychotherapy\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What are the most pressing problems in the practice of psychotherapy? - Frontiers of Psychotherapist Development\" \/>\n<meta property=\"og:description\" content=\"What are the most pressing problems in the practice of psychotherapy? 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For example, it\u2019s a bit of a scandal that, on average, therapists do not get better with&#046;&#046;&#046;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/darylchow.com\/frontiers\/what-are-the-most-pressing-problems-in-the-practice-of-psychotherapy\/\" \/>\n<meta property=\"og:site_name\" content=\"Frontiers of Psychotherapist Development\" \/>\n<meta property=\"article:published_time\" content=\"2023-08-25T09:03:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-05-02T16:55:21+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/darylchow.com\/frontiers\/wp-content\/uploads\/2024\/05\/most-pressing.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1036\" \/>\n\t<meta property=\"og:image:height\" content=\"581\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Daryl Chow, MA, PhD\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Daryl Chow, MA, PhD\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"6 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/darylchow.com\/frontiers\/what-are-the-most-pressing-problems-in-the-practice-of-psychotherapy\/\",\"url\":\"https:\/\/darylchow.com\/frontiers\/what-are-the-most-pressing-problems-in-the-practice-of-psychotherapy\/\",\"name\":\"What are the most pressing problems in the practice of psychotherapy? 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