It seems that we share more in common with Homer Simpson than we like to admit. Did you know that social psychologists found that in general, people rate themselves as more attractive
In my doctoral study of highly effective psychotherapists(2), the results of an area investigated about therapists self-ratings of their Healing Involvement (HI) in therapy left us initially scratching our heads. Orlinsky and
Why do therapists with higher self-perception of healing involvement (HI) in their work are more likely to be performing poorer than their peers with low HI self-ratings? We can speculate a few explanations:
1. The illusion of validity:
Ask any couple who lives together, what is the percentage of house chores that each of them does, it will add up to be beyond 100%. The first psychologist recipient of a
In our work as therapists, a healthy dose of optimism may keep us going. But leaving it only to our intuition, inflated confidence without other sources of confirmation, can be a slippery slope.
2. The more effective bunch are more critical of their work:
Past psychotherapy research suggests some possibilities. Hailing from the Vanderbilt psychotherapy research group, Najavits and Strupp(6) found that effective therapists are more self-critical and reported making more mistakes
As it seems, those who think they are novices think more like experts, and those who think they are experts are actually more like novices.
What are we to do to avoid the “illusion of validity”? Given that we therapists are typically an optimistic bunch, we need some pillars in place to prevent us from falling prey to an expert’s “I-know-it-all” mindset. This calls for adopting scaffold in your practice. Allow me to explain the “3-Dimensional Perspective” that can benefit your professional development and your client:￼
1. Elicit client’s formal feedback:
Whatever measures you choose, be it the Outcome Rating Scale & Session Rating Scale (ORS/SRS), Outcome Questionnaire (OQ-45), or the Clinical Outcome Routine Evaluation (CORE), employ it consistently in your clinical practice. Past studies indicate that routine outcome monitoring is likely to as much as double your effectiveness and reduce deterioration rates. In all, feedback effects contribute around 5-10% of the improvements in therapy.7 (Recall that specific treatment models contribute a tiny erm, 0-1% of the outcome).
2. Video-record your sessions:
Experienced therapists are more likely to say that this activity is something you do only when you are in school. Do you see the “illusion of validity” creeping in here?
Among other approaches, the folks from the intensive short-term dynamic psychotherapy (ISTDP) advocate for the recording of
It is essential to have someone to not only provide case consultations, but also a supervisor who can help you design an
I highly recommend for supervisees to arm themselves with two things when you go for supervision: bring your session-by-session outcome graphs and your session audio-video recordings. Put deteriorating or no-progress cases as a priority, and view segments of the recording together. Talk to your supervisor about this practice, if he or she isn’t familiar with it. Get on to the International Center for Clinical Excellence (ICCE) website for free resources on this, or even purchase the FIT manuals (one of the ebooks is clinical supervision). The primary aim of this is to bring your client’s perspective into the conversation in supervision, and not let it slip into either a “pad on the back” episode or a gossip session. Stay close to the music of therapy, and not just talk about it.
Now, clinical supervisors might be helpful for case discussions, but if your supervisor does help you reach beyond your “growth edge”, i.e., develop and tailored learning plan, seek out a mentor as well. This is someone who can point you in
Each of the three practice activities described above, compliment each other. The third activity, of seeking a clinical supervisor/coach/mentor is likely what most of you already are doing. I also highly recommend this for the highly experienced therapists. If our clients are to experience growth and change, we first need to continuously experience this ourselves. It is likely that the first two, Elicit Clients’ Formal Feedback, and Video-Record Your Sessions, are the most difficult to kick-start. As with most behavioral change, start measurably small. If you are new to all of this, print out the outcome measure you want to adopt using (The outcome rating scale/session rating scales are free-to-use). Seek out others who are doing so already. Ask a question in the ICCE forum.
(Stay tuned. I will be elaborating on each of the three points above in future posts)
Consider the above “3-Dimensional Perspective” to enhance your craft.
1. Epley, N. and Whitchurch, E. (2008). Mirror, mirror, on the way: Enhancement in self-recognition. Personality and Social Psychology Bulletin 349:1159-70.
2. Chow, D. (2014). The study of
3. Orlinsky, D. E., & Ronnestad, M. H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth. Washington: American Psychological Association.
4. Kahneman, D. (2011). Thinking, fast and slow. New York, NY: Farrar, Straus
5. Davis, D. A., Mazmanian, P. E., Fordis, M., Van Harrison, R., Thorpe, K. E., & Perrier, L. (2006).
6. Najavits, L. M., & Strupp, H. H. (1994). Differences in the effectiveness of psychodynamic therapists: A process-outcome study. Psychotherapy: Theory, Research, Practice, Training, 31(1), 114-123 6. Najavits, L. M., & Strupp, H. H. (1994). Differences in the effectiveness of psychodynamic therapists: A process-outcome study. Psychotherapy: Theory, Research, Practice, Training, 31(1), 114-123.
7. Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. Psychotherapy: Theory, Research, Practice, Training March, 48(1), 72-79.