[first entry after Corona-break]

...and what makes a good therapist anyway?

In German probably most people know the saying “Practice creates the master.” While the general idea of this saying immediately feels correct, upon closer look we probably have to admit that only correct practice makes perfect. In their editorial work “The cycle of excellence” Rousmaniere, Goodyear, Miller, and Wampold (2017) hang on these questions and provide ideas on how to improve one’s skills as psychotherapists.
They create the concept “deliberate practice” to explain the phenomenon that most therapists will stay on one level of expertise throughout their careers – it seems that only those therapists with routine work experience will become better and better experts who also engage in sufficiently many hours of deliberate practice – actually 4,5 times more hours than less effective therapists (p. 9). We also learn that, in the US system, graduate students are highly motivated to learn how to become therapists, but that after they enter independent practice with some level of competence they only develop their curiosity very diffusely and find deliberate practice (e.g. in form of ongoing supervision, additional training of specific missing skills, and self-tracking of performance) not only challenging but also much less pleasant than graduate school (p. 13). In the literature, extremely highly-achieving therapists, however, showed “perseverance and passion for long-term goals” (Duckworth et al. as cited in Rousmaniere et al. 2017, p 13).
So what makes a good therapist? Or, asked in a more research-oriented way that is: Which therapist variables predict psychotherapy effectiveness?
The list of characteristics and actions of effective therapists is long: the ability to form an alliance across a range of patients, facilitative interpersonal skills visible with “difficult” clients are most prominent. But what does “facilitative interpersonal skills” mean? Besides the classics, warmth and empathy, emotional expression, hopefulness, problem focus and alliance-bond capacity, we find the interesting elements persuasiveness, delivery of a cogent treatment, professional self-doubt and deliberate practice (Wampold in Rousmaniere et al., pp. 56ff). That means, those therapists have better outcomes who are persuasive about their treatment modality (and thereby also convinced of it), who stay focused, and who still keep a certain level of self-doubt whether what they do is beneficial. The theoretical orientation per se is, however, unrelated to outcome (as are age, gender, profession, adherence to treatment protocol, and other elements).
This is not the place to summarize all recommendations of this intriguing book, but to answer the questions posed above based on its main ideas: no, more client hours do not make us better therapists per se. Fore and foremost we are to find the orientation that makes us passionate and convinced of what we do, to stay curious about other modalities, and to engage in career-long professional development (deliberate practice) which we should also model to our students. And while deliberate practice does not make perfect, it brings us closer to our goal of serving our clients the best we can. At present, this is the best available option a therapist can choose.

Rousmaniere, T., Goodyear, R. K., Miller, S. D., & Wampold, B. E. (Eds.) (2017). The cycle of excellence. Wiley Blackwell.