[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.

"[...] I think an explicitly anthropomorphic approach is unsatisfactory, and worth reconsidering. If body and environment form constituent parts of what we call 'mind,' it becomes very difficult to see how other animals, with other kinds of bodies, living in other kinds of environments, will 'mind' in ways sufficiently like our own to permit the attribution of humanlike mental states. After all, if the ideas of the umwelt, Gibson’s ecological theory, and embodied sensorimotor theories have something going for them, then we have to accept that we don’t see the 'world-as-it-really-is'; we see it only as it reflects our human needs and physical capacities." (p. 223)


from:
Barrett, L. (2011). Beyond the brain: How body and environment shape animal and human minds. Princeton, NJ: Princeton University Press.

[Crumbs]

In their book “A passion for specificity: Confronting inner experience in literature and science”, Caracciolo and Hurlburt, (2016) use a conversational method attempting (1) to describe the characteristics of mental experience (when reading literature) and (2) to determine where experience as conveyed in literature and experiences apprehended by the scientific method might be able to meet.
Here is how they close their discourse:

“In Lieu of a Conclusion
[....]
That’s it? You’re just stopping?
Here, as in most relationships, there is no real end. We have opened ourselves to dialogue, paid uncompromising attention to phenomena, and tried to let go of our presuppositions, and now have paused to share what has happened. It is up to you, dear reader, to determine the extent to which our struggles resonate with your experience.” (p. 316)

I found that a surprising conclusion as this sentence could have equally said by a Gestalt therapist summarizing what s/he is doing with clients. Speaking with Laskowska (2017, p. 96, transl. ahc) I would add: “...and what of that you want to put into practice in your daily life.”



Caracciolo, M., & Hurlburt, R. T. (2016). A passion for specificity: Confronting inner experience in literature and science. Columbus: The Ohio State University Press.

Laskowska, B. (2017). Worte finden – Die Nöte einer Gestalttherapeutin [Finding words – A Gestalt therapist’s woes]. Gestalttherapie, 31(2), 75–97.