In my previous post, I wrote about my history with imposter syndrome as a therapist—convinced that I wasn’t really a good therapist until I was confident. To resolve this self-doubt, I turned to expanding my knowledge in different ways of doing therapy. I did things almost all therapists do to learn more. I met with a peer or one of my mentors to learn new ways of responding to challenging client situations; I read books on and would take in-depth courses to learn therapies that were new to me.
At one point I was convinced that Schema Therapy was the answer to my imposter syndrome woes, then it was EMDR and then ACT. I simply wanted more tools and strategies to help more of my clients to get better, faster and more profoundly. Over time, my pool of knowledge expanded and I felt more confident and supported by my peers in knowing I could turn to them for answers.
Despite these helpful endeavours, there was one glaring issue that always remained, a fly in the ointment I could never fish out. My clients were not improving any faster or more noticeably than they had before. I would learn so much and yet my average number of sessions would hover around 4-6 in total. In Australia, clients get a referral from their doctor to have up to 10 rebated sessions with a psychologist (after COVID it became 20 sessions), but more often than not my clients would end therapy before finishing the 10 sessions.
It turns out I’m not alone. Research has been unearthing that most clients reach a clinical improvement approximately 20%-40% of the time. Clinical improvement or change means that when a client is given a measure to monitor therapy, such as the Outcome Rating Scale, they move from ‘dysfunctional’ to scoring consistent with a ‘normal’ population. These rates of clinical change are stagnant, they have been for a long time, more than 40 years (see Miller, Hubble, & Chow’s Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness). Yes, you heard that right. Forty years. Despite more experience, therapies, strategies and tools, the needle isn’t moving. We are reasonably effective—we just aren’t improving.
The rest of this piece is about how I finally managed to buck the trend and improve my outcomes as a therapist.
As a demonstration, below is the full suite of my outcome statistics, since 2021, which is when I dived into a system of development called ‘Deliberate Practice’. My chosen measure of change in therapy is the Outcome Rating Scale (ORS) and I use FIT Outcomes, a web-based outcome monitoring system, to track my outcomes.
| Outcome Metric (Closed Cases) | Research Established Benchmarks | My outcomes (2021)
Total cases = 72 |
My outcomes (2022)
Total cases = 87 |
| Average session # | 6 | 4.16 | 8.7 |
| Dropout % | 20%-22% | 20.5% | 10.3% |
| Clinical change % | 25%-40% | 51.3% (n = 37) | 65.5% (n = 57) |
Based on this table, you can see that I doubled the number of sessions I had with my clients, cut the amount of unplanned dropouts in half, and improved the number who experienced clinical change from about half to about two-thirds of my clients.
What Is Deliberate Practice?
A system of development has begun to emerge in the therapy space over recent years coined ‘Deliberate Practice’. There is a good chance you have heard about it by now. Folks like me and the pioneers who came before, have been trumpeting its message of hope for some time—that it is possible for therapy outcomes to improve.
Deliberate Practice is not a new idea; it has been present in domains of performance for quite some time, such as in music and sport. These domains are very well versed in how to apply Deliberate Practice and its core components, which there will be more on later in this piece. While Deliberate Practice is not new, it was only recently unearthed and defined. It was the late and great K. Anders Ericsson that discovered this species of development. I believe what Charles Darwin was to discovering evolution, K. Anders Ericsson will be to discovering a system of development. He had a keen interest in learning about what separated the very top of performers from the rest of their respective field. Ericsson found that these top performers applied Deliberate Practice, where others did not.
Anders Ericsson defined deliberate practice as: “individualized training activities especially designed by a coach or teacher to improve specific aspects of an individual’s performance through repetition and successive refinement. To receive maximal benefit from feedback, individuals have to monitor their training with full concentration, which is effortful and limits the duration of daily training.”
It turns out that there is much that those of us in the therapy space can learn from our older brothers and sisters from music and sport. It was Scott Miller, a therapist and researcher, who, with Ericsson as his guide, pioneered Deliberate Practice in the therapy space. Even though Deliberate Practice targeting therapy is in its infancy, it is being shown as a difference maker in improving therapy outcomes, unlike anything before.
My Deliberate Practice Journey
Throughout my Deliberate Practice journey, I have embarked on learning objectives that were targeted towards improving my outcomes as a therapist—to lower my client dropout rate and increase the percentage that were achieving reliable improvements in their well-being. I have listed out my learning objectives, in the order I started them:
- Obtaining client feedback and outcome data to better react to an individual’s therapy needs and identify which fundamentals of good therapy I need to address.
- Strengthening my goal-setting process with clients to better align with their wants and preferences and thereby increase their therapy ‘buy in’.
- Catching my tendencies to try to problem solve on behalf of the client, instead of encouraging them to explore their challenges for themselves, by encouraging myself and them to turn towards challenging emotions and experiences:
In my opinion, tackling the above learning objectives has been an essential mechanism for me to improve my effectiveness as a therapist. There has been plenty of toil and frustration, I am more often than not out of my comfort zone, but it has also been the most gratifying experience of personal growth and pride. My confidence has reached new heights, but I still maintain a healthy level (mostly) of self-doubt. My relationship with my self-doubt has also transformed, from seeing it as the bane of my existence, to now seeing it as one of my strongest allies. Deliberate Practice has been worth every struggle and it’s something that I feel compelled to share and teach to others, so that you can experience the growth that I continue to experience.
The Four Core Components of Deliberate Practice
The remainder of this piece will lay out the four core components of Deliberate Practice—its main ingredients, with examples from my own journey. I hope you enjoy the ride and please do not hesitate to contact me if you would like to learn more. I am more than happy to provide what support and assistance I can to engaging in Deliberate Practice as a therapist.
Developing these components of Deliberate Practice can be a significant challenge. After all, true growth is difficult and slow. With guidance, however, they can be achieved, especially if they are broken down and pursued at a manageable pace. It is my hope that in defining these components, you will begin to see Deliberate Practice as achievable. It is here that our current system of learning can fall. In the current system we use, it is all too easy for these elements to be missing, either in part or in full. All four components are required for growth to succeed.
Individualised Learning Objectives
Step out of your comfort zone—tackle your weak spots
It’s essential that when you address your weak spots, that you also step out of your comfort zone. If you’re comfortable, you’re not growing. Growth triggers us to feel vulnerable, which inevitably kicks off our fight vs flight response. However, if you have the urge to shut down or give up when challenging yourself, it means that you’re in the ‘panic zone’ and pushing yourself too hard. Pushing into the panic zone may work at times for athletes, but it’s not necessary for a therapist trying to improve a skill. This means that there’s a ‘sweet spot’ of discomfort when attending to a weak spot; this is called the ‘zone of proximal development’ or ‘learning edge’. It’s the space that sits between our comfort and panic zones.
When we are at our learning edge, we experience discomfort to some degree. There may be an urge to withdraw, but it is not overpowering. That’s the space you want to be in whenever you’re addressing your weak spots, because being in our learning edge means we’re growing while not becoming overwhelmed.
When it comes to my own growth, I don’t expect myself to address any more than one behaviour at a time. Taking on any more than this increases the risk that I dip into my panic zone. This is especially important because whenever I’m about to start practicing a desired behaviour, I’m at my most apprehensive, but over time as I repeat the behaviour, I become more confident and comfortable with it. I repeat and practice over and over, for as long as it takes, even months if needed, until I become comfortable enough with the behaviour, often so comfortable that I start to enjoy enacting the desired behaviour. I now enjoy something I once feared—how cool is that!
Now you start to understand the power I find in not just setting individualised learning objectives that are consistently manageable, but in the entire process of Deliberate Practice. I have never before experienced such a strong feeling of sustained growth. I remember in the past when I completed a course in how to do a certain kind of therapy, like trauma-focused CBT, I would be given all these modules, filled with different topics and techniques. I would feel overwhelmed and unsure about which technique is best for me to concentrate on.
So, as a safety behaviour, I would automatically try to “play it safe” by learning everything the course offered all at once. Inevitably my brain would become like an overfull glass of water and the knowledge would start to spill. At best I would come away from a course that totalled 12+ hours’ worth of content, likely only remembering one or two concepts or techniques. I may as well just start taking one bite of a burger then walk away! It’s essentially the same effect. But instead, these therapy courses would cost me $600, so that’s a very expensive bite of knowledge.
This is a major factor why I have been a whole lot pickier in determining which courses to undertake. Why would I spend so much money on a course which won’t help my outcomes and will just feel overwhelming, when I can continue to follow my deliberate practice system? After all, my therapeutic outcomes never improved until I started Deliberate Practice anyway.
Focus on what matters most—the fundamentals
To maximise the effectiveness of one’s goals, the goals should focus on addressing what matters most to improve outcomes—on the fundamentals of what we do. The fundamentals in therapy include creating a therapeutic relationship with a client, working on what the client is motivated to work on (goal alignment), agreement with the client on the means to working on their goals (process alignment) and creating hope for the client that they can improve, among others.
Before I started Deliberate Practice, I couldn’t say with confidence which of these fundamentals I was weakest in. Which is why my first learning objective pertained to gathering client feedback in the hopes of clearing up this picture. After some time collecting clients’ data via the Outcome Rating Scale (ORS) and Session Rating Scale (SRS), I noticed that the score for goal alignment on the SRS was often the lowest score clients were giving me.
This was supported by client’s qualitative feedback as well, as they would say things like “I’m not quite sure what we’re supposed to be working on” or “I don’t know where all this is going”. It was from such feedback that my next learning objective was born, which was to strengthen my goal-setting process with clients. Deliberate Practice helped me realise that my goal setting with clients was almost non-existent!
Focus on the steps to the destination, not just on the destination itself
Goal setting is an integral feature of deliberate practice, but goals must be tailored to the individual. One needs to be mindful of their desired outcome when seeking to improve their effectiveness. My first outcome goal in this journey was to gain actionable, qualitative feedback from my clients at the end of each therapy session as much as possible.
However, it’s not enough to identify a desired outcome alone. Research supports that the best performers set most of their attention on the ‘process steps’ to an outcome goal. If goal setting were like a ladder, they focus on the rungs from the bottom step to the top, not just the top step. Focusing on the process is vital to helping change be more focused and manageable. As a result, I’m far more likely to sustain positive levels of engagement and motivation in pursuing my goals. For the above-mentioned outcome goal, my process steps looked something like this:
- Pick measures for gaining client feedback (Outcome Rating Scale and Session Rating Scale).
- Pick a software program to track client session feedback and my outcome statistics.
- Identify an introductory spiel to give clients for the ORS and SRS.
- Practice the intro spiels until I was comfortable with them.
- Use client feedback from the ORS and SRS to inform my learning objectives.
I have had numerous outcome goals (learning objectives) in my Deliberate Practice journey so far, and each of them have contained process steps like the example above. Below I’ll elaborate on successive refinement to lay out how my process steps would evolve from where they started over time.
A Coach
As human beings, we are notoriously not very good at being able to self-assess our weak spots, as our own biases and self-protective tendencies can get in the way. What can help work around this, is to have someone other than ourselves, who is an expert in the area we want to improve in and can therefore guide you in tackling your weaknesses. In Deliberate Practice this person is called a ‘coach’.
Coaches can be found in every performance domain, such as music and sports. Coaches help us not only see what we cannot about ourselves but can help us come up with strategies that we may never have considered on our own. A coach can observe from the outside, with a vantage point to guide us around the roadblocks we are blind to. When we apply such coaching to therapists, a coach will focus on the factors related to the therapist, not the client. A coach will focus on applying core fundamentals and principles, instead of encouraging the mastering of a specific technique.
I had a fantastic coach, Nathan. He helped me identify and keep in contact with my learning edge, gave gentle correction without being critical, created a safe environment for me to be vulnerable, encouraged me to find my own style and modelled by being open to feedback himself. I can’t overstate how game-changing these approaches were for me. I felt a sense of adrenaline from growth that I had never felt before in other forms of professional development, I think because the coaching allowed me to experience growth in my weak spots in real time.
Coaching sessions would start with me identifying a desired behaviour I wanted to generate in a therapy session or a client scenario I wanted to improve in. After choosing a target, Nathan would give me space to practice my desired behaviour through a form of role-playing. He would offer guiding principles and feedback that would help me sharpen and focus my desired behaviour. Once I was happy with what I had created, he would then guide me through practicing the desired behaviour multiple times to help it consolidate and sink in. Then, in the final stages of the coaching session, Nathan would guide me in formulating a plan to practice my desired behaviour until we met again.
The coaching I received was so effective that I eventually built up enough confidence to continue this portion of my deliberate practice journey without any formal coaching, as I have decided to trust myself and what I had learnt. I know this is a risky proposition, but I have watched my outcome statistics continue to gradually improve since I finished with Nathan about six months ago. I also know that I can return to coaching if my outcome statistics ever start to stagnate.
Feedback
We all know feedback is important. Those that are open to the feedback of others tend to improve more effectively than those that ignore it. However, as Scott Miller and his co-authors proposed, it also must be the ‘right kind’ of feedback if it is to help one increase their ability. There are certain characteristics of feedback that are more likely it to be beneficial, they write:
“Feedback is more likely to be effective when it is timely, immediate, continuous, individualized, focused on specific goals, includes a plan of action, task versus person oriented, designed for remediating deficits or reducing given behaviours versus reinforcing or enhancing existing strengths, and delivered by a trustworthy and respected authority. Similar findings have been reported in psychotherapy research. As is introduced in Chapter 7, studies of routine outcome monitoring—soliciting feedback from clients on an ongoing and formal basis—have shown it decreases dropout and improves outcomes”.
Good feedback helps us see into our blind spots and sets the path to tackling where we are weakest. One of the trickiest elements to gaining feedback is opening to it in the first place. It’s easy to feel turned away at the prospect of exposing ourselves to vulnerability or by the idea that clients will see us as lacking competence. However, the effect of eliciting feedback is more often a feeling of empowerment, for both you and the client. It helps us feel more capable of strengthening ourselves, can become a fantastic tool for modelling an adaptive response to growth and for clients to feel a sense of agency in designing their therapy. Before, I felt an urge to avoid discussing why a client’s session rating scores had dropped, whereas now I feel compelled to see these occurrences as an opportunity for improvement that can benefit both me and the client. The benefits of good feedback far outweigh the costs.
Successive Refinement
Repetition alone does not equal improvement—that’s the core premise of successive refinement. For successive refinement to happen, the three other components of Deliberate Practice need to combine. Successive refinement may sound obvious, but a key to Deliberate Practice is to not take it for granted. We must consistently observe whether our efforts are working, to inform if we need to try something different, even if just making subtle behavioural changes.
The urge to disengage from these efforts and stay put in our comfort zone is a natural urge that doesn’t go away. If you’re finding yourself unwilling to make an intended change, you may be expecting too much of yourself. In that case it’s ok to ask yourself what the roadblocks are or to reduce the size of your desired behaviour. Being psychologically and mentally flexible; allowing yourself to take smaller steps when you’re overwhelmed and to go bigger when you have the energy to do so, I believe, is the beating heart of sustaining growth. It’s when we feel like we can’t be flexible, or we don’t allow ourselves to be, that will cause growth to perish.
Despite the fact the Halloween was not so long ago, I’m not ending on such a dark note. I’d much prefer to end with a message of hope. Deliberate Practice is hard—no bones about it. This is because growth is hard. I know that it’s possible to keep trudging onward through the winter storm of vulnerability and fear that tells us to turn back for the safety and warmth of our comfort zone.
I have been walking through this storm with Deliberate Practice for almost two years now. I strongly believe that to change, I had to dig deep. It’s been frustrating, uncomfortable and at times exhausting. While I take pride in the fact that my outcome statistics have improved, it’s the sense of self-acceptance and belief I now feel, that makes it all worth it. To know that I can now muster the courage to face my fears, and that with time the changes will come if I stick to my system. The strength of perseverance this journey has given me is something I will always treasure.
Thanks for sharing this! You are helping our agency come around to the idea of deliberate practice, and I think it will be helpful.
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“Clinical improvement or change means that when a client is given a measure to monitor therapy, such as the Outcome Rating Scale, they move from ‘dysfunctional’ to scoring consistent with a ‘normal’ population.”
I don’t understand. Many psychiatric mental illness diagnoses are rejected for the lack of objective testing. It sounds as if a person undergoing therapy of the type mentioned here, fills out a form to rate his subjective sense of wellness. Therapists then evaluate their efficacy based on non-scientific data. What am I missing?
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You are missing nothing. There is no objective means to assess “success” in any “mental health treatment” modality. This is why psychiatry/psychology are not actually scientific endeavors. There is no way to even select out a legitimate group for experimentation, let alone obtain an objective measure of pathology or success, for ANY DSM “diagnosis.” Perhaps it’s the last point you are missing after all!
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Ron, I am over the moon to hear that! In case it helps you explore the idea of Deliberate Practice further, you can always head over to the resources page of my website. There you will find plenty of resources to help you dig deeper. You can contact coaches to help you learn more or if you’re on Facebook there are some fantastically supportive groups of therapists to answer any questions on DP: https://deliberatepracticepsych.wordpress.com/resources/
Please feel free to reach out if you have any questions!
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How does “therapy” work? What are the “mechanisms” or areas of concern within the person’s mind, brain, “soul”, “emotional center” that are repaired or treated or improved upon? What takes place within the person that makes therapy a useful approach to helping him/her? Why does a person feel better? What happens and how?
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I would suggest the same question applying to psychiatric drugs and to electroshock “therapy,” and see no actual answers to any of these questions.
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Dr. Murphy, your thoughts, please. I am curious. How can you measure success without an objective test? How do you make a diagnosis as a psychologist without a reliable tool to assess your patient? Do you submit coded billing claims to insurance companies? They must receive a genuine diagnosis I assume and signs of progress.
Thanks
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I know I’m not Dr. Murphy, but I think you have put your finger on a most important issue: how CAN one measure success when the “diagnoses” themselves aren’t even based on any kind of objective test, let alone the outcomes! But insurance companies have become accustomed to accepting DSM “diagnoses” for purposes of reimbursement. In fact, that is what the DSM was invented for and the only actual legitimate use for the manual. It is psychiatry itself that has tried to parlay a very subjective billing document into some kind of pseudo-scientific diagnostic tool for “disorders” that can’t be objectively defined, let alone tested for.
What, indeed, is success in such a scenario? And who gets to decide?
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From my reading and experience there seems to be three main camps on the claimed effectiveness for any from of psychotherapy.
One camp is occupied by the main players in each modality or therapeutic school. They are all competing in a market place of ideas, for power and status – most of the research is done by therapists themselves, so those with the most to gain from their approach coming out on top. It also seems that the approaches that are elevated over others are those that are a best fit for the broader political, economic and cultural zeitgeist. Given the research is done mostly by those with the most to gain its horribly biased and therefore of little merit
Another camp is also occupied by those with the most to gain and the research is done mostly by therapists – however this camp eg Bruce Wampold in the great psychotherapy debate etc – are at least attempting to get us closer to truth by looking in greater detail at the research.
This camp assumes therapy is efficacious and they they are interested in what bits of therapy make it useful – dismantling studies and other forms of research have been carried out to try and understand what is it that actually helps in any therapy. What they have shown is the following.
The most important, indeed key factor in any psychotherapy’s success is absolutely nothing to do with psychotherapy – The most important factor is all about the individuals resources coming into therapy – resources in the broadest sense, finances, health, family, friends, meaning, purpose etc.
Next most important is placebo, then how comfortable the person feels with the therapist or the pseudo relationship, then comes shared goals/hope and right at the bottom is modality/theoretical orientation/techniques.
Then we have a third camp, also made up of therapists and people in related fields – these people are even more interested in getting us closer to truth and they assess psychotherapy in relation to its cultural position. There are many authors here but William M Epstein over several books including The Illusion of Psychotherapy, Psychotherapy as Religion and Psychotherapy and the Social Clinic, Soothing fictions has taken the best of the research apart and analysed it on methodological grounds. What he demonstrates is there is no evidence for any psychotherapy being effective and it can be harmful.
It’s really incredible that a field with such terrible research and routine poor outcomes and clearly making absolutely no difference to human wellbeing as evidenced by the ever rising numbers of people suffering manages to maintain any sort of cultural power position.
This brings us back to psychotherapies usefulness to power and maintaining the status quo by obfuscating the real causes of so much distress in myriad cultural disorders. As David Smail highlighted it then loads individuals with responsibility to somehow adjust to ever worsening conditions. This constantly and falsely advertised transcendent heroic individualism or delusion is also picked apart by David Smail and William M Epstein.
In my own experience working in the sector most of the people I know and come across aren’t aware of the critics of the research literature and simply carry on like it doesn’t exist even when its pointed out.
It seems so often the case that the road to hell is paved with good intentions.
some of these ideas are also laid out here https://www.madinamerica.com/insane-medicine/
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An ironic thing is that if we took to heart Smail & Epstein’s criticism of psychotherapy; that is, it is just a reflection of “heroic individualism” posing as a science, we would abandon it, and leave people to their own devices. In a word we would support heroic individualism.
Some of us are acutely aware that psychotherapy and its cousin, psychiatry, are not sciences, and indeed are more pseudosciences; but the question of whether they are sometimes helpful or not is not answered by pointing out they are not scientific. Talking with one’s pastor is sometimes helpful even though there is no scientific evidence for much of what’s talked about. And in a world where psychiatry is constantly shooting itself in the foot, many grassroot helping services are springing up. Are they more helpful or less?
I would say some attempt to measure outcome is better than none. The problem with “deliberate practice” is the demand characteristic of the measure – I think there is a real risk of people filling in the forms wanting to appease the therapist/grassroot helper. But don’t give them up, rather find supporting evidence. Two major ones – are they in full-time work or study now? Are they on medication now? These are sociological indictors; and by all means criticise these, but suggest alternatives.
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I do agree that social indicators are a legitimate way to measure success – is the person working or involved in activities of some sort, do they have any kind of social interactions, are they sleeping better, are they off of disability payments, are they exercising, etc. But even there, we can’t assume one set of outcomes for everyone. For some, disability is an unavoidable reality. For some, working in a capitalistic 9-5 job is not going to be realistic, regardless of “therapy.” So again, there does need to be some sense of what “success” looks like, but I think we agree it needs to be very much individualized to the person in question, even if some kind of generalized guidelines are agreed to. And it seems we both agree that “symptom reduction” is not a very useful “outcome measure!”
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There is nothing which proves that psychotherapy has any benefit even if the poor slob begins working full time or sleeps great. Who’s to say they had anything to do with his interaction with a therapist? Where is the objective test that his paranoia eased or his failures to concentrate consistently diminished or that his depression lifted a wee bit? Can’t measure depression or problems focusing. He goes to work. Work is killing him, he hates it so much. Everyday spent at work he comes closer to ending his life! So what was accomplished? BTW, who is to say that preventing suicide is a worthwhile goal?
IOW, playing devil’s advocate, we cannot even define the issues being “treated” let alone measure “improvements”. This is the flaw, the justified criticism of anti-psychiatry.
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Why is it a criticism of “antipsychiatry?” Sounded like a fantastic critique of psychiatry itself! And I agree with you, which is why I argue that the only person qualified to tell if something “works” is the client comparing what they got to what they wanted to get out of the deal.
No one has to tell you if your shoes fit or if you liked the meal you were served.
Thanks for sharing!
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Talking to God is proven to be transformative to hundreds of millions. “For me, at the time, it felt like an enormous relief, a lifting of burden, a sense of connecting with the universe in a way I never had before. Very powerful!”
“It makes sense that Jesus mattered to me as a late teenager, when I had a born-again experience “At that point Jesus became not only my Lord and Savior, but also my best friend and closest ally.”
“Jesus was my model of self-giving love…” Bart Ehrman. me, too.
He saw the richest wheat lands of Europe turned into a wilderness.
He saw famine – ‘planned and deliberate; not due to any natural
catastrophe like failure of rain or cyclone or flooding. An administrative
famine brought about by the forced collectivization of agriculture
. . . abandoned villages, the absence of livestock, neglected fields:
everywhere, famished, frightened people.’
In a German settlement, a little oasis of prosperity in the collectivized wilderness, he saw peasants kneeling down in the snow,
weeping, and asking for bread. In his diary he wrote: “Whatever else
I may do or think in the future, I must never pretend that I haven’t
seen this. Ideas will come and go; but this is more than an idea. It is
peasants kneeling down in the snow and asking for bread. Something
that I have seen and understood.’ malcolm muggeridge, who found God and was transformed by Him utterly
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I am not sure power and the status quo would want to abandon something that serves its interests? maintaining the illusion of broken brains or faulty thinking, attitudes and beliefs locates the issues and solutions inside the individual. As people have pointed out this de-contextualises and de-politicises distress. People accessing services have come to believe in the myth of psychotherapy. i don’t think Smail or Epstein would suggest human care and compassion can’t be useful and is not needed
These human qualities just don’t require a cultural power player known as a therapist to offer it with psychobabble aplenty- most therapists, myself included, have no more a clue as to what is going on or how to live beyond the resources I’m/we’re lucky enough to have than anyone else does.
Psychotherapy can also be very harmful – consider the illusion we represent and what we can get people to think about and disclose in a session – this can be horribly re- traumatising and de-stablising yet when people drop out, likely much worse most of the time zero follow up is offered – so again we get to delude ourselves because we simply don’t get to see the harms done – the care stops when they leave the office/wage space – we simply have not a clue as to what life is like for anyone we see its all done on our terms in our offices – illusion on illusion.
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Sorry I am not sure how to respond to a number of people at once. I agree that there is a long way to go. As humans are imperfect and if humans design therapy and Deliberate Practice, they will have flaws as well. It’s true that the subjective nature of what is measured and factors like client’s not wanting to upset their therapist in giving feedback are just some examples of where issues can arise.
I know a good amount of time could be spent on how to improve upon therapy or any system, like Deliberate Practice. It’s important to have these discussions, it’s the vital to encourage improvement!
I think at the end of the day what matters if that we take account of these flaws to try and improve what we are doing.
The point that on individualisation being vital resonates with me as well. Getting better at individualising the work I do with clients is one of my main focuses at present. Has anyone else heard of or have thoughts on Goals Based Outcomes (GBO) in therapy? Like some of the work being done by Mick Cooper and Duncan Law? I believe the main idea GBO is that clients should be choosing their own outcome measures, as this will be more meaningful to them, not to have the therapist choose the outcome measure!
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I agree if you’re going to do therapy, the client has to be the one to decide on what a “good outcome” looks like! No one else can do it but them and have them feel self-determined about their successes. “Therapy” or any other intervention done “for the client’s own good” is almost always the opposite of “therapeutic.”
The biggest problem with THAT idea is that at the beginning, many of the clients I had did not know what they thought a “good outcome” would be for them. The first part of my approach for such people is to help them get to the point where they could make a decision as to what they wanted their life to look like, or what they wanted to change about their lives. Sometimes that’s 90% of the problem – the client has had so many people telling them what to do, think, or feel that they have lost any sense of their own purpose and intentions in life. They do NOT need a therapist or psychiatrist or anyone else piling on more “shoulds” and “should nots” to their already burgeoning heap of them!
But of course, every client is different. Those who already know what they’re trying to achieve have been the easiest to work with, as a few questions helps them identify such barriers as they are encountering (or putting up themselves) and they’re off to the races! But such folks are rare in my experience.
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Steve says, “Sometimes that’s 90% of the problem – the client has had so many people telling them what to do, think, or feel that they have lost any sense of their own purpose and intentions in life. They do NOT need a therapist or psychiatrist or anyone else piling on more “shoulds” and “should nots” to their already burgeoning heap of them.”
THAT’S why I think “psychotherapy” is pure bullshit.
No one needs “a therapist” who’s paid to label and/or drug them. People need someone who’ll listen for free. There called FRIENDS.
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Conclusion: Health care professionals should be aware that the phenomenon (POSTPARTUM DEPRESSION) in Asian cultures is as prevalent as European cultures.
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Everyone needs a positive sense of self, and those who don’t often end up in “therapy”. But a positive “sense of self” is something I never found “in therapy”; in fact, it was the opposite, which is why I have so little faith in “psychotherapy”. The only thing I sensed “in therapy” was the therapist getting their “sense of self” AT MY EXPENSE, and in more ways than one.
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And the only thing “deliberate” I experienced “in therapy” was being browbeaten by the therapist/psychiatrist so they could get their pound of “therapeutic” flesh —
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