Most of my career has been spent providing and studying psychotherapy. Together with my colleagues at the Institute for the Study of Therapeutic Change, I’ve now published 8 books and many, many articles and scholarly papers. If you are interested you can read more about and even download many of my publications here.
Like most clinicians, I spent the early part of my career focused on how to do therapy. To me, the process was confusing and the prospect of sitting opposite a real, suffering, client, daunting. I was determined to understand and be helpful so I went graduate school, read books, and attended literally hundreds of seminars.
Unfortunately, as detailed in my article, Losing Faith, written with Mark Hubble, the “secret” to effective clinical practice always seemed to elude me. Oh, I had ideas and many of the people I worked with claimed our work together helped. At the same time, doing the work never seemed as simple or effortless as professional books and training it appear.
Each book and paper I’ve authored and co-authored over the last 20 years has been an attempt to mine the “mystery” of how psychotherapy actually works. Along the way, my colleagues and I have paradoxically uncovered a great deal about what contributes little or nothing to treatment outcome! Topping the list, of course, are treatment models. In spite of the current emphasis on “evidence-based” practice, there is no evidence that using particular treatment models for specific diagnostic groups improves outcome. It’s also hugely expensive! Other factors that occupy a great deal of professional attention but ultimately make little or no difference include: client age, gender, DSM diagnosis, prior treatment history; additionally, therapist age, gender, years of experience, professional discipline, degree, training, amount of supervision, personal therapy, licensure, or certification.
In short, we spend a great deal of time, effort, and money on matters that matter very little.
For the last 10 years, my work has focused on factors common to all therapeutic approaches. The logic guiding these efforts was simple and straightforward. The proven effectiveness of psychotherapy, combined with the failure to find differences between competing approaches, meant that elements shared by all approaches accounted for the success of therapy. And make no mistake, treatment works. The average person in treatment is better off than 80% of those with similar problems that do not get professional help.
In the Heart and Soul of Change, my colleagues and I, joined by some of the field’s leading researchers, summarized what was known about the effective ingredients shared by all therapeutic approaches. The factors included the therapeutic alliance, placebo/hope/expectancy, structure and techniques in combination with a huge, hairy amount of unexplained “stuff” known as “extratherapeutic factors.”
Our argument, at the time, was that effectiveness could be enhanced by practitioners purposefully working to enhance the contribution of these pantheoretical ingredients. At a minimum, we believed that working in this manner would help move professional practice beyond the schoolism that had long dominated the field.
Ultimately though, we were coming dangerously close to simply proposing a new model of therapy–this one based on the common factors. In any event, practitioners following the work treated our suggestions as such. Instead of say, “confronting dysfunctional thinking,” they understood us to be advocating for a “client-directed” or strength-based approach. Discussion of particular “strategies” and “skills” for accomplishing these objectives did not lag far behind. Additionally, while the common factors enjoyed overwhelming empirical support (especially as compared to so-called specific factors), their adoption as a guiding framework was de facto illogical. Think about it. If the effectiveness of the various and competing treatment approaches is due to a shared set of common factors, and yet all models work equally well, why would anyone need to learn about the common factors?
Since the publication of the first edition of the Heart and Soul of Change in 1999 I’ve struggled to move beyond this point. I’m excited to report that in the last year our understanding of effective clinical practice has taken a dramatic leap forward. All hype aside, we discovered the reason why our previous efforts had long failed: our research had been too narrow. Simply put, we’d been focusing on therapy rather than on expertise and expert performance. The path to excellence, we have learned, will never be found by limiting explorations to the world of psychotherapy, with its attendant theories, tools, and techniques. Instead, attention needs to be directed to superior performance, regardless of calling or career.
A significant body of research shows that the strategies used by top performers to achieve superior success are the same across a wide array of fields including chess, medicine, sales, sports, computer programming, teaching, music, and therapy! Not long ago, we published our initial findings from a study of 1000’s of top performing clinicians in an article titled, “Supershrinks.” I must say, however, that we have just “scratched the surface.” Using outcome measures to identify and track top performing clinicians over time is enabling us, for the first time in the history of the profession, to “reverse engineer” expertise. Instead of assuming that popular trainers (and the methods they promote) are effective, we are studying clinicians that have a proven track record. The results are provocative and revolutionary, and will be reported first here on the Top Performance Blog! So, stay tuned. Indeed, why not subscribe? That way, you’ll be among the first to know.