You’ve heard of it, right? Lake Wobegon? The fictional town in Minnesota made famous by master story-teller, Garrison Keller. The place where, “all the people are strong, good-looking, and above average?”

Turns out, if the city were “Psychotherapy,” it would not be a fictional place. Since 2012 when the first study appeared in the literature, others have been published documenting the tendency of practitioners to overestimate their effectiveness — on average, by 65% (1, 2). The impact on professional development could not be greater. Again, multiple studies show, for example, therapists do not improve with time or experience despite obtaining regular supervision or attending the latest continuing education workshops (3).

If you are like most therapists, you’re likely feeling skeptical about such findings — and there are some exceptions. More on that in a moment.

In the meantime, consider the results of a study my colleagues and I just published in Practice Innovations. We knew that research to date had relied exclusively on therapists in Western cultures and wanted to explore whether The Lake Wobegon Effect would be observable in other cultures — particularly, those valuing humility and modesty. Turns out, similar to therapists from the US, Canada, Australia and Europe, Chinese psychotherapists (N = 223) rated themselves as above average (the mean percentile rank being statistically indistinguishable).

So, who are the exceptions? In the studies documenting that most therapists become more confident while remaining average or achieving poorer outcomes, some — between 15 and 25% — defy the trend and actually improve with time and experience.

What is it that they do? Returning to Lake Wobegon, they neither express nor rely on feelings of humility. Rather, they engage in activities that engender the self-doubt required for making changes in how they work. One example is measuring their performance. Indeed, the only study ever published to document improved outcomes at the individual practitioner level involved therapists routinely measuring client progress, identifying those at risk of dropout or a negative or null outcome, and obtaining feedback targeted to their specific clinical errors and performance deficits (4).

Whether you are an experienced practitioner or new to the field, have been measuring your results for years or wanting to get started, the upcoming Feedback Informed Treatment Intensive will help you put Lake Wobegon in the rearview mirror. Three days, online, and ongoing support from a worldwide community of helping professionals dedicated to improving the outcome of behavioral health services. Click the icon below for more information or to register. As always, feel free to reach out with any questions.

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

UPDATE 9/23/24

Access the article here.