I’m not sure what was going on in our field last week. From the emails I received, it seemed something big — no, monumental. Here are just a handful of the highlights:
“The single modality that’s transforming how clinicians do therapy … and making them so successful.”
A new approach for “Getting to the heart of complex and deep-rooted clinical issues, fast.”
A “unique and integrative approach for … building thriving relationships that last!”
You will learn to offer “transformative trauma healing results … [and] become the go-to trauma healer.”
Plus, certifications in “complex trauma, PTSD, and dissociation,” “polyvagal therapy,” and — no irony intended — “Narcissistic Abuse Treatment Clinician.”
Now, truth is, I get a lot of email. On any given day, a certain percentage of what lands in my inbox is made up of solicitations. A couple of advertisements for training in this or that therapy would, therefore, have gone unnoticed.
This was different. One day alone I received 41 separate come-ons — all with the same bold promises and time-limited discounts for “special customers” like me.
I still don’t know what led to the deluge. What is certain is that it had nothing to do with advances in the “science of psychotherapy.” Over the last 50 years, treatment methods have proliferated despite a lack of evidence of differential effectiveness between approaches. And even when a randomized controlled trial indicates a particular approach works, none show practitioners become more effective when they are trained in that modality.
Consider a study out of the United Kingdom (1). There, massive amounts of money have been spent training clinicians to use cognitive behavioral therapy (CBT). Clinicians participated in a high intensity course that included more than 300 hours of training, supervision, and practice. Competency in delivering CBT was assessed at regular intervals and shown to improve significantly over the course of the training program. And yet, despite the tremendous investment of time, money, and resources, outcomes did not improve. In short, clinicians were as effective as they’d been before being trained.
Contrast the field’s relentless pursuit of “treatment technology” with the work of psychologist Timothy Anderson. A decade-and-a-half ago, he developed a tool for measuring therapists’ interpersonal skills. Known as The Facilitative Interpersonal Skills Performance Task (FIS), it assesses a range of abilities (e.g., warmth, empathy, verbal fluency, hope, emotional expression and persuasiveness) by rating therapist responses to video simulations of challenging client-therapist interactions. It turns out that therapists who perform well on the FIS establish stronger relationships and are more effective (2). More to the point, the evidence shows FIS-related skills are trainable and that such training leads to better results (3, 4, 5).
Next month, I’ll be posting a summary of a study my colleagues and I just published documenting the impact of using deliberate practice to improve interpersonal skills — namely, empathy (You won’t be surprised to learn that clinicians’ assessment of their abilities did not correlate with their actual performance).
In the meantime, take a listen to the interview below with Dutch researchers, Sabine van Thiel and Kim de Jong. Their recently published study identified multiple, different types of therapist FIS response styles — including the elusive, “supershrink.”
Until next time,
Scott
Director, International Center for Clinical Excellence
P.S.: The final fireside chat with me and Daryl Chow is scheduled for the last Tuesday of this month. It’s free, of course, but you must register to secure a spot. Click here.
Hi Scott,
My fantasy – based on 30 years of Internet reality?
Your email address probably landed on a big-time ad agency’s list. The owner is probably away on vacation, and a new admin wasn’t monitoring which solicitation was going to whom.
While 41 is a bit heavy, it happens.
Marlene
Thanks for posting this. This research validates common factors theory and ironically contradicts this notion that psychotherapy is a “science”. While some of these skills/traits may be teachable (I have doubts about this), it truly is the *person that the therapist is* that makes them effective. Authenticity matters here, and someone “acting” as a therapist based on how they “should” be “performing” will likely not be as effective or well received as someone who naturally embodies these traits.
This is fascinating! Thank you
Is it possible to get a list of all those cool research papers you flashed on screen? I was watching on a small screen and couldn’t capture them. Thanks.
My view of the most effective therapy is the therapist providing sufficient support for the client’s explicit & implicit experiencing, with the latter being typically more effective. Done effectively enough, the result is the unforced/spontaneous activation of the client’s emotional experiencing, which I’ve termed therapeutic catharsis. The forced activation of emotional experiencing is NOT therapeutic. I also think of the therapist’s congruence as the delivery system for empathy and unconditional positive regard.
This is exciting research pointing to a “radical revolution” in how we think about training therapists. We get little to no training in Facilitative Interpersonal Skills (FIS), which include adapting our voice & body language in appropriately responsive ways to clients. I’ll seek out Bill Stiles’ work on “layers of responsiveness”, to learn more about addressing not only what the client is saying, but also the implied underlying need. I appreciated the research implying that therapists who are too accommodating to clients, find it difficult to bring about change. Thank you for this interview. It builds on Routine Outcome Monitoring (ROM) to highlight individualised growing edges for therapist development & tailor-made foci for their Deliberate Practice.
I have to wonder, when the research is showing the effectiveness when will graduate schools begin to add to their base curriculum?
Hi Scott,
I have used FIT for over 7 years now. Although many in my organization have been skeptical of the method, I can see both sides. I wish that the interpersonal skills could also emphasize on therapist self-care, because I believe that a big part of it is also emotion regulation skills. A holistic approach from the organization would be tremendously supportive.
I would love to briefly share some of my experiences. After 7 years of practice, I had a new manager who focused mostly on numbers. This was never a practice of mine.
I can only speak of my own experience. When I take care of myself, including regular 45-minute Mindfulness-Based Stress Reduction, 45-minute workouts, and supportive food, I see significant benefits. I used to have 45 minutes at work to practice, and the results of my FIT were amazing, even though I worked with clients diagnosed with BPD.
I used FIT to notice what I needed to increase or decrease in terms of self-care, as strange as this may sound. After all, if my effectiveness is based on interpersonal skills, then my duty is to support myself prior to my clients. It’s the same logic as putting my mask on first before my kids in an airplane.
Anyhow, interestingly enough, as I struggled with this new manager, my self-care at work decreased, and I ended up in burnout. Now, months later, I am still noticing that the management style has a significant impact on my interpersonal effectiveness with my clients because it is related to my self-care. I am noticing still not being as effective I used to be.
Thank you for reading my comment.
I wish you a wonderful day,