What topics are practitioners interested in learning about?
If you read a research journal, attend a continuing education event, or examine the syllabus from any graduate school course, you’re likely to conclude: (1) diagnosis; (2) treatment methods; and perhaps (3) the brain. As I’ve written previously about, the brain is currently a hot topic in our field.
Ask clinicians, however, and you hear something entirely different. That’s exactly what Giorgio Taska and colleagues did, publishing their results in a recent article in the journal, Psychotherapy. Here’s what they found.
Regardless of age or theoretical orientation, the top three topics of interest among practicing clinicians were: (1) the therapeutic relationship; (2) therapist factors; and (3) professional development.
Let’s consider each one in turn.
Number one: the therapeutic relationship. Honestly, when was the last time you attended a workshop focused solely on improving your ability to connect with, engage, understand, and relate to your clients? The near complete absence of such offering is curious, isn’t it? Especially when you consider that the quality of the therapeutic bond is the single best predictor of treatment outcome, the most evidence-based principle in the literature!
Paradoxically, research shows that therapists who are able to solicit negative feedback about the alliance early in the treatment process have better outcomes in the end. Turns out, soliciting such feedback and using it to strengthen the working relationship is a skill fewclinicians–despite their beliefs to the contrary–possess.
There’s a simple solution: download and begin using the Session Rating Scale, a simple, four-item alliance measure designed to be administered at the end of each session. Multiple, randomized clinical trials now show that formally seeking client feedback not only improves outcome but decreases both drop out and deterioration rates.
Number two: therapist factors. In other words, you!
Some time ago, veteran psychotherapy researcher Sol Garfield–one of the editors of the prestigious Handbook of Psychotherapy and Behavior Change–called the therapist the “neglected variable” in psychotherapy research. Available evidence documents that the clinician doing the therapy contributes 5 to 9 times more to outcome than the method used.
Which brings us to topic number three: professional development.
Large, multinational studies document the central importance that professional development plays in the identity and satisfaction of clinicians. And yet, as I wrote not long ago, “the near ubiquitous mandate that clinicians attend so many hours per year of approved ‘CE’ events in order to further their knowledge and skill base has no empirical support.” So, what does work? Recent research by Singapore-based psychologist Daryl Chow shows that the best invest 4.5 more hours outside of work engaged in activities specifically aimed at improving their performance than their average counterparts–an process known as deliberate practice.
First point is right on and links to number three as well. It is rare that conferences, workshops fosus on relationship-building or, for that matter, much of anything related to therapeutic skills, improvement of communication, etc. One of my early mentors was Robert Carkhuff who developed a “response rating scale” to help therapists evaluate their response to a client’s statements. I was triple dipped in that scale and quickly found from Carkhuff that an ‘incorrect’ response was often as good as a correct one in that the client would often jump to “correct” what had been said. The scale was a -5/+5 rating of responses based on reflection of client statements and also on the ability of the therapist to “read between the lines” to make statements that stretched the client to say more. It was extremely helpful to me back in the 1980s as l was learning and has continued to this day to be a great way to check on myself and my comments, responses for strength and helpfulness in my work with clients. Too bad we don’t see more of that in training efforts these days ! Thanks for the comments and best wishes to you in your work. Steve Leatherwood