On Being a Master Therapist

Practicing What You Preach

Jeffrey A. Kottler, Jon Carlson

• Publisher: Wiley
• Year: 2014
• Print ISBN: 9781118225813
• eBook ISBN: 9781118282410
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Learn from master therapists and bring your skills to the next level

Bringing a breath of fresh air to the therapy profession, this compelling and thoughtful resource urges readers to move from competency to full mastery in the mental health field. Combining the findings of hundreds of previous studies, interviews with a wide range of master therapists, own unique experiences and perspectives, Jeffery A. Kottler and Jon Carlson have devised a guide that takes therapists out of their comfort zones.

Professionals in the fields of psychology, counseling, social work, and human services, as well as graduate students studying for these professions, will find a level of honesty and candor in this resource, which tackles a range of essential topics in a frank, personal tone, and closes with a meaningful discussion about the challenges of striving for mastery. Master therapists and authors Kottler and Carlson explore a range of hot-button topics, such as:

• Cultural misunderstandings
• Disliking your clients (or having clients dislike you)
• Receiving negative feedback from clients
• Injecting creativity into the therapeutic process
• Finding time for social justice and advocacy

On Being a Master Therapist provides a much-needed look at a range of topics that aren't often given such genuine and insightful treatment, with the goal of helping you attain the attributes that truly distinguish excellence in clinical practice. Start on your journey toward mastery with this thoughtful resource.

CHAPTER 1
WHAT IS A MASTER THERAPIST ANYWAY— AND HOW DO YOU GET TO BE ONE?

Raise your hand if you consider yourself a “master therapist.”

If you’re feeling uncertain, or perhaps too modest, then consider someone you know—a former teacher, supervisor, mentor, or perhaps a cherished colleague—whom you consider to be of extraordinary skill and expertise.

What qualifies someone to be identified in this lofty category of exemplary professional? Often, such judgments are made based on so-called “reputation” in the community, or the recommendation of colleagues, or perhaps acknowledgment of scholarly achievement, none of which may have a direct connection to clinical excellence. As we begin our journey together to explore what it means to be a therapeutic “master,” we must acknowledge at the outset that there is hardly a consensus in our field about what exactly this means. Are master therapists those who have attained eminence as a function of their longevity, position of power and influence, or publication record? Do they represent clinicians with a full caseload and long waiting list? Are they perhaps those whose clients and ex-clients sing their praises with wild passion and enthusiasm?

Even should we agree on what constitutes excellence in therapy, is this assessment based on the mastery of certain clinical skills, particular personal qualities, or professional characteristics? Perhaps it includes those with the deepest possible understanding of a conceptual framework or the most successful positive outcomes in the most efficient period of time?

Whether or not you feel comfortable including yourself among this illustrious group, on what basis would you consider nominating a colleague? Perhaps a therapist talks a good game, appears wise and knowledgeable, even reports dramatic success with intractable cases, but how do you really know what goes on beyond closed doors when sessions are in progress? Is a therapist’s reputation in the community or among peers actually a reliable measure of mastery? Can we even trust the critical judgment of their clients, who may report tremendous satisfaction with services? Perhaps this assessment is based on factors that have little to do with the therapist’s expertise or skill and more to do with other things, such as how much he or she is liked.

Historically in our field, those who have received the most attention, even deification, are largely a group of elderly white male theorists (like the two of us!) whose main attributes may be the ability to sell their particular ideology and portray themselves in writing or public speeches as charismatic and wise. Such abilities are certainly laudable but may not directly translate into mastery as a clinician. The fact that someone developed new ideas, can explain things well, or is a persuasive speaker or gifted writer does not necessarily mean that he or she is all that effective in sessions. In fact, often quite the opposite is true. Whereas there are notable exceptions, we have learned over the years from our own interviews with over 100 of the most famous theoreticians in the field, as well as observing them in sessions, that many of them struggle working with clients just like everyone else. Whether you agree with that assessment or not, our point is that just because someone is well known in the field for the ability to promote a particular theoretical perspective does not necessarily mean that they are master practitioners of that framework.

Some of the world’s greatest therapists labor in relative obscurity. They don’t enjoy the limelight. They may not care to speak or write about their work. They just adore working with their clients, have attained an extraordinary degree of competence, and don’t choose to talk much about what they’re doing. We hardly know they exist.

What Is a Master Therapist?

As a counterpoint to this project, we have completed a previous investigation of what constitutes “bad therapy” and discovered there was hardly a consensus among our field’s leaders. We may have some idea that a certain percentage of clients become worse as a result of treatment (estimated between 10% and 40%, depending on the diagnosis), but there isn’t necessarily agreement on what most often leads to negative outcomes. Some theorists we interviewed said with great authority that bad therapy is a negative outcome for the client, which makes perfect sense. But others described it as occurring when: (1) the therapist loses control of him- or herself, (2) invalid assumptions are made, (3) the same mistakes are repeated over and over, (4) obsolete or untested methods are employed, (5) the therapist just goes through the motions, (6) there is an inadequate alliance, (7) the client doesn’t feel understood, (8) the therapist is overly arrogant or unjustifiably overconfident, or (9) the therapist isn’t satisfied with the result even though the client may be perfectly content. It is therefore not surprising that there would be just as much debate about what qualifies an extraordinary practitioner.

Do we rely on self-identification of the most accomplished among us? According to one study by Jeffrey Sapyta and colleagues, 9 out of 10 clinicians describe themselves as “above average.” This is consistent with other studies in which the vast majority of drivers (80%) describe themselves as more skilled than others. Even more interesting (and amusing) are the 90% of graduate business students at Stanford (who we assume would be well prepared to understand statistics) who all described themselves as better qualified and prepared than their peers. This “illusory superiority effect” is consistent among our species across a range of behaviors in which almost all of us consider ourselves to be masters in our chosen fields. After all, who is willing to admit that they are only average, or even less than fully competent?

Assessing one’s own level of competence in almost any area is notoriously unreliable, especially in those dimensions that are most integrally tied to our self-esteem, such as our professional practice. There is overwhelming evidence that self-confidence has absolutely no relationship to mastery of a skill or behavior. In his studies of self-deception, for example, evolutionary biologist Robert Trivers observed that there is often an inverse correlation between professed knowledge and confidence versus actual performance. In other words, those who most loudly and passionately claim they are extraordinary in their work are often those who are the least effective.

If self-selection of excellence is subject to cognitive bias and exaggeration, should we use other criteria such as recognition by colleagues, including the conferring of awards or “fellow” status? While certainly an indication of respect, does such recognition really mean that the professional is truly exemplary as a therapist? Such awards usually represent scholarly, academic, or political accomplishment.

Of course, there have also been numerous attempts to apply more objective, quantitative measures to the assessment of mastery. While empirical studies of treatment outcomes do provide a degree of precision to the discussion, they also tend to focus on rather definable factors in the process that may or may not represent ultimate, meaningful progress. Do we simply ask clients to report on their own satisfaction, a strategy often recommended by a number of researchers in the field? That brings up the interesting question of whether some clients are actually the most reliable judges of their own experience. How often have you seen clients who say they are not happy with therapy, yet appear to be making remarkable progress? Likewise, how often have clients claimed they are totally satisfied with the way things are going, yet there doesn’t seem to be any noticeable change in their behavior outside of sessions? Time and time again, some clients say how much they appreciate their treatment, how much they are learning and growing, yet other reports by family members dramatically contradict this report.

There are many other ways that we might identify exemplary clinicians—whether they are in great demand, whether their clients refer others, evaluations by supervisors, stature in the community, respect of colleagues and peers, demonstrations of their work in public forums. Yet each of these methods has limitations, in part, because we can’t really agree on a consistent definition of mastery. Another significant reason for the confusion is all the different ways it is possible for therapists to operate at peak performance, depending on their style, personality, theoretical orientation, client population, and clinical context. This is really not that different from the ways that mastery is demonstrated in other fields.

Consider, for example, two baseball pitchers. The first is in his twenties, tall, strong, muscular, intimidating, featuring a blazing 97-mile-an-hour fastball. The second pitcher, in his twilight years, a bit stooped and slow in his movements, commands a variety of “junk” pitches that are off-speed and move all over the plate. Each of them is regarded as superior in their performance, but they have evolved very different ways of achieving their outcomes, relying on particular strengths and resources at their command. This is exactly the case with regard to extraordinary therapists, each of whom has figured out a unique way to persuade and influence their clients.

Different Standards of Mastery

One of the accepted myths in our field is that there are a discrete number of theoretical models, perhaps a half-dozen popular ones, that most therapists employ in their work. Whereas it is not surprising that a number of practitioners identify themselves closely with cognitive behavioral, psychodynamic, existential, narrative, feminist, or other orientations, the reality is that very few of us apply these in pure form. Each of us has evolved our own unique style of practice that resembles nothing else exactly like it. In addition, depending on your chosen approach, each with its own most valued skills and interventions, effectiveness will be assessed differently. An accomplished cognitive-behavioral therapist may work in a business-like fashion and follow a treatment protocol, depending on what the client wants to address. A more psychodynamic therapist might judge mastery based on the quality of interpretations that reveal underlying core issues in need of attention. A humanistic-existential therapist might be less interested in identifying a specific presenting problem and more concerned with creating a deep connection with clients in the context of a warm, caring, and supportive relationship.

Although there are certainly some features that would cross all boundaries, no two master therapists perform therapy in the same way. You’ve confirmed this over and over again each time you watch an identified master therapist working with a client. It is one of the true mysteries of the therapy universe that historical figures as diverse as Carl Rogers, Albert Ellis, Virginia Satir, Fritz Perls, and Sigmund Freud could have all been effective in their work given their apparent extreme differences in values, style, and approach. Of course, one possible explanation is that although their espoused ideas and approaches appeared to be polar opposites, what made them truly great were other, more personal characteristics that empowered their chosen methods.

As we’ve mentioned, people consistently overestimate their own competence, especially in domains that are integrally tied to their core being. Moreover, what therapists say they do in their sessions may bear only a remote resemblance to what actually transpired. You may think that it was a particular confrontation or elegant interpretation that made the most difference to a client, but, more often than not, the client will hone in on something else entirely that you may not even remember.

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JC

I remember one time when my five children were young and I was working long hours, basically burning the candle at both ends and getting very little sleep. It was during a particularly boring afternoon session with a woman who was complaining about her teenage daughters that I must have dozed off.

“Excuse me?” I heard a voice say, startling me awake. “But were you sleeping just now?”

“Actually, no,” I said to her. “I was just closing my eyes for a moment to concentrate more deeply on what you were saying.”

The client knew that I was lying to her, but rather than seeming irritated or disappointed, she seemed to just accept this feeble explanation and ignore it. It bothered me that her expectations were so incredibly low that she refused to become angry or dissatisfied with the poor level of care I was providing. In fact, she was wildly enthusiastic about what a great therapist I was and referred many of her friends and family over the years. She described me as a “wizard” and a “miracle worker,” even though I was rarely fully present with her and felt ashamed of my lack of attentiveness.

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JK

Similar to Jon’s story, one of the seminal cases of my professional career, one that completely changed the way I think about what is good and bad therapy, occurred with an older woman I’d been seeing for many months with little, if any, noticeable change in her behavior during that time. Even more frustrating ...

Table of contents

• Cover
• Titlepage
• Copyright
• Preface
• Introduction: Two Variations on a Theme
• 1 What Is a Master Therapist Anyway— And How Do You Get to Be One?
• 2 What We (Think We) Know So Far
• 3 Deep Compassion and Caring
• 4 Sophisticated Interpersonal Skills: Really, Really Listening
• 5 Being Fully Present While Focusing on the Other
• 6 Knowing What Maybe/Probably/Mostly Makes a Difference
• 7 Speaking the Truth
• 8 Making Mistakes—But Not the Same Ones Over and Over
• 9 Inviting and Responding to Constructive Feedback
• 10 Who You Are Is as Important as What You Do
• 11 Acknowledging Commonalities, Responding to Differences
• 12 Love Is a Four-Letter Word in Therapy
• 13 Getting Wild and a Little Crazy: Promoting Creative Breakthroughs
• 14 Promoting Social Interest and Advocacy
• 15 Being a Work in Progress
• Epilogue
• References
• About the Authors
• Index
• End User License Agreement