I recall a former tutor during the early days of my original psychotherapy training at CCPE saying to assembled open mouthed students not to aspire to be an okay therapist, but to aim to be a great therapist. The theme of the lecture was how to develop a private practice in counselling and psychotherapy. At the time I wondered what this would mean to aspire to greatness. He went on to explain that the world is full of therapists, you only had to search online for them in seemingly any corner of the globe to know that, he advised, but that the world contained less great therapists. Great therapists are those who seek to address their own so-called edge material, he suggested, who were not afraid to ask challenging questions of their clients and who had a robust commitment to their own personal growth and their ongoing continuing professional development (cpd).
I recalled these sentiments this week when discussing therapy approaches with colleagues. I believe that sometimes there are occasions when a therapist needs to step up and do more than merely listening. I often wonder whether one’s way of practicing as a therapist is really a summation of the various mentalised mannerisms adopted from one’s influential figures throughout training, be they fellow students, past tutors, supervisors, lecturers or indeed clients who made a huge impression on learning the craft of how to be an effective therapist. The bold sentiments from this tutor stayed with me because they countered the less bold aspiration of others who were intent on being just a good enough therapist and who did not seem intent on pushing their own boundaries. For example, the trainees who refuse to move outside their comfort zone.
I am attracted to the integrative approach, rather than adhering to a strict interpretation of one particular modality and approach, as I understand it better serves the needs of my clients. Why, for instance, would one stick to a dogmatic perspective in how to facilitate therapeutic change when clients can be so different and unique? For instance, why would a blank screen non relational approach, and prioritising an emphasis on working with transference, be appropriate for every single client you see? Equally, why would a relational approach be suitable for everyone, especially someone who needs tighter psychic boundaries in their life? Moreover, why would one adopt transpersonal language with every client when some presentations may be from an atheist background, who might perceive transpersonal language as a form of ‘woolie objectification’?
Therapists who stick to one approach, whether an approach containing a theoretical orientation or a specific way of working, can risk being blinded to the unique needs of each and every client. I can hear my ex tutor now, saying that every person you see is completely unique. There has never been one of them before and there will never be another one of them again. Yet through group supervision I have witnessed therapists applying standardised approaches such as using cognitive approaches in a blind manner, or others who work primarily somatic perspective, blindly adopting a ‘felt sense’ approach to all presenting issues. I am often left wondering why one should have one primary orientation in terms of approach and theory when no two clients are the same. For me, as an integrative therapist, I believe in the importance of keeping an open mind at the start of the work and resisting the temptation to follow a so-called tried and trusted approach.
So, what does greatness entail? Perhaps it is more than being open minded and curious. It might amount to greater risk taking in how to work with clients. So much of therapeutic practice adopts what I term the ‘nodding dog’ approach. This is when a practitioner sits and listens, and occasionally nods. However, whilst the support and empathy aspects of initially building safety and rapport with a client are hugely important, there might be something limiting if the therapist does not proceed to address and name (when appropriate) the avoidances that are in the so-called ‘energetic field’. Perhaps there might be what are termed “elephants in the room” that are not being named. Or, there might be more subtle avoidances present that need addressing. Therapists who fear encountering negative transference from clients might collude and avoid asking difficult questions because of their own fear of confrontation in that moment. Or, they might be worried about upsetting their client and fear that they will leave their practice.
So much of psychotherapy training deals with the supportive and empathetic aspects of practicing in the field but less of the truth seeking that goes beyond just nodding like a dog listening to clients. Offering a supportive and empathetic listening environment is, of course, of crucial importance but truth needs also to be addressed or the therapeutic relationship will feel just like a ‘tea party’. Indeed, it is precisely for hearing the truth which will keep clients ultimately coming back as they are receiving something which they don’t receive elsewhere in their lives. Their friends can offer a supporting ear but friends often have their own vested interests in such relationships and might not be best placed or appropriately trained to identify blind spots. A professionally trained therapist should have no vested interests.
Sometimes the therapist can, however, be blinded to what is actually happening in the therapeutic room. They might be lacking in experience to understand the dynamics of what is occurring or they might have unresolved personal issues themselves, which the client unconsciously touches upon in their story telling. A therapist seeking to build a private practice in the early stages of their career might want to be overly pleasing and accommodating least their client stops attending. Or perhaps a therapist is blocked or is in denial about an aspect of their own development or are lazy and not pushing themselves to develop and to embrace new ways of working or to embrace new ideas. The role of supervision should help to shine a light on such problems, so long as the therapist (and the supervisor themselves) have sufficient awareness of unconscious material in the triangulation between therapist and client and supervisor and therapist.
The concept of deliberate practice and outcome measurement in psychotherapy is often ignored, however, in therapy teaching and learning training centres. Supervision and tutoring is invariably conducted within the limited framework of the modality that is being practiced. Tony Rousmaniere’s book on deliberate practice for psychotherapists contains the following points: that most therapists do not improve throughout their career, that most therapists actually become less effective, and in order to bolster improvement, you need to practice skills in a deliberate fashion to overcome your own weaknesses and bolster your strength.
Noel Bell is a UKCP accredited psychotherapist and can be contacted on 00 44 7852407140 or noel@noelbell.net
