Why are there so many approaches and new theories that proliferate in the world of counselling and psychotherapy? There are over 500 different types of psychotherapy in existence. Yes, that’s 500, not 5, or even 50. In addition, when you look at the adverts for continuing professional development (cpd) courses there is a whole host of new seemingly ‘sexy’ themes in course content such as trauma informed, neuroscience informed, parts based plurality, embodiment this and that, mindfulness approaches, somatic connecting and so on. All of these potentially exciting new approaches can be intent on chasing new insights, and potential silver bullet knowledge and information that could represent the missing ingredient in bringing about greater therapeutic change in the consulting room. The core ingredients for how therapeutic change occurs can appear to be less ‘sexy’. Who, for example, responds favourably to a cpd advert that refers to empathy in the title?
The increased emphasis on theory and approaches could, therefore, be missing the point. If the question is always can I only just find the right cpd course to boost clinical effectiveness, then perhaps the proliferation of theories and approaches will continue unabated.
Deliberate Practice would suggest that the best performing therapists are the ones who are dedicating time in their week to reaching for objectives and performance improvement which might be just above their current abilities. That’s usually accomplished by targeting areas of weakness. This helps deal with the risks of becoming autonomised and confident, when control over that behaviour is lost, and the explanatory system to account for failures grows too (clients are resistant, or are too complex, for example, or you haven’t done one of the cool new cpd courses yet). Engagement in deliberate practice is far more effective than the latest cpd course or new approach. But before you enter a personal improvement plan you first need a measure of where you are at in your current performance. Who do you work well with and who do you work less effectively with? Having such outcomes measurement data can then inform a more creative and intelligent use of the cpd courses market, supervision and appointing change agents. (See elsewhere for more on feedback informed treatment, and how to measure performance, which is outside the scope of this blog post).
Rather than concentrating on theory, modality, or combining some new approach into one’s practice through cpd, deliberate practice would suggest enacting the core principles that the client feels engaged by and which led to better outcomes. So, what are these core ingredients for therapeutic change? William Miller and Theresa Moyers, in their book Effective Psychotherapists, Clinical Skills that Improve Client Outcomes (2021), offered a list of the eight characteristics that research says are to be found in the best performing therapists.
1. Empathy
It is not surprising that research indicates that good therapists try to see things from their client’s point of view, and aim to see the world through their eyes. Just like empathy is strongly associated with patient satisfaction in medical circles (Kortlever et al., 2019), so it is the case in the therapy world. (See meta-analysis of more than 6000 clients from the study by Elliott et al., 2018).
2. Non-judgemental acceptance
A good therapist will be able to listen without judgement or condemnation, as well as being respectful. Acceptance is about refraining from judgement and listening without blame or shame, both of which can tend to cause defensiveness and prevent change.
3. Affirming and validating
In person-centred language this can also be referred to as ‘warmth’ or ‘positive regard’. A good therapist will appreciate and affirm things about people that they work with, things which they might have lost sight of.
4. Genuineness
A good therapist will be emotionally engaged and will tell people what they are thinking, without appearing fake. They will be on your side and will become involved in your problems. We know from research in medicine (Rollnick et al., 2009) that the patients of doctors with good relationship skills, who listen well, are more likely to follow their advice and, therefore, will have better health outcomes. The same is true for therapy.
5. Focus
Effective therapists are the ones who work with their clients to find a focus for the therapy and will adopt a collaborative approach in setting and developing clear goals as well as a plan for achieving them (Imel & Wampold, 2008). Therapeutic progress is far more likely when goals are agreed (Tryon & Winograd, 2011).
6. Promoting hope and optimism
In the same way that it matters that you believe in the therapy you are getting, it also matters that your therapist believes in what they are doing. It also helps that they believe in your ability to change.
7. Solution-focused and strengths-based
In some therapy circles, the words ‘solution focused’ are often ridiculed, as it can imply too much of the pop psychology mentality. But choosing to highlight their clients strengths and resilience, especially as they may be coming to therapy at a time when they’ve lost belief in themselves can be very effective.
8. Advice and guidance
Effective therapists are not just the brooding detached analyst, forcing the transference through their silence. Therapy is relational whilst keeping professional boundaries.
Remember that no one skill represents a silver bullet, each characteristic should be practised alongside the others in this list. But the list can be a useful template from which to investigate and evaluate current personal effectiveness, and help to produce a map to guide more effective personal improvement and ultimately greater clinical performance.
Noel Bell is a UKCP accredited psychotherapist based in London and can be contacted on 07852407140.
