How do the supershrinks do what they do? Are they made or born? Is it a matter of temperament or training? Have they discovered a secret unknown to other practicing clinicians, or are their superior results simply a fluke, more measurement error than reality?
Enter the Institute for the Study of Therapeutic Change, an international group of researchers and clinicians dedicated to studying what works in psychotherapy. For the past several years, the group has been tracking the outcomes of thousands of therapists treating tens of thousands of clients in myriad clinical settings. Like many other researchers, they found wide variations in therapeutic effectiveness among practicing clinicians and tried to determine why.
When they attempted to determine the characteristics of the most effective practitioners, they smacked headfirst into a brick wall. Neither the therapists’ person nor their technical prowess separated the best from the rest. In the end, nothing they could point to explained why some clinicians achieved consistently superior results.
The project would have remained shelved indefinitely had one of the members not stumbled onto the work of Swedish psychologist K. Anders Ericsson. Ericsson was widely considered “the expert on experts.” For the better part of two decades he’d been studying the world’s best athletes, authors, chess players, pianists, mathematicians, teachers, pilots, and others.
The key to superior performance? As absurd as it sounds, the best of the best simply work harder at improving their performance than others do. Such deliberate practice, as Ericsson points out, isn’t the same as the number of hours spent on the job, but rather the amount of time specifically devoted to reaching for objectives just beyond one’s level of proficiency.
For example, in a deliberate practice study of 20-year-old musicians, Ericsson and his colleagues found that the top violinists spent twice as much time (10,000 hours on average) working to meet specific performance targets as the next best players, and 10 times as much time as the average musician.
As time-consuming as this level of deliberate practice sounds—and it is—it isn’t enough. According to Ericsson, to reach the top level, attentiveness to feedback is crucial.
With considerable chagrin, the Institute for the Study of Therapeutic Change realized that what therapists do is irrelevant to greatness. The path to excellence would never be found by limiting their exploration to the world of psychotherapy, with its ancient theories, tools, and techniques. Instead, they needed to redirect their attention to deliberate practice and superior performance, regardless of calling or career.
Scott D. Miller, PhD, is the founder of the International Center for Clinical Excellence an international consortium of clinicians, researchers, and educators dedicated to promoting excellence in behavioral health services. Dr. Miller conducts workshops and training in the United States and abroad, helping hundreds of agencies and organizations, both public and private, to achieve superior results. He is one of a handful of “invited faculty” whose work, thinking, and research is featured at the prestigious “Evolution of Psychotherapy Conference.” His humorous and engaging presentation style and command of the research literature consistently inspires practitioners, administrators, and policy makers to make effective changes in service delivery. Learn more at scottdmiller.com.
Mark Hubble, PhD, is a cofounder of the Institute for the Study of Therapeutic Change. He has co-authored and edited numerous professional articles and books, including The Heart and Soul of Change: What Works in Therapy; Escape from Babel; Psychotherapy with Impossible Cases; and The Heroic Client. Recently, Hubble co-released a self-help book, Staying on Top and Keeping the Sand Out of Your Pants: A Surfer’s Guide to the Good Life.
Barry L. Duncan
Barry L. Duncan, PsyD, is a therapist, trainer and researcher with over 17,000 hours of clinical experience. He is a best-selling author of The Heart and Soul of Change: Delivering what Works in Therapy (APA, 2010), What’s Right with You and On Becoming a Better Therapist (APA, 2010). Dr. Duncan is a sought after media expert and has appeared on Oprah and The View. The author of over 100 publications and 15 books, Dr. Duncan travels the globe providing seminars and workshops.
Dr. Duncan is the director of the Heart and Soul of Change Project, a practice-driven, training and research initiative that focuses on what works in therapy, and more importantly, how to deliver it on the front lines. He has received numerous awards for his contributions to the mental health field, including the Wright State University School of Professional Psychology’s first annual “Outstanding Alumnus Award,” the Menninger Foundation’s 15th Annual Award for Scientific Writing for the book The Heart and Soul of Change, and the Psychotherapy Networker “20th Anniversary All Time Top Ten Award” for the article “Exposing the Mythmakers,” recognizing it as one of the most influential features in the magazine’s history. Barry’s other books include The Heroic Client (2nd edition, Jossey Bass, 2004); Heroic Clients, Heroic Agencies: Partners for Change 2nd ed., 2010 Edition); the 2nd edition of Brief Intervention for School Problems (Guilford, 2007)