The Best Practices of Highly Effective Therapists

How Leaders in Psychotherapy Ensure Success

Scott Miller, Mark Hubble, and Barry Duncan

That therapists differ in their ability to affect change is hardly a revelation. All of us have participated in hushed conversations about fellow therapists whose performance we feel falls short of the mark. But we also recognize that some practitioners are a cut above the rest. With rare exceptions, whenever they take aim, they hit the bull's-eye. Nevertheless, since researcher David F. Ricks coined the term supershrinks in 1974 to describe a class of exceptional therapists---practitioners who stood head and shoulders above the rest---little has been done to further the investigation of supershrinks (and pseudoshrinks, those whose clients experience poor results.

Instead, professional time, energy, and resources have been directed exclusively toward identifying effective therapies. Trying to identify specific interventions that could be reliably dispensed for specific problems has a strong commonsense appeal. No one would argue with the success of the idea of problem-specific interventions in the field of medicine. But the evidence is incontrovertible. Who provides the therapy is a much more important determinant of success than what treatment approach is provided.

The Making of a Supershrink

How do the supershrinks do what they do? Are they made or born? Is it a matter of temperament or training? Answering these questions is critical. If being the best is matter of birth, personal disposition, or chance, the phenomenon would hardly be worth further study. But should their talents prove transferable, the implications for training, certification, and service delivery are nothing short of staggering.

The first key to superior performance? As absurd as it sounds, the best of the best simply work harder at improving their performance than others do. When asked about Michael Jordan—widely regarded as the greatest basketball player of all time—and the reason behind his success, most would cite natural advantages in height, reach, and leap as key. Notwithstanding, few know that "His Airness" was cut from his high school varsity basketball team! So much for the idea of being born great. It simply doesn't work that way.

Jordan didn't give up when thrown off the team. Instead, his failure drove him to the courts, where he practiced hour after hour. As he put it, "Whenever I was working out and got tired and figured I ought to stop, I'd close my eyes and see that list in the locker room without my name on it, and that usually got me going again."

Such deliberate practice, as Swedish psychologist K. Anders 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. Widely considered "the expert on experts," with almost two decades of experience studying the world’s best athletes, authors, chess players, dart throwers, mathematicians, pianists, teachers, pilots, physicians, and others, Ericsson chides anyone who believes that experience creates expertise. "Just because you've been walking for 50 years doesn't mean you're getting better at it," he says. Interestingly, he and his group have found that elite performers across many different domains engage in the same amount of such practice, on average, every day, including weekends.

As time-consuming as this level of practicing sounds—and it is—it isn't enough. According to Ericsson, to reach the top level, attentiveness to feedback is crucial. Studies of physicians with an uncanny knack for diagnosing baffling medical problems, for example, prove that they act differently from their less capable, but equally well-trained, colleagues. In addition to visiting with, examining, taking careful notes about, and reflecting on their assessment of a particular patient, they take one additional critical step. They follow up. Unlike their "proficient" peers, they don't settle. Call it professional compulsiveness or pride, these physicians need to know whether they were right, even though finding out is neither required nor reimbursable. "This extra step," Ericsson says, gives the superdiagnostician, "a significant advantage over his peers. It lets him better understand how and when he's improving."

Knowing What You Don't Know

The time has come to confront the unpleasant truth: our tried-and-true strategies for improving what we do have failed. Instead of advancing as a field, we've stagnated, mistaking our feverish peddling on a stationary bicycle for progress in the Tour de Therapy. This isn't to say that therapy is ineffective. Quite to the contrary, the data are clear and unequivocal: psychotherapy works. At issue, however, is how we can learn from our experiences and improve our rate of success, both as a discipline and in our individual practices.

The present era in psychotherapy has been referred to by many leading thinkers as the "age of accountability." Everyone wants to know what they're getting for their money. But it's no longer a simple matter of cost and the bottom line. People are looking for value. As a field, we have the means at our disposal to demonstrate the worth of psychotherapy in eyes of consumers and payers, and markedly increase its value. The question is, will we?

This blog is excerpted from “Supershrinks." Read the full article here. >>

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Topic: Professional Development

Tags: add | deliberate practice | diagnosing | good therapists | good therapy | practices | psychologist | psychotherapy | success | supershrinks | TED | therapist | therapists | therapy

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