The Path to Clinical Confidence

The Path to Clinical Confidence

More Training Isn't Always the Answer

By Lynn Grodzki

March/April 2020

What would cause a therapist who has a PhD, a full practice, the respect of her peers, appreciation from her clients, and decades of experience in the field to feel unsuccessful?

Naome, a psychologist in private practice for 20 years, contacted me for business coaching. She told me that she struggles with a core sense of insecurity and was worried that her lack of self-assurance may point to a serious professional deficiency. “I think at this age and stage of life, I should feel good about my work. I have a successful practice, but I just don’t feel as confident as I thought I would at this point in my career,” she said, sighing loudly. “Maybe I need more training. One course I’m interested in costs $5,000 though, a pretty steep price for me right now.” She sighed again, and frankly, I felt like sighing too.

I’ve been tracking the number of times I’ve heard stories like Naome’s from the therapists I coach. Although they range in their clinical focus, experience level, age, and background, they all tend to agree that more training is the solution to their insecurity. But is their rush to seek ever-more competence in the face of low confidence always what’s needed? This question has led me to think a lot about clinical confidence lately. What is it? What’s the relationship between confidence and competence? How can we better help therapists develop a deeper sense of self-assurance about…

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Friday, May 8, 2020 9:54:56 AM | posted by Ned Ferris
Cognitive dissonance is a blast! I fall into this pattern of behavior myself, and I have to admit that access to this publication is only the result of spending a significant portion of money on training! I am glad that I have the training, and I am glad to have this publication too. I can empathize with you on the need for perfectionism growing up, but with modesty too. Good grades got attention from adults; broadcasting them meant social isolation. I too have completed a vast number of training courses and have all the feedback in the world to show academic/clinical competence... but it does not shake that wrenching feeling in your gut that you could have done 'more' ...whatever 'more' means. I think this is a function of feeling that you are or are not 'enough.' You saying that you can notice small, positive changes as a result of your practice is what keeps me going too. You may not always have the answer, but you DO know that you care about this person, 100%, and that you will do your best. Honestly, some people may have never experienced this in the relationship before, and that could be their everything to find new life again. We are enough; we always have been. Belief in this notion appears to be where salvation is.

Wednesday, April 22, 2020 9:56:16 AM | posted by Robin Barstow
Thank you for this very helpful and interesting article. The only thing I felt was very much missing was the obvious point (at least to me and my practice) that one use the same techniques we are offering to our clients/patients. I practice CBT at work AND on myself. I regularly do worksheets on my own stressful thoughts, for example, to understand myself and my subconscious better. To be more mindful of my presence! I love our field and feel very proud to be a part of it!

Monday, April 20, 2020 10:27:25 AM | posted by Jeffrey Von Glahn
I propose that the key to the therapist acquiring confidence is that person making a conscious decision during a session about how to proceed at any point in that session. The focus of such an act is for the therapist to “hear” what one’s fund of experience is “saying” about how she is experiencing the client. What is being “listening” for is implicit/non-verbalized responses from that fund of experience. Once “heard” or acknowledged in the therapist’s mind, it is then consciously attended to and assessed for its usefulness. Consciously acting on that inner analysis is IMHO the key to building confidence. The fundamental basis for this suggestion is that all human experience is unique. Robotically following someone else’s thinking in this matter is the opposite kind of an experience. It does little, at best, to build up one’s practice experience. For those who are already, at least in their minds, raising banners with “INTUITION NO!” on them, consider Kahneman and Klein’s (2009) reconceptualization of that concept, with their idea of skilled intuition. There are two key features to this view of intuition. One is an environment that exhibits stable relationships between a person acting on a cue found in that setting and the resulting response from what is acted on. The other condition is prolonged practice in an environment in which feedback is “both rapid an unequivocal.” Firefighting and the practice of medicine were cited as examples, while the prediction of a prospective value of a stock and a distant political event are not. Adhering to someone else’s thinking is acting like an automaton, not as your natural exuberant self as you would in interacting with a significant other. Clients are acutely sensitive to the former, and experience the latter with great relief. See research by David Rennie for an enlightening analysis based on his post-therapy interviews with clients about problematic aspects of their therapy with another therapist. Rosenzweig focused on “implicit procedures” and “unverbalized aspects of the therapeutic relationship.” He also mentioned “the indefinable effect of the therapist's personality.” IMHO, it’s no longer “indefinable.” See my 2018 article in PsycINFO. The key to the therapist’s role is providing sufficient support for the client’s experiencing, and that is best accomplished by his/her being as natural as possible.

Sunday, April 19, 2020 10:25:57 AM | posted by David
Thank you Lynn for the excellent article! I really like your REPAIR kit for boosting confidence. I also love the idea in peervision groups to talk about the sessions that go really well for us. In addition to boosting our confidence, I'm certain that we would all learn just as much from each others's successes as we do from each others' struggles. I look forward to suggesting this in the next peervision group that I host.