Early in the therapeutic relationship, a client begins yelling, “NO, you tell me what to do!” The graduate student counselor sits stunned, her face turning red and her body feeling hot. This is the first client to ever yell at her. The client is clearly frustrated by the therapist’s unwillingness to tell the client what to do in the client’s life and by the therapist’s insistence that the client needs to make the client’s own decisions. The therapist responds that she cannot tell them what to do, but she gently offers to help the client work through options.
The vignette above is an example of an experience many graduate students may have early in their careers and it is similar to an experience I, myself had as a novice therapist. In my master’s program, I was told therapists do not give advice, but over time, I began to wonder, is this true? Should I have said something else? How would an effective therapist handle this?
On the other hand, consider the following vignette:
A client is about to get married and, in a counseling session, the therapist says, “I know I’m not supposed to give you advice, but I would encourage you to tell your family that you are getting married before you go through with the wedding.” Suddenly, the therapist realizes that she is breaking her give no advice rule. She panics and quickly adds, “It is your decision ultimately, but I want you to consider all the options.”
What did the therapist just do? Did she overstep a line by appearing to demand that the client take a specific action? In retrospect, these vignettes may be easy to unpack, but in real-time, issues like these may be daunting for therapists in training.
Speaking from my own experience as a former mental health therapist in a community clinic and current doctoral student, I often wonder, am I doing this right? Therapy is so ambiguous. Still, my supervisor seems to know what to do, what to say, and how to respond in a variety of situations, but how did she get like that? Does it just take time and practice? Is there another way to become better?
As a driven student and a future psychologist, I want to know with some certainty that I am helping people make the changes they want in their lives and if I am not, I want to work on specific strategies that will ultimately enhance my skills. I decided to pursue a doctorate because I want to be the best therapist possible. Ultimately, my mission as a graduate student is to demystify the process of becoming an effective therapist. I want to know who effective therapists are and what they do to be so impactful. I also want to know how they developed from a novice therapist to the effective or master therapist. I believe effective therapists hold wisdom that beginning therapists like myself would benefit from learning.
During my work at a community clinic, I noticed that some therapists were more effective than others. Clients also expressed an affinity for some therapists over and above others. For example, some therapists would be requested more often than others and the less requested therapists experienced more frequent, premature terminations with clients. There is some scholarly evidence supporting my suspicion that therapist skill and involvement significantly impacts client outcomes.
While it seems understandable that therapists differ in skill level, I was surprised to learn that some believe psychology is a field without a crystalized, unified, or central source of therapeutic rules or expertise. This is not because the people conducting therapy are unskilled, it is because of the nature of the work. The growth of expertise has been stunted in therapy provision because outcomes are hard to measure and sources of quality feedback are sparse. In other fields, expertise may be more systematically developed because practitioners are able to predict results, provide quality feedback, and practice deliberately. In therapy, it is difficult to receive quality feedback and challenging to predict therapeutic outcomes because there are so many factors involved. Deliberate practice, as it relates to therapy, is only recently being studied.
I wonder, are quality feedback and deliberate practice the answers to becoming an effective therapist? I believe that these elements are part of the answer, but not the whole answer. I am still curious about the identity and many characteristics of effective therapists. I am left with so many questions. Are effective therapists people who can tolerate uncertainty? Are they humble in their approach to therapy? Are they critical of their ability and obsessive about improvement? Are they flexible and open? Are they grounded and authentic?
Given the many questions swirling through my head as a new doctoral student, my goal is to demystify the process of becoming an effective therapist someday. I want to make this process transparent so that anyone who is motivated and willing can improve. This is what excites me about studying to become a counseling psychologist. The emphasis on research and practice will enable me to use research about effective therapists to develop as a therapist and provide better services to clients.
Stephanie Chambers-Baltz, M.A.
Southern Illinois University, Carbondale