People in general have difficulty assessing their own competence, regardless of the their field. Worse, the least skilled are the most likely to see themselves as among the best. In the popular press, this scenario has been named the Lake Woebegone Effect, with a nod to Garrison Keillor’s stories in which “all the children are above average” in his fictional town.
An oft quoted study showed that 90% of people surveyed thought they were better than the average driver and the rate wasn’t much lower among people who had been in multiple car accidents.
Therapists are no better at self-assessment. Most rate themselves as being above average in terms of their clinical skills and performance in comparison to other clinicians with similar credentials.
This stance is partly because of a “positivity bias,” the tendency for people to rate positive traits as being more true of themselves than negative traits. It is partly because of the fact that more and more agencies are reducing or eliminating individual supervision by senior clinicians as one of the tactics for cutting costs. Further, few graduate programs teach tools of self-assessment.
Clinicians therefore rely on “soft” measures to determine their own effectiveness. But the Lake Woebegone Effect applies: A clinician’s positive feelings about the work they do isn’t a reliable indicator of progress toward patient goals. Staying true to a model of therapy may or may not be helpful to an individual patient. Yes, the therapist may be doing the model “right” but it may not be a “fit” for the patient. Positive patient responses on satisfaction surveys are not reliable indicators either. Liking the therapy and/or the therapist does not necessarily equate with effectiveness.
8 Habits of Above Average Therapists
Statistically, only 50 percent of therapists can, in fact, be above average. The bell curve applies to therapist competence just as it does to everything else. Average may even be good enough much of the time. But therapists who want to count themselves among the class of especially effective, above average clinicians share the following habits. They:
1.Continuously get good data
One study of outcomes of thousands of therapists from a wide variety of settings showed that those slowest to adopt valid and reliable procedures for establishing their baselines had the poorest outcomes. Effective clinicians monitor client progress and assess ultimate outcomes with reliable, valid measures. They ask their clients to complete short paper and pencil or computer checklists or surveys on a regular basis and analyze the data.
2. Develop a clear treatment plan with each client
Above average therapists actively involve each client in treatment planning. Research shows that when clients participate in setting goals and monitoring treatment, they are more likely to be engaged in their treatment. Effective therapists collaborate with clients to set goals that are clear, specific, and concrete.
3. Prior to each session, review the plan and set goals for the session
Top clinicians go into each session prepared. They take time to think about the individual patient and to consider how treatment is progressing. They prepare a line of questioning that will move this particular patient toward his or her particular goals.
4. Monitor client progress
It’s been shown that when therapist and client discuss progress together and refine how they are working accordingly, the client is more committed to the work, less likely to drop out, and more likely to improve. At the beginning of each session, effective clinicians check in with the client about how he or she thinks therapy is working for them. They ask clarifying questions to be sure they understand the feedback and make adjustments accordingly.
5. Resist the tendency to become too wedded to one approach
Superior therapists have a number of skill sets to draw upon. They are able to shift their approach according to patient needs as well as patient feedback. Some patients, for example, respond best to concrete advice and directives. Others are better served by expressive techniques (like sand trays or art) or by a more person-centered approach.
6. Reflect on each session
Journaling tends to increase effectiveness in almost anything, from weight loss to quitting smoking to developing one’s self-esteem. It’s not surprising that success in treating patients is no different. Post-session, effective therapists reflect on and record progress as well as thoughts about how to move treatment forward at the next session. They do not rely on computer dropdown menus for case notes – even if their agency uses them for record keeping.
7. Get good supervision
The most effective clinicians seek out knowledgeable, experienced supervisors and see them regularly even if they must do it on their own time and at their own expense. They make maximum use of supervision by bringing hard data as well as their personal reflections about each of their client’s progress.
8. Keep learning
Above average therapists take continuous learning seriously. Although sufficient for maintaining licensure, they do not accept the premise that answering questions about an article or two or attending one day workshops are adequate for improving skills. Instead, they develop their skills and add skill sets by periodically signing on for an “externship” that meets regularly over months or even years or for a course that requires true dialogue and practice.
Cost cutting by insurance companies, practices and agencies doesn’t support many of these activities. They take time and they generally aren’t billable. But the research shows that the above average clinician still makes them all a priority. They consistently engage in self-monitoring and self-improvement regardless of expense, how much time it takes, whether it is supported by their workplace or whether they have a demanding and busy home-life. They are committed to the idea that excellence in doing therapy takes practice and accountability both to their clients and to themselves.