On Becoming a Better Therapist: Socially Just, Relational Practice

I am very excited to announce that the third edition of On Becoming a Better Therapist has begun. There are a few differences that define the third edition. Perhaps the most obvious is that my two esteemed friends and colleagues, Drs. Jeff Reese and Jacqueline Sparks will be joining me as co-authors. Two currently relevant issues will take center stage as they apply to both the Partners for Change Outcome Management System (PCOMS) and becoming a better therapist: socially just practice and enhancing common factors effects.


Socially Just Practice

The theme of socially just practice is a notable focus of this edition, although it has always been an important part of PCOMS and my earlier work regarding “client-directed” practice. While there have been great strides regarding diversity, inclusion, and multicultural competence, a need remains to translate these values into actionable behaviors and practices in psychotherapy itself. Beyond ensuring representative diversity and educating dominant culture practitioners about white privilege and other inherent biases (which are critically important), less has been proposed about the nuts and bolts of doing culturally responsive treatment or systematically applying a socially just paradigm with this client with this therapist. We will argue that there are pitfalls in any approach to psychotherapy that presumes correctness, applicability across clients, or the special expertise of the therapist. Is there such a thing as a social justice approach or cultural expertise that embraces the unique experiences and knowledge of each client?

      On Becoming a Better Therapist                        2nd ed

We will encourage therapists to think beyond theories as representing how people really are and what people have to do to realize benefits or make changes. By valuing theories, models, or points of view as social constructions, we are less likely to force ideas on those whose life experiences and views of reality are different from our own or the prevailing wisdom about anything, including working with clients from underrepresented populations. This, of course, doesn’t mean racial inequality, unrecognized white privilege, or widespread discrimination don’t have acute or cumulative effects. Rather, it means that individual experience differs substantially, and this, above all, should be the calling card of psychotherapy.

Having said that, what is the next step with socially just psychotherapy? How do we practice social justice one client at a time? We will make the case that the next step is PCOMS. While all routine outcome monitoring (ROM) systems support a social justice paradigm via ongoing self-examination of effectiveness specifically related to cultural competence with under-represented populations, PCOMS takes this notion much further by providing a structure for cultural humility and client accompaniment. The third edition aims to fully develop these concepts and show how routine client feedback is a safeguard for ensuring that clients’ unique views, backgrounds, experiences, and local knowledge truly guide practice. We will articulate the use of both the Outcome Rating Scale and Session Rating Scale as tools of cultural humility that both open and tailor conversations based on client feedback. PCOMS, we will argue, provides a mechanism for routine attention to multiculturalism and consumer involvement.    

Relational Practice

The second major difference of the third edition from previous editions is a full elaboration of the common factors and relational context of PCOMS and psychotherapy itself. The science of psychotherapy continues to guide clinical practice toward a relational perspective of psychotherapy and to a common factors understanding of therapeutic change. Although the common factors have a rich and storied past, this book intends to take the understanding and application of the common factors further, incorporating the dialogical/relational processes of feedback and including the advantages of specific techniques, when they fit client goals and preferences. We believe that a research-supported, evolved perspective of the common factors, translated into clinical application, can inform and improve both practice and training.

Consequently, this book presents a sophisticated meta-analytic conceptualization of the common factors that includes feedback as a common factor. An organizing theme will be that psychotherapists should conceptualize how they spend time in therapy commensurate to the amount of variance accounted for by the different factors—a fresh conceptualization arising from clinical practice. Client, or so-called extra therapeutic factors, what consumers bring to the therapeutic endeavor, account for most of the variance of psychotherapy outcome. Included in client factors are both the distress of racial/ethnic injustice, discrimination, and oppression as well as the resiliencies and resources to cope with or overcome it. Attention to these important influences is congruent with our focus on the common factors and their differential impact on outcomes.

We will further articulate an integration of socially just practice and the common factors with our attention to therapist effects, and what therapists bring to psychotherapy. Therapist factors account for most of the variance of any treatment delivered. Following our theme of spending time in therapy commensurate to the amount of variance accounted for by the various factors, we will conceptualize therapist factors as the key to how one spends time outside of therapy to accelerate development and improve effectiveness, thus connecting to a central theme of previous editions, keeping one’s development on the front burner. Consequently, we will dig into therapist factors as they apply to psychotherapy outcome in general, and to feedback effects and social justice, particularly. We will examine therapist attitudes toward ROM, professional self-doubt, humility, and particularly, cultural humility.

Finally, given we are addressing the important issue of social justice and that we are three white, middle-class, cis-gendered individuals, a legitimate question arises regarding our credibility. Besides applying our views regarding social construction to what we are proposing, we address this in three ways. First, we will include both under-represented therapist and client examples. Second, we intend to make the point that outcome, from the client’s perspective, is the best arbiter of racial and cultural competence. Finally, we plan to invite readers from diverse backgrounds and social locations to comment on our work to at least mitigate the inevitable blind spots of our own backgrounds. In so doing, we will be learning from, and making adjustments based on, requested feedback, in keeping with the overall themes of the book itself.

Please contact me at barrylduncan@comcast.net if you would like to be a reader or would like to present an example of PCOMS supporting work with under-represented populations.

Categorized in: History of PCOMS