Nobody can go back and start a new beginning, but anyone can start today and make a new ending.
The great Jeffrey Kottler and the late Jon Carlson (Kottler & Carlson, 2014) asked me to consider four questions about what made my work effective. The next four blogs will address these questions.
What is it that you do (or who you are) that you believe is most important in contributing to your effectiveness as a master therapist, meaning a professional who produces consistently good outcomes and feels reasonably confident in your work?
There are two parts to this question: What I do and who I am. What I do that is the most important in contributing to my effectiveness is that I routinely measure outcome and the alliance (via the Partners for Change Outcome Management System, a.k.a. PCOMS) with every client to ensure that I don’t leave either issue to chance. This allows me to deal directly and transparently with clients, involving them in all decisions that affect their care and keeping their perspectives the centerpiece of everything I do. In addition, it serves as an early warning device that identifies clients who are not benefiting so that the client and I can chart a different course, which, in turn encourages me to step outside my therapeutic business as usual, do things I’ve never done before, and therefore continue to grow as a therapist. Finally, PCOMS keeps my focus on what matters most to the client both in terms of what needs to change outside of therapy as well as during the hour. It allows me to focus every session with every client on the alliance so that I tailor what I do to the client’s expectations. Although it sounds like hyperbole, identifying clients who are not benefiting is the single most important thing a therapist can do to improve outcomes — more than 20 randomized clinical trials (RCT) now support this assertion.
Before I say what it is about me, let me first remind you that the client is the engine of change. I believe that as therapists develop, they learn that their best ally for successful psychotherapy is not the books on their shelves touting the latest miracle cure, but rather the person in the room with them right now. After what the client brings to the table of change, the therapist is the most potent influence on outcome — not what model or technique he or she is wielding, but rather who the therapist is. Therapists account for most of the variance of change of any treatment delivered. What I bring to the therapeutic endeavor is that I am a true believer. I believe in the client, in the power of relationship and psychotherapy as a vehicle for healing and change, and I believe in myself, my ability to be present, fully immersed in the client, and dedicated to making a difference.
There is an old story about two apprentice Zen monks who are discussing their respective masters while cleaning their temple. The first novice proudly tells his companion about the many miracles that he has seen his famous master perform. “I have watched,” the young novice says, “as my master has turned an entire village to the Buddha, has made rain fall from the sky and has moved a mountain so that he could pass.”
The other novice listens attentively and then demonstrates his deeper understanding by responding, “My master also does many miraculous things. When he is hungry, he eats. When he is thirsty, he drinks. When he is tired, he sleeps.”
Like the first monk, many have become too enamored of “miracles” touted by the masters. My experience with thousands of clients and the research about change, however, has taught me to discard the claims of the gurus and snake oil salesmen, and instead honor more simple but enduring acts: believing in clients, the power of partnership, and my ability to show up in full. These simple but magical acts are the eating, drinking, and sleeping of effective therapy and master therapists.