Why Clients Are the Best Teachers of Psychotherapy

A lot of recent attention has been paid to “deliberate practice” as a method to improve therapist performance. It is defined as individualized training activities specifically designed, usually by a supervisor, to improve aspects of an individual’s performance through repetition and successive refinement. Derived from studies of experts in sports, music, and medicine, deliberate practice involves repetitive cycles of skill-building activities selected on the basis of their abilities to help individuals make gradual improvements in performance.


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Why Deliberate Practice Is Inherently Reductionistic

Psychotherapy, however, is not a sports or music performance. Deliberate practice is inherently reductionistic and, at best, applicable to beginning-level counseling skills. A mountain of research suggests that psychotherapy is not easily reduced down to discreet skills that translate into increased benefit for clients. Although it has been proposed that deliberate practice should focus on therapists' intrapersonal and interpersonal skills, it remains unclear the extent to which these qualities ultimately relate to client outcomes.

About Deliberate Practice and Psychotherapy

Deliberate practice downplays the complexity of the therapeutic process. Psychotherapy is inherently idiosyncratic to the individuals involved and relationally unique, not a disembodied set of interpersonal skills practiced by repetition. Psychotherapy is an in-the-moment process defined more by uncertainty and discovery than a series of skills practiced like multiplication tables. It is this indeterminacy that gives therapy its texture and infuses it with the excitement of discovery.

This allows for the “heretofore unsaid,” the “aha moments,” and all the spontaneous ideas, connections, conclusions, plans, insights, resolves, and new identities that emerge when you put two people together in a room and call it psychotherapy. Psychotherapy is dynamic and interactive as well as relationally and culturally idiosyncratic—a far different endeavor than shooting a basketball or playing an instrument.

As if it wasn’t enough for some to reduce psychotherapy to a set of models and techniques applied mechanistically to client problems and diagnoses, deliberate practice seeks the same with the unique relational, discovery, and cultural contexts of psychotherapy.

Deliberate practice also ignores the massive research about therapist development and what therapists say about improving over the course of their careers. Just like mechanistically applied models and techniques ignore client ideas about change, deliberate practice overlooks what therapists say about getting better at this work. And what do therapists say? 

A massive, 20+ year, multinational study of over 11,000 therapists (Orlinsky & Rønnestad, 2005) reports that it is intimately connected to therapists’ experiences with clients and what they learn from them. Almost 97% of the therapists studied reported that learning from clients was a significant influence on their sense of development, with 84% rating the influence as “high.” It appears therapists genuinely believe that clients are the best teachers (Read about the clients who taught me the most in a series of blog posts titled “Clients Who Made Me Better").


Why Clients Are the Best Teachers of Psychotherapy

Clients provide the opportunity for constant learning about the human condition, different cultures, and worldviews, as well as the myriad ways that people transcend adversity and cope with the unthinkable. But while we learn a great deal almost by osmosis from our clients, the Partners for Change Outcome Management System (PCOMS) takes the notion that “the client is the best teacher” to a different, higher, and more immediately practical level.

PCOMS provides unambiguous data about whether clients are benefiting and whether our therapeutic services are a good fit for them. From their reactions and reflections, we receive information that we can use in figuring out the next step to take in therapy.

In short, tracking outcomes enables clients—especially those who aren’t responding well to our therapeutic business-as-usual—to teach us how to work better. In fact, clients who aren’t benefiting offer the most opportunity for learning by helping us to step outside our comfort zones, learn new perspectives, and try different interventions.

When we embrace these experiences and harvest client teachings, we can accelerate our development. Here we explore what has been learned from successful and unsuccessful clients, about anything that happened that was new or different, and about how such experiences influence our thoughts about our identity and how we do this work.


Accelerate Your Development and Improve Your Client Outcomes

Read more about PCOMS and how to accelerate your development and improve your client outcomes in On Becoming a Better Therapist.

Better Outcomes Now, the web application for PCOMS, allows you to truly see whether you are improving over time and identifies those clients who are ultimately the best teachers of psychotherapy you'll ever have.

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