#4. Why Our Self-Assessment Might be a Delusion of Reality

Homer
It seems that Homer Simpson share more in common with humanity than we like to admit. Did you know that social psychologists found that in general, people rate themselves as more attractive that they really are?1

In my doctoral study of highly effective psychotherapists2, the results of an area investigated about therapists self-ratings of their Healing Involvement (HI) in therapy left us initially scratching our heads. Orlinsky and Ronnstead3 describes someone with high HI as someone who views themselves as personally invested, efficacious in relating with the client, affirming, and highly skilling, experiencing flow states in therapy, and employ constructive coping strategies. What we found was a negative relationship between their outcomes performance and HI rating. In other words, therapists who rated high on their HI scores were more likely to be less effective than their peers! How is this possible? Going further, the same group of therapists we studied, half of them rated their current effectiveness as above average. None rated below average. What’s more, these self-assessment of effectiveness ratings did not predictor their actual client outcomes. Continue reading

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#3. Clinical Practice vs. Deliberate Practice

In times of change, learners inherit the Earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists. – American moral and social philosopher, Eric Hoffer (1973, p. 22)


Question: Would you hire this guy? Imagine an NBA basketball player decides that he doesn’t need training outside of competitions, because he has gotten so good at his game, and all he needs to do is continue play more game. If you own an NBA team and it’s drafting day, would you invest in this guy? Probably not. You won’t bet your money on the “Learned”, but you would do so for the “Learners”.

Many mental health professionals, counsellors, psychologists, psychiatrists, nurses, social workers, and marriage and family therapists alike, spend hundreds of hours clocking in our practicum years in order to be accredited and/or licensed to practice. Not to be confused, the word “practice” here means, well, work. It is not practice per say. It is the real deal. We end up falsely believing that since we have spend all that time in practice during our educational years, we are well equipped for the real work, that is, clinical practice. Thank goodness not everyone falls into this “Learned” group. Others whole heartedly believe that learning is lifelong. These are the “Learners”. But both “Learned” and “Learners” group have to deal with the same professional development issue: What keeps me at sharp at my skills in helping people?

It is crucial to make a distinction between work, and work that targets at getting us better at what we do. Therapists often confused that they worked hard to improve at their craft when they find themselves experiencing “flow” states during sessions. Clearly, when we are engaged in the therapeutic encounter, we strive to be fully present, attuning and relating to the emerging emotions and unfolding lived experience of this person who is in front of me seeking help and counsel. We get taken by this process, sharing a specific aim to ameliorate the person’s suffering. Continue reading

#1. Therapy Learnings: A Memorable Practice

Memory is the mother of all wisdom.- Aeschylus

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There are many lessons I’ve learned that I’ve forgotten. Some times, my memory is like an old bookshelf, stock-piled with timeless stories, references, and guidebooks, but shelved in such randomness that there is no quick-way to find a particular book. If I can’t retrieve an important lesson, what good is it that I’ve have experienced it, but not able to recall it?

About two years ago, this geriatric problem confronted me. I was in my group private practice in Western Australia (SPOT), and I was seeing a young adult male, Jonah, who was depressed over the past two months. After the first two initial sessions, even though I felt that we had a good working rapport – along with his scores on the Session Rating Scale (SRS) indicated good engagement levels, I was daunted by the fact I still didn’t seem to get a sense of who he was. It was this paradox of communicating with him, but not knowing him. At that moment, I didn’t know what more to ask in order for me to get a sense of who he is, and how he was experiencing himself. It was an odd feeling, because I didn’t often run into such a situation relating with a person, what more after a few sessions. Aside from reflecting my disconnect with him, I didn’t know what else to do at that point.

My drive home left me thinking about Jonah. I ruminated, closed to bashing myself (with soft pillows) for not being able to get deeper with this pleasant and friendly client in my therapy office. Then my mind wandered. I felt like listening to the Beatles (Perhaps I wanted some Help!). Sgt Pepper was near at hand. I hit that last track.

It was “A Day in The Life”… That’s it! I’ve learned this before. Several years back, during my post-graduate training, I read Irvin Yalom’s wonderful book, The Gift of Therapy. One of the golden nugget that struck me then was about Asking for a blow-by-blow account of a person’s daily activities. How could I have forgotten this?

At the start of the next session, , that was what I did. I requested for him to share with me the details of what he did the day before, almost an hour-by-hour account. In between his part-time work at the supermarket and swimming training, he was ferried about by his mother. Why was this important? He felt he was not in control of his life, and he also felt bad if he was to tell him mum to back off a little, especially since she has been divorced and alone. Further discussions revealed that he also longed for connection with his mates, but has been plagued with a sense of inferiority (e.g., working in a low paying job, no car).

This session with Jonah struck home on two fronts. The first was that we were able to progress further on improving his life situation. He ended up sitting his mother down and having a talk about needing to move along in his life. The second was for me. I was confronted with the fact that my retrieval memory was like my old bookshelf, messy and disorganised. I needed to get organised.

Since then, on friday afternoons before I pack my bag and head home, I gather my thoughts and spend 3-5 mins, typing out my TherapyLearnings for the week.


Here’s How:

At the end of every typical work week, look at your work calendar to recall all of the clients that you’ve met. Pick one of the cases that strike you the most in that week. Write down one thing that you want to remember about your experience. This could be a lesson that you’ve learned from interacting with that client, a feedback that was given to you, even a mistake that you felt you’ve made? (Did you know that more effective therapists are more likely to elicit negative feedback than less effective counterparts? More on that).

Benefits:

1. You develop your own learnings, bespoke from your own clinical experiences.
2. In a month, you will have 4 learnings. In a year, you will have 48 such gems in your pocket! (well, probably less that 48. I highly encourage holidays).
3. The act of writing it out helps with the consolidation process of the memory, as well as aiding future retrieval. Be forewarned of this pitfall: “Since it’s so important, I will be able to recall it.” For a busy professional, things easily slip us by, and we miss making a pit-stop at the memory bank.


Suggested Format:

You can choose to do this on a notebook that you dedicate to your own TherapyLearnings, or you can choose to do this on apps for portable devices (e.g., tablets, smartphones). Free note taking apps like Evernote and Simplenote are available, and it syncs on multiple devices. Although I use Evernote premium for my web-clippings and other more advanced note-taking, I use Simplenote for my TherapyLearnings. As the name alludes, it is no-frills. Just create a tag therapylearnings for each of your weekly notes. A bonus feature about this is that you can share and collaborate each note with your colleagues in your TherapyLearning Group (more on this below).

Date: ________

Title: A succinct and catchy title helps e.g., A Day in a Life

Learnings: A one-sentence summary of this therapy learnings

Example: Provide a brief snippet of the case that led to this learning, in order to make it more alive and personalised for your future recall.

Keep each TherapyLearning to a maximum of 140 words. Constrains are helpful. For busy professionals, time is a luxury. By self-imposing a word limit (the 140 word limit was borrowed from Twitter), it helps to get the mind to pack a punch, keeps it focused, and makes it doable on a regular basis.

TherapyLearnings Group: I recommend doing this on any individual basis. Complementarily, a TherapyLearnings group can be formed to sharpen this weekly nuggets. A small group size of 4-5 is beneficial. It would typically take 45-60mins for each to share. One tidbit for someone can also be an impactful vicarious learning for the other. Resist the temptation of going into the group without first noting your therapylearnings down. This helps to keep the phenomena of group-think at bay. Walter Lippmann’s quipped, “where all think alike, no one thinks very much.”

 


Stick-It:

Recall -> Pick one -> Write

Psychotherapy is one of the few professions that practice actually means the real thing. Our task is to predispose ourselves to learn from our ongoing clinical practice. In order to learn, we must develop the ability to have a retrievable memory. This is the hallmark of a memorial life. This is worth remembering.