Monday, 2 November 2015

The ideal therapist doubts their professional skills, but loves themselves as a person

Given a choice, you might think it better to undertake psychotherapy with a confident therapist than a self-doubting one. After all, you want a firm hand to guide you through a storm. But in fact, there's evidence that therapy clients do better when their therapist has professional self-doubts. In a new paper published in Clinical Psychology and Psychotherapy, Helene Nissen-Lie and her colleagues tested their idea that therapist self-doubt might not always be helpful, and specifically that the ideal mix is professional doubt combined with personal self-compassion.

To see if this is true, the researchers analysed data from 255 mental health clients treated at 16 outpatient clinics in Norway by 70 different psychotherapists (including 46 psychologists, 14 psychiatrists and 8 physiotherapists specialising in a form of "psychodynamic body treatment"). The clients are described as having a wide range of clinical symptoms and disorders, the most frequent diagnoses being anxiety disorder and depression, and over half the sample met the diagnostic criteria for a personality disorder. The majority of the therapists followed a psychodynamic approach, just over 29 per cent were humanistic therapists and over 28 per cent used cognitive techniques.

The therapists filled out questionnaires about their professional doubts and confidence (for example, they said whether they ever worried that they were doing more harm than good); answered questions about their coping strategies; and also about how much compassion they showed themselves (for example, they said whether they cherished themselves, or whether they are their own worst enemy; how much they self-protect or self-blame). The clients meanwhile completed measures of their interpersonal problems and their symptom distress before and after treatment, and periodically for two years after treatment ended (the results are based on comparing pre-treatment scores with the average of the distress and symptom scores that were recorded at all the post-treatment time points).

Consistent with past research, therapists who were self-doubting appeared to be more effective at their job – their clients showed greater reductions in interpersonal distress. But furthermore, and as the researchers predicted, there was an interaction between therapists' self-doubt and self-compassion. That is, the most successful client outcomes were seen for therapists who expressed a combination of professional self-doubt and greater personal self-compassion. This combination "seems to pave the way for an open, self-reflective stance that allows psychotherapists to respect the complexity of their work, and, when needed, to correct the therapeutic course in order to help clients more effectively with their challenges," the researchers said.


Nissen-Lie, H., R√łnnestad, M., H√łglend, P., Havik, O., Solbakken, O., Stiles, T., & Monsen, J. (2015). Love Yourself as a Person, Doubt Yourself as a Therapist? Clinical Psychology & Psychotherapy DOI: 10.1002/cpp.1977

--further reading--
The mistakes that lead therapists to infer psychotherapy was effective, when it wasn't
Clinical psychology trainees outperform experienced therapists on knowledge and skills
Older, more experienced therapists cry more often in therapy

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

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