As Sigmund Freud asked, “The great question that has never been answered, and which I have not yet been able to answer, despite my thirty years of research into the feminine soul, is ‘What does a woman want?’” (Jones, 1955, p. 421).
Psychotherapy researchers may wonder the same thing about psychotherapists. More than 50 years of psychotherapy research has brought some enlightenment. For example, we know that some therapists seem to be more effective than others and even effective therapists are differentially effective (Kraus, Castonguay, Boswell, Nordberg, & Hayes, 2011). However, we still have not fully grasped what therapists need in order to be effective.
Because the essence of psychotherapy is embodied in the therapist (Wampold & Imel, 2015), understanding the needs of therapists seems a critical component in understanding their effectiveness. It is safe to assume that, if therapists’ needs were more adequately met, then they would be more effective clinicians. Yet we have only rudimentary understanding of what factors may influence therapist effectiveness and well-being. Understanding therapists’ needs is an important step in assisting therapists in being effective. Therapist access to information and support may be an important component to their effectiveness.
As members of the Society of the Advancement of Psychotherapy’s (SAP; Division 29) Professional Practice Domain, our mission is to promote and advance the practice of psychotherapy in part by addressing the needs of practicing psychotherapists. In order to determine how to be of value to them, we want to assess what the needs of private practitioners are and how practitioners access resources. As a preliminary step, we spoke informally with therapist colleagues in our various communities to get a basic understanding of what questions need to be addressed.
When we began to discuss therapist needs, we were struck at the vast number of resources available to therapists. Resources for therapists are available through national organizations (American Psychological Association, APA Practice Organization, American Association of Marriage and Family Therapy, National Association Social Work), state and local organizations, and a multiplicity of Continuing Education providers. Yet, the therapists we spoke to were often not aware of these resources or were not comfortable utilizing them. This was surprising, yet after discussing it among ourselves and with several therapists in the community, we realized this could be due to multiple factors.
The therapists we spoke with said there was readily available information and support to them on the Internet or in research articles, but they were much more likely to seek information from other therapists in an interpersonal exchange, if possible, because the information gained in this context seemed more relevant and in-depth. The typical delivery of information via the Internet or written literature may not match therapist needs, personality, or learning style. Psychotherapists’ personality variables may influence their preference for more engagement with their information. Many therapists value interpersonal relationships and may want more personal interaction, yet resources are often available mainly via computer or digitally.
The sheer volume of material available to therapists also may actually be a barrier to accessing needed information. Therapists may be overwhelmed and uncertain of which resources to select, especially because there is no centralized way to access the material. Resources for therapists are scattered among a variety of different disciplines—MFT, LPC, LCSW, PhD, PsyD, and MD. Therapists are busy and often do not have time to locate resources between sessions. Simply trying a Google search may be ineffective if therapists do not know how to access more specific websites, including those not immediately available on common search engines. This may also contribute to the desire to receive information relationally; it is much easier to have a five-minute conversation with a trusted colleague than spend 30 minutes surfing unfamiliar Internet sites. In addition, some of the therapists we spoke with had some animosity toward their professional organization (the APA), which prevented them from utilizing the resources available to them through those organizations.
It is clear from our conversations with psychotherapists that they have needs not currently being met. In our attempt to understand what the needs are and why they are not being fulfilled, we reviewed the current literature available on the subject. There have been previous surveys of psychotherapists’ needs. Tasca and colleagues (2015) surveyed Canadian clinicians in a practice research network with a broad range of settings on what they wanted from psychotherapy research. They found that research on therapeutic interventions, processes, outcomes, and professional and practice issues, particularly those related to the therapy relationship, were most important. McAleavey and colleagues (2014) surveyed 596 therapists in college counseling centers in a practice research network on what types of research are most clinically valuable; the therapists rated research on the counseling process, high-risk behaviors and disorders, the effectiveness of counseling, minority populations, and therapist and client factors to be the most relevant.
There are no survey data, however, on the broader range of needs private practitioners have and sometimes struggle to meet. We therefore thought it might be informative to talk directly with psychotherapists in private practice. Although we plan a more in-depth investigation, our preliminary conversations with therapists revealed several specific unmet needs, including information related to business logistics such as billing, insurance, training in new Current Procedural Terminology or ICD-10 codes, and marketing. Other needs include those related to increasing or managing income, clinical consultation, maintaining good self-care, and resources related to legal and ethical support.
A common need expressed by our colleagues was for peer consultation and support. It seems many of us ask our friends and colleagues when we need information about new codes or ethical dilemmas. Conversations may take place in the context of association and division listservs, formal peer support groups, or by just asking the professional colleague next door. One area of inquiry we hope to include in our formal survey relates to this apparently common use of colleagues for information. Our ethics code supports going to colleagues for help with ethical and clinical issues. For example, one question we have heard asked frequently of colleagues has to do with reporting of child sexual abuse. If a colleague has already gone through the various legal and ethical channels and discovered a particular process is applicable in a given state, it makes sense another colleague can benefit from that. While this meets the needs for accessible information as well as streamlining the process, there may be some reasons for caution, especially when there is little research on the effectiveness of peer consultation/support (Carney & Jefferson, 2014).
In addition, the existing research tends to focus on consultation about cases or on therapy process or outcome, not around providing practical information such as resources on business practices, technical matters, or self-care. While there may be some evidence the support provided in peer consultation groups helps with burnout or stress management (Truneckova, Viney, Maitland, & Seaborn, 2010), for example, there is little research on how these groups relate to improving other important aspects of self-care.
Our preliminary conversations yielded several general questions that led us to develop a semi-structured interview protocol, which we will use in a qualitative investigation of the needs of private practitioners to be conducted this fall. Our questions center on what resources and information therapists need, what resources have been useful, what resources are lacking, how therapists access resources, and what the barriers are to accessing resources. Our purpose is to gain a more in-depth understanding of the needs of those whose primary professional endeavor is conducting psychotherapy in a private practice setting. Based on our qualitative results, we plan to develop and distribute a survey of therapist needs to a large sample of private practitioners. Our goal is to discover what private practitioner needs are in order to tailor the Division 29 Practice Domain’s approach more closely to the current needs of those we serve.
As psychotherapists, we spend most of our time trying to understand and help clients with their needs. Asking the question, “What do psychotherapists want and need?” has raised our own awareness and self-reflection. Am I getting all I need to be an effective therapist? If not, what stops me? Is it time, money, energy, or lack of knowledge about where or how to get those needs met? We hope that asking the question is the first step in finding an answer and that resolving the question of what therapists want and need is not as perpetual a mystery as Freud’s confusion about women!