Psychotherapy Bulletin

Psychotherapy Bulletin

2020 President’s Column 55(1)

Author’s Note: Have thoughts on this vision or anything else pertaining to the Society? Feel free to email me at [email protected] and keep the dialogue going. 

As a third-year graduate student, I recall being asked to engage in a classroom debate on the question of whether good psychotherapists were “born versus made”. We were allowed a few weeks to prepare arguments before our teams faced off to debate the issue, with notecards of points and citations at the ready. As a young psychotherapy researcher and practitioner, as well as a double ruby debater, this class assignment was personal on many levels. Oddly, I do not recall which side of the argument I was assigned. I do, however, remember which side won: born. Based on the citations available 20ish years ago, it was hard to argue against innate expertise. Unfortunately, I continue to hear those same tired citations and persisting belief that training and education in psychotherapy is, essentially, irrelevant to the development of psychotherapy expertise. 

I will pick one notable example that was likely on the required reading list for many: Strupp and Hadley (1979). Often referred to as Vanderbilt I, the primary finding of the study was that psychotherapists evidenced variable trajectories of effectiveness and that some therapists were better than others. The study was published in a psychiatry journal at a time when a new class of anti-depressant medications was entering the market on a large scale. Because of this, a message that dismissed psychotherapy effectiveness and disparaged psychotherapy training found ears at the ready. Design flaws were overlooked, the finding of variable trajectories was ignored, and the study was errantly cited and repeatedly mischaracterized. Strupp clearly appreciated the adverse impact of how the study and findings were portrayed. After nearly 20 years of citations involving mischaracterization, he attempted to clarify some of the most salient issues (Strupp, 1998). Yet, the earlier article continues to be misunderstood and speciously cited into the present. Worse, it is cited by psychotherapists. If we don’t value what we do, who will?  

As conventional wisdom increasingly endorsed the idea that training and education were irrelevant, those psychotherapists who excelled in working with clients may have become even more vulnerable to the fundamental attribution error than is typical. I witnessed that phenomenon just a couple of years ago at a major psychotherapy conference when I attended a panel session featuring “master” (clearly inappropriately and anachronistically named) psychotherapists discussing their work and expertise with one another. During the question/answer period, I asked the panel to reflect back on their graduate training years and identify the single most important thing they learned during their training. Every single respondent on the panel stood firmly on the belief that they had learned nothing at all of significance during their graduate training and education. While they did not go quite so far as to suggest they were “born” with innate expertise, they very definitely perceived themselves to be entirely self-made experts. 

I have re-visited that panel discussion in my head many times over the last couple of years. I wish I had not sat down quite so quickly. I wish I had probed the conditions that facilitated the development of expertise in these psychotherapists. I strongly suspect I would have learned that, albeit innately talented, supervisory relationships were key to their early developmental gains in specific expertise as psychotherapists. How many of us can look back and identify a formative supervisory relationship that left an imprint on us as psychotherapists? 

There are many good quotes disputing the concept of being self-made, but my favorite is this one (variably attributed): “There is no such things as a ‘self-made’ man. We are made up of thousands of others. Everyone who has ever done a kind deed for us, or spoken one word of encouragement to us, has entered into the make-up of our character and of our thoughts, as well as our success.” 

I am not dismissing innate talent but placing it in a larger context that expands credit and acknowledges the role of others. It is true that talented aspiring psychotherapists are already making small incremental gains in salient professional competencies, some via life experiences and others via instruction, even before the begin their formal training and education in psychotherapy (for a review that supports this conclusion, see Hatcher & Lassiter, 2007). Those preparatory experiences likely reflect the kind words or deeds, described by Adams, as well as the insights and resiliency tied to negative life events. 

Importantly, there is a marked period of exponential professional growth in professional competencies during the professional training years, (see Price et al., 2017; Callahan, 2019, for empirical evidence of that effect). Not only does supervision and mentorship inherently underlie the entire zone of proximal development (Vygotsky, 1930-1934, 1978) for psychotherapy expertise, supervision transcends our professional training structures and is utilized worldwide in the development of psychotherapists. Further underscoring the importance of those years, when close supervision is discontinued, development of psychotherapy expertise typically stagnates (for a comprehensive review that reaches that conclusion, see Tracey et al., 2014). Taken together, it appears that close supervision and mentorship is critical to calibrating the expertise any given psychotherapist will carry forward into their career. 

The relationships we nurture with one another, as psychotherapists, facilitate our expertise by providing conditions for safe exploration, identification of growth edges, and constructive feedback. Let’s be generous with credit for the sources of influence past and present and endeavor to meaningfully share our multigenerational expertise with one another into the future. Our Society can offset risk of professional isolation by providing a salve of meaningful connections that brings psychotherapists at every career stage together. 

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Cite This Article

Callahan, J. L. (2020). President’s column. Psychotherapy Bulletin, 55(1), 2-4

References

Callahan, J. L. (2019). Master’s level accreditation in health services psychology: A primer to the special section with commentary. Training and Education in Professional Psychology, 13(2), 73-83. http://dx.doi.org/10.1037/tep0000248

Hatcher, R. L. & Lassiter, K. D. (2007). Initial training in professional psychology: The practicum competencies outline. Training and Education in Professional Psychology, 1(1), 49-63. https://doi.org/10.1037/1931-3918.1.1.49

Price, S. D., Callahan, J. L., & Cox, R. J. (2017). Psychometric investigation of competency benchmarks. Training and Education in Professional Psychology, 11(3), 128-139. https://doi.org/10.1037/tep0000133

Strupp, H. H. (1998). The Vanderbilt I study revisited. Psychotherapy Research, 8(1), 17-29. https://doi.org/10.1093/ptr/8.1.17

Strupp, H. H., & Hadley, S. W. (1979). Specific vs nonspecific factors in psychotherapy: A controlled study of outcome. Archives of General Psychiatry, 36(1), 1125-1136. https://doi.org/10.1001/archpsyc.1979.01780100095009

Tracey, T. J. G., Wampold, B. E., Lichtenberg, J. W., & Goodyear, R. K. (2014). Expertise in psychotherapy: An elusive goal? American Psychologist, 69(3), 218-229. https://doi.org/10.1037/a0035099

Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes (M. Cole, V. John-Steiner, S. Scribner & E. Souberman., Eds.) (A. R. Luria, M. Lopez-Morillas & M. Cole [with J. V. Wertsch], Trans.) Harvard University Press. (Original work published ca. 1930-1934)

 

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