The Paradoxical Foundation for Psychotherapy Expertise
“The humble man makes room for progress; the proud man believes he is already there.”
Ed Parker (1983)
In their series of articles, Tracey and colleagues (Tracey, Wampold, Goodyear, & Lichtenberg, 2015; Tracey, Wampold, Lichtenberg, & Goodyear, 2014) explore barriers psychotherapists face in developing expertise. Specifically, Tracey et al. (2014, 2015) noted that psychotherapists often (a) struggle to obtain meaningful feedback on their work with clients and (b) fail to engage in deliberate practice. Because clients can withhold or not be asked to provide critical feedback during the treatment process, psychotherapists may develop an overly positive view of their work and misunderstand their limitations. Thus, it is unsurprising that research has not demonstrated a strong link between psychotherapist experience and psychotherapist expertise (Beutler et al., 2004; Hill & Knox, 2013).
Tracey et al. (2014, 2015) give several helpful recommendations for developing psychotherapist expertise. These recommendations focus on obtaining accurate feedback from clients about how the psychotherapist is doing and then implementing planful action based on the feedback received. Although these suggestions are helpful, we believe they are likely to fail if not accompanied by a paradoxical set of psychotherapy skills that is grounded in humility (Hook, Davis, Owen, Worthington, & Utsey, 2013; Paine, Sandage, Rupert, Devor, & Bronstein, 2015).
Humility involves both intrapersonal and interpersonal characteristics (Davis et al., 2011). On the intrapersonal dimension, humility involves an accurate view of self, including an awareness of and ability to acknowledge personal mistakes and limitations; on the interpersonal dimension, humility involves a relational stance that is other-oriented, rather than self-focused. Openness, perhaps humility’s most critical defining feature, infuses both intrapersonal and interpersonal dimensions and underlies all its components (Davis et al., 2011; Davis, Worthington, & Hook, 2010; Hook et al., 2013; Paine et al., 2015). At face value, humility may appear to be the opposite of expertise, but we argue that humility is foundational to implementing the suggestions put forth in the Tracey et al. (2014, 2015) articles.
First, a psychotherapist must be humble to seek out and incorporate feedback. Openness, valuing input from the other (or client), ability to acknowledge possible need for skill improvement, and willingness to engage in self-scrutiny would all be therapist prerequisites of any such feedback incorporation efforts.
Some reasons for, and roadblocks to, successful incorporation of client feedback are: (a) because of its potentially threatening nature, psychotherapists can shy away from requesting client feedback and instead prioritize their own subjective sense of how clients are doing (Lambert, 2010; Lambert, Harmon, Slade, Whipple, & Hawkins, 2005); and (b) because low humility is associated with compromised openness (Davis et al., 2011), psychotherapists with low humility can interpret client feedback as being a product of “client issues” (e.g., labeling the client “resistant” or “difficult”) and fail to accept their own need for behavioral change. We believe that humility is a crucial and necessary antidote to the removal of both roadblocks.
Second, a psychotherapist must also be humble to engage in deliberate practice. Deliberate practice is difficult and strikingly different from the type of practice most of us do in our everyday work lives: It is designed specifically to improve performance (Colvin, 2008). Often a teacher or supervisor is an important component to deliberate practice because of the depth of knowledge needed for delivering critical performance feedback and stimulating continued improvement (e.g., McMahan, 2014; Paine et al., 2015).
Again, openness, valuing input from the other (teacher or supervisor), ability to acknowledge possible need for skill improvement, and willingness to engage in self-scrutiny would all be therapist prerequisites of any such feedback incorporation efforts. For many psychotherapists, this kind of designed practice is unfortunately rare once graduate school has been completed and one’s license obtained.
Deliberate practice also occurs at the edges of one’s abilities and performance (Coyle, 2009). For example, in one research study comparing elite and sub-elite figure skaters, the elite figure skaters spent more time practicing difficult skills, such as jumps, than did the sub-elite figure skaters, and it was suggested that very elite figure skaters spend a larger amount of time working on skills that are at the edges of their abilities (Deakin & Cobley, 2003).
Over time, psychotherapists can come to most resemble sub-elite figure skaters, in that they may find a type of work or population with which they feel comfortable and stay in their comfort zone. Humility is necessary for challenging any such comfort and working to master the more difficult “jumps” of therapeutic expertise; it requires a relentless willingness to wrestle with the learning struggles, demands, and failures of change, and to constantly work at the edges of ability and performance.
Expertise is a preeminent goal of psychotherapy education and a preeminently desired practitioner objective. But what prerequisite variable or set of variables makes the process of acquiring therapeutic expertise possible?
If psychotherapists are to meaningfully incorporate the suggestions proposed by Tracey et al. (2014, 2015), we contend that humility is that very foundational characteristic—the sine qua non—for actualizing expertise. When operating from a place of humility, psychotherapists are increasingly freed to incorporate client (and supervisor) feedback, further fortified in maximizing deliberate practice efforts, and better positioned to make treatment expertise a psychotherapeutic reality: The expert psychotherapist is foremost a humble psychotherapist.
Cite This Article
Hook, J. N., Watkins Jr., C. E., Davis, D. E., & Owen, J. (2015). Humility: The paradoxical foundation for psychotherapy expertise. Psychotherapy Bulletin, 50(2), 11-13.
Beutler, L., Malik, M. L., Alimohamed, S., Harwood, T. M., Talebi, H., Noble, S., & Wong, E. (2004). Therapist variables. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 277-306). New York, NY: John Wiley & Sons.
Colvin, G. (2008). Talent is overrated: What really separates world-class performers from everybody else. London, England: Portfolio Publishing.
Coyle, D. (2009). The talent code: Greatness isn’t born. It’s grown. Here’s how. New York, NY: Bantam Books.
Davis, D. E., Hook, J. N., Worthington, E. L., Jr., Van Tongeren, D. R., Gartner, A. L., Jennings, D. J., II, & Emmons, R. A. (2011). Relational humility: Conceptualizing and measuring humility as a personality judgment. Journal of Personality Assessment, 93(3), 225-234. doi: 10.1080/00223892.2011.558871
Davis, D. E., Worthington, E. L., Jr., & Hook, J. N. (2010). Humility: Review of measurement strategies and conceptualization as personality judgment. Journal of Positive Psychology, 5(4), 243-252. doi: 10.1080/17439761003791672
Deakin, J. M., & Cobley, S. (2003). An examination of the practice environments in figure skating and volleyball: A search for deliberate practice. In J. Starkes & K. A. Ericsson (Eds.), Expert performance in sports: Advances in research on sports expertise (pp. 90-113). Champaign, IL: Human Kinetics.
Hill, C. E., & Knox, S. (2013). Training and supervision in psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 775-811). Hoboken, NJ: John Wiley & Sons.
Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Jr., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353-366. doi: 10.1037/a0032595
Lambert, M. J. (2010). “Yes, it is time for clinicians to routinely monitor treatment outcome.” In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy(2nd ed., pp. 239-266). Washington, DC: American Psychological Association. doi: 10.1037/12075-008
Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing feedback to psychotherapists on their patients’ progress: Clinical results and practice suggestions. Journal of Clinical Psychology, 61(2), 165-174. doi: 10.1002/jclp.20113
McMahan, E. H. (2014). Supervision, a nonelusive component of deliberate practice toward expertise. American Psychologist, 69(7), 712-713. doi: 10.1037/a0037832
Paine, D. R., Sandage, S. J., Rupert, D., Devor, N. G., & Bronstein, M. (2015). Humility as a psychotherapeutic virtue: Spiritual, philosophical, and psychological foundations. Journal of Spirituality in Mental Health, 17(1), 3-25. doi: 10.1080/19349637.2015.957611
Parker, E. K. (1983). Infinite insights into kenpo: Vol. 2. Physical analyzation I. Los Angeles, CA: Kam IV.
Tracey, T. J., Wampold, B. E., Goodyear, R. K., & Lichtenberg, J. W. (2015). Improving expertise in psychotherapy. The Psychotherapy Bulletin, 50(1), 7-13.
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. doi: 10.1037/a0035099