Psychotherapy Articles

Psychotherapy Articles

On Being the Instrument of Change

Author’s Note: Michael Karson teaches clinical and forensic psychology in the Graduate School of Professional Psychology at the University of Denver. His new book, What Every Therapist Needs to Know, was recently published and can be purchased here.


We know that psychotherapy outcome research cannot imitate randomized clinical trials for diseases because, for one among many reasons, the person of the therapist cannot be abstracted from the provision of treatment. The therapist is the treatment. What are the implications for training and lifelong learning?

Over the course of a psychotherapy career, we will meet only a few patients who suffer from a deficiency in information: the occasional teenage girl who does not know she can still eat 1500 calories a day and not gain weight, the occasional depressive who just needs to hear that his ideas about being special are oppressing him, the occasional phobic who just needs some information on how harmless germs really are. These patients are wasting their money on us; they can get the information they need online. The vast majority of people we work with need to change themselves, not just add some new information to who they already are. They need to change their response tendencies, their perceptual patterns, their self-concepts, their ways of organizing experience. We know that these kinds of tendencies and patterns are learned in the first place within interactive relationships, and they need interactive relationships to be learned differently. One reason is that people will not do the hard work of changing themselves without a strong collaboration. It turns out that collaboration is a two-way street, and that we have to be subject to change if we are to be effective in changing others. In this work, we are the instrument of change, not just the messenger.

Now, how many of us are prepared to be an instrument of change, a creature of relational authenticity, metaphorical ideation, and wise, affectionate circumspection? If that already describes you, you’re wasting your money on graduate school or further improvement because you only need information that is available online: some new vocabulary words, a few techniques for working with people, and the results of some relevant studies. Every profession has its nomenclature, but learning it does not make you a better professional, only better credentialed. I know that I needed—and still need—a lot more than that, reminders to approach rather than avoid conflict, ways to value process over content, exercises in thinking metaphorically, gluttony for corrective feedback, comfort with intense emotion and finite but close relationships, and an appreciation of the difference between blame and responsibility.

I am still a work in progress, changing my values, my ways of thinking, my response patterns, and my ideas about my place in the world. What has helped me has been avid reading, and affectionate, playfully challenging growth-oriented relationships that help me to keep getting over myself. The crucial element for becoming competent at any complicated endeavor is to experience corrective feedback as desirable—feedback from supervisors, from clients, from colleagues, from students, from reality. A pitch you cannot hit is itself a master teacher, not a humiliation: it teaches you the limits of your current competence and challenges you, with the help of others, to rise to that sort of occasion in the future. Improvement should be challenging and fun; otherwise, you spend your energy pretending to be competent instead of acquiring competence. Nearly everyone agrees they want to learn to do the work better and not just be told they already know how, but only the ones who think that means they are going to have to change themselves really mean it. Change can be disorienting and is almost always discomfiting.

Our field seems hung up on the question of helping people get better. This is ironic, since we seem to have embraced the medical model (again) except for the one thing that the medical model has that we can actually use, namely, an effort to make patients better. Instead, we tell patients that they are already perfect just as they are, that they should accept their depression and anxiety or make it go away with drugs, but they certainly should not be expected to change their own behavior (because that sounds like *shudder* blame). We conduct outcome research on symptom-checklist reduction, and not on whether the person is actually over the depression, for example. We also get pressured to tell trainees and recent grads that they too are practically perfect in every way.

Everyone has ideas about what a good person is. It seems to me that these ideas ought to be shared and interrogated by lively debate with colleagues and friends, vetted for idiosyncrasies and excessive ethnocentrism, and then cheerfully deployed as a revisable backdrop for the therapy we do and as a focus of our own development. Spend several hours a week trying to become a better person, whatever that might mean for you. For me, it has meant trying to have a big heart and an open mind, trying to think systemically even when irritated, laughing at myself whenever I think I’m all that, and reading literature and history rather than Facebook posts and gossip columns at least some of the time. If I find my rate of good ideas declining, I get back to the program, as I do for my physical improvement if I find myself huffing on a staircase. As others report regarding physical exercise, it eventually becomes pleasurable to read Tolstoy and to recognize that one might be a vessel but not a font of good ideas.

Michael Karson, Ph.D., J.D., A.B.P.P. (Clinical) teaches clinical and forensic psychology in the Graduate School of Professional Psychology at the University of Denver, but he practiced for 25 years before entering academia. He is first or sole author of six books, the latest of which is What Every Therapist Needs to Know. He blogs at

Cite This Article

Karson, M. (2018, October). On being the instrument of change. [Web article]. Retrieved from



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