Deliberate Practice Makes Perfect: Improving Therapist Effectiveness

Abstract

Psychotherapy works. The results of numerous studies show that those individuals treated are better off than those not treated or on waitlists with an average effect size of .8 (Duncan et al., 2008). To put it in perspective, the effects of psychotherapy are equal to those found for coronary artery bypass surgery and 4 times greater than fluoride in the prevention dental cavities. Yet, three persistent problems plague the psychotherapy field: 1) clients drop out of therapy at alarming rates – almost half of clients decide not to continue and prematurely terminate; 2) not only do therapists not notice when clients are at risk for dropping out, they also do not detect when things are getting worse (approximately 10% of clients get worse after starting therapy); and 3) a small percentage of clients (10%) accounts for the largest amount of expenditures (Minami, 2008). This last finding may be the result of therapists not realizing when things are not working or getting worse and instead of changing course, doing more of what is not working, over and over again. Along these lines, most therapists do not have an accurate sense of their helpfulness and on average, overrate their effectiveness by 65% (Chow, 2014). Given the issues with retention, coupled with the self-assessment bias among therapists, it’s not surprising that psychotherapy outcomes have not appreciably improved over the past 40 years.