No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Master Therapists: Explorations of Expertise.
... Such developments can leave the beginning therapist feeling lost, confused, frustrated, and ill-prepared, in addition to feeling inadequate to help clients. In fact, when novices are confronted with the complex and demanding problems of their clients, they can become subject to cognitive and emotional overload, discouragement, and burn out (Jennings, Skovholt, Goh, & Lian, 2013;Sperry & Carlson, 2014). ...
... They are able to "draw upon this knowledge efficiently and parsimoniously to determine the best course of action regarding specific client problems" (Jennings & Skovholt, 2016, p. 25). Experts recognize that while clients' complaints may be similar (e.g., complaints of anxiety or depression), they don't focus on that solely; they are readily alert and attentive to the uniqueness, subtleties, ambiguities, and nuances that each client offers, which distinguishes them from other clients with similar complaints (Jennings et al., 2013;Jennings & Skovholt, 2016). Furthermore, experts' knowledge base, experience, and sense of comfort with the processes of psychotherapy can have a cumulative result: reducing the potential hazardous human effects (e.g., feeling inadequate as a practitioner, frustrated, lost, etc.) that dealing with client ambiguities can have on them. ...
... If they are fortunate, they slowly pick it up through trial and error or through good prelicensure supervision. The sad part, however, is that the majority of practitioners never get exposed to the thought processes that belie clinical Introduction 13 expertise and mastery, and thus never reach their full potential (Jennings et al., 2013;Jennings & Skovholt, 2016). Like birds born in captivity, if they don't learn the songs of their species at the critical moments, they are permanently impaired and often do not survive burnout in the wilds of clinical practice. ...
... A hallmark of these experts is the clinician's technical skill, as well as her response to larger contextual issues (7,8). In order to demonstrate this competency, one must have exceptional relationship skills, and cultivate strong working alliances (8,28). Several studies and simulations have demonstrated that highperforming therapists have significantly better outcomes than others. ...
Introduction
The therapeutic relationship continues to be one of the most important factors in therapeutic outcomes. Given the place of emotion in the definition of the therapeutic relationship, as well as the demonstrated positive impact that emotional expression has on therapeutic process and outcome, it stands to reason that studying the emotional exchange between the therapist and client further would be warranted.
Methods
This study used a validated observational coding system--the Specific Affect Coding System (SPAFF) and a theoretical mathematical model to analyze behaviors which make up the therapeutic relationship. Specifically, the researchers used to codify relationship-building behaviors between an expert therapist and his client over the course of six sessions. Dynamical systems mathematical modeling was also employed to create “phase space portraits” depicting the relational dynamics between the master therapist and his client over six sessions.
Results
Statistical analysis was used to compare SPAFF codes and model parameters between the expert therapist and his client. The expert therapist showed stability in affect codes over six sessions while the client’s affect codes appeared to be more flexible over time, though model parameters remained stable across the six sessions. Finally, phase space portraits depicted the evolution of the affective dynamics between the master therapist and his client as the relationship matured.
Discussion
The clinician’s ability to stay emotionally positive and relatively stable across the six sessions (relative to the client) was noteworthy. It formed the basis for a stable base from which she could explore alternative methods to relate to others that she had allowed to dictate her actions, which is in keeping with previous research on the role of therapist facilitation of the therapeutic relationship, emotional expression within the therapeutic relationship, and influence of these on client outcomes. These results provide a valuable foundation for future research on emotional expression as a key component of the therapeutic relationship in psychotherapy.
... It seems likely that studies of clinicians nominated by their peers as "master" therapists (Jennings & Skovholt, 1999;Jennings, Skovholt, Goh, & Lian, 2013) or "passionate" therapists (Dlugos & Friedlander, 2001), research into the cultivation of therapist expertise (Miller, Hubble, Chow, & Seidel, 2013, 2015, and investigations of characteristics of effective therapists (Anderson, Ogles, Patterson, Lambert, & Vermeersch, 2009;Nissen-Lie, Monsen, & Rønnestad, 2010;Nissen-Lie et al., 2015) could contribute to an understanding of therapist wisdom, because all these constructs can be viewed as aspects of an overarching dimension of "exceptionality." On the whole, wisdom does not appear to have emerged as a particularly salient theme within this body of work. ...
Objective:
To explore the nature of professional wisdom, through learning from the experiences of a group of highly experienced senior therapists.
Method:
Twelve senior psychotherapists took part in qualitative in-depth interviews about their professional role and their views around a range of aspects of therapy theory and practice. Interview transcripts were subjected to thematic analysis.
Results:
The analysis yielded nine wisdom themes, clustered within three domains. Each domain represented efforts to resolve dilemmas arising from the experience of being a therapist, around the use of theory in psychotherapy practice, the type of therapeutic relationship that is most helpful for clients, and the experience of therapeutic failure.
Conclusions:
Therapist wisdom can be viewed as a form of contextualized knowledge, which functions as a source of emergent insights that arise as responses to the limitations of prevailing ways of thinking. Research into the nature of therapist wisdom draws attention to sources of knowledge within philosophy and the humanities that have the potential to enhance therapy practice and contribute to our understanding of therapist expertise.
... This idea of organizing master therapists' characteristics into opposites to accent their paradoxical nature has already appeared in Jennings, Skovholt, Goh, and Lian (2013), though their list of opposites differs from ours. While an accent put by therapists on one or another pole may differ in various contexts and countries, we may hypothesize that what defines a master therapist is the ability to balance these polarities and to resolve these inherent tensions without prematurely sticking to one of the poles. ...
Existing research suggests that although many master therapists’ characteristics are interculturally valid, at least some of these characteristics are culturally bound. Interviews with nine peer-nominated Czech expert psychotherapists were subjected to thematic analysis which revealed 16 themes, organized into six more general categories: (a) Humble attitude towards mastery, clients, and colleagues, (b) Relationship, (c) Awareness of one’s needs, limits, and resources, (d) Continuous development, (e) Engagement, and (f) Awareness of the complexity of psychotherapeutic work. The results are discussed in the context of cultural differences, as well as specific historical circumstances of the development of the Czech therapeutic scene.
There may be quite substantial differences between individual therapists’ treatment outcomes—differences that cannot be attributed to their choice of treatment method but which instead seems to reflect their more personal qualities, including their ability to provide a secure base for the patient and to display competence, relational skills and other features that influence the development of trust and a sustainable therapeutic relationship and alliance. Some of these therapist factors are outlined in this chapter.
There is a need for studies that advance our knowledge of therapist effectiveness, expanding the definition of what constitutes
therapeutic success. In the present study, four aspects of clinical outcome were analyzed using a sample of highly experienced
psychotherapists (mean years of experience as therapy practitioners = 30) who also serve as clinical teachers. The four aspects
were: (1) overall change in different outcome domains, including long-term outcome; (2) outcome with clinically distressed
clients (i.e. clients above the level of clinical disturbance at pretreatment); (3) level of drop-out; and (4) the degree to which
clients re-entered treatment during the follow-up period. Participants were 48 clients treated by 18 therapists. Treatments
were open-ended, ‘therapy as usual’, mostly within the setting of independent private practice. Outcome measurements
included the OQ-45.2 and IIP-64, with repeated measurements during therapy and extended long-term follow up (up to
3.5years). Cohen’s d effect sizes and multilevel growth trajectories were estimated for patient change in symptomatic and
interpersonal distress. The findings indicate that these therapists obtain very good outcomes overall, particularly with clients
above cut-off for clinical disturbance. Moreover, there was a high level of maintenance and increase of treatment gains over
time. No clients dropped out. Overall, the findings suggest that a sample of highly experienced therapists obtain particularly
good outcomes as defined in more comprehensive terms than what is typical in psychotherapy research. Implications for the
understanding of therapeutic success and clinical expertise are discussed.
ResearchGate has not been able to resolve any references for this publication.