On The Pursuit of Expertise in Psychotherapy

Self-evaluation

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“I can…” skills

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1.

Critically evaluate the "State of the Art" of the field of psychotherapy. When asked the question, "Is Psychotherapy effective and which therapy approach should I choose?", you can offer an informed answer.

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2.

Identify HYPE in the field of psychotherapy and include in your answer to the previous question Consumer Guidelines on what to watch out for.

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3.

Describe what "Expert" therapists do that leads them to get better treatment results. Indicate what are the implications for how you conduct psychotherapy?

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4.

Enumerate the Core Tasks of psychotherapy and the trans-theoretical consensual behavioural principles common to diverse psychotherapeutic interventions.

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5.

Employ a Case Conceptualization Model (CCM) of risk and protective factors of your patients that informs both assessment and treatment decision-making.

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6.

Provide patients, significant others and fellow therapists with feedback based on the Case Conceptualization Model.

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7.

Establish, maintain, and monitor the quality of the therapeutic alliance using session-by-session Feedback Informed Treatment. Ensure that you are culturally, racially, gender and developmentally sensitive when conducting both assessment and treatment.

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8.

Use Guided Discovery and Motivational Interviewing procedures.  Develop the “Art of Questioning", including that used in Single Session Treatment.

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9.

Enhance patient treatment engagement and their participation in conducting intersession activities ("Homework"). Ways of having patients conduct self-monitoring. 

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10.

Address any patient therapy-interfering behaviours. Ensure patient well-being and safety issues from the outset of therapy.

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11.

Collaboratively set an agenda at the beginning of each session with patients.

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12.

Conduct Collaborative Goal -setting to establish "SMART" treatment goals that nurture realistic HOPE.  (Specific, Measurable, Attainable, Relevant/Valued. Timely GOALS)

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13.

Use THREE TIMELINES in order to collaboratively develop a life-span perspective of the patient's risks and strengths-based protective factors.

1)        TimeLine One is a list from the patient’s birth to the present of any stressful life events and losses and any professional or non-professional interventions that were received by the patient.

2)      TimeLine Two is list of any “in spite of behaviours", evidence of Islands of competence, and resilience that the patient evidenced.

3)      TimeLine Three begins at the present time and extends to the patient's future in terms of TREATMENT GOALS.

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14.

Conduct psychoeducation so patients come to appreciate the interconnections between their thoughts, feelings and behaviours.

What are the differences between thinking Fast and Slow and the implications for behaviour change?

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15.

Help patients better appreciate how they inadvertently, unwittingly, and perhaps unknowingly produce the very behaviours that maintain and exacerbate their presenting problems that undermine their efforts to change.

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16.

Conduct skills training for intra-personal (emotion regulation flexibility, distress tolerance, self-soothing and the like) areas on both an individual and group basis. The level GROUP COHERENCE is the best predictor of treatment outcome and know ways to create and assess such coherence on a session-by-session basis.

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17.

Conduct skills training for inter-personal training (communication, conflict management and related areas) on an individual and group basis. 

Draw a distinction between the patient NOT having the knowledge and abilities ("skills deficit") VERSUS a "performance deficit" – i.e. emotions, beliefs and social factors getting in the way of the patient implementing these skills.

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18.

Bolster your patient’s strengths and resilience in six domains (physical, interpersonal, emotional, cognitive, behavioural, spiritual).  When indicated, integrate your patient's spirituality and religion into the treatment process.

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19.

Implement Generalization guidelines in order to increase the likelihood of achieving transfer and maintenance of the areas that were worked on in therapy (not just “TRAIN AND HOPE FOR TRANSFER") 

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20

Engage patients to perform PERSONAL EXPERIMENTS whereby they can obtain results ("collect data") that they take as "evidence" to unfreeze their beliefs and expectations about themselves, others and the future. Ways to have your patients become their own therapists. Help them see themselves as "survivors" and even "thrivers", instead of as “victims."

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21.

Conduct Active Aftercare, providing booster sessions, if indicated. Help the patient to become his/her own therapist and "take your voice with them".