A new paradigm for developing mastery in psychotherapy

In General by Dr. Keith Witt


A number of years ago I bought a positive psychology class conducted by Bill O'Hanlon. In it he cited a meta-analysis of psychotherapy research with two fascinating findings that I've pondered over ever since:

#1: Psychotherapy helps people be healthier, feel better, and improve their lives. Not surprising, but good news none the less!

#2: The contributors to positive change--also called the variance of positive change in psychotherapy--break down into:

40% client factors (like nutrition, exercise, relationships, sleep, self-acceptance, abilities to ask for and receive caring influence, etc).
30% quality of the therapeutic relationship.
15% method of treatment.
15% placebo effect.
Over the years, many of my clients have thanked me for helping them with various life issues (and psychotherapy deals one way or another with all life issues). When they say this, I often ask, "What did we do that helped?" Responses generally include some version of, "You understood me and my concerns and helped me find a way through." This essentially means, "We had a good relationship, and I discovered, learned, or developed resources to progress." Each time I hear such answers, I think of those 30% therapeutic relationship, 40% client variables statistics.

This last year I've gone twice to Brazil to teach in a transformational program developed by Marcelo Cardoso and Sean Esbjorn-Hargens. I love the Brazilian students and teachers and admire the program's approach. The teaching is enormously effective in helping people learn new perspectives, but also--more importantly in my opinion--results in significant growth of an average of one full level on the participants' values and self lines of development over 15 months. Up to now, only years of rigorous meditation has been associated with such vertical growth. I suspect that the program's transformational success is largely a result of how Marcelo and Sean decided to apportion workshop time: 60% for personal exploration and transformation, 20% for content, and 20% for practicing personal and professional skills--pretty much the opposite of most traditional programs.

For almost a year, a Brazilian team and I have been wrestling with the idea of teaching Integrally informed psychotherapy to these and other students, and have yet to come up with a model I'm satisfied with. I think this is partially a function of how I've been conditioned to understand and teach therapy over my career--focusing primarily on methods of treatment and secondarily on maintaining a healing relationship and supporting clients' strengths and resources.

Judging from the success of the program in Sao Paulo, maybe the best way to achieve mastery in therapy is to spend 60% of your training time on personal exploration and growth!

In 1975 I was working with one of the first couples I'd ever seen as a therapist and was feeling somewhat panicked and stuck. The husband and wife were a volatile couple, and had no problem blasting each other during our sessions. It's quite a shock the first time to be the therapist in the room when a couple gets into primitive relational defenses! I asked my friend and supervisor Herb Gravitz for help, and Herb said, "Just love them."

"Just love them," was brilliant advice! Herb was simultaneously teaching me to not take sole responsibility for keeping this couple together and making them happy, but also to embrace being an avatar of love in the session. That one piece of "Just love them," advice has informed my work more than any of the systems that I've since studied, generated, and taught.

Integral psychology is a metatheory that encompasses all psychological theories with the understanding that everyone gets to be right, but no one is right all the time. I've found the Integral metatheory invaluable in understanding that there are countless paths to happier/healthier/more successful lives, but I keep falling into the 20th century trap of thinking that teaching psychotherapists multiple systems is the way to enhance mastery.

I do believe Integral is an invaluable framework to help develop true mastery in the art of psychotherapy. That being said, how do we best teach and support new psychotherapists in training? This is the question my Brazilian friends and I have been struggling with, and I think their transformational program has an answer--focus primarily on the personal development and authenticity of trainees.

I think it's time for all of us who train and supervise therapists, who write about psychotherapy, and who generate psychotherapeutic systems to consider this new paradigm. Let's focus mostly on therapists' growth as human beings! Let's privilege cocreating and maintaining superior therapeutic relationships, and relentlessly supporting clients identifying, expanding, and creating healthy resources like diet, sleep, self-acceptance, sex, work, friends, lovers, family, and community.

Of all the effective therapists I've known, worked with, trained, and supervised, this is what they increasingly focus on throughout their careers. They study multiple systems and at any given moment in a session enact the ones that their intuition guides them to, while always maintaining a focus on the quality of the therapeutic relationship and supporting and enhancing clients' internal, interpersonal, and cultural resources.

I believe that such an emphasis is a new paradigm for developing mastery in psychotherapy.


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