On 24 March, our discussion was based fairly loosely on ‘Expertise in Psychotherapy An Elusive Goal?’ by Tracy, Wampold, Lichtenberg and Goodyear. The paper largely supports the view that experience as a psychotherapist leads to increased confidence but does not lead to expertise.
The group found it problematic to define expertise or to accept the definition in the paper which discussed it in terms of reputation, performance or client outcomes. The paper seemed more concerned with measurements and techniques used in psychology than psychotherapy.We were particularly unhappy with the authors’ promotion of a ‘ disconfirming stance’ which for some of us suggested experimenting with a different approach to the one we believe to be efficacious in order to make a comparison. Others of us felt that it might be understood to mean having a questioning attitude to our practice and a lack of assumption that we are already working in the optimal way.
We felt that if we have a body of knowledge to bring to our work, a recognition of our limitations, ever developing self awareness, good use of supervision, we were likely,over time, to develop something that might be called expertise. The discussion progressed to the more attractive goal of becoming a peer-reviewed Master Practitioner rather than an expert.
A frank conversation followed in which we admitted how difficult it is to tolerate the low status we are given in the eyes of other health professionals and some lay people. We noticed how hard it is for the quality of our work to be rated or for meaningful comparisons to be made between therapists . Consequently, much of our competence goes unrecognised. The depth and quality of the therapeutic relationships we make are impossible to measure. The private nature of therapy means that any skill we may possess is not seen. This invisibility can lead to attacks in the form of contempt or envy. Contempt from those who feel threatened by or ignorant of therapy and envy from those who resent us the privilege of holding secrets . We tend therefore to be generally under estimated ,given low status and only feel valued by peers in the therapy world.
We bolstered ourselves by each focusing on what we perceive to be our strengths. Some members found it easier than others. We noted that the personal qualities which correlate positively with a good outcome for clients included a degree of self doubt, deliberate practice, an ability to form working alliances across a range of clients, a high level of facilitative skills, keenness and curiosity. Qualities all members of this group possess.