In therapy -- how accurate is our therapist's self-assessment?
Jan 1, 2013
Insight-oriented psychotherapy -- psychotherapy based on the belief that if you can truly "understand yourself", then one has the basic requirements to recover from disabling forms of psychological distress. Insight involves accurate "self-assessment", and helping others to gain insight requires accurate self-assessment on the part of therapists. But, how accurate are therapists' self-assessments?? This post exames that question.
I have given details of difficulties I have had receiving competent therapy from psychiatrist, psychologists and other providers of "therapy" and difficulties I have had seeking recourse for incompetent professional services from mental health service providers -- see my previous posts here [LINK] and here [LINK] -- Just how common are these problems with therapists' "self-assessment" as it is called, and what can be done about it? A new study, by Steve Walfish and colleagues [LINK] provides some information about the first issue, at least -- but gives rise to further concerns -- and some "reassurance" -- I'm not alone in receiving shoddy service from arrogant "professionals" reluctant to see themselves as they are, and who refuse to be accountable for the poor quality of their services like Simon Kuttner.
Walfish' study was not "original", in conception, but gives rise to significant concerns if you're worried about the quality of care you, or someone you love, is worried about the care received -- In a classic study conducted at the General Electric Company in the USA, Meyer (1980) asked engineers to self-assess their performance compared to other engineers with similar jobs and salaries. The average engineer rated his performance to be at the 78th percentile compared to peers. Of the 92 engineers studied, only two placed themselves below the 50th percentile.
Walfish and colleagues (2012) extended this area of research with a multi-disciplinary sample of mental health professionals. Respondents were asked to: (a) compare their own overall clinical skills and performance to others in their profession, and (b) indicate the percentage of their clients who improved, remained the same, or deteriorated as a result of treatment with them. Results indicated that 25% of mental health professionals viewed their skill to be at the 90th percentile when compared to their peers, and none viewed themselves as below average. Further, when compared to the published literature, clinicians tended to overestimate their rates of client improvement and their rates of client deterioration.
Walfish and colleagues note that, whatever therapists' motivations (unconscious or conscious) may be, therapist self-assessment bias may be at the root of therapists’ reluctance to take advantage of advances in “lab test” results that can predict client worsening and lessen the chance that such a phenomenon will be acted upon by the therapist in a timely manner. Several studies have now shown that deterioration can be predicted (e.g., Finch, Lambert, & Schaalje, 2001 [LINK]; Spielmans, Masters, & Lambert, 2006 [LINK]) and that supplying therapists (and clients) with this information can reduce deterioration rates and bolster client recovery. (see the attached article for details of these references).
As psychotherapists who are truly below average in effectiveness may not recognize that their skills are deficient, or even above-average psychotherapists may not recognize that their patients are regressing, an argument may be made for all psychotherapists to monitor progress and outcome using "formal" methods rather than clinical judgment. This strategy makes reduction of perceptual bias specific on a case-by-case basis, and easier to implement than efforts to overcome this problem through supervision and related strategies aimed at enhancing self-assessment and self-reflection. I have attempted to encourage clients ot therapists (and therapists themselves) to adopt these practices, and move towards more "collaborative" approaches to treatment, such as including guidelines for trauma treatment -- see my website here [LINK] and here [LINK].
One of the most disheartening things for clients, of course, is that they are powerless to "protect" themselves from incompetent therapists, like the Simon Kuttners of this world, because the so-called professional associations and regulatory bodies seem even more reluctant than themselves to acquaint themselves with this sort of research and take clients' feedback as seriously as they should. Foremost amongst these socially, and professionally, irresponsible individuals and groups are Simon Kuttner, and the New Zealand Psychologists Board.