August 2021 Clinical Supervision Topic: Therapist Effect

This month we’re talking about therapist effect as one of the common factors. Check out the write-up from last year as we’ll use some of the content to guide our exploration this month.

We know that the client extra-therapeutic factors account for 40% of the therapy outcome, or if we were going to say it from a medical model perspective, social determinants of health account for about 50%. These include, but aren’t limited to: genetics, social and physical environment, faith, persistence, support of family members, socioeconomic level, race or other physical/identity characteristics. Except for the last area, these are things that will change to varying degrees throughout a person’s life. We don’t have any control over them and they greatly affect the work.

We also know that therapist themselves greatly affect how the work goes. This is in how we develop relationships with clients, how we deliver a modality (there are intra-modality discrepancies in effectiveness), and a few other things. Check out this finding from a research article that I often reference:

This month in our work together, we’ll take directly from this article and discuss the following (feel free to reflect on this in preparation for our sessions):

• What have you shifted in your therapeutic alliance approach since we delved more deeply into it four months ago? How can you tell when an alliance is strong vs. average?

• Which interpersonal skills are you nailing? Not sure about?

• What does expressing professional doubt mean to you, and how do you do it?

• What’s your off-shift clinical skills training game look like?

Looking forward to seeing you all soon. So grateful to be doing this work with you.

September Clinical Supervision Group Topic: Therapeutic Modalities

I just want to take a minute and say how great Anna Caitlin’s photography is. All of the work on my website is from her, and every time I get to post one of her pictures I feel happy and inspired. Thanks Anna! She’s a local photographer here in Portland; hit her up if you need some portraits done for you or your loved ones.

Our September topic is therapeutic modalities. I want each of you to have a broad overview of the most widely-used modalities as you navigate towards your clinical license. I want you to feel competent in describing these to your clients so they are aware of their options. I want you to feel comfortable using some of the tools within each of these modalities, and know which situations call for which techniques. I also want you to understand the basic assumptions of each modality, and the problems each one was developed to address. I’ve created a chart that reviews some of them and describes when and how to use them. Please look it over (feel free to print if needed) and come ready to discuss your own experience, critiques and questions within each modality.

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Download the Therapeutic Modalities Chart PDF here.

Comment below, email or text with any questions. Looking forward to seeing you all!

Self-Compassion for Clinicians

Self-compassion developed for yourself will make you a better clinician for others. Self-compassion is highly correlated with a decrease in mental illness symptoms, particular in depression and anxiety. When we know how to personally employ these tools, it is easier to understand how to help others implement them.

If you’ve got about 15 minutes, read this. It’s a great overview of the practice of self-compassion, as conceptualized by Dr. Kristen Neff. And here’s a brief explanation of self-compassion and why it matters (taken from here, which links to research on this):

Self-compassion has been defined as being kind to one’s self (Neff, 2003b) and being able to use self-reassurance and soothing in times of adversity (Gilbert, 2009; Neff, 2003b). It includes being nonjudgmental about one’s self (Gilbert, 2009; Neff, 2003b) and recognizing one’s experience as part of the human condition (Neff, 2003b). Self-criticism, on the other hand, is characterized by maladaptive emotion-regulation strategies such as being harsh and judgmental about one’s self (Gilbert, 2009; Neff, 2003b). It is associated with feeling isolated (Neff, 2003b) and being in flight or fight or social rank mode, therefore exacerbating a sense of threat in difficult times (Gilbert, 2009).

Whereas self-criticism has been associated with a number of mental health problems, such as depression and anxiety (Clark, Watson, & Mineka, 1994), there is growing evidence that self-compassion has beneficial effects on mental health and well-being (e.g., Galante, Galante, Bekkers, & Gallacher, 2014) from two lines of research.

Reflection: Now think of a client you recently met with who could benefit from this information. Which part would you share with them, and how would you share it in an effective and accessible way? What might be some of their responses? How does your own work around self-compassion impact your work?

Clinical Empathy

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Empathy!

I get excited about empathy. It’s a simple concept that takes practice. Every time you review it, you figure it out a bit more. It’s different from sympathy, as Brene Brown illustrates here. And use of it leads to better clinical outcomes (here).

Empathy is connecting with someone and with what they see and feel. It’s like standing with them inside their house and looking out the same window while they describe what they are seeing. It’s logically understanding how they are experiencing the world, then finding a time where you have felt similarly (though the details may be different), and compassionately communicating this to them. By doing this, you create a space for them to have their experience. You let them know you are right there with them; they are not alone. This promotes acceptance, connection, healing. What an honor, right? To be able to do this for a fellow human being in their moment of need.

Earlier in my work career, I thought I was using empathy because I felt bad for every person with whom I worked. The people I serve often have had trauma in their childhood, then enlist in the military and have trauma there, only to discharge and experience hardships like homelessness, mental illness and addiction. In retrospect, I think I was somatically feeling what they were feeling, or at times, simply feeling pity. Neither of which are inherently bad. But it was hard for me to sustain personally; the emotional cost was significant. Shifting my approach has been more sustainable and more personally meaningful. (By the way, one of my favorite modalities which supports this kind of empathy is Motivational Interviewing.)

Talk to me: how have you been learning about empathy? I love hearing about the different ways people utilize it.