Video: Dr. John Norcross on the impact of a therapist’s confidence
Dr. John Norcross discusses the impact of a therapist’s confidence on the outcome of a therapeutic endeavor
LF: Isn’t there some research showing that if you don’t – how much the therapist believes in what they’re doing has a big effect, as well?
JN: Yeah. It’s our hope – you know, most of us talk about kind hope and positive expectations, and indeed, that’s quite powerful in predicting who does well in psychotherapy. But it’s our confidence and hope that what we have is going. Many years ago, Jerome Frank talked about the role of hope and expectancy and ritual and he was one of the first, of course, to advance this idea that many psychotherapies work. In fact, when you control for therapy allegiance in the research, many psychotherapies do work. Frank said, “But I think what really works is someone who believes what they’re doing is important.” Which is why, when we come out of a clinical workshop and we try something, we say, “Well, this is going to work. I just learned it.” It may or may not be the technique, but certainly clients pick up on our enthusiasm and our interest and our experimentation. It probably has a lot more to do with successful psychotherapy than the particular treatment method we’re using.
LF: So when you’re saying you want people to be themselves and chose the pieces, they need pieces from A and B maybe, but they need to choose them themselves and the ones that really sit right with them.
JN: That’s right. Otherwise, it feels like a false self that they’re play-acting. When I give clinical workshops on treatment adaptation, we frequently talk about this point. And I haven’t quite learned a way of phrasing it so it doesn’t sound too confusing. So I usually preface it by saying, “It’s going to sound like I’m talking out of both sides of my mouth.”
Psychotherapists with experience and dedication can certainly have a broader style of relating and use more methods than they think they can. That is, we can be what Arnie Lazarus called “authentic chameleons.” We can be different with each person. It’s a discriminative function. That is, we come to be comfortable in ourselves. We can say, “Well, at this moment the patient needs this. And my next patient may need that.” So we can broaden ourselves with time and experience.
At the same time, even the best chameleon can’t do plaid. We need to respect what our limits are to find out what we’re not enthusiastic about. And that may even have nothing to do with effectiveness. For example, during some early years of my internship at Brown, I worked with a very structured, CBT protocol for dental phobics. It was very effective. It was also for me, very boring. So, this is an important concern of many people, oral health, I’m glad they were getting treatment and I’ve never done it since
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