Hallmarks of a good therapist: Humility and Self-Doubt

Humility and self-doubt are hallmarks of a good therapist | Aeon Ideas – by Helene A Nissen-Lie – Feb 2020

‘The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.’

This phenomenon – observed in the 1930s by the English philosopher Bertrand Russell – has a technical name, the Dunning-Krüger effect. It refers to the tendency for the worst performers to overestimate their performance, whereas the top performers underestimate their own.

That’s because when you truly become an expert in a field, you’ve learned enough to see all the details and complexity and how much else is still unknown.

Unfortunately, psychotherapists’ self-assessment is biased, too. When asked to rate their own performances in delivering psychotherapy, therapists tend to overestimate themselves.

What’s more, in one study, overconfidence was more typical of those therapists who were rated to be less competent by an independent expert rater.

In contrast, other studies have found that it’s the therapists who rate themselves more negatively who are typically judged the most competent by independent experts.

This also describes my experience with medical doctors. The ones most sure of themselves were also the most wrong. My neurologist worked with me for a couple of years trying to find a diagnosis and asked *me* if I thought I might have Ehlers-Danlos. We were great partners until his retirement.

Inspired by these findings, a recent German study compared therapists’ estimations of their clients’ progress with their clients’ actual improvement in therapy.

The more modest or conservative a therapist’s estimation of their clients’ progress (relative to their clients’ actual improvement), the more their clients’ symptoms had reduced and their quality of life had increased.

Such findings help to explain the outcome of a series of naturalistic psychotherapy studies that my colleagues and I conducted recently.

One particular finding stood out:

those therapists with higher scores on professional self-doubt (for instance, they lacked confidence that they might have beneficial effects on clients, and felt unsure how best to deal effectively with a client) tended to receive more positive ratings from their clients in terms of the therapeutic alliance (ie, the quality of the relationship between therapist and client) and the outcomes of therapy.

…the result makes perfect sense in light of the earlier research showing the benefits of therapist humility.

The willingness to listen to the other is probably central in explaining why humility is beneficial.

A humble attitude might also be necessary for therapists to be open to feedback about their client’s actual progress, rather than just assuming that all is going well, or indeed blaming the client for a lack of progress.

Is humility a paradoxical component of expertise? Not really: an expert is first and foremost one who continues to learn – and this seems to apply as much to psychotherapists as it does to other professions.

Taken all together, the growing evidence for the benefits of therapist humility supports the early observation of the Danish philosopher Søren Kierkegaard, writing in 1859, that ‘all true helping begins with a humbling’.

At a time when people tend to think that their value is based on how confident they are and that they must ‘sell themselves’ in every situation, the finding that therapist humility is an underrated virtue and a paradoxical ingredient of expertise might be a relief.

…this will involve a cultural change, so that qualified therapists can act as role-models of humility, to clients and to students, without fear of ‘losing face’ or authority.

Author: Helene A Nissen-Lie is an associate professor of clinical psychology at the University of Oslo in Norway.

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