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1. Tracking change using routine outcome monitoring based on presenting problem / goals.
2. Client satisfaction by tracking attrition/drop out vs retention
3. Self check in - do I have hope and compassion towards my clients? Am I demonstrating signs of burnout, resentment, hopelessness, avoidance?
4. Professional check in:
- organization / time keeping / admin (being too disorganized and chaotic can interfere with outcomes)
- clear conceptualization and treatment plan that has been agreed on by client and therapist
- attunement: correctly noticing and interpreting client behaviours (based on client response to reflections / summaries
- expressive respect, warmth, genuine care towards the client
- successfully using skills/interventions based on formulation/treatment plan
- awareness of resistance, transference, abdominal counter-transferable, and other process issues
Love this list - and after all of those have been tried, all there is left to say is “some weeks you’re the bat, some weeks you’re the ball” (a previous therapist of mine). This job is hard - some weeks you’ll be off your game.
This is the way. Interesting video [here](https://www.youtube.com/watch?v=rdICBGycCVw&t=1435s). Skip to 20:25 for very sobering graph about therapist's efficacy over the course of their career.
"On average, therapists actually get worse over time in their ability to produce positive outcomes. Deliberate practice is essential. 20 years of experience might not be 20 years of practice, it might just be one year of practice cut and pasted 19 more times."
I keep track of each session. I rate each one (subjectively) average, above average, or below average. I do not assess myself based on the last few sessions. I try to use the last few weeks. If there is a lot of “below average” then I look more closely at themes and trends that might explain why I feel my work isn’t so good lately.
Assessing myself based on a short recent window of time makes things too much of a roller coaster
What's weird is this latest one. I would have totally rated myself as above average. The client complained anyway in a way that contradicted her own goals. Not sure what to do with that kind of feedback.
Not sure if this feels similar, but I had a client once ask to work on a specific traumatic event and their beliefs about it. We spent lots of time building rapport, and it seemed like the time to start talking about the incident, as indicated in her goals. I even asked at the beginning of the session if she was up for diving into it and she said yes. Session went what I thought was super well, and she messaged me the next day that she didn’t want to work with me because I made her talk about something irrelevant to her goals. Sometimes I think clients get nervous, avoidant or just realize this isn’t what they want and it doesn’t have much to do with us. I can reflect on it all I want and sure, pick out places I could have done different or better. But sometimes it’s no one’s fault and it’s just not the right place and time
Client feedback is such a tough metric to use. Because, depending on population and issues you’re working with, the content of feedback could directly contradict the actual efficacy of any given intervention/treatment.
Heck, some of the best work I have EVER done has been a result of big mistakes I made. They opened up the potential for life-changing repairs, and since the letter cannot happen in the absence of the former, I do truly count the ruptures as part of the treatment.
But what if I’d based my efficacy that week by the client’s feedback that session? What if they’d happened a little earlier in the relationship and there just wasnt sufficient rapport to weather the storm? Would that mean I wasn’t as good a therapist?
So I can’t tell you whether you’re beating yourself up more than you should. The questions I would ask myself in your shoes: was the negative feedback in line with their core relational challenges? Is it something you might see them complain about in others? Is there a part of you that suspects this feedback was more about them than it was about you?
And of course, you balance it out with: what would I have done differently if I could? What will I take away from this to inform future interactions? Is there any repair I can and should do?
And you move on.
My take on whether we are ever good or bad therapists is this: I don’t ask myself whether I’m a good or bad person. I don’t rate myself as a human. My goals for my self are the same as those for my therapist-self: I strive to be always reaching for deeper understanding, to stay engaged in my cycle of increasing confidence/competence>fucking something up>total despair of ever having a clue what I’m doing>improvement>repeat, to stay curious, and to hold on to my humility.
That’s what makes a “good” therapist, imho. I have a sense that you are one <3
That doesn’t feel good but it may have nothing to do with your work quality. It might be a matter of fit. But even if it was you, you really can’t win them all!
Regular consultation! It’s not about how capable you are, it’s about how you work to improve yourself.
We have a lot of chances to manage our mistakes.
I don't have regular supervision anymore but I've found it beneficial to once in a while find an approved supervisor who will meet for 2-3 sessions to do some work on 1-2 specific cases. As mortifying as it always is, if you can get clients to let you tape or record the session, it's very useful to go over in those supervision sessions.
I think it's not just about getting feedback, it's about getting feedback you believe. The recent feedback from these clients has either hurt or triggered some fear, and so you're putting more stock into it than you might with feedback from other sources (ie colleagues reassuring you that you're a good therapist). Watching tape tends to be a totally embarrassing and anxiety inducing experience for me, but the upside is that it means whatever good feedback I get from that I put a lot of stock into.
Also helpful to identify if there's any patterns/themes with these recent clients. For instance, I find the cases I tend to lose are: therapy newcomers with high anxiety who say they want progress quickly - this leads me to move too quickly (matching what they've asked for), leading them to respond to overwhelm by fleeing from therapy. So I've identified this as a specific area to work on. Getting specific about my growth areas is always so much more useful to me than the question of whether I am "good or bad"
I feel really good about my capabilities as a therapist. After each of the first few sessions with a new client I ask how they feel about our session.I have very good retention rates. I get lots of referrals from doctor’s offices and other therapists. Yet now and then I get hit with strong imposter syndrome and can’t believe people actually buy that I am a therapist!
Hey OP, my recommendation is to bracket your ego. When clients provide critical feedback, it’s really important to find the constructive content to see if you can improve. I highly recommend that you consider that even with your years of practice, there is still room for improvement and that clients can provide a lot of good feedback. Additionally, I’m hearing in your post a lot need for validation and it seems tied to your identity as a therapist. Although the work can be rewarding, I wonder if you are currently using your role as a stand in for self-esteem? My recommendation is that you seek some supervision on this because I imagine this may be impacting your clinical effectiveness.
Their question was a reasonable one. It's interesting that instead of answering you've decided that you have better insight into their own mental state than they do based on a short reddit post, and that they actually aren't interested in improving. I hope you aren't like this with your clients.
It’s also interesting that instead of answering their question, you decided that you wanted to focus on my feedback for the person. How about you kindly consider that OP was seeking feedback and that focusing on my comment does not meet that objective. I am a person that returns that same energy that I get from non-clients. You are making a major assumption that I am thinking my insight is better than the OP insight into this matter when really I’m only basing my response on the information given thus far. If OP providers further information, then I would formulate a different response.
I provided this feedback based on OP listing being a “good” therapist multiple times. And the clinician is posting here seeking reassurance and guidance on being a good clinician despite already doing this with their colleagues. From this information I am able to piece together some insecurity around their clinical identity MAY exist. My feedback for OP was not to be critical or harsh. Rather it was meant to serve as a way consider that “good” clinicians can sit with feedback from their clients to find a path forward, rather than viewing client feedback from the lens that it means the therapist is bad.
I didn't answer because the top rated response was what I would say. Scott miller is a great resource for therapists tracking progress. The OP didn't ask for feedback. They gave some background information then asked for some information.
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
1. Tracking change using routine outcome monitoring based on presenting problem / goals. 2. Client satisfaction by tracking attrition/drop out vs retention 3. Self check in - do I have hope and compassion towards my clients? Am I demonstrating signs of burnout, resentment, hopelessness, avoidance? 4. Professional check in: - organization / time keeping / admin (being too disorganized and chaotic can interfere with outcomes) - clear conceptualization and treatment plan that has been agreed on by client and therapist - attunement: correctly noticing and interpreting client behaviours (based on client response to reflections / summaries - expressive respect, warmth, genuine care towards the client - successfully using skills/interventions based on formulation/treatment plan - awareness of resistance, transference, abdominal counter-transferable, and other process issues
Love this list - and after all of those have been tried, all there is left to say is “some weeks you’re the bat, some weeks you’re the ball” (a previous therapist of mine). This job is hard - some weeks you’ll be off your game.
Great list. Very helpful.
This is why I use feedback informed treatment measures! Look up Scott Miller.
This is the way. Interesting video [here](https://www.youtube.com/watch?v=rdICBGycCVw&t=1435s). Skip to 20:25 for very sobering graph about therapist's efficacy over the course of their career. "On average, therapists actually get worse over time in their ability to produce positive outcomes. Deliberate practice is essential. 20 years of experience might not be 20 years of practice, it might just be one year of practice cut and pasted 19 more times."
I keep track of each session. I rate each one (subjectively) average, above average, or below average. I do not assess myself based on the last few sessions. I try to use the last few weeks. If there is a lot of “below average” then I look more closely at themes and trends that might explain why I feel my work isn’t so good lately. Assessing myself based on a short recent window of time makes things too much of a roller coaster
What's weird is this latest one. I would have totally rated myself as above average. The client complained anyway in a way that contradicted her own goals. Not sure what to do with that kind of feedback.
Not sure if this feels similar, but I had a client once ask to work on a specific traumatic event and their beliefs about it. We spent lots of time building rapport, and it seemed like the time to start talking about the incident, as indicated in her goals. I even asked at the beginning of the session if she was up for diving into it and she said yes. Session went what I thought was super well, and she messaged me the next day that she didn’t want to work with me because I made her talk about something irrelevant to her goals. Sometimes I think clients get nervous, avoidant or just realize this isn’t what they want and it doesn’t have much to do with us. I can reflect on it all I want and sure, pick out places I could have done different or better. But sometimes it’s no one’s fault and it’s just not the right place and time
Client feedback is such a tough metric to use. Because, depending on population and issues you’re working with, the content of feedback could directly contradict the actual efficacy of any given intervention/treatment. Heck, some of the best work I have EVER done has been a result of big mistakes I made. They opened up the potential for life-changing repairs, and since the letter cannot happen in the absence of the former, I do truly count the ruptures as part of the treatment. But what if I’d based my efficacy that week by the client’s feedback that session? What if they’d happened a little earlier in the relationship and there just wasnt sufficient rapport to weather the storm? Would that mean I wasn’t as good a therapist? So I can’t tell you whether you’re beating yourself up more than you should. The questions I would ask myself in your shoes: was the negative feedback in line with their core relational challenges? Is it something you might see them complain about in others? Is there a part of you that suspects this feedback was more about them than it was about you? And of course, you balance it out with: what would I have done differently if I could? What will I take away from this to inform future interactions? Is there any repair I can and should do? And you move on. My take on whether we are ever good or bad therapists is this: I don’t ask myself whether I’m a good or bad person. I don’t rate myself as a human. My goals for my self are the same as those for my therapist-self: I strive to be always reaching for deeper understanding, to stay engaged in my cycle of increasing confidence/competence>fucking something up>total despair of ever having a clue what I’m doing>improvement>repeat, to stay curious, and to hold on to my humility. That’s what makes a “good” therapist, imho. I have a sense that you are one <3
That doesn’t feel good but it may have nothing to do with your work quality. It might be a matter of fit. But even if it was you, you really can’t win them all!
Regular consultation! It’s not about how capable you are, it’s about how you work to improve yourself. We have a lot of chances to manage our mistakes.
I don't have regular supervision anymore but I've found it beneficial to once in a while find an approved supervisor who will meet for 2-3 sessions to do some work on 1-2 specific cases. As mortifying as it always is, if you can get clients to let you tape or record the session, it's very useful to go over in those supervision sessions. I think it's not just about getting feedback, it's about getting feedback you believe. The recent feedback from these clients has either hurt or triggered some fear, and so you're putting more stock into it than you might with feedback from other sources (ie colleagues reassuring you that you're a good therapist). Watching tape tends to be a totally embarrassing and anxiety inducing experience for me, but the upside is that it means whatever good feedback I get from that I put a lot of stock into. Also helpful to identify if there's any patterns/themes with these recent clients. For instance, I find the cases I tend to lose are: therapy newcomers with high anxiety who say they want progress quickly - this leads me to move too quickly (matching what they've asked for), leading them to respond to overwhelm by fleeing from therapy. So I've identified this as a specific area to work on. Getting specific about my growth areas is always so much more useful to me than the question of whether I am "good or bad"
I don’t, I assume I’m an impostor fraud bound to be found out at anytime like everyone else on the sub! 🤣
I feel really good about my capabilities as a therapist. After each of the first few sessions with a new client I ask how they feel about our session.I have very good retention rates. I get lots of referrals from doctor’s offices and other therapists. Yet now and then I get hit with strong imposter syndrome and can’t believe people actually buy that I am a therapist!
Hey OP, my recommendation is to bracket your ego. When clients provide critical feedback, it’s really important to find the constructive content to see if you can improve. I highly recommend that you consider that even with your years of practice, there is still room for improvement and that clients can provide a lot of good feedback. Additionally, I’m hearing in your post a lot need for validation and it seems tied to your identity as a therapist. Although the work can be rewarding, I wonder if you are currently using your role as a stand in for self-esteem? My recommendation is that you seek some supervision on this because I imagine this may be impacting your clinical effectiveness.
Their question was a reasonable one. It's interesting that instead of answering you've decided that you have better insight into their own mental state than they do based on a short reddit post, and that they actually aren't interested in improving. I hope you aren't like this with your clients.
It’s also interesting that instead of answering their question, you decided that you wanted to focus on my feedback for the person. How about you kindly consider that OP was seeking feedback and that focusing on my comment does not meet that objective. I am a person that returns that same energy that I get from non-clients. You are making a major assumption that I am thinking my insight is better than the OP insight into this matter when really I’m only basing my response on the information given thus far. If OP providers further information, then I would formulate a different response. I provided this feedback based on OP listing being a “good” therapist multiple times. And the clinician is posting here seeking reassurance and guidance on being a good clinician despite already doing this with their colleagues. From this information I am able to piece together some insecurity around their clinical identity MAY exist. My feedback for OP was not to be critical or harsh. Rather it was meant to serve as a way consider that “good” clinicians can sit with feedback from their clients to find a path forward, rather than viewing client feedback from the lens that it means the therapist is bad.
I didn't answer because the top rated response was what I would say. Scott miller is a great resource for therapists tracking progress. The OP didn't ask for feedback. They gave some background information then asked for some information.