What’s the best way to learn?

Question: “How do I grow as a new therapist? ”

As a new therapist, I’m struggling to know which therapy model is the best fit for me. My basic training has been in CBT, and I’ve explored DBT and ACT, as well as the more humanistic, person-centred approaches. 

It feels like there’s so much to consider and so much to learn, and it’s as if there’s not enough time in the day to learn everything I need to know. I’ve been advised that being eclectic in my approach would be helpful since it would enable me to borrow from different approaches, but I wonder if that’s really the best way to develop myself as a therapist. 

In conversations with my peers, there’s also a feeling that we haven’t been guided much in our development beyond reading textbooks and improving our interpersonal skills. Learning to be a good therapist seems like it goes far beyond book knowledge and being able to communicate well, although I’m not sure what goes into helping me build a strong foundation early on. 

My fear is that I graduate knowing the fundamentals of being a counsellor but without the knowledge and know-how of growing in a way that helps me to work with my clients more effectively. It’s almost like, “You’ve completed the course – you’re a counsellor now!” when it really feels as if I’m just getting started by that point. 

Could you please offer some advice on how to grow as a new therapist and what I (and my peers) should be focusing on to become the best therapists we can be? We’re going to be working with clients who face some difficult struggles and it’s important that we’re prepared as much as possible to help them with their issues.

Response from Dr. Chua:

It sounds like you are looking at what’s ahead of you as a counsellor and overwhelmed with all the things you have to do.

I’m not a fan of eclectic therapy, which is often a mishmash of random techniques thrown at clients. This approach fails to offer us a concrete way of conceptualising cases and treating our clients, who deserve better when they come to us. They deserve something that actually works, and so we need to learn something that works.

You mentioned that you have basic training in CBT and have explored others to check the right fit for you. It is very hard to keep the theories and practices straight in your head if you are learning too many things at once. So, I suggest you pick one modality to master at a time. I always recommend CBT to start with because it’s the broadest, most evidence-based theory. A foundation in CBT serves you well for the “third wave ” therapies like DBT and ACT.

You can maintain a primary focus on one approach, and then attend classes in other modalities. Not to dilute your learning in CBT, but to enhance it. There’s a difference between borrowing from other modalities within the framework of your main approach, and simply having a mixed salad bowl of techniques from different models. I believe every good modality has a good theory, and every good theory is imperfect. When you can integrate from different theories (this comes after you’ve built your foundation), you’ll be able to come up with a better understanding of your clients.

Read as widely as you can, particularly on the well established modalities. Check APA div. 12 for a list of evidence-based modalities.

But keep your main focus to one. Think of it as listening to your favourite kind of music. As a music fan you might listen to new artists and explore different genres, but much of your time is spent listening to the artists and composers you enjoy most.

To give you an idea of how I train myself, for CBT, I am completing my certification from Beck CBT Institute and I do the following:

1. Read ‘CBT – Basics and Beyond’, and ‘Cognitive Therapy for Challenging Problems’by Judith Beck are the basic textbooks. There are many good resources for CBT. Guilford Press publishes pretty good books and you can also get a sense of who’s who when you read more journal articles. Read the material (and take notes) until you know it so well you could teach it. That’s my gauge of how well I’m learning.
2. Training videos: Psychwire.com offers The Beck Institute training videos and, because of Covid-19, they are also offering live online training.
3. Supervision: I cannot emphasise enough for important supervision is. And I don’t care how experienced you are. We need to be supervised and to learn from others. It’s too easy to pick up bad habits in therapy, to be overconfident, and to drift away from fidelity to the modality if we are not supervised. So weekly or biweekly supervision is very important.

Far too often, supervision is viewed only as case management or when you have a “big problem” with a case. On the contrary, supervision shouldn’t just be about case management, it should be about what you do in therapy regularly. And while it’s tempting to only present selective cases, the ones you’re doing well in, I recommend not to waste your time and money that way. Supervision is meant for improvement not affirmation.

Present weekly cases, preferably with recordings. Nothing challenges your ego quite like someone watching you in session. On the other hand, nothing will be as helpful as someone carefully watching your sessions and helping you improve. It can be painful, but so is exercising, root canal, or learning a difficult language. Sometimes, pain is necessary for improvement. If you’re too comfortable as a therapist, alarm bells should ring if you have good self-awareness.

When it comes to being certified in a particular model, I don’t think that’s indication of a gold-standard therapist by any means. Certification means you know and understand, say, CBT, but you can know CBT and still be ineffective as a therapist. Proficiency in a model isn’t enough, you have to invest in your overall development as a therapist. Of course, we live in a society that automatically equates certification with quality, but that’s not necessarily the case. A certificate or qualification simply means you’ve met the basic requirements of a programme.

Finally, an often underrated part of training is personal therapy. You have issues. We all do. Even if you don’t, by some miracle, if you are never a client, you will never know what your client experiences in therapy. You can’t listen well when you are carrying a heavy burden. Our empathy is limited by our own mental health. So, go for personal therapy and engage in the process of untangling and dealing with your own issues. Make it a part of your own training to receive therapy as a commitment to keeping yourself psychologically healthy.

You are a good therapist as long as you are learning, being supervised, and growing. You will never be “there”. Anyone who thinks they are a great therapist is not a great therapist. If psychologists such as Irvin Yalom (89-years-old) and Edith Eger (93-years-old) can say they’re still learning and improving, then that certainly applies to the rest of us.

Any therapist who thinks they know it all lack the humility and intellectual curiosity to be a good therapist. We can approach every client with our knowledge of psychology, but we are never the experts of our clients. They are. So we have to be continuously learning and listening – and avoid assumptions. We are limited and we will definitely fail. If you think you have a 100% success rate, your clients aren’t honest with you. Your failures will keep you humble and remind you that you are no better or superior than your client, or other therapists who are striving to learn and grow. All we might be able to say is that we’re a little more experienced, a little farther down the road.

Learning is always a journey without a destination. I was recently thinking about this process of learning and realised that the best learners throughout history always maintained a humble intellectual curiosity and a keen sense of who they are. Benjamin Franklin is one example of this. Not the humblest personality (he admitted as much himself, despite his best efforts), Franklin was nevertheless aware of what he didn’t know, and he used that awareness to continue his learning until the end of his life.

Take your time, be curious, and don’t rush. External pressures might make you feel like you need to learn and know everything now, and you should find a way to make those pressures background noise in your mind.

Being a good therapist is, first and foremost, to recognise that you’re no better than anyone else…but you are as capable as your curiosity and passion for what you do will permit. Begin from a place of curiosity and you’ll soon find yourself immersed in the kind of learning that’s right for you.