157: Psychotherapy Training: Poor, Good or Outstanding?

One Student’s Experience

In today’s podcast, Rhonda and I are super-pleased to interview Kyle Jones again. For some time now, Kyle has been telling me that he wants to talk about his psychotherapy training experiences on a podcast. This subject is near and dear to my heart, since I do a great deal of training, so Rhonda and I decided to do this second interview with Kyle, and it’s a good one, I think! You may recall our recent interview with Kyle on his interesting research and perspective on the treatment of LGBTQ individuals several weeks ago.

Kyle is a brilliant and super-friendly 5th year graduate student in clinical psychology at Palo Alto University, and has been a member of my Tuesday evening psychotherapy training group at Stanford for the past four years as well. Kyle now sees patients at the Feeling Good Institute in Mt. View, California. He has also been promoted to small group leader in our Tuesday group, and does superb work as a teacher.

During today’s interview, Kyle, Rhonda and I focus on many critically important training and treatment issues. Kyle states that he has been exposed to many fine teachers promoting a wide variety of popular treatment “packages” at the Palo Alto University and at his practicum sites, including traditional CBT, ACT, EMDR, psychodynamic therapy, and more. However, in all cases, the therapist was encouraged to “sell” this or that approach to the patient. Unfortunately, this has a tendency to trigger resistance, and is the main cause of therapeutic failure in clinical settings as well as controlled outcome studies as well.

Paradoxical Agenda Setting, which is the secret spice of TEAM Therapy, was never mentioned in his training at Palo Alto University. When you do Paradoxical Agenda Setting, you bring the patient’s subconscious resistance to conscious awareness, and then you melt it away with a variety of innovative techniques like the Magic Button, Positive Reframing, Magic Dial, Acid Test, Gentle Ultimatum and more. The rapid reduction the patient’s resistance often leads to the high-speed, mind-boggling recoveries we frequently see in TEAM-CBT.

Kyle emphasized that he has not see a single teacher or therapist even use the simple Invitation Step in therapy, in spite of the fact that it is so incredibly basic. Essentially, after empathizing with your patient, you ask if there is something she or he wants help with during the session, or if the patient needs more time to talk and get support. Most therapists wrongly believe that this question is unnecessary since the patient is coming to therapy, so he or she MUST want help.

But in fact, nearly ALL patients have some degree of ambivalence about recovery, and if this ambivalence is ignored, the patient may, and probably will, resist the therapist’s efforts to “help.” Rhonda enthusiastically agrees that the Invitation Step is incredibly powerful and admits that it took her several years to “get it,” and that she also resisted using the Invitation Step it at first, thinking it wasn’t needed. But she failed her Level 3 Certification Exam in TEAM-CBT because she didn’t know how to do it! Once she began using it, her practiced changed dramatically. And then she easily passed her exam with flying colors!

Intense therapist resistance to these new techniques is extremely common. I once supervised a clinical psychology post-doctoral fellow at Stanford who resisted using the Invitation Step with her patients for the first two months of our supervision. All she did was schmooze with her patients.

Finally, I asked her why she wasn’t using the Invitation Step. She told me she was afraid her patients would say, “Yes, I DO want some help with problem X, Y or Z.” And then she might not know how to help them solve whatever problem they had! She said, “As long as I just schmooze with my patients, I know that nothing will change, but they’ll think it’s good therapy!” Fortunately, after we discussed this dilemma, she began using the Invitation Step, along with many other Paradoxical Agenda Setting techniques, and her clinical work improved a ;pt.

Kyle also emphasizes the incredible value of the Brief Mood Survey and Evaluation of Therapy Session with every patient at every session, and yet most teachers and therapists in his graduate program, as well as those at his practicum sites, are not using these instruments. I think this is arguably an ethics violation, since therapists’ perceptions of how their patients feel can be wildly inaccurate. I predict that within ten years, all therapists will be required by licensing agencies and insurers to use these kinds of assessment instruments.

The importance of assessment instruments in clinical work and training was underscored by my experience several days ago with a patient who gave me incredibly poor grades on empathy as well as helpfulness at the end of a free, two-hour phone session. I had sensed the session had not gone especially well, but I didn’t realize just how awful it was until I saw my ratings! The scores on Empathy and Helpfulness were among the worst I’ve received in the past 25 years.

This was illuminating, but disturbing, as I’d been trying my best but I had clearly failed my patient in a big way, and he was ticked off! I would not have known just how angry and upset he was if I had not been using the Evaluation of Therapy Session.

I had a fairly sleepless night, and emailed him the first thing in the morning to find out what emotions I’d overlooked, and urged him to express his angry feelings toward me. This led to a tremendous and highly gratifying therapeutic breakthrough.

Kyle was generous in his praise for the training we do in our Tuesday group, and I feel extremely fortunate to have had the chance to work with Kyle! I am hopeful that the training methods my colleagues and I have been developing over the past 20 years will begin to catch on, but have to admit that I’ve run into fairly strong resistance from many therapists who fight and oppose our new training and treatment methods.

By the way, the Tuesday group is totally free for all clinicians in the San Francisco Bay Area, or from anywhere for that matter. We’ve had commuters and visitors from as far as Denver, Portland, and even China. If you want to dramatically improve your therapy skills, and have an interest in some of the new treatment and training methods we’re using, and want free personal work as well, this might be an option for you, and we’d be really happy to have you visit and maybe even join us!

David, Rhonda, and Kyle