Do therapists get better over time? Discussing therapist expertise with Dr. Terence Tracey

Psychotherapy and Applied Psychology: Conversations with research experts about mental health and psychotherapy for those interested in research, practice, and training

In this conversation, Dan and Dr. Terence Tracey talk about therapist expertise.
Terry explains the importance of routine outcome monitoring (ROM) and the limitations of therapist expertise. They delve into the concept of hypothesis testing and the value of disconfirming hypotheses. Overall, the conversation explores the themes of therapy effectiveness, growth as a therapist, and the role of feedback in improving therapists' outcomes. The conversation explores the challenges of disconfirmation and the importance of routine outcome monitoring for therapist growth. It highlights the value of professional self-doubt and the willingness to ask questions and seek disconfirming evidence. The concept of confidence and the need to challenge and let go of ideas is discussed. The distinction between structured and unstructured professions is examined, with a focus on the ill-defined nature of psychotherapy. The role of deliberate practice in psychotherapy is explored, along with the need for supervision and ongoing feedback. The lack of improvement in therapists over time and the potential impact of training programs on therapist growth are also discussed. The conversation concludes with reflections on the reactions to the findings and the importance of minimizing confirmatory biases. The conversation explores the need for reflective practice in therapy and the barriers that prevent therapists from engaging in it. The idea of incentivizing reflective practice is discussed, along with the need for time to reflect and generate hypotheses. The conversation also touches on the challenges in integrating reflection into training and certification processes. The performative nature of expertise and the value of outcome data are explored. They cover topics such as building time for reflection, integrating reflection into practice, differentiating good and bad therapists, and the importance of outcome data.
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