See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/282703349 Love Yourself as a Person, Doubt Yourself as a Therapist? Article in Clinical Psychology & Psychotherapy · October 2015 DOI: 10.1002/cpp.1977 CITATIONS READS 13 2,167 7 authors, including: Helene A. Nissen-Lie Michael Helge Rønnestad University of Oslo University of Oslo 20 PUBLICATIONS 140 CITATIONS 108 PUBLICATIONS 2,193 CITATIONS SEE PROFILE SEE PROFILE Per Høglend Tore Stiles University of Oslo Norwegian University of Science and Techno… 105 PUBLICATIONS 2,307 CITATIONS 143 PUBLICATIONS 3,336 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Systematic Case Studies in Psychotherapy View project International Study of the Development of Psychotherapists View project All content following this page was uploaded by Odd E Havik on 13 October 2015. The user has requested enhancement of the downloaded file. Clinical Psychology and Psychotherapy Clin. Psychol. Psychother. (2015) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/cpp.1977 Love Yourself as a Person, Doubt Yourself as a Therapist? Helene A. Nissen-Lie,1* Michael Helge Rønnestad,1 Per A. Høglend,2 Odd E. Havik,3 Ole Andrè Solbakken,1 Tore C. Stiles4 and Jon T. Monsen1 1 Department of Psychology, University of Oslo, Oslo, Norway 2 Institute of Clinical Medicine, University of Oslo, Oslo, Norway 3 Department of Clinical Psychology, University of Bergen, Bergen, Norway 4 Department of Psychology, NTNU, Trondheim, Norway Objective: There are reasons to suggest that the therapist effect lies at the intersection between psycho- therapists’ professional and personal functioning. The current study investigated if and how the inter- play between therapists’ (n = 70) professional self-reports (e.g., of their difficulties in practice in the form of ‘professional self-doubt’ and coping strategies when faced with difficulties) and presumably more global, personal self-concepts, not restricted to the professional treatment setting (i.e., the level of self-affiliation measured by the Structural Analysis of Social Behaviour (SASB) Intrex, Benjamin, 1996), relate to patient (n = 255) outcome in public outpatient care. Method: Multilevel growth curve analyses were performed on patient interpersonal and symptomatic distress rated at pre-, post- and three times during follow-up to examine whether change in patient out- come was influenced by the interaction between their therapists’ level of ‘professional self-doubt’ and self-affiliation as well as between their therapists’ use of coping when faced with difficulties, and the interaction between type of coping strategies and self-affiliation. Results: A significant interaction between therapist ‘professional self-doubt’ (PSD) and self-affiliation on change in interpersonal distress was observed. Therapists who reported higher PSD seemed to evoke more change if they also had a self-affiliative introject. Therapists’ use of coping strategies also affected therapeutic outcome, but therapists’ self-affiliation was not a moderator in the interplay between therapist coping and patient outcome. Conclusion: A tentative take-home message from this study could be: ‘Love yourself as a person, doubt yourself as a therapist’. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages: • The findings of this study suggest that the nature of therapists’ self-concepts as a person and as a ther- apist influences their patients’ change in psychotherapy. • These self-concept states are presumably communicated through the therapists’ in-session behaviour. • The study noted that a combination of self-doubt as a therapist with a high degree of self-affiliation as a person is particularly fruitful, while the combination of little professional self-doubt and much positive self-affiliation is not. • This finding, reflected in the study title, ‘Love yourself as a person, doubt yourself as a therapist’, indi- cates that exaggerated self-confidence does not create a healthy therapeutic attitude. • Therapist way of coping with difficulties in practice seems to influence patient outcome. • Constructive coping characterized by dealing actively with a clinical problem, in terms of exercising re- flexive control, seeking consultation and problem-solving together with the patient seems to help patients while coping by avoiding the problem, withdrawing from therapeutic engagement or acting out one’s frustrations in the therapeutic relationship is associated with less patient change. Keywords: Therapist effects, Therapist Personal and Professional Selves, Patient Outcome, Multilevel Growth Curve Modelling *Correspondence to: Nissen-Lie Helene, Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317 Oslo, Norway. E-mail: [email protected] Copyright © 2015 John Wiley & Sons, Ltd. H. Nissen-Lie et al. The Therapist as a Professional and as a Person answers. Recent studies show that therapists’ personal and interpersonal qualities seem to be particularly rele- It may be difficult to compare the work of psychotherapy vant to psychotherapy outcome, for example, their facili- with other professions because of its specific requirement tative interpersonal skills (Anderson et al., 2009); their that, to be of help to clients, the therapists must succeed capacity for affirmation, responsiveness, genuineness and in integrating their professional capacities and expertise with empathy with different types of clients (Bohart, Elliott, their personal attributes in a way that almost blurs the dis- Greenberg, & Watson, 2002)—but also their being convinc- tinction between them. That is perhaps why neither—on ing and persuasive (Oddli & Rønnestad, 2012; Wampold, the one hand—therapist professional qualifications, such 2014); their ability to resist counter-aggression when as years of professional experience, amount or type of confronted with devaluation and rejections by patients training, adherence to treatment protocols or competence (Lambert & Barley, 2002; Safran, Muran & Eubanks-Carter, in delivering interventions, nor—on the other hand—global 2011; von der Lippe, Monsen, Rønnestad, & Eilertsen, personality traits or general emotional well-being, have 2008); and their ability to manage countertransference been found to consistently predict psychotherapy process reactions (Hayes, Gelso, & Hummel, 2011). As already and outcome (Barber, 2009; Beutler et al., 2004, Lambert & mentioned, thus far, these factors seem more important Barley, 2002; Tracey, Wampold, Lichtenberg, & Goodyear, than more professional factors, such as practice experience, 2014, Tschuschke et al., 2014; Webb, DeRubeis, & Barber, training, as well as adherence and competence, in 2010; Wolff & Hayes, 2009). distinguishing between therapists (Beutler et al., 2004; Based on a review of the literature on therapist character- Tracey et al., 2014; Wampold & Imel, 2015; Webb, istics, our suggestion is that professional qualifications DeRubeis, & Barber, 2010). Even though we have empiri- (such as competence related to diagnostic assessment and cally based indications that many psychotherapists over technical skills) must merge in an optimal way with time integrate their personal characteristics into their the personal and uniquely subjective aspects of therapists professional work (e.g., Rønnestad & Skovholt, 2013), we (i.e., their ways of being with others, attachment style, do not know if or how such integration may impact personality and non-verbal expressiveness) to create processes and outcomes of psychotherapy. We know little effective practice (Strupp & Anderson, 1997; Heinonen, about how the relationship between psychotherapists’ Lindfors, Laaksonen, & Knekt, 2012). This claim corre- personal and professional functioning may impact pro- sponds logically to the current notion that it is not specific fessional role performance. On this background, we seek therapeutic interventions or common factors that account to explore how selected aspects of professional and per- for the effect of psychotherapy but rather the interaction sonal characteristics interact in contributing to more or less or even the synergy between the two (Nissen-Lie, 2013; change in patients. Norcross & Lambert, 2011; Wampold & Imel, 2015). On the basis of our own previous research and other researchers’ studies on what characterizes effective and ineffective thera- pists, in the current study, we aim to explore the potential interplay between some aspects of psychotherapists’ profes- Therapist Self-Perceptions sional and personal functioning. In order to examine the interaction between therapists’ self-concepts as a person and as a therapist, we relied on measures of psychotherapist functioning as observed from Therapist Characteristics Influencing Therapy the psychotherapists themselves. The value of self-report Outcomes in psychotherapy has been questioned (see Dunning, 2005; Orlinsky, Rønnestad, & Willutzki, 2004). Despite this, The individual therapist seems to matter as much to the ef- associations between therapist self-appraisals and patient fect of treatment as any of the other notable factors in psy- outcome have been reported in a number of recent studies chotherapy, such as the therapeutic alliance (Wampold & applying therapist measures developed by the Society for Imel, 2015). That is, both the individual therapist and the Psychotherapy Research Collaborative Research Network quality of the alliance explain