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The Seven Questions Project: Summary

Experts share their psychotherapy wisdom

It's about time we wrap up this project, which has lasted longer than most people's experience in therapy. Today I'll summarize the Seven Questions Project, how it was developed and who joined in the discussion.

Psychotherapy includes a broad range of ideas, techniques and personalities, making it difficult to define. Opinions from any single person inevitably contain conscious and unconscious biases - even belief in the unconscious reveals a bias. As a psychologist writing a User's Guide for Psychotherapy, I recognized the need to elicit opinions from my colleagues to have a fair overview of therapy.

Without the resources to interview a representative sample of practicing clinicians, I thought I'd survey the most influential: those who wrote the material therapists read in training, the heads of professional organizations and the popular voices of contemporary psychology. Last November, I made a list of the psychotherapy dream team: 35 clinicians with unique contributions to the craft and science of therapy. They were names off my bookshelf, people I Googled and others I initially dismissed with: "no way, they'll never take the time for this." Once the list was complete, I searched for contact information and drafted an email asking for participation, offering only plugs for their books and websites in return.

With who determined, I moved on to what. They're all busy professionals so I knew my survey had to be simple and straightforward. While a personalized interview would certainly be interesting, I wanted uniformity in the questions to allow for comparison. I hoped to illuminate the theory of my respondents as well as their character, and open-ended questions would allow responses of any length or depth. After some deliberation, I decided on these seven:

  1. How would you respond to a new client who asks: "What should I talk about?"
  2. What do clients find most difficult about the therapeutic process?
  3. What mistakes do therapists make that hinder the therapeutic process?
  4. In your opinion, what is the ultimate goal of therapy?
  5. What is the toughest part of being a therapist?
  6. What is the most enjoyable or rewarding part of being a therapist?
  7. What is one pearl of wisdom you would offer clients about therapy?

I wanted the questions to be relevant for clients currently in therapy (Q1, Q2, Q7), illuminate theoretical differences (Q1, Q3, Q4, Q7) and tell us something personally revealing about the therapist (Q5, Q6). These questions sound a little like career day in junior high, but they highlight key elements of therapy and allow for a wide range of responses.

Of the 35 invited clinicians (18 PhD, 12 MD, 2 MFT, 1 MSW, 2 other), there were 14 completed responses (7 PhD & 7 MD). Most sent answers through email, although one preferred a phone interview and another agreed to face-to-face. Of the nine women and 26 men invited, three women and eleven men participated. I tried to sample from the broad spectrum of theoretical orientations (including mindfulness, humanistic, ACT, feminist, DBT, Jungian, EMDR and a variety of systems models), but responses came primarily from cognitive behavioral, psychodynamic and eclectic clinicians, one existential therapist and one who believes "there is no psychotherapy."

To my delight, the responses were varied, informative and revealing. I didn't know the participants would give such personal and at times controversial answers. Take a look at a sample of my favorite lines and click through to the complete interviews here:

Policymakers:

  • James Bray, President, American Psychological Association
    "Many clients come to treatment and are not ready for change, so they first need help to get ready for change."
  • Nada Stotland, President, American Psychiatric Association
    "In insight-focused, psychodynamic psychotherapy, there are two difficult problems: remembering painful events and circumstances, and facing the fact that you play a major role in your own problems."
  • Jeffrey Barnett, President, APA Division 39 (Psychotherapy)
    "When we learn to face our fears and attack them in new and more adaptive ways, anything is possible."
  • Warren Procci, President, American Psychoanalytic Association
    ". . . in my own work I often find that it's when I'm trying too hard to help them, that the therapeutic process is hindered."

Theorists/Academics:

  • Donald Meichenbaum, Founder, Cognitive Behavioral Therapy
    "Any advocate that says ‘This is the CURE' or proposes a ‘REVOLUTIONARY' approach does not deserve your attention, nor you money."
  • Thomas Szasz, Author The Myth of Mental Illness
    "There is no such thing as mental illness, hence also no such thing as psychotherapy."
  • Glen O. Gabbard, Contemporary psychoanalyst and author
    "The toughest part of being a therapist is being truly ‘present' with the patient."
  • Judith Beck, CBT clinician and PT blogger
    "[Therapists] don't ask for feedback from their patients, either during sessions when they notice clients have become upset or at the end of sessions."
  • Daniel Amen, Renowned brain researcher & clinician
    "Think about the brain, how to improve it and you will be more effective in all you do."

Popular Authors:

  • David Burns, Author of the Most Prescribed Self-Help Book
    "Learning to accept failure on multiple levels is, to my way of thinking, the key to become a world-class therapist."
  • John Gray, Bestselling relationship author of all time
    "Therapists should be like a muse: somehow, just by sitting with that person for an hour, you're inspired to be a better person."
  • Harville Hendrix, Bestselling relationship author
    [Ultimate goal:] "To surrender the judgmental mind, achieve sustainable connection with others and become loving of others and oneself."
  • Harriet Lerner, Women's psychology/relationship author
    "I can't change their husband (mother/sister/son/etc), and . . . change is often a slow, bumpy process."
  • Irvin Yalom, Existentialist and novelist 
    "If only we can inculcate in the patient this passion for curiosity; to fertilize this curiosity about themselves. . ."

Bonus Responses:

Over the past few months I invited any and all therapists to chime in with their answers. Five brave souls took the challenge. I also included my own response:

  • Stephen Diamond, PT blogger, authority on Jung and the Diamonic
    "Suffering may have meaning. Even value. It may be the primary motivation to change. So rushing to alleviate the patient's suffering is not always necessarily in his or her best interest..."
  • Roia, Music therapist in an inpatient facility
    "I would say that coming to terms with and accepting ourselves as we are in this lifetime and maybe not taking ourselves so seriously would be an ultimate therapy goal."
  • Jared DeFife, PT blogger, post-doc fellow at Harvard Med
    "Being open, vulnerable, and honest with another human being is an incredibly brave and courageous act."
  • Cheryl Fuller, Jungian therapist and blogger
    "[The toughest part is] letting someone you have worked with, sometimes for years, go knowing that you will never hear how things turn out for that person."
  • Michael Formica, PT blogger, teacher of Eastern medicine
    "My job is to put myself out of business. When a client feels that they no longer need me to support them in their transition into a new phase in their life, then the work is - for that time - complete."
  • Ryan Howes, PT blogger and psychologist
    "I see therapy as two people collaborating to help the client gain a greater understanding of self, increased self-efficacy, higher capacity for intimacy and acceptance of limitations."

I welcome any comments or questions. Stay tuned for the final installment in this series where I'll present some conclusions, reflections and musings on the overall project.

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