How to use your career to have a large impact (with Ben Todd)

1. Implement Deliberate Practice

Engage in deliberate practice by consciously and intentionally pushing your performance just beyond your current abilities, rather than merely repeating activities to achieve proficiency.

2. Measure Outcomes Objectively

For therapists, conduct a baseline assessment of your effectiveness using standardized outcome measures (not just impressions) and continuously monitor results to identify where and with whom your outcomes falter.

3. Seek Expert Coaching

Engage a coach with more expertise than yourself to help design specific exercises that target your identified performance deficits, as self-coaching can be ineffective.

4. Cultivate Humility for Growth

Adopt a mindset of humility by acknowledging your shortcomings and areas for learning, as this is essential for pushing your performance to the next level rather than simply building false confidence.

5. Prioritize Therapeutic Relationship

Focus on building a strong therapeutic relationship characterized by understanding, empathy, and collaboration, as this factor contributes 8-9 times more to positive outcomes than specific models or techniques.

6. Foster Client Hope & Expectancy

Actively create a sense of hope and positive expectation of results in clients, as this factor contributes four times more to treatment outcomes than the particular model or technique used.

7. Develop Therapist Self-Regulation

Work on your ability to reflect on your work, respond effectively, and regulate your emotions and thoughts during sessions, as who the therapist is matters significantly more to results than the specific model.

8. Create Feedback-Friendly Culture

Deliberately practice specific skills to cultivate an atmosphere where clients feel comfortable providing critical feedback early in therapy, as clients often withhold negative information until it’s too late to intervene effectively.

9. Utilize ORS and SRS Tools

Use free tools like the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) to regularly assess client well-being across individual, relational, and social domains, and to measure the quality of the therapeutic relationship.

10. Identify Your Performance Edge

Pinpoint the specific circumstances (e.g., types of clients, presenting issues) where your therapeutic outcomes and performance begin to break down, as these are the areas ripe for deliberate practice.

11. Focus on Influenceable Deficits

When choosing what to practice, ensure the skill is predictive of positive outcomes, is influenceable by your actions, and addresses ongoing, recurrent patterns in your behavior rather than random client variables.

12. Avoid Proficiency Complacency

Be wary of the tendency to stop learning and improving once you’ve achieved a sense of proficiency, as confidence can increase while actual ability declines over time.

13. Evaluate Therapy Duration

As a client, expect to see some improvement within the first 3-5 sessions; if no improvement is evident by session 10, consider switching therapists, as the chances of success with that particular pairing rapidly diminish.

14. Don’t Replace Outcomes with Relationship

As a client, guard against the tendency to accept a comfortable relationship with a therapist as a substitute for actual therapeutic outcomes, especially if your initial goals are not being met.

15. Recognize Implementation Challenges

Understand that successfully adopting new, effective practices requires significant effort in implementation, as merely learning an idea does not guarantee its successful application in practice.

16. Broaden Healing Perspective

Shift your focus beyond Western psychotherapy models to explore and understand how other cultures and peoples heal, fostering a more inclusive and effective approach to helping.

17. Seek Empathy-Specific Training

Actively pursue specific training in empathy, as it is a crucial and potent contributor to treatment outcomes that is often neglected in traditional professional education beyond basic coursework.

18. Critically Evaluate Research

Be critical of meta-analyses that don’t directly compare bona fide treatments or that compare active treatments to inert controls (like relaxation for trauma), as these methods can inflate perceived effectiveness differences.

19. Leverage Self-Doubt for Growth

Use any anxiety or uncertainty about your ability to help others as a guiding force to continuously seek ways to be more effective and improve your practice.

20. Act on Client Feedback

Once clients provide feedback, ensure you act on it to adapt your approach and improve the fit of the therapy to their needs, rather than just collecting the information.