There are shrinks, and then there are SUPER-shrinks (with Daryl Chow)

1. Systematically Measure Client Outcomes

Therapists should consistently measure client outcomes to gain real-time feedback, check blind spots, and inform their work, as this is a crucial first step in improving effectiveness.

2. Integrate Data with Intuition

Therapists should integrate client-rated outcome data with their clinical intuition to make better, more responsive decisions, rather than relying solely on one or the other.

3. Prioritize Therapist’s Personal Effectiveness

As a therapist, understand that therapeutic models (e.g., CBT, emotion-focused) contribute minimally (0-1%) to client outcomes; focus instead on developing your personal effectiveness.

4. Dedicate Time to Deliberate Practice

Therapists should dedicate time outside of therapy sessions to deliberately improve their skills and focus on client outcomes, as this predicts higher effectiveness.

5. Cultivate Alliance Building Skills

Therapists should cultivate their ability to facilitate and engage with a wide array of clients, as the therapist’s skill accounts for 97% of the variance in alliance formation, a key factor in outcomes.

6. Honor Client Preferences & Factors

Therapists must prioritize and attend to client preferences (e.g., spiritual viewpoint, ethnic community) and utilize client factors (resources, relationships) as they account for 80-87% of outcome variance.

7. Adopt Continuous Calibration

Therapists should adopt a continuous calibration approach, adapting and recalibrating their methods based on client responses rather than rigidly applying a “pill model” of therapy.

8. Embrace Self-Doubt and Surprise

Highly effective therapists exhibit a degree of self-doubt and are more frequently surprised by client feedback, indicating an openness to change their views and adapt their approach.

9. Predict Client Outcome Scores

Therapists should predict client outcome scores before clients complete questionnaires, aiming to be disconfirmed to identify blind spots and elicit more specific feedback for improvement.

10. Inquire About Outcome Discrepancies

When client-reported outcomes differ from therapist predictions or expectations, therapists should inquire directly about the discrepancy to uncover new information and adapt their approach.

11. Cultivate a Sustainable Learning System

Therapists should create a sustainable, ongoing learning system to guide their practice, ensuring continuous personal and professional growth that also nourishes them.

12. Hold Personal Truths Lightly

Clinicians should hold their own beliefs and theoretical “truths” lightly, remaining open to different viewpoints and adapting their approach based on the client’s unique worldview.

13. Offer Therapeutic Friendship Space

To help a struggling friend, offer non-evasive, non-invasive space for them to talk, listen attentively to their inner life (what they will, won’t, and can’t say), and focus on their biggest pain points and needs.

14. Predict Before Learning

When reading a new book or learning a topic, first make predictions about what you expect to learn or already know; this creates a “schism” that enhances engagement and learning by highlighting discrepancies.

15. Select Outcome-Tracking Therapists

When seeking a therapist, prioritize those who systematically track client outcomes, demonstrate warmth and care, possess relevant skills, and are licensed, rather than focusing solely on credentials or endorsed modalities.

16. Evaluate Initial Therapy Sessions

In initial therapy sessions, assess if the therapist genuinely likes you, creates a safe space for unspoken concerns, is responsive to your needs, and provides a sense of hope or a clear path forward beyond just an intake Q&A.

17. Give Direct Therapist Feedback

Clients should strive to vocalize feedback to their therapist, even if difficult, as this is crucial for the therapist to understand what’s working or not and to adjust the therapy effectively.