When it comes to therapist education, we have a bad case of “that’s how we’ve always done it.” Our education system is slow to change, including how to address client-informed care, working within interdisciplinary teams, and subject areas such as substance use and sexuality. This creates workforce problems where employers find that new graduates are not prepared to enter the workforce, and they may take up to two years of training to become proficient at their jobs (Blumenthal and Their, 1996). Extra required education does not seem to fulfill this need (Neimeyer, Taylor, & Wear, 2009; Webb, DeRubies, & Barber, 2010), nor does rigorous training to enter the field (Miller, Hubble, & Chow, 2018). Add to this that therapist skills tend to diminish over time (Miller, Hubble, & Chow, 2018) with Dubin (1972) estimating that a therapist’s knowledge half-life was 10-12 years, meaning that in 10-12 years, a therapist’s knowledge would only be half as complete as it was at graduation. Given the increased rate of advancement and accessibility to knowledge, this number is likely to be much lower nearly 50 years later.
The Annapolis Coalition convened in 2002, through which many great points were made to address improvements in therapist education, workforce issues, and updating therapist approaches to new knowledge and ways to practice. Subsequent to that, the Coalition convened a panel in 2004 to address developing competencies in behavioral health care. Among their primary objectives was a call for the field to adopt the usage of evidence-based teaching methods, not just teaching evidence-based methods (Hoge, 2007). Anyone who has sat through countless didactic lectures knows that having information spoken at you does not necessarily make you understand it any better. However, this method is still popular because it is easier for the lecturer.
A second problem is that we have novice therapists practice their skills with other novice therapists. Even in attempting to address the different learning needs brought up previously, well-meaning educators understand the need for hands-on learning. However, practicing on people who have the same skillset as a student doesn’t further the education when mistakes are made, and can likely reinforce mistakes rather than correcting them. Instead, the deliberate practice model outlined by Miller, Hubble, & Chow (2018) reminds us that it is not just enough to have treatment that gets feedback, but also involves the coaching of more experienced clinicians to identify and correct these deficits.
As a field we pay lip service to the need for continuing supervision and consultation. However, the way we see this implemented is not to have this as a best practice or industry norm, but rather an optional privilege for those with the time and resources to engage in this luxury. Further still, consultation groups tend to naturally come together around peer groups, which may run into the same deficits described above with novel skill learning, and it may further reinforce blind spots as group think and absence of diverse experiences is limited with “we don’t know what we don’t know.”
Instead, educators and supervisors should be modeling the continuing pursuit of knowledge and engagement in competencies as outlined by Hoge (2007). Engaging in lifelong learning needs to be demonstrated as a norm, not just passively suggested. This also addresses some of the compartmentalized learning issues we have previously discussed. Until we change how we think about learning, we are bound to pass the mistakes on to the next generations of therapists.
Blumenthal, D., & Their, S. O. (1996). Managed care and medical education (editorial). Journal of the American Medical Association, 276, 725-727.
Dubin, S. S. (1972). Obsolescence or lifelong education: A choice for the professional. American Psychologist, 27, 486-498.
Hoge MA, Morris J, Daniels A, et al. (2007). An Action Plan on Behavioral Health Workforce Development. Rockville, Md, Substance Abuse and Mental Health Services Administration
Miller, S. D., Hubble, M., & Chow, D (2018). The question of expertise in psychotherapy. Journal of Expertise, 1, 121-129.
Neimeyer, G. J., Taylor, J. M., & Wear, D. M. (2009). Continuing education in psychology: Outcomes, evaluations, and mandates. Professional Psychology: Research and Practice, 40, 617-624.
Webb, C. A., DeRubeis, R. J., & Barber, J. P. (2010). Therapist adherence/competence and treatment outcome: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78, 200-211.