Researchers suggest that psychotherapists are an essential element in positive mental health outcomes and that excellent psychotherapists produce more positive client outcomes. Mental health organizations, training programs, and psychotherapists may benefit from insights into how excellent psychotherapists optimize their therapeutic practice. This study details results from a consensual qualitative research investigation of personal and professional development in high-performing psychotherapists. Participants were 12 licensed psychotherapists who were nominated by their clinic directors as their client outcome measures placed them in the top 25% of psychotherapists at their respective clinics. A semi-structured interview protocol was used to guide interviews that were transcribed and analyzed by a research team. Analyses yielded seven primary themes or domains that included: Specialization, Personal Identity Development, Multicultural Self-Awareness, Advocacy, Therapeutic Relationship, Work/Life Balance, and Advice for Beginning Psychotherapists. Practice implications for training and therapist development, as well as future research areas are discussed.
AllenJ. J.ParkerA.OglesB. M. (2024). A review of the facilitative interpersonal skills performance task and rating method: Science and practice. Clinical Psychology: Science and Practice, 31(2), 211–223. https://doi.org/10.1037/cps0000187
2.
American Psychological Association. (2003). Guidelines on multicultural education, training, research, practice and organizational change for psychologists. American Psychologist, 58(5),377–402. https://doi.org/10.1037/0003-066X.58.5.377
3.
American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832–864. https://doi.org/10.1037/a0039906
4.
American Psychological Association. (2017a). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code
AndersonT.CrowleyM. E. J.HimawanL.HolmbergJ. K.UhlinB. D. (2016). Therapist facilitative interpersonal skills and training status: A randomized clinical trial on alliance and outcome. Psychotherapy Research, 26(5), 511–529. https://doi.org/10.1080/10503307.2015.1049671
8.
BaileyR. J.EreksonD. M.CattaniK.JensenD.SimpsonD. M.KlundtJ.VogelerH. A.SchmuckD.WorthenV. E.CaldwellY.BeecherM. E.GrinerD.HobbsK. (2022). Adapting stepped care: Changes to service delivery format in the context of high demand. Psychological Services, 19(3), 494–501. https://doi.org/10.1037/ser0000564
9.
BarkhamM.LutzW.LambertM.J.SaxonD. (2017). Therapist effects, effective therapists, and the law of variability. In CastonguayL. G.HillC. E. (Eds.), How and why are some therapists better than others?: Understanding therapist effects (pp.13-36). American Psychological Association.
10.
BarnettJ. E. (2008). Impaired professionals: Distress, professional impairment, self-care, and psychological wellness. In HersenM.GrossA. M. (Eds.), Handbook of clinical psychology (Vol. 1, pp. 857–884). John Wiley & Sons.
11.
BarnettJ. E.BakerE. K.ElmanN. S.SchoenerG. R. (2007). In pursuit of wellness: The self-care imperative. Professional Psychology: Research and Practice, 38(6), 603–612. https://doi.org/10.1037/0735-7028.38.6.603
12.
BarnettJ. E.HomanyG. (2022). The new self-care: It’s not all about you. Practice Innovations, 7(4), 313–326. https://doi.org/10.1037/pri0000190
13.
BarnettJ. E.JohnstonL. C.HillardD. (2005). Psychotherapist wellness as an ethical imperative. In VandeCreekL.AllenJ. B. (Eds.), Innovations in clinical practice: Focus on health and wellness (pp. 257–271). Professional Resource Press/Professional Resource Exchange.
14.
BartonH. (2020). An exploration of the experiences that counsellors have of taking care of their own mental, emotional and spiritual well‐being. Counselling & Psychotherapy Research, 20(3), 516–524. https://doi.org/10.1002/capr.12280
BrownJ.WiendelsS.EyreV. (2019). Social justice competencies for counselling and psychotherapy: Perceptions of experienced practitioners and implications for contemporary practice. Counselling & Psychotherapy Research, 19(4), 533–543. https://doi.org/10.1002/capr.12247
17.
Chambers-BaltzS.KnutsonD.BecerraM.HughesA.Cantu CantuL.CadaretM. (2021). Determined to improve: An exploration of therapist perspectives about their development.Psychotherapy, 58(4), 437–448. https://doi.org/10.1037/pst0000399
18.
Chambers-BaltzS.KnutsonD.ChwaliszK.CanbyAKaneT. (2023). The experiences of support staff in a traumatic brain injury rehabilitation center. Rehabilitation Psychology, 68(1), 53–64. https://doi.org/10.1037/rep0000475
19.
ChowD. L.MillerS. D.SeidelJ. A.KaneR. T.ThorntonJ. A.AndrewsW. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52(3), 337–345. https://doi.org/10.1037/pst0000015
20.
ConstantinoM. J.BoswellJ. F.CoyneA. E.SwalesT. P.KrausD. R. (2021). Effect of matching therapists to patients vs assignment as usual on adult psychotherapy outcomes: A randomized clinical trial. JAMA Psychiatry, 78(9), 960–969. https://doi.org/10.1001/jamapsychiatry.2021.1221
21.
DavisD. E.DeBlaereC.OwenJ.HookJ. N.RiveraD. P.ChoeE.Van TongerenD. R.WorthingtonE. L.Jr.PlaceresV. (2018). The multicultural orientation framework: A narrative review. Psychotherapy, 55(1), 89–100. https://doi.org/10.1037/pst0000160
22.
DlugosR. F.FriedlanderM. L. (2001). Passionately committed psychotherapists: A qualitative study of their experiences. Professional Psychology: Research and Practice, 32(3), 298–304. https://doi.org/10.1037/0735-7028.32.3.298
23.
FouadN. A.GrusC. L.HatcherR. L.KaslowN. J.HutchingsP. S.MadsonM. B.CollinsF. L.Jr.CrossmanR. E. (2009). Competency benchmarks: A model for understanding and measuring competence in professional psychology across training levels. Training and Education in Professional Psychology, 3(4, Suppl), S5–S26. https://doi.org/10.1037/a0015832
24.
GoodyearR. K.WampoldB. E.TraceyT. J. G.LichtenbergJ. W. (2017). Psychotherapy expertise should mean superior outcomes and demonstrable improvement over time. The Counseling Psychologist, 45(1), 54-65. https://doi.org/10.1177/0011000016652691
25.
HatcherR. L.FouadN. A.GrusC. L.CampbellL. F.McCutcheonS. R.LeahyK. L. (2013). Competency benchmarks: Practical steps toward a culture of competence. Training and Education in Professional Psychology, 7(2), 84–91. https://doi.org/10.1037/a0029401
26.
HeinonenE.Nissen-LieH. A. (2020). The professional and personal characteristics of effective psychotherapists: A systematic review. Psychotherapy Research, 30(4), 417–432. https://doi.org/10.1080/10503307.2019.1620366
27.
HillC. E, (Ed.). (2012) Consensual qualitative research: A practical resource for investigating social science phenomena. American Psychological Association.
28.
HillC. E. (2015). Consensual qualitative research (CQR): Methods for conducting psychotherapy research. In GeloO. C. G.PritzA.RiekenB. (Eds.), Psychotherapy research: Foundations, process, and outcome (p. 485–499). Springer, Vienna. https://doi.org/10.1007/978-3-7091-1382-0_23
29.
HillC. E. (2020). Helping skills: Facilitating exploration, insight, and action (5th ed.). American Psychological Association. https://doi.org/10.1037/0000147-000
30.
HillC. E.SpiegelS. B.HoffmanM. A.KivlighanD. M.GelsoC. J. (2017). Therapist expertise in psychotherapy revisited. The Counseling Psychologist45(1), 7–53. https://doi.org/10.1177/0011000016641192
31.
HookJ. N.OwenJ.DavisD. E.WorthingtonE. L.UtseyS. O. (2013). Cultural humility: measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353–366. https://doi.org/10.1037/a0032595
32.
JohnsonW. B.BarnettJ. E.ElmanN. S.ForrestL.KaslowN. J. (2013). The competence constellation model: A communitarian approach to support professional competence. Professional Psychology: Research and Practice, 44(5), 343–354. https://doi.org/10.1037/a0033131
KrausD. R.CastonguayL.BoswellJ. F.NordbergS. S.HayesJ. A. (2011). Therapist effectiveness: Implications for accountability and patient care. Psychotherapy Research, 21(3), 267–276. https://doi.org/10.1080/10503307.2011.563249
35.
LambertM. J.FinchA. E. (1999). The Outcome Questionnaire. In MaruishM. E. (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed., pp. 831–869). Lawrence Erlbaum Associates Publishers.
36.
LeiterM. P.MaslachC. (2004). Areas of worklife: A structured approach to organizational predictors of job burnout. In PerrewéP. L.GansterD. C. (Eds.), Emotional and physiological processes and positive intervention strategies (pp. 91–134). Elsevier Science/JAI Press.
37.
LevittH. M.BambergM.CreswellJ. W.FrostD. M.JosselsonR.Suárez-OrozcoC. (2018). Journal article reporting standards for qualitative primary, qualitative meta-analytic, and mixed methods research in psychology: The APA Publications and Communications Board task force report. American Psychologist, 73(1), 26–46. https://doi.org/10.1037/amp0000151
38.
MaslachC.LeiterM. P. (1997). The truth about burnout. Jossey Bass.
39.
MillerA. E. (2022). Self-care as a competency benchmark: Creating a culture of shared responsibility. Training and Education in Professional Psychology, 16(4), 333–340. https://doi.org/10.1037/tep0000386
40.
Moore-LobbanS.SinghA. A.O’Leary WileyM. (2021). Introduction to the special issue: Integration of practice, advocacy, and research in counseling psychology. The Counseling Psychologist, 49(7), 946–957. https://doi.org/10.1177/00110000211019667
41.
MosherD. K.HookJ. N.CaptariL. E.DavisD. E.DeBlaereC.OwenJ. (2017). Cultural humility: A therapeutic framework for engaging diverse clients. Practice Innovations, 2(4), 221–233. https://doi.org/10.1037/pri0000055
42.
MosherD. K.HookJ. N.FarrellJ. E.WatkinsC. E.DavisD. E. (2017). Cultural humility. In WorthingtonE. L.DavisD. E.HookJ. N. (Eds.), Handbook of humility: Theory, research, and applications (pp. 91–104). Taylor & Francis.
43.
MyersS. B.SweeneyA. C.PopickV.WesleyK.BordfeldA.FingerhutR. (2012). Self-care practices and perceived stress levels among psychology graduate students. Training and Education in Professional Psychology, 6(1), 55–66. https://doi.org/10.1037/a0026534
44.
Nissen-LieH. A.HavikO. E.HøglendP. A.MonsenJ. T.RønnestadM. H. (2013). The contribution of the quality of psychotherapists’ personal lives to the development of the working alliance. Journal of Counseling Psychology, 60(4), 483–495. https://doi.org/10.1037/a0033643
45.
Nissen-LieH. A.RønnestadM. H.HøglendP. A.HavikO. E.SolbakkenO. A.StilesT. C.MonsenJ. T. (2017). Love yourself as a person, doubt yourself as a therapist?Clinical Psychology & Psychotherapy, 24(1), 48–60. https://doi.org/10.1002/cpp.1977
46.
NorcrossJ. C.VandenBosG. R. (2018). Leaving it at the office: A guide to psychotherapist self-care (2nd ed.). The Guilford Press.
47.
NorcrossJ. C.WampoldB. E. (2019). Evidence-based psychotherapy responsiveness: The third task force. In NorcrossJ. C.WampoldB. E. (Eds.), Psychotherapy relationships that work: Evidence-based therapist responsiveness (pp. 1–14). Oxford University Press. https://doi.org/10.1093/med-psych/9780190843960.003.0001
OwenJ. (2013). Early career perspectives on psychotherapy research and practice: Psychotherapist effects, multicultural orientation, and couple interventions. Psychotherapy, 50(4), 496–502. https://doi.org/10.1037/a0034617
50.
OwenJ.DrinaneJ. M.KivlighanM.IIIMillerS.KoptaM.ImelZ. (2019). Are high-performing psychotherapists both effective and consistent? A test of therapist expertise. Journal of Consulting and Clinical Psychology, 87(12), 1149–1156. https://doi.org/10.1037/ccp0000437
51.
OwenJ.TaoK. W.DrinaneJ. M.HookJ.DavisD. E.KuneN. F. (2016). Client perceptions of psychotherapists’ multicultural orientation: Cultural (missed) opportunities and cultural humility. Professional Psychology: Research and Practice, 47(1), 30–37. https://doi.org/10.1037/pro0000046
52.
OwenJ. J.TaoK.LeachM. M.RodolfaE. (2011). Clients' perceptions of their psychotherapists' multicultural orientation. Psychotherapy, 48(3), 274–282. https://doi.org/10.1037/a0022065
53.
PereiraG. L.Trujillo SanchezC.Alonso-VegaJ.Echevarría-EscalanteD.Froxán-PargaM. X. (2023). What do we know about highly effective psychotherapists? A systematic review. Anales de Psicología / Annals of Psychology, 39(1), 10–19. https://doi.org/10.6018/analesps.499371
RogersC. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21(2), 95–103. https://doi.org/10.1037/h0045357
56.
RønnestadM. H.OrlinskyD. E.WisemanH. (2016). Professional development and personal therapy. In NorcrossJ. C.VandenBosG. R.FreedheimD. K.CampbellL. F. (Eds.), APA handbook of clinical psychology: Education and profession (pp. 223–235). American Psychological Association. https://doi.org/10.1037/14774-015
57.
SkovholtT. M.Trotter-MathisonM. (2016). The resilient practitioner: Burnout and compassion fatigue prevention and self-care strategies for the helping professions (3rd ed.). Routledge. https://doi.org/10.4324/9781315737447
58.
SpeightS. L.VeraE. M. (2008). Social justice and counseling psychology: A challenge to the profession. In BrownS. D.LentR. W. (Eds.), Handbook of counseling psychology (pp. 54–67). John Wiley & Sons.
TraceyT. J. G.WampoldB. E.LichtenbergJ. W.GoodyearR. K. (2014). Expertise in psychotherapy: An elusive goal. American Psychologist, 69(3), 218–229. https://doi.org/10.1037/a0035099
62.
WampoldB. E.OwenJ. (2021). Therapist effects: History, methods, magnitude, and characteristics of effective psychotherapists. In BarkhamM.WolfgangL.CastonguayL. G. (Eds.), Handbook of psychotherapy and behavior change (7th ed, pp. 297–326). Wiley.
63.
WiseE. H.HershM. A.GibsonC. M. (2012). Ethics, self-care and well-being for psychologists: Reenvisioning the stress-distress continuum. Professional Psychology: Research and Practice, 43(5), 487–494. https://doi.org/10.1037/a0029446
64.
WiseE. H.ReumanL. (2019). Promoting competent and flourishing life-long practice for psychologists: A communitarian perspective. Professional Psychology: Research and Practice, 50(2), 129–135. https://doi.org/10.1037/pro0000226
65.
YounS. J.CastonguayL. G.XiaoH.JanisR.McAleaveyA. A.LockardA. J.LockeB. D.HayesJ. A. (2015). The Counseling Center Assessment of Psychological Symptoms (CCAPS): Merging clinical practice, training, and research. Psychotherapy, 52(4), 432–441. https://doi.org/10.1037/pst0000029
