By Rachel Dundas, Registered Psychologist

Certified Trauma Practitioner

What does it mean to be an effective therapist?

Surely, most new graduates are entering the therapy profession with energy, enthusiasm, and aspirations to support and empower their clientele. Intentions, however, do not always translate to therapeutic effectiveness. Does being an effective therapist mean you have a full caseload and a waiting list? Or does it mean that you receive cross referrals from professionals who respect your work? Maybe you know you are an effective therapist because new clients mention existing clients referred them. Or maybe there is some other way? How does one know they are an effective therapist?

Therapy effectiveness has long been discussed in psychology literature, relying on the scientific method to standardize, measure, and assess the results of specific therapeutic approaches. In more recent years, the emphasis on therapy effectiveness has increased, with funders, academics and regulators alike wanting to ensure not only that their dollars are well spent, but that the public has access to “good” therapy. After all, ethical guidelines are clear in the practice of psychology: services are to be beneficial to the client. But what exactly do effective therapists do to actually help their clients?

Effective therapists help their clients create change.

When I was starting out as a therapist, I used to read a poem to clients to help them understand the therapy process:

The Change Poem, Author Unknown

If you always think the way you’ve always thought,

You will always feel the way you’ve always felt.

If you always feel the way you’ve always felt,

You will always do what you’ve always done.

If you always do what you’ve always done,

You will always get what you’ve always gotten.

If nothing changes, nothing changes.

I am a firm believer that therapeutic effectiveness is directly related to a therapist’s ability to educate, coach, and motivate clients to make changes in their lives. But how exactly do therapists create change for their clients? It seems like a simple concept, but it continues to be a billion-dollar industry, with therapists, insurance companies, and consumers alike opening their pocket books every year in search of professional development, self-improvement, self-fulfillment, and self-actualization, all in the name of creating change.

So how does the efficient and effective therapist create change for their clients? I believe they facilitate breakthroughs in the therapy room.

Breakthroughs are those moments of clarity and insight, where clients develop a deeper understanding of themselves, their thoughts, their motives, their desires, and the impact these have on their behaviour—past, present and future. These therapeutic breakthroughs can also come about by gaining insightful understandings of the motives and behaviours of a friend, lover, or family member. As therapists, we have all experienced those therapeutic breakthrough moments with clients in our counselling rooms. Maybe it looked like your client’s eyes widening, as they digested the weight of what had just been said. Perhaps it was them verbalizing a realization of the role they are playing in their own problems, as they grow to understand and face the reasons their behaviours developed. Sometimes, these breakthroughs in therapy can be more obvious, such as when clients exclaim “wow, I never thought of that!” One thing remains constant in all of these examples: in each of these moments, the clients developed insight into themselves, their lives, and their behaviours, and these are the moments that ultimately lead to breakthroughs, and change, in therapy.

I once heard healing equated to self-understanding. That it is through understanding one’s self, one’s triggers, one’s emotions and behaviours, along with the roots of them and how they play out in our lives, that leads to breakthroughs in therapy and ultimately acceptance, change, growth, and healing. In my experience as a Psychologist, as both a professional and an individual, I would agree. Creating breakthroughs for clients through therapy: a valiant and effective, yet lofty goal for a therapist indeed.

So how can we ensure that our services are effective and that these therapeutic breakthroughs, and the changes that follow, flow easily and effectively? For some clients, the development of the insights and understandings that lead to breakthroughs can come naturally and easily. Perhaps they have a high level of emotional intelligence and self-understanding, and just require a small nudge to create the changes they need in their lives. Other clients may require more substantial intervention to develop this understanding, but over time and with support, they can get there. But what about our clients who seem to have blocks in their progress? Those clients who have done years of therapy already, yet they can’t seem to shake their depression, anxiety, or their traumatic pasts? It is these clients who are the hardest to create breakthroughs for, yet they are the ones who stand to gain the most.

Psychedelic therapies may be one option to support our most difficult to treat clients. After the advances made in psychedelic research during the 1950s and 1960s were abruptly shelved due to unfavorable media coverage and Nixon’s “war on drugs,” the new frontier of psychedelics continues to gain traction as favourable research results renew interest in these ancient plant medicines. Research out of John Hopkins University, for example, offers incredibly promising results in treating the distress of terminal illness. Effect sizes on the reduction of symptoms of depression and anxiety were reported to be four times the size of those ever reported in antidepressant drug trials, and were sustained months later at follow up. This is promising research to say the least.

Psychedelic medicines, such as psilocybin, Ketamine, and MDMA (to name a few that are currently the subject of research across North America and beyond) potentially offer a promising way to create change and promote client healing. Psychedelics are believed to both widen a client’s window of tolerance as well as break down the dissociative barriers between our conscious and unconscious thoughts and memories. It is through this mechanism, while being supported in a safe and therapeutic environment, that clients can develop deeper understandings and insights about themselves, and therefore create breakthroughs in therapy. During post-experience integration counselling, clients can be supported in applying these insights to their day to day lives. During pre-experience work, clients develop rapport with their therapist, learn about the risks and benefits of plant medicines, and develop an understanding of the process and what to expect.

Often, clients with treatment resistant depression or post-traumatic stress will suffer from affect phobias or phobias to calm. These protective processes interfere with the client’s ability to participate in and benefit from therapy, even with therapists who are using trauma informed approaches like EMDR (Eye Movement Desensitization and Reprocessing). Due to the client’s inability to regulate and tolerate the emotional content that their dissociative barriers protect them from, even with support, many will drop out of therapy or assert that it didn’t work for them. Phobias to calm interfere even with basic therapeutic interventions, such as the guided creation of a calm place. Highly specialized supports are required, long term preparatory work is needed, and appropriately trained therapists in these areas are few and far between. Plant medicines offer a new frontier in the treatment of these clients who show high levels of disturbance and experience limited treatment gains from standard therapeutic approaches.

Breakthroughs in therapy are crucial to creating change for clients. Psychedelic medicines have the potential to awaken therapists and clients alike to their healing potentials, shifting long standing mental illness into growth, creating relief for clients, and opening a new avenue of support for therapists to offer. This is an exciting time for the field of psychology, as researchers work hard to ensure the safety and effectiveness of these approaches. I for one, will be among the first in line to offer those who are suffering some relief. Will you join me?