What does it take to be a good (enough) therapist?

What does it take to be a good (enough) therapist?

May 28, 2024 | Psychotherapy

By Dr Ella Davey

 

What do you think makes a good therapist?

Their depth of experience? Their expertise? How quickly you can see improvements, perhaps through feeling calmer or less conflicted? Or perhaps you conceptualise a good therapist as being someone who makes you feel heard and valued? Or do you rather appreciate the insight a good therapist can help bring about?

The truth is we all have slightly different ways of evaluating the goodness of our therapists. I, for example, once had a therapist who was not only warm, patient, and creative, but also owned an elderly tortoiseshell cat who would sit and purr on my lap during sessions, comforting me to the core and – I’m sure about this – simultaneously regulating my anxious breathing and heartrate.

Such seemingly intangible aspects of what was, for me, an overall positive therapeutic experience can be difficult to quantify, let alone recreate. Yet, the best therapeutic experiences, and the best therapists, are definitely never completely perfect, nor even, necessarily, great. In fact, evidence tells us that the very best therapists are only ever just good enough.

Based on Donald Winnicott’s[1] concept of an infant who requires a ‘good enough caregiver’: one who is fallible and human as opposed to one who is perfectly responsive every time, so it has been said that what clients need most is a therapist who can show them, through their realness and humanity, that faultless care is neither attainable nor necessary when it comes to their healing path­[2]. Instead, a ‘good enough’ therapist should, ideally, embody core qualities such as empathy, authenticity, and competency which the client can then experience within a relationship characterised by safe boundaries and an attitude of mutual curiosity.

The good enough therapist, essentially, is constantly communicating to their client:

“I know I can’t reliably make all your challenges disappear, and sometimes I’ll even get things wrong. But that’s OK, because what’s important is that I’m here now and we’re going to work this through together, as best we can.”

To illustrate this idea further, several schools of therapy, despite their outward differences, have tended to agree that therapists should ideally aim to:

Give a hoot

At the heart of every good enough therapist, lies an ability to care about, attune to, and resonate with another person’s experiences. Of course, some people are naturally more empathic than others, but empathy is also something that can be cultivated and practised. Research has consistently shown it is essential for therapists to be capable of finding ways to authentically connect with their clients and to show them, often without words, that therapy is somewhere they will be listened to and also felt with. Empathy is the thing that, more than anything else, enables the development of a rapport capable of supporting even the most difficult or painful of conversations.

Be a real human being

A good enough therapist knows therapy works best when it’s a collaborative process in which neither party is anything other than themselves. Often, the right therapist for someone isn’t necessarily the person who appears the most polished, or the most qualified. What people often discover is that they tend to benefit most from someone who can provide them with a safe, affirming space where they can explore their thoughts and feelings. People also benefit from someone who is aware that everybody, including them, still has a lot to learn and who is open to receiving feedback in terms of what they’re getting right or what they might need to work on.

Good therapists, ideally, are similarly self-aware enough to know they’re likely trying to do the best they can in a line of work which, on a bad day, can make them feel quite the opposite. The ‘good enough’ bit comes in balancing the endeavour to be a skilled helping professional whilst acknowledging the inevitability of being a perfectly imperfect human being. A sense of humour, too, is useful since sharing laughter with someone in the midst of the occasionally bleak, black comedy of life can sometimes be the best treatment of all.

Not be a know-it-all finger-pointer

Everybody knows how difficult it can be to speak our worst bits out loud: the qualities we don’t like in ourselves or some of the things we’ve done in the past or, perhaps, we still do. Ten times more difficult is to have finally found the courage to tell someone about these who, in their response, inadvertently confirms the certainty that we really are these awful things, except now, instead of them simply festering in our own head, they are being evaluated by the calm-faced, know-it-all therapist who is sitting opposite us, nodding, purse-lipped, and head tilted.

As an antidote to this, Carl Rogers[3], founder of the client-centred approach, encouraged therapists to try hard to embody a non-judgmental warmth and acceptance of their clients, and to view each as cherished and valuable, no matter what. Such humanism can enable a space in which people can feel okay (enough) to explore their deepest worries without fear of censorship, in turn, leading to the fostering of security, empowerment, and a greater willingness to take ‘risks’.

Actively listen using the mind and the body

Some people might be surprised to realise that we not only listen with our ears but also with our bodies[4]. A good enough therapist will be listening carefully to what their client is telling them in words and hopefully then responding sensitively or insightfully. At the same time, good enough therapists will also be listening to what the client is telling them in other ways, including with their tone of voice, facial expressions, posture and even their silences since these modes of communication can, sometimes, tell a rather different story.

Furthermore, there are other therapists, including those who work psychodynamically or relationally, who will also be actively listening to a number of signals which may be coming from their own mind or body. These so-called ‘countertransference’ communications can provide an eerily accurate ‘reading’ of the client’s difficulties and also highlight matters of importance within the therapy itself which can be worth paying attention to, such as when the client feels bored, blocked, or angry but may be struggling to express or even realise this themselves.

Walk the Line

And finally, good enough therapists know how important it is to establish clear, appropriate therapeutic boundaries so that their clients can come to appreciate the extent of the therapeutic relationship and, crucially, the sense of safety and privacy it can provide. Often, therapeutic work around so-called ‘boundary issues’, whilst sometimes highly challenging, also proves transformative for clients through being helped to discover important aspects about themselves or their relationships outside the therapy room.

A good enough therapist will be careful not to introduce confusion by sharing too much about their own lives or by giving the impression they are a friend, rather than a professional. Much has been written on this subject and many debate the exact ‘lines’ therapists should aim to walk, but common standards of conduct exist which all strive to respect clients’ dignity and autonomy and for good reason, since when major boundary issues occur, therapeutic disasters can sometimes be the result[5].

In summary

Being a good enough therapist involves aspects of both doing and being. By cultivating skills such as empathy, active listening, non-judgement and safe therapeutic boundaries, therapists can provide their clients with an open space that promotes curiosity as to what it is to be human whilst embarking on a journey towards healing and personal growth.

[1] Winnicott, D. W. (1971). Playing and Reality. Routledge Classics.

[2] Borg, L. K. (2013). Holding, attaching and relating: A theoretical perspective on good enough therapy through analysis of Winnicott’s good enough mother, using Bowlby’s attachment theory and relational theory: A project based upon an independent investigation [Master’s thesis, Smith College]. https://scholarworks.smith.edu/theses/588/

[3] Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy. Constable.

[4] Schore, A. N. (2014). The right brain is dominant in psychotherapy. Psychotherapy, 51(3), 388–397.

[5] British Association of Counselling and Psychotherapy (BACP) (2024, May). Boundaries: what complaints tell us. https://www.bacp.co.uk/about-us/protecting-the-public/professional-conduct/what-complaints-tell-us/boundaries/

In conversation with Dr Tanya Lecchi

In conversation with Dr Tanya Lecchi

May 25, 2024 | Our Mission

By Letticia Banton
Image by Caspar David Friedrich – Wanderer above a sea of fog

 

Dr Tanya Lecchi is the Co-Founder and Clinical Director of Inner Citadel Institute. For our first blog post, we asked Tanya a dozen questions about her vision for the Inner Citadel Institute and her inspiration as a psychotherapist. Forever reflective and insightful, we hope you enjoy Tanya’s responses.

What inspired you to establish the Inner Citadel Institute?

The Inner Citadel started as a clinic. I wanted to move away from services designed around a medicalisation of human suffering, seen as an internal, individual dysfunction, to create a clinic where therapists approach clients’ experiences as meaningful responses to painful relational and social circumstances.

I also wanted to develop a community of practitioners who share similar values, including respect for and appreciation of difference, non-judgment, freedom, and inclusivity. I would like to offer meaningful experiential training courses and CPD, designed to facilitate ongoing personal engagement.

By being part of a group, practitioners can discuss topics in depth, do readings together, work on case studies, and try to develop embodied knowledge over time. In my experience it’s very important to create some relational intensity to facilitate the integration of new learning, allowing the material to be digested and become our own. All these factors can support transformative learning experiences.

Does your vision for the Institute reflect your own practice and your own training – a way of being that’s very integrated and relational?

Yes, that’s what I try to work on and embody – it’s what I believe in. The main idea is that whatever we do it’s not just an intervention, a technique, an exercise, or something that we do to get a specific effect.

There is always a relational process going on. While we try to facilitate a deeper relational engagement, grounded in an authentic interest in the other, we also need to allow it to happen (or not) and emerge naturally. We need to create the conditions for a relational contact that is different enough to what caused the suffering in the first place – this new kind of intersubjective meeting will involve a reorganisation of the client’s usual ways of being-with.

These new ‘templates’ will emerge from the working out of new relational possibilities within the therapeutic relationship and will be characterised by the unique subjective contribution of both therapist and client. It’s a deeply creative, moving process, able to open up other possibilities for relating to self and other.

Looking back, what motivated you to train as a psychologist?

As a kid I wanted to become a medical doctor – I had a profound desire to dedicate my professional life to alleviating people’s suffering. I really valued my ongoing relationship with my GP; to be able to go back to this person who was holding me in mind and could help when I was unwell.

That felt like a deeply meaningful job. Then, my initial focus on physical wellbeing started to shift. In particular, I remember that, when I was about 12, I found Psychology and Alchemy by Jung at the school library. I was captivated by the power of its metaphor of a transformational journey from darkness to the unification of apparently irreconcilable opposites, thus reaching new levels of consciousness.

That idea profoundly fascinated me, inspiring further reading into psychoanalysis, depth psychology, and contemplative traditions. In my free time I started to practice martial arts and meditation, at the same time as thoroughly enjoying the study of philosophy at my grammar school, exploring questions related to the human condition. I started to move away from a positivist approach and a medicalised view of the body, developing more interest in the psyche and the humanities.

In the end, I thought psychology could represent a middle ground between medicine and philosophy. I qualified as a clinical psychologist and then completed training in relational psychotherapy. Embracing a constructivist perspective allowed me to appreciate the limitations of theoretical, abstract knowledge, while cultivating what William James called living contemplation – a form of intuitive awareness.

During my training I was invited to deepen my mindfulness practice, in particular through Insight Dialogue, a form of interpersonal meditation. I went on several retreats, which helped me cultivate tranquillity and concentration, as well as presence to myself and others. This meditation practice, alongside a personal experience of relational psychotherapy and then psychoanalysis, have been crucial aspects of my professional journey.

I then integrated the experiential side of my training with the research I conducted as part of my PhD on childhood trauma, which led to the design and evaluation of a mindfulness-based intervention for maltreated children in residential care. Studying developmental psychology and doing research with young people shaped my way of working with adults too, as I always hold in mind their childhood experiences and feel open to encounter younger self-states in the course of therapy.

What has been a great privilege over the course of your career to date?

Thinking now about this question, flashes of apparently small relational moments emerge in my mind. Memories about groups that I taught, moments that were intensely moving in the work with certain people, including sitting together in silence while feeling a deep sense of connection.

And at other times moments of great crisis that elicited intense emotions and required a profound process of change, clarification, and repair. I remember situations when, while feeling deeply impacted by the interaction taking place and the themes explored, I was grounding myself, trying to be present, holding the space in a state of radical openness and acceptance.

Many times I was just witnessing something powerful that other people were able to repair themselves. I am also connecting to several moments of meeting with my clients, whom I fondly remember while they share their vulnerabilities, as well as their strengths, allowing very tender parts to be seen. I think that’s something unique to this profession, which I feel very grateful for.

What is the highlight of your work?

I think it’s related to presence – to being fully there and sticking with what is coming up. It’s quite a radical act – trusting that it will be enough, that whatever happens, we can deal with it, we can survive and transform it. Of course, there are circumstances which are impossible to concretely change, but the experience can be survived. Being with it and going through it, instead of avoiding or defending, opens the door to change and beauty also in the midst of trauma.

And the greatest challenge?

At a meta level, it’s not easy to allow this kind of work to happen, to explain to our clients and the wider community that there is value in slowing down and being with a process that can be messy, paradoxical, and complex. At times, the work can get very stuck. It can be insightful in one session and then become apparently repetitive, but something profound might be happening, even though we might not consciously grasp it in that very moment.

Allowing ourselves to wander a little bit and get lost and then get back on track… there is deep value in that, but it’s difficult to trust it if you have never been into therapy before. This is a challenge I encountered in my personal therapy too. Furthermore, there are times when there is the urgency to feel better, which I totally empathise with, but it might push people to try to find a quick fix that is often illusory.

This can be quite difficult to communicate and may also be destroying a client’s hopes about feeling better quickly. I think it’s difficult to embrace depth psychotherapy in our society right now, where everything is very quick and we want to feel instantly better.

Tricky question… but who is the ‘thinker’ who has most inspired you?

The work of Iain McGilchrist, who explored the differences between the brain’s right and left hemispheres and their effects on society and human history, is special to me. In summary, the left hemisphere is detail oriented and sees what is familiar, explicit, decontextualised, and reduced to its parts, while the right hemisphere has greater breath and sees what is fresh, unique, never fully known, implicit, and in flux.

McGilchrist describes how the left hemisphere is increasingly becoming predominant in the modern world, moving us away from the richness and complexity that it cannot grasp. I find this idea extremely compelling and able to shed light on the emergence of very different approaches to therapy, deriving from two opposing visions of the world. I think we have the opportunity to reflect on our assumptions and harmonise these views, remembering that the right hemisphere is the ‘master’, while the left hemisphere is its ‘emissary’.

What is the psychology book you always return to?

Hope and Dread in Psychoanalysis by Stephen Mitchell (1993). Discussing how contemporary psychoanalysis is moving beyond Freudian drive theory, Mitchell describes the analytic process as both personal and interpersonal, emphasising the wishes and needs of both analyst and patient. In particular, he explores their experiences of hope and dread, which I deeply relate to.

I remember my own hopes when I started my personal therapy – the experiences I really wanted to talk about, to transform. And, as a therapist, when there is a new client coming for a consultation, I always notice an authentic desire to help and support change. But then there is also the dread, which might emerge when we experience painful relational dynamics that resemble the past and might create a sense of stuckness, a fear of not being able to help enough. It can be difficult.

There can be a lot of anguish in the work, but the hope comes back – there is a dialectical movement between these polarities, which allows therapy to progress. Within the relational dance between client and therapist, moments of crisis and impasse are inevitable but shouldn’t be chronic.

And one poem, song, or piece of prose or art that provides solace and comfort?

I will choose a painting because bypassing language can be so immediate. There is a very well-known painting, Wanderer above the Sea of Fog by Caspar David Friedrich, which touches something profound in me. There is something about the unknown. What is there in that mist? What cannot be seen?

But there is this spaciousness, the sublime that is being contemplated and observed, and maybe there is some hope and dread… there is something about a journey into what we don’t know. To me it feels like an appreciation, a reverence for nature, for the landscape that we can inhabit. And the person in the painting… they look bold being there, but at the same time you’re just a man in a big world and nature is majestic.

To me it’s quite vital to recognise that we’re not the only beings in this world. I think it’s important as psychologists to look and see how insightful the arts, literature, and poetry can be in describing the human psyche. Psychological theory and research are not the only perspective that exists – turning towards literature and the arts can open everything up and make it much more interesting and nuanced. There is so much we can’t grasp by simply carrying out scientific research.

What insight can you offer for people starting out on their own journey of psychotherapy as a client?

I would invite them to be conscious of the importance of the relational process, paying attention to what happens in the first few sessions before making a decision. Asking for a consultation is a very good practice – this would allow for an in-depth exploration of what the client is looking for, as well as helping them to have a sense of how the therapist works.

The sessions should feel comfortable enough – as therapy can be challenging at times, we need to assess whether we feel held enough by that particular therapist, whether we are safe enough to share our vulnerabilities and be known. Many other things that happen in the work are just implicit and impossible to rationalise – I wouldn’t try to overthink, but simply ask ourselves if we can trust that the other person would be able to support us in this journey.

And what insight might you offer to people who are looking to train as a psychotherapist?

My recommendation would be to start from a personal experience of therapy, if they haven’t done that yet, because it’s important to see what it looks like, what it feels like, and have a sense of ‘what kind of approach I’m curious about’. If therapy works for me, can I see myself doing that kind of job? Moreover, personal therapy can already be a very important piece because everything starts from the work on our Self.

Then I would try to look for courses where there is a continuous relational experience with tutors and within the group – one where the person can be really supported throughout their journey. A course needs to help trainees develop their way of being a therapist. The learning needs to be evidence based, but I would look for training that allows students to bring and respect their own point of view, their own consciousness. Their subjectivity will be there anyway – we can’t pretend it’s not part of the picture.

So, look for training where you engage both the right and left hemispheres. You have the theory, the technicalities, the more academic side of the left hemisphere. But also the right hemisphere, the implicit, the living experience. It’s important to always allow room for both. I think that’s a good way to develop our therapeutic practice.