You are free to choose your therapist

Did you know you are free to choose the type of therapy you want to reach your goals? There are no barriers whether you choose a clinical social worker, a counselor, an occupational therapist, a family therapist, a psychologist, a speech therapist, or a physiotherapist. There are details affecting agency managed, plan managed, and self-managed implications, and price limits that may apply, and some professions may be obviously better or lesser suited to solving some goals, but the point remains, anyways you look at it, you have some awesome therapists to choose from.

Do you choose therapy based on profession or the therapist based on who is best at working their job? I consistently rate on average over 90% for client feedback on “Did the therapist listen, understand and respect me”, over 90% for “Did we work on what I wanted to work on and talk about today, over 90% “Is the therapists approach a good fit for me” and over 90% for “Today’s session was about right for me”.

So when I say clients say they rate the sessions over 90% satisfaction, I know because I ask every session. This leads to high rates of satisfaction, next to no treatment dropout in the first 3 sessions, and great rates of therapy being done productively because we are on target.

Who would I choose as a therapist?

I like to google google’s advice. You might like to try it. Personally, I would choose someone with who I can connect with, the relationship is essential to effective therapy and they would have to be ticking the boxes above for me just like I tick the boxes for people above. Next, I would want them to be relevant, in an above-average, push that bell curve kind of way. To excel at how they go about what they do and yet be human. Not so professional they lose sight of listening and learning. Research into what makes effective therapists effective backs this up, yet not in ways you might think.

Some surprising findings about who makes awesome therapists. Spoiler – It’s not what you think.

Scott Miller et al have been studying excellence in therapy for decades. What they have found will both shock you, and seemingly make no sense. In the field of psychotherapy, there are therapists (outliers) on the bell curve who consistently outperform across time regardless of the people they see.

Research show clearly that of over 400 plus therapeutic modalities, no modality is any more effective than any other modality. When you hear how ‘evidence based’ cognitive behaviour therapy is, it is evidence based. Just not any more effective than other therapies. They don’t mention that in the marketing for obvious reasons. In fact it may be even less effective, with high treatment dropout because if people don’t complete the therapy, they are excluded from the results, thus boosting outcomes. It is not people completing therapy, it is the therapy not completing the people. Nonetheless, no therapy predicts undue success.

Neither does, and this will continue to surprise even me, level of training and years of experience! How can this even be possible? If I took my car to a mechanic, I would expect that years of experience and level of training must make a difference. Perhaps not. One quirk of experience is the more you think you know, the less you listen. The less human you become. And therapy is very much about remaining human.

What we learn even when we don’t know much, is that people who are open to learning, open to listening, and deliberately practicing the habits of therapy that produce better outcomes will outperform the bell curve no matter how inexperienced and untrained they may appear on the surface. At heart, it is what is going on inside them and outside the therapy room to make them the spectacular therapists, they are working to be. That’s why level of training and level of experience doesn’t differentiate. Sure, if you have someone who has high levels of training and high levels of experience and is brilliant at doing therapy, they are going to make that extra training and level of experience count. But having those per se doesn’t make you a great therapist. It just makes you great at training and well…experience. But everything is experienced right. Was it deliberate practice?

I have 22 years of therapy experience, two degrees (one in agricultural economics and one in social work) but what makes me different is I get clients to feedback as part of our work together and I deliberately practice attuning better to what clients need in session to make our work and their outcomes successful. 

The Bell Curve shows the same therapists as consistently awesome. 

In 2004, Atul Gawande wrote “The Bell Curve – What happens when patients find out how good their doctors really were.” It revolutionised the health world.

Gawande, looked at cystic fibrosis life longevity for different hospitals because there were excellent statistics across decades. Some hospitals were held in high esteem, had wonderful bedside manner and lovely staff, incidentally all following the national guidelines, but poor results! People were dying in greater numbers. Markedly so. What was going on?!? There were however other cutting-edge practitioners who consistently year after year stayed ahead of the curve, innovating, what was seeming madness became accepted norm. Then they would break the boundaries again. Medicine and research play catchup with truth as they always must. The results were uncomfortable but illuminating. Being nice does not equal results or high regard an influence on the outcome. Results respect results. Death does not lie. You are either delivering or you are not. Research, the noun, is yesterday’s news. Research, the verb, is the heart of any excellence should it exist.

NDIS threw the rule book out, ignoring decades of carefully tendered professional silos.

And almost no one noticed. This is a BIG, BIG deal, transforming the market. As an agricultural economist (former), and clinical social worker (current), you can see I am excited by the possibilities. Yet you are the beneficiary of this foresight to let the market decide. And the market is deciding. In fact, you are deciding right now. And the outcomes of choice and control are encouraging. The cream will continue to rise to the surface, continue to invest back into SEO, their website, their research, their customer relations. You can try to ignore these things but while you are standing still raking in the money, not reinvesting in staff training, marketing, connecting, practicing, others will be steadily passing you by. And consumers will vote.

Just witness the latest awesome ebooks and guides, one from Leap In on Future Planning – A guide for parents and carers. I love Leap In’s email marketing work and reposting their work. Outstanding work. Or the Disability Support Guide, fantastic in many respects save for neglecting to mention social work as allied health therapy, social work being the one profession with the greatest number of provider registration group eligibility cut through of any profession in Australia. We are the fruit salad of the food groups for professions. Yet getting back to the Disability Support Guide, outstanding, customer-centric nonetheless, I highly recommend it (with that one glaring oversight, please fix it, folks). 

Somehow, what troubles people isn’t so much being average as settling for it…

…What the best may have, above all, is a capacity to learn and adapt—and to do so faster than everyone else.

atul gawande

“The Bell Curve”

NDIS did not say you must see x professional for therapy. NDIS provides a suite of professional therapies from which you can engage them to work on your goals. Therapy just became a race.  

How does this affect you? Well, it depends on what strategy you are following to spread the risk and maximize opportunity.

 NDIS revolutionised therapy practice and almost nobody no one noticed. How does that affect you? Well, it depends on what strategy you are following. Is NDIS solo therapy or NDIS combination therapy the best option for care for you or your loved one? What is solo therapy or smorgasbord therapy? What strategy do you choose to get the best therapist? I will focus on this in the following post because it needs more attention, and it is a serious question affecting where you get the best therapy. Whatever you have choice and control to suit every budget. And you can change at any time. But don’t constrict yourself to thinking in terms of traditional therapy boundaries like I need to see a psychologist, or I need to see an Occupational Therapist. What you need is the best therapist.

There are some practical pros and cons like OT’s work with large motor skills for instance. But beyond some of those, many areas like behaviour, even sensory, relationships, mental health, social skills, activity scheduling, liaising with schools, and habits of improved daily living capacity are the preserve of the best and brightest practitioners dedicated to learning and practicing how to be excellent and committed to helping support people living with a disability. I have that lived experience.

NDIS in its wisdom to back the free market, did well not to stand in its way. I know NDIS is not perfect. The verb perfect does not mean, without fault, the original meaning of perfect, is working towards a goal. For that we should be thankful.

Don’t let the professional moniker/allegiance dictate who the best therapist is for you. It’s results that count. And client feedback and outcomes informed practice should provide some guide to that. My clients/participants do. Should the therapist have experience in the area you need, or is the capacity to develop experience, more predictive of the success you rightly crave? Perhaps you can have both. 

You don’t need the best therapist to be your best. Relationship is not a competition. We are walking in a sacred space.

There are many good therapists doing awesome work out there. They don’t have to be at the extreme right of the bell curve to do good work and deliver an awesome result. It just helps.

Therapy is not a competition for me to beat my chest and proclaim I am better. Being better at relationships is possible but not to be ‘competified’, this is the sacred space of therapy. It would be quite unseemly for me to do otherwise, not necessarily true and how would we know for sure anyway. Yet the fact of the matter, if not the spirit of the matter (which is more important) relevance can be known. The sad truth is that many professions in the interests of prioritizing marketing have already lowered the level of the sacred to a ‘competified’ or commodified product. Everyone loses when we do this. We need to take back the sacred. Many people already intrinsically do this. It has not been lost. Therapy remains a special space and time that is spoken of in reverence often. This will never be lost because participants will not let it be lost. 

While ‘average’ therapists aren’t elite, it doesn’t mean they are not awesome. How therapy really works.

You have to remember with the bell curve that all therapists are of value and likely doing awesome work. They are after all represent people who even if they aren’t the elite of the elite are still elite in being caring, kind folk who have trained, listen, have a voice and make a tremendous impact and contribution to society. They may even be as good as or certainly better than elite therapists who become full of themselves and lose sight of the sacred trust in which they have been placed to help serve, support and coach others. It would be very Un-Australian to be otherwise.

The other factor in therapy that is healing you, is you! The inner healer in you at play. This also should not be desecrated. The therapist is not the star of the show to be revered. You are! It is you doing the work after all. We each have tremendous capacity to heal and what therapy is doing when it involves a healer like a therapist is bring an outer healer to help/assist with the inner healer that we all have naturally within us. This may sound mystical but I am trying to communicate something practical and true. We each have a natural drive to heal. It is emotional and it is physical. That is why therapy can resonate so strongly and feel so powerful. It is resonating within, around and outside us with these natural processes and drive and hope towards healing. For our indigenous folk, the sense of community is so strong to life and belonging, that even my indigenous participants now who are torn from family due to moving location, can yearn for that deep sense of connection to kith and kin, and country.

Therapy is around us, between us, in us. Just notice. It’s natural. It’s already happening. All the time.

Healing is best seen in children, their amazing ability to bounce back and heal. One of the ways we learn is through play. It is how we learnt to walk, it is how we learnt to talk. We tried this, we tried that. We fell over. We got up. We watched and copied. Then all of a sudden we did this amazing thing. We walked. We talked. It didn’t happen overnight, but it did happen.

The natural capacity of the body to repair itself communally (which indigenous folk exemplify for us), emotionally (which sleep and dreaming does at night, or tries to) and to repair itself physically (also through sleep and bruise processes, and inflammation and anti-inflammation processes that work quietly in the background) all help us survive better. You are a truly amazing creation, however that happened. We are truly amazing miracles walking in hope. Life will find a way.

Never underestimate the power of life and ‘play’ to heal. Therapy in the best of senses is helping you play with ‘you’ and your life. Creating options. Providing choice and control. A sense of connection to your self and hopefully to others. Honour therapy. It is sacred space we are walking among. It is not owned by professions. Like country for indigenous folk, it is not to be bought or owned. It is there for all. 

This is why NDIS called participants, participants; and not clients. You are participating in your healing and development of capacity. Helpers, healers and therapists are not the stars, nor the rescuers nor the main reason that change is happening which would make us beholden to the healer. No. Just borrowed people on the stage of your life for a season of time. The ability not a further disability, not another form of indentured servitude. No, you are free. Therapy is free. You are free. I am so grateful. Because you are awesome.