Determined to Improve: An Exploration of Therapist Perspectives About Their Development

Scholars note that therapist performance is one of many factors that contribute to client treatment outcomes. Given that the performance of therapists matters, researchers have identified several methods and models for improving therapist effectiveness. However, scholars have yet to explore highly effective therapists' perspectives on their motivation to develop, the methods they use, and the impact of their efforts to develop. The present study used a consensual qualitative research (Hill & Knox, 2021) approach to explore dynamics underlying therapist development of expertise. Semistructured interviews were conducted with 12 therapists whose outcome data placed them in the top 25% of clinicians of their respective clinics, according to their supervisors. The researchers reached consensus at each stage of analysis as they organized data into domains, core ideas, and cross-analysis. Domains and corresponding subdomains were: (a) struggle with personal, external, and response to barriers subdomains, (b) therapist characteristics with striving, presence, skills, and values subdomains, and (c) development with early career, formal, feedback, relational, personal/identity subdomains. Implications for practice and areas for future research are discussed. Clinical Impact Statement Question: What do highly effective therapists do to improve and what motivates them to improve? Findings: Therapists experience struggles in their development, they possess personal characteristics that orient them toward growth, and they engage in a range of developmental activities. Meaning: These findings indicate that therapists who view struggles as opportunities for growth, value growth, and engage in individualized growth process continue to improve. Next Steps: Future research should seek to understand the individualized methods therapists engage in to improve, how they engage in feedback processes, and how they personalize therapy based on each individual client's needs.