The World of Expertise in Counseling and Psychotherapy

Research suggests that characteristics and attitudes of the therapist may be a significant contributor to psychotherapy outcome. Researchers using both quantitative and qualitative methods have explored the characteristics of expert practitioners. This chapter provides an overview of the literature on therapist variables and master therapists, describes the validity of the peer nomination process for selecting master therapists, and explains how qualitative meta-analysis is utilized to integrate findings from various countries. Finally, the importance of obtaining an international perspective on master therapists is emphasized. Qualitative studies on the practices of expert therapists in different countries offer rich descriptive narratives for how optimal therapy works in different country and cultural contexts. More qualitative studies are needed to understand old and new constructs from different cultural perspectives.

Master Therapists

The search for the best outcomes in psychotherapy and counseling has been a long and winding trail. Traditional research methods attempting to quantify expertise have yet to map the complex path and characteristics of expert psychotherapists and counselors. This book blazes a new trail using extensive qualitative research methods to understand psychotherapy experts. Ten peer-nominated, active practitioners representing four different professions were interviewed by three interviewers for a total of over 100 hours. Based on the data from these interviews, we offer a portrait of the master therapist as well as an exploration of central characteristics, emotional wellness and resiliency of masters, how they construct the therapy relationship, ethical values of these experts, a history of the concept of expertise, and a description of our research methods. Master Therapists continues to be a valuable resource for counseling and therapy practitioners and scholars because it explicates the cognitive, emotional, and relational (CER) model of counseling expertise and provides the initial context for the more recent surge of expertise studies in counseling and psychotherapy. This research-based qualitative work provides essential signposts and markers on the road to psychotherapy expertise.

Personal and Professional Characteristics of Japanese Master Therapists

This study explores the characteristics of 10 Japanese master therapists who gained the largest number of nominations from Japanese psychotherapists. Qualitative data analysis was processed utilizing the grounded theory approach and the consensual qualitative research method. Results clarified important characteristics of Japanese master therapists. First, as a foundation, they possess positive personality traits, such as modesty, warmth, sincerity, absence of self-centeredness, and resilience. Second, they possess an exceptional ability to perceive and process various cognitive and emotional information from the client, from the therapist him- or herself, and from the therapy process. Third, master therapists are able to continuously learn from their experiences, stimulated by their curiosity and creativity, as well as their sense of responsibility and discipline as professionals. Finally, cross-cultural comparison of Japanese and American master therapists are discussed, a model of master therapist development is proposed, and suggestions for future research and therapist training are offered.

Czech Master Therapists

Existing research suggests that although many master therapists’ characteristics are interculturally valid, at least some of these characteristics are culturally bound. Interviews with nine peer-nominated Czech expert psychotherapists were subjected to thematic analysis that revealed 16 themes, organized into six categories: (1) humble attitude toward mastery, clients, and colleagues; (2) relationship; (3) awareness of one’s needs, limits, and resources; (4) continuous development; (5) engagement; and (6) awareness of the complexity of psychotherapeutic work. The results are discussed in the context of cultural differences, as well as specific historical circumstances of the development of the Czech therapeutic scene. Despite the fact that master therapists’ characteristics show fundamental similarity across countries and cultures, conducting studies in diverse environments may contribute to the formulation of a rich and culturally sensitive description of what is means to be a master therapist.

Bringing It All Together

Responding to calls for international psychotherapy research, a qualitative meta-analysis (QMA) exploring the essential qualities of master therapists from a global perspective was conducted on seven master therapist studies from the United States, Canada, Czech Republic, Portugal, Singapore, Japan, and Korea. Based on the analysis of 111 themes, we identified the following eight meta-categories representing common strengths and characteristics among 72 master therapists from seven countries: (1) Distinctive Clinical Abilities, (2) Professional Development, (3) Relational Orientation, (4) Cognitive Complexity and Intricate Conceptualization, (5) Therapeutic Alliance, (6) Pursuit of Deep Self Knowledge and Growth, (7) Humility, and (8) Experience. The meta-categories are discussed in relation to the psychotherapy research literature on therapist factors and expertise. The Synthesis Model of Master Therapists from Around the World is introduced, and recommendations for research and training are provided.

Master Therapists’ Construction of the Therapy Relationship

Qualitative research methods were used to elicit master therapists' statements regarding their use and understanding of the therapy relationship. The master therapists were identified and recruited in a previous study (Jennings & Skovholt, 1999) through a procedure used to create a sample of information-rich cases. The result of the analysis is a Model of Relationship Stances. The Safe Relationship Domain is composed of three categories of therapist actions: Responding, Collaborating, and Joining. The Challenging Relationship Domain also is composed of three categories of therapist actions: Using Self, Engaging, and Objectivity. The domains and categories are conceptualized as relationship stances utilized by the master therapists to meet individual client needs.

The Cognitive Emotional, and Relational Characteristics of Master Therapists

Cognitive, emotional, and relational characteristics among 10 peer-nominated master therapists were identified through qualitative research methods. Results suggest that master therapists (a) are voracious learners; (b) draw heavily on accumulated experiences; (c) value cognitive complexity and ambiguity; (d) are emotionally receptive; (e) are mentally healthy and mature and attend to their own emotional well-being; (f) are aware of how their emotional health impacts their work; (g) possess strong relationship skills; (h) believe in the working alliance; and (i) are experts at using their exceptional relational skills in therapy. These findings suggest that researchers studying therapist expertise may want to explore emotional and relational characteristics in addition to an almost exclusive focus on the therapist's cognitive attributes.

Portrait of the Master Therapist: Developmental Model of the Highly Functioning Self

Skovholt, Jennings, and Mullenbach summarize and integrate data from all four qualitative studies and offer pathways to expertise taken by the ten master therapists, culminating with a portrait of the master therapist. The portrait includes central characteristics, paradoxical characteristics, eight overall themes, and a major expansion of the Cognitive, Emotional, and Relational (CER) Model of Master Therapists.