Humility and Self-Doubt Are Hallmarks of a Good Therapist

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‘The whole problem with the world is that fools and fanatics are always so certain of themselves, and wiser people so full of doubts.’ This phenomenon – observed in the 1930s by the English philosopher Bertrand Russell – has a technical name, the Dunning-Krüger effect. It refers to the tendency for the worst performers to overestimate their performance, whereas the top performers underestimate their own. The Dunning-Krüger paradox has been found in academic and business settings, but what about in the context of psychotherapy? Is it better to have a confident therapist or one with self-doubt?

Unfortunately, psychotherapists’ self-assessment is biased, too. When asked to rate their own performances in delivering psychotherapy, therapists tend to overestimate themselves. What’s more, in one study, overconfidence was more typical of those therapists who were rated to be less competent by an independent expert rater. In contrast, other studies have found that it’s the therapists who rate themselves more negatively who are typically judged the most competent by independent experts.

Inspired by these findings, a recent German study compared therapists’ estimations of their clients’ progress with their clients’ actual improvement in therapy. The findings provide the most convincing evidence of humility as a therapeutic virtue to date. The more modest or conservative a therapist’s estimation of their clients’ progress (relative to their clients’ actual improvement), the more their clients’ symptoms had reduced and their quality of life had increased.

Such findings help to explain the outcome of a series of naturalistic psychotherapy studies that my colleagues and I conducted recently, in which we assessed the contribution of a variety of therapist variables to therapy outcomes. One particular finding stood out: those therapists with higher scores on professional self-doubt (for instance, they lacked confidence that they might have beneficial effects on clients, and felt unsure how best to deal effectively with a client) tended to receive more positive ratings from their clients in terms of the therapeutic alliance (ie, the quality of the relationship between therapist and client) and the outcomes of therapy. This finding surprised us at first. We believed that less – not more – doubt would be beneficial for the client. However, the result makes perfect sense in light of the earlier research showing the benefits of therapist humility

The willingness to listen to the other is probably central in explaining why humility is beneficial. A humble attitude might also be necessary for therapists to be open to feedback about their client’s actual progress, rather than just assuming that all is going well, or indeed blaming the client for a lack of progress. Humility might also give therapists the willingness to self-correct when needed, and motivate them to engage in ‘deliberate practice’ (which is intended to improve skills based on careful monitoring of performance and provision of feedback). Referring to their own findings, as well as to research on ‘master therapists’ (therapists who have been nominated as especially competent by their peers), Michael Helge Rønnestad at the University of Oslo and Thomas Skovholt at the University of Minnesota – both experts on the development of

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