Clinical summary: Psychotherapy Trainees Overestimate Their Interpersonal Skills

Longley, M., Kästner, D., Daubmann, A., Hirschmeier, C., Strauß, B., & Gumz, A. (2023). Prospective psychotherapists’ bias and accuracy in assessing their own facilitative interpersonal skills. Psychotherapy, 60(4), 525–535. https://doi.org/10.1037/pst0000506

In a famous quote, psychologist David Dunning once said “… people think of themselves as anything but average.” This also applies to professional psychotherapists who tend to overestimate their clinical skills and their patients’ outcomes. In one well-known study, no therapist rated their skills as below average relative to their peers, and 77% of therapists estimated that their patients showed symptom reduction which was considerably higher than the actual patient improvement rate of 33%. Psychological research commonly refers to this as self-assessment bias. Related research indicates that physicians with the highest self-assessment of their skills tend to have the lowest levels of skills as assessed by independent judges. Dunning speculated that people who lack expertise also might lack the necessary self-reflective skills to realize that they lack proficiency. In this study of psychotherapy and psychology trainees, Longley and colleagues assessed trainees' facilitative interpersonal skills (empathy, warmth, acceptance, understanding). Research suggests that these therapist skills are associated with patient improvement and account for differences in therapists’ outcomes. The authors had trainees provide narrative responses to videos of psychotherapy interactions. Then they (1) asked independent experts to rate the trainees’ responses for facilitative interpersonal skills, and also (2) asked the trainees to rate their own facilitative interpersonal skills related to these videos. Like professional therapists in previous research, trainees showed a significant self-assessment bias. Almost half of trainee psychotherapists assessed their facilitative interpersonal skills significantly higher (1 standard deviation higher) than the observer-rated average. Students and trainees were particularly over-confident about their warmth, acceptance, understanding, and alliance bond capacity. The authors also looked at several predictors of this over-estimation. Gender, age, and experience had no relationship to the self-assessment bias. However, those trainees with greater ego strength (perhaps indicating greater general self-confidence) showed the greatest overestimation of their facilitative interpersonal skills.

Practice Implications

Psychotherapy providers are not alone in overestimating their skills, other professionals do the same. Research like this suggests that we (psychotherapists) may not be as warm, empathic, and understanding as we think we are. To paraphrase Dunning, psychotherapists and trainees think of themselves as anything but average when it comes to their facilitative interpersonal skills. Nevertheless, psychotherapists and trainees must strike a balance so that they convey hope about their patient’s progress and confidence in their work without being unrealistically optimistic. That is, therapists require a sufficient level of professional self-doubt and humility that generates self-reflection and continuous self-improvement. Self-reflection is necessary to identify ruptures in the therapeutic alliance and to identify when clients are not benefitting. This level of self-reflection and humility may allow therapists to be flexible and to adapt what they are doing for the well-being of their clients.

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