The paradox of professional humility Can being humble make you a better therapist? Sally Brown talks to Helene Nissen-Lie about the emerging and intriguing concept of professional humility
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L ove yourself as a person, doubt yourself as a therapist?’ – the title of this paper published by the Norwegian academic Helene Nissen-Lie and colleagues in 2017 has intrigued me ever since I came across it. 1 The research was an exploration of some of the factors in fl uencing therapist e ff ectiveness, including a seemingly contradictory correlation – that therapists who reported high levels of professional self- doubt tended to have clients who reported the best therapeutic alliances and outcomes of therapy. The study built on several years of research, together with colleagues Helge Rønnestad, David Orlinsky and others, into the ‘person of the therapist’ for Nissen- Lie, which is ongoing. ‘We started out not predicting the fi ndings that we actually got, which is always exciting,’ Nissen-Lie told me over Zoom from her home city of Oslo, where she is Professor of Clinical Psychology at the University of Oslo. ‘We found that the more you admitted that you had di ffi culty in comprehending your client or helping the client, or the more you doubted yourself in your clinical e ff ectiveness, the better the client thought the collaboration was. It was surprising – we believed that less, not more, doubt would be bene fi cial to the client.’ Perhaps what makes the research all the more intriguing is the caveat in the title – ‘love yourself as a person’. The best client outcomes were seen in therapists who expressed more doubt about their professional e ffi cacy but who had a nurturing ‘personal introject’ – in other words, a strong sense of self and positive relationship with themselves. So what
Nissen-Lie and colleagues had identi fi ed wasn’t simply about lack of con fi dence – it was about a di ff erent quality altogether. Although fi rst labelled professional self-doubt, Nissen- Lie came to realise that this quality might be better described as professional humility. Humility has been described as a warmth- based virtue characterised by both interpersonal and intrapersonal qualities. Interpersonally, it describes having an accurate view of the self, including an understanding of strengths and weaknesses. Intrapersonally, humility describes a way of being that is other – rather than self- orientated and focused on connection. 2 In therapists, professional humility has been de fi ned as having three layers: ‘trait humility’ or personality; clinical humility such as attitude to practice or client work; and cultural humility – an awareness and valuing of client di ff erences. 3 Emerging concept Therapist humility has been identi fi ed as an ‘emerging concept’ in the fi eld of research ‘Humility has been described as a warmth-based virtue characterised by both interpersonal and intrapersonal qualities‘
into therapist e ff ects, 4 but as Nissen-Lie points out, the Danish philosopher Søren Kierkegaard had already observed that ‘all true helping begins with a humbling’ in 1859. The importance of humility was also recognised two decades ago by Helge Rønnestad and Thomas Skovholt who identi fi ed the quality in so-called ‘master therapists’. An important and necessary part of therapist development, according to Rønnestad and Skovholt, is going through a ‘series of humiliations’ in their interactions with clients. 5 One of the characteristics of the ‘senior professional phase’ is an acceptance of our limitations as a therapist, they say, with practitioners at this stage in their career likely to ‘express more humility and see themselves as less powerful change agents’. Other writers have also recognised the importance of humility in therapists – in 1999 Val Wosket in her now classic text The Therapeutic Use of Self (Routledge) observed that ‘a sense of humility is the best companion the therapist can hope for’. 6 The process of gaining wisdom and experience as a therapist, she says, is like a period of mourning, as we relinquish the ‘quest for omnipotence’ and learn to see ourselves as ‘vulnerable and ordinary’. Therapist effects Why professional humility has remained under the radar until recently is perhaps a re fl ection of the lack of research generally into the ‘person of the therapist’. Although most modalities acknowledge the importance of the use of self in the therapeutic process, and we know that
30 THERAPY TODAY MAY 2024
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