to not react defensively to criticism from the client or when the client is not improving. You need to be open to seeking out supervision to try to better understand what is di ffi cult for the client in working with you, and not go home feeling totally bogged down – “I’m a useless person, I don’t know what I’m doing, I should do something else”. If you have the sort of generosity referred to in the study title – you love yourself – you can allow yourself when necessary to also change path, to admit that this was not a very good way of helping this person, or that you misunderstood. So it’s not enough to be humble – you have to be willing to use whatever you gather from this openness, this stance, to improve.’ According to Hook, humility often develops as we mature, but it is in fl uenced by our environment and whether we see humility modelled by others. 18 We can also see humility modelled in inspirational public fi gures, or learn about it from fi lms or in reading fi ction. Nissen-Lie suggests that trainers and supervisors could be role models to trainees by demonstrating a ‘tolerance for not knowing, embracing ambiguity and containing your shortcomings and limitations without fear of “losing face” or authority’. 1 As a simple starting point she says we could do worse than look to Kierkegaard and his thoughts on the ‘art of helping’: ‘Translated from the Danish, he said that the helper must fi rst and foremost humble himself under the person who wants help, and thereby understand that to help is not to dominate but to serve. And to help is a willingness for the time being to tolerate being in the wrong, and not understanding what the other understands. I think that’s quite inspiring.’ ■ ‘Humility is particularly important when dealing with clients whose cultural background differs from that of your own’
so its positive e ff ect might somehow depend on other factors.’ 14 Humility is particularly important when dealing with clients whose cultural background di ff ers from that of your own. Research by US psychologist Professor Joshua Hook, who has specialised in studying various aspects of humility, has found that clients who perceive their therapists as being more culturally humble report being more aligned with their therapists, and having better therapy outcomes. 15 An essential element of cultural humility, according to Hook, is the acceptance by therapists of their limitations and underlying assumptions, and a willingness to remain open to when they have made missteps with clients from other cultures, and to address misunderstandings with the client in order to make repairs. Cultivating humility One of the challenges with research in this area is that many studies rely on self-reports, and it can be hard to assess our own humility – it’s been argued that truly humble people may feel like it’s bragging to claim this as a personal virtue or characteristic. 16 This might explain why a recent US study that replicated Nissen-Lie’s fi nding that therapists with higher levels of both self-doubt and self- e ffi cacy had better client outcomes didn’t however fi nd a similar link with therapists who reported higher levels of humility. 17 Respondents to the study had to give themselves a Likert-style rating from ‘strongly agree’ to ‘strongly disagree’ for statements such as ‘I admit it when I don’t know how to do something’ – questions that may be hard to answer truly objectively. As the study researchers commented, we still don’t have a satisfactory way of measuring humility, and given that humility captures a broad range of attributes and attitudes, ‘it may be particularly di ffi cult for therapists to gauge their own level of humility’. Although it may be the case that some people are naturally more humble than others – and that those people are drawn to helping professions – could a commitment to honest self-re fl ection, underpinned by self-compassion, help us develop our humility? ‘This is the key,’ says Nissen-Lie, referring to self-compassion: ‘In our data, we did not fi nd that feeling anxious in sessions was a positive thing, and we need to be able
REFERENCES 1. Nissen-Lie HA, Rønnestad MH, Høglend PA, Havik OE, Solbakken OA, Stiles TC, Monsen JT. Love Yourself as a Person, Doubt Yourself as a Therapist? Clinical Psychology & Psychotherapy 2017; 24(1): 48-60. 2. Davis DE, Hook JN, Worthington EL Jr, Van Tongeren DR, Gartner AL, Jennings DJ, Emmons RA. Relational humility: conceptualizing and measuring humility as a personality judgment. Journal of Personality Assessment 2011; 93(3): 225-234. 3. Davis EB, Cuthbert AD. Humility and psychotherapist effectiveness. In: Worthington EL, Davis DE, Hook JN (eds). Handbook of humility: theory, research and applications. New York: Routledge; 2017 (pp286–300). 4. Lutz W, Barkham M. Therapist effects. In: Cautin R, Lilienfeld S (eds). Encyclopaedia of clinical psychology (1-6). Hoboken, NJ: Wiley-Blackwell; 2015. 5. Rønnestad MH, Skovholt TM. The developing practitioner – growth and stagnation of therapists and counsellors. New York; Routledge, 2013. 6. Wosket V. The Therapeutic Use of Self. Abingdon: Routledge; 2017. 7. Wampold BE, Owen J. Therapist effects: history, methods, magnitude, and characteristics of effective therapists. In: Barkham M, Lutz W, Castonguay LG (eds). Handbook of psychotherapy and behavior change (7th ed). Hoboken, NJ: Wiley; 2021 (pp297–326). 8. Orlinsky DE, Rønnestad MH (eds). How psychotherapists develop: a study of therapeutic work and professional growth. Washington DC: American Psychological Association; 2005. 9. Nissen-Lie HA, Monsen JT, Rønnestad MH. Therapist predictors of early patient–led working alliance: a multilevel approach. Psychotherapy Research 2010; 627–646. 10. Kruger J, Dunning D. Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology 1999; 77(6):1121-34. 11. Owen J, Jordan TA, Turner D, Davis DE, Hook JN, Leach MM. Therapists’ multicultural orientation: client perceptions of cultural humility, spiritual/religious commitment, and therapy outcomes. Journal of Psychology and Theology 2–14; 42(1): 91-98. 12. Constantino MJ, Boswell JF, Coyne AE, Muir HJ, Gaines AN, Kraus DR. Therapist perceptions of their own measurement- based, problem-specific effectiveness. Journal of Consulting and Clinical Psychology 2023; 91(8): 474–484 13. Ziem M, Hoyer J. Modest, yet progressive: Effective therapists tend to rate therapeutic change less positively than their patients, Psychotherapy Research 2020; 30(4): 433-446. 14. Odyniec P, Probst T, Margraf J, Willutzki U. Psychotherapist trainees’ professional self-doubt and negative personal reaction: changes during cognitive behavioral therapy and association with patient progress. Psychotherapy Research 2019; 29:1: 123-138, 15. Hook JN, Davis DE, Owen J, Worthington EL, Utsey SO. Cultural humility: measuring openness to culturally diverse clients. Journal of Counseling Psychology 2013; 60: 353–3. 16. Hill PC, Laney EK, Edwards KJ, Wang DC, Orme WH, Chan AC, Wang FL. A few good measures: Colonel Jessop and humility. In Worthington EL, Davis DE, Hook JN (eds). Handbook of humility: theory, research and applications. New York: Routledge; 2017 (pp119–134). 17. Clements-Hickman AL, Reese RJ. The person of the therapist: therapists’ personal characteristics as predictors of alliance and treatment outcomes. Psychotherapy Research 2023; (33)2: 173–184. 18. Hook JN, Davis DE, Worthington EL Jr. What we have learned, where we are likely to go. In: Worthington EL, Davis DE, Hook JN (eds). Handbook of humility: theory, research and applications. New York: Routledge; 2017 (pp343–355).
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