Have you ever felt unsure about how to help a client? Have you felt powerless to change a difficult situation in a client’s life? Have you ever worried that you were doing a client more harm than good? While those may be painful thoughts to have for you as the therapist, they may actually be good news for your clients.
In our previous research summary post, we highlighted research by Nissen-Lie and colleagues on the relationship between therapists’ self-doubt, their level of self-affiliation, and client outcomes which found that therapists who scored high on measures of professional self-doubt (PSD) while also scoring high on measures of self-affiliation (i.e. treated themselves with care and nurturance) had the better client outcomes than therapists who either had low levels of self-affiliation or therapists who had high self-affiliation but low levels of PSD (which was the group who ended up having the worst client outcomes).
We are revisiting Nissen-Lie et al.’s work this month to discuss what we see as a potential overlap between their research and the research on the difference between two types of self-criticism from the Forms of Self-Criticizing and Self-Reassuring Scale (FSCRS): inadequate self versus hated self. This research on therapist self-doubt and self-affiliation may help us understand the FSCRS research that shows that high scores on hated self predict slower response and less access to compassion whereas higher inadequate self predicts faster response and ability to access self-compassion.
In Nissen-Lie et al’s research addressing therapist self-doubt, the self-doubt questionnaire items (e.g. “Lacking confidence that you might have a beneficial effect on a patient”, “Demoralised by your inability to find ways to help a patient”) appear to us to be similar to the inadequate self items on the Forms of Self-Criticizing and Self-Reassuring Scale (e.g. “There is a part of me that feels I am not good enough”, “I remember and dwell on my failings”). We also saw overlap between the items Nissen-Lie and her colleagues used to measure self-affiliation (e.g. “I think up ways to hurt and destroy myself”, “I tenderly cherish myself”) and the hated self items on the FSCRS (e.g. “I stop caring about myself”, “I have become so angry with myself that I want to hurt or injure myself”).
Rather than looking at self-doubters and self-haters as two different groups as in the FSCSR research, Nissen-Lie and her colleagues found an interaction between the two such that, with regard to client outcome, self-doubt was beneficial for therapists who love themselves most/hate themselves least and less beneficial for therapists who love themselves less/hate themselves more.
The results of this study make us wonder whether we should be paying more attention to the interplay between self-doubt and self-hatred both for ourselves as therapists and for our clients. Rather than trying to decrease self-criticism in general, maybe we should only be working to decrease self-hatred/increase self-love and help ourselves and clients to understand what is functional about their self-doubt.