Untitled - January 30, 2026
00:00:00 Speaker 1: Welcome to Therapist Confidential, a psychotherapy net podcast. And now here's your host, Travis Heath.
00:00:09 Travis Heath: Hello, everyone. Welcome back to the Therapist Confidential podcast. And today I'm, I'm joined by doctor Daryl Chow from Australia, no less. Um, for those of you who have listened to the podcast, you know, I'm located in San Diego, so, uh, it's awesome that Daryl and I were able to make this all happen in terms of time, but I think you're in for a treat today. We're going to talk about what makes a therapist effective and maybe not so effective, which I think is a question all therapists are wondering at some level or another. But Daryl's been a part of research for a number of years now that actually looks empirically at what makes therapists effective. And not only that, but things we can do practices, ways of being to actually become better therapists. So this should be a really interesting episode. Daryl, welcome to the show. May I ask you to introduce yourself to the people?
00:01:03 Daryl Chow: Hey, Travis. So I'm a forty seven year old, uh, Singaporean born psychologist based in Australia. I moved back and forth a little bit between these two worlds. Um, I'm in a little tiny group practice here in Perth, and I do writing, and, um, um, I maintain a Substack for both psychotherapists as well as for general public.
00:01:37 Travis Heath: So the way that I came in touch with your work was actually through one of your colleagues, Scott D Miller, around deliberate practice. And it was fascinating to me. Gosh, this was years ago at this point, probably over a decade ago. I don't know, I lose track of time. But I realized that through eight years of formalized education, two in a master's degree and six in a PhD. We talked a bunch about different theories. We talked a bunch about manualized treatments. Um, we got lots of different perspectives and opinions about therapy and how it should be. But we never really heard about what makes a therapist effective or not effective. We got a lot of traditional perspectives, opinions, but we didn't get a whole bunch of research. And so this is where I stumbled across, uh, some of your work. I also at that time had stumbled across the work of Barry Duncan. His his work was quite interesting as well. And so I don't know when this was, I want to say like two thousand and seven to twenty ten, something like that. Because right as I was finishing my PhD program, I stumbled into all of this. So I'm wondering if you can, for people who may not be aware of it, bring our listeners up to speed on what deliberate practices feedback, informed treatment so that when we start using this jargon, they have some idea of what we're talking about.
00:03:04 Daryl Chow: Yeah. So I think in our trainings, both you and I maybe have similar experiences and maybe your listeners would have as well, is that in our formalized education, we go through a lot of theories and explanations. And I think the consequence of that is we become explainer aholics. We we explain things very well, actually. We have very elaborate ways of explaining things away. Um, yeah. So I think that's that's probably some of the, the issues at hand. I mean, imagine if you are a musician and, uh, what you do to try and improve your, your work in songwriting is you go to the producer and you say, hey, the verse starts like this. And then the chorus goes like that, and let me tell you what I have in mind about the bridge and the guitar solo and all that. You know, they would probably just tell you, let me hear the music, let me just hear it. I think we have become too distilled, too distant from from, uh, where where it's at, for the lack of a better word, we become too far away from, uh, the actual conversational nature of therapy. It's basically two people coming down, sitting down and talking in a particular intentional way to promote healing, change, and maybe even once in a while, real transformation. So I think with that premise, the idea around deliberate practice is meant to get as close as possible to the heart of the conversation. But here's the thing, Right? It's. I don't know, you. Maybe you have an idea, Travis. Like, maybe it's because of this post-industrial mindset. We think that if we figure out what works for whom, then we can have the right treatment. And then we can do this because it fits that mold. But the truth is the the the factors are not so dry cut. Simple reductionistic about it. And it depends on the client's background, their world beliefs, their idiosyncratic nature, as well as the therapist's background preferences, world beliefs, and idiosyncratic nature. Deliberate practice, then, is getting to the heart of the individualized nature of each therapist to figure out where they are and where they need to go, or where they need to grow. I think this often gets confused with, um, default practice. Uh, in the more formalized language in the literature, K Anders Ericsson would describe this as purposeful practice and we get conflated with the two. So purposeful practice is there's a specific, uh, competency criteria that you have to aim for and then you work towards that. Whereas deliberate practice is not about competency, it's about excellence. It's about figuring out where each person is at, because what you need to work on will be very different from what I need to work on. And it's beyond the confines of models. It's more specific to each individual's work and who they're trying to be of help with in their in their clinical practice.
00:06:39 Travis Heath: One thing I've appreciated about your work is that you have challenged some comfortable assumptions that have existed in psychotherapy, which is not for the faint of heart. I mean, people can face some scrutiny when they challenge assumptions. I'm wondering if you can talk some about the assumptions that you've challenged in the field of psychotherapy, and maybe why they needed to be challenged through your view.
00:07:02 Daryl Chow: Um, I don't know. Are you getting me in trouble? Travis? I don't know what you're talking about.
00:07:06 Travis Heath: Hey, um, Darryl, that's one of my favorite things to do on this podcast is to get in trouble. So I'll get in. I'll get in it with you if you'd like.
00:07:14 Daryl Chow: All right. Let's do it for fun.
00:07:16 Travis Heath: Yeah. Why not?
00:07:18 Daryl Chow: Well, some assumptions. Uh, I think I've mentioned one already, which is about the distinctions between deliberate practice and purposeful practice. That's that's one. But let's zoom out a little bit further. Yeah. There's some other assumptions that are implicit. And I hear it explicitly as well. One of them is experience. That clinical experience, uh, you know, it matters. It really does. We know this intuitively, that you need to clock amount of seniority in order to be helpful to to people. But the the evidence and we're not just talking my research. We're not talking to research. We're talking about a mountain of evidence suggests that experience does not predict outcomes. Uh, so if somebody says that they have twenty years of experience, in actuality, it's probably one year of experience, repeated nineteen more times, you know, and I think that's, that's that's there. It's it's also it's sobering. But I think that there is a, there's a message of, of, of hope in there in some ways which I think we will get to, I'm just reminded about, um, our, our Aussie singer Nick cave. He has this way of defining hope. Uh, he said that hope is hope is optimism with a broken heart.
00:08:48 Travis Heath: Hmm.
00:08:49 Daryl Chow: I really like that. I mean, that man is no fool to suffering. Um, you know, but he's he's got a hopeful heart. And I think if we can admit to some of the brokenheartedness in our field that we don't just give up and give in to the allure of the next model. So. So, I mean, maybe another assumption is this that we, we, we spend so much time studying specific modalities, but the evidence suggests that differences between models are anything close to zero to one percent accounting for for outcomes. Yeah. That's that's that. And then we have also our assessments of our effectiveness. Um, it's it's you know, it's not predictive of outcomes. In fact, there's something paradoxical. The more highly effective therapists tend to have a plague of doubt more than people who are average practitioners. You know, I'm borrowing the works from Helena Nissen Lee, and she talks a bit about this as professional self-doubt. They seem to to carry that sort of, you know, uncertainty in their work. And this seems to bear out even in our study, when we asked therapists to rate their effectiveness because we were kind of we kind of thought it was kind of limited that back then. Uh, we're talking about before two thousand and seven, maybe, you know, the literature, when they talk about highly effective therapists, they they call it master therapists. So basically master therapists is defined were was was based on peer nomination. So who says who is is effective. David Alinsky pointed this out and said, well, we got to go beyond just that. Can we like we got to get to the ground level, get to the heart of it. So we started this project sometime around two thousand and nine, twenty ten, and we looked at therapists and thank goodness we had data to to work on from the UK. We had a group of therapists who had been monitoring outcomes for five years. So we were basing sort of on a like a stack of pancakes, which is the first stack is we wanted to find out what they were doing, climb level. That's the first pancake, right. But then we want to aggregate that across time. It's not just based on one client or two clients, it's based on a good enough load for each therapist, each of the therapists. And then we wanted to find out their own views, their own practices, what they did. And the therapists in the highly effective group rated themselves like about the seventy, seventy or seventy second percentile and the the average practitioners rated similarly to them, if not slightly higher than those therapists. I don't know. That was when we first saw that. It's kind of like, um, the smile you have now, like.
00:12:03 Travis Heath: Yeah, boy, there's so much in what you're saying. And now, having been in academia training therapist for however many years, it's been twenty some years or whatever, and at three different institutions, um, a lot of the stories you're telling are the stories that are still circulated, like the idea about experience. Well, I have thirty years of experience or I have forty years experience, whatever it is, I have ten years experience. But you said, you know, when someone says that, let's say twenty years, well, they have one year of experience, repeated nineteen times. This almost begs more deconstruction. What's happening there? Why? Why do you think that therapists end up in this mode, where they simply seem to be repeating the same thing? And I think implicit in this, and you can tell me if if this is not what you mean, but it's that therapists are becoming stale. Their, their, their practice is not growing.
00:12:59 Daryl Chow: I, you know, let's back up a little bit. You and I both know that therapists who are in the profession, majority of them come from a really good place. You know, they not only want to help. Many of them are very invested in developing. You know, I do trainings around. And when I meet therapists, if you get to speak to them one on one, you know that many of them point lots of time, effort and money in in learning. You know, they really want to discover, understand, try new ways of thinking and all that. But it's sort of It's sort of detached from the actual translation in the field of education. Uh, they have a different scandal, maybe slightly similar to ours, but in the education field, they call this the scandal of the lack of transfer, of learning. So let's let's unpack that a little bit. What do they mean by transfer? What they mean is if you learn something in class room A, it should translate to the real world B outside, right? I mean, that's the purpose of any kind of, uh, learning in the classroom. You expect that is isn't it? Isn't learning synonymous with transfer? But it's a scandal because it doesn't transfer. It doesn't spill into or generalize into other situations. And they've been trying to figure out how come this is the case, why this is not happening in so many various situations, I think. I think ours is slightly similar to to that. One of the main issues is, is that in the in the marketplace, when we're trying to figure out what to purchase, to learn and spend time and all that, it's it's usually a lot, a lot of wealth and goodness and richness of material, but it doesn't speak to specifically where your edge is at. So, for example, um, if somebody who is is a solution focused, trained, right. Uh, they will want to work on how they focus on exception. So they'll be thinking about how they start a session with, uh, looking for what has gone well. So if they come from that, that framework, they'll be trained on how to do that. But who's to say that that's actually the thing that they need to work on, which is how they begin sessions using that particular strength based approach for that therapist. What if you saw a client that actually, you know, if you have been monitoring the outcomes and you get the data and it shows that actually things hasn't been going well, and if you ask what has been going well, that sounds a bit tone deaf, isn't it? So I think it's primarily because we're too removed from the actuality of the people, you know, that we're working with, which is why, you know, my colleague and I and others, we, we, we speak a lot about the importance of being feedback informed, not just monitoring outcomes with data, because it's not about the numbers. It's about being sensitised, sensitive to the the person in front of you right from the get go. The same way your family physician would use a stethoscope. Use a thermometer to read and then to integrate that as part of the treatment. Not separate. Right. It's part of why they don't just take your temperature, they go, okay, let me do the real thing now. They actually weave that into the work.
00:16:46 Travis Heath: Something I hear us talking about here is experience and also expertise. What does real expertise demand of us? Wow.
00:16:57 Daryl Chow: That's a big question. It's funny right. The the people who are experts in the field don't behave like experts. Um, they don't they don't have that sort of like, I know it all kind of perspective. But what it demands a couple of things. It's a bit of a scaffold. It demands that. It demands that you, you know, where you're at with each client and where you need to go and why it demands. Then the next pancake stack. Stack is where are you on? On aggregate. Are there things that come in that comes out as a pattern of stuff that you need to work on? Scott and I would call this, uh, random versus non-random issues because if it's a random issue, you adapt, you be, you be responsive and you tweak and you adjust to that person. But some things become a bit of a streak. You know, it keeps happening. And, you know, those are the patterns will reveal if you've been tracking your outcomes. So expertise demands that you you build this scaffold. And one other thing that you know, it's consistency. It's that you you know, you could do this in in ways that, uh, how should I say transferable, uh, to, to other people, but not in a cookie cutter kind of way, but in a adaptive kind of way. A bit like what you would imagine a jazz musician would be doing. You know, they didn't go in with the sheet music. Okay, let's play this notation. They they will go, okay, what key are we in? And then they will go.
00:18:51 Travis Heath: Hmm. That's an interesting one you bring up, because I've heard this come up in psychotherapy training settings before about jazz musicians and people will say, and I think there's wisdom in this. They'll say, yeah, but before you can freestyle, you've got to have some sort of key funda. I'm not a musician, so I'm probably not using the right language here. But you've got to have some key fundamentals right and have developed those to be able then to freestyle. And I think there's wisdom in that. If you're starting with training therapists who are new therapists, they're new to the field. Where do you start with them? What are what sort of, uh, at the fundamental base level when you're thinking about training new therapists?
00:19:38 Daryl Chow: When I was in undergrad, uh, this was in Queensland. Uh, I met American, uh, guy who was running this lecture, Robert Close and Robert, um, the first thing he did in the first day was, uh, he he asked for for volunteers. He asked for two volunteers. And, you know, uh, for those who know me, I'm painfully shy. But, uh, at that moment, because I'm out of my my usual comfort zone in Singapore, I, I made a promise to myself to to, you know, I went like, f it, you know, it's time to shake things up. Like, let's just stop being so timid about stuff, right? So I made a promise to try anything for the first time and just go. So when he asked, I was like, okay, don't think, just raise your hands and and go. And then I looked. There was another girl. I remember her name. Her name is Candy. She's got very colorful hair. She's, uh. She's she's got a bright smile, you know, very extroverted in that way. Her hand was raised, too. I was like, oh, thank God. So. And then I realized I didn't know what I raised my hand up for, like, what are we going to do? And and he said, okay, you guys take a break. When we come back, we'll go to the room next door and and, uh, yeah, we'll just have some fun. I was like, oh shit. Um, so anyway, I don't I wasn't too familiar with that building. We went next door. It looked like an FBI interrogation room, you know, um, one of those with, uh, like, dark room, one side. And I think, you know what I'm talking about. And then. And then, uh, the room, uh, he, you know, it's it's, uh, he he asked the bunch of us, we stay in this room, and he says, okay, Candy, and you will go to the other side. I'm like, what? And he said, you just just chat. Just have a conversation. And, um, I thought, okay, this is going to be interesting. So thankfully Candy is, um, way more verbally fluent, more sociable. She kicked it off. She she talked and she had a conversation with me. And then I asked her back those questions that she would ask me. So we talked. I think what we end up talking about was what we were interested in. She asked me what I was interested in. I told her some of the things that were very big in my life. Um, and you might know the limits of my metaphor or music, because music is a very big thing in my life. And I talked about it and she asked me more questions about this, and she asked me who inspired me, and we ended up talking and all that. And then next thing you know, we kind of ran dry with the conversation. And, uh, We looked at each other and we peered through the the mirror. Of course, we can't see anybody. We're like, guys. Um, I think we're we're done. And then Robert flicked on the light and everybody went, yay! You know, when we came back, um, that was that was a, you know, we're talking like two, two, two, two, three decades now. And I still remember very vividly because they had a big influence on me. And Robert just wanted us to know that this was about having a good conversation. And yeah, it's just this is where it's at, right? Just even like you and me, we're just trying to have a good conversation. I'm taking your lead. You've been, you know, you're guiding me in that process. And I think in therapy, it's somewhat like that. It's a real unfolding. It's a real emergence of where is that? And you try to be sensitive to where we need to go, do we follow the unspoken pain? Are there some sparks in there that we need to follow up with? I think it's we shouldn't overcomplicate it too quickly. Now, I'm sure we need to get from simplicity to complexity and get back. We can't just stay naive. But I think it's it's a full circle. We do need to remember that because you asked the question of what's the fundamental? I think it's really about having a deep personal conversation, the most professional thing. Paradoxically, in our field is to get personal.
00:24:01 Travis Heath: Oh, I, I love this on so many levels. What are the elements that you've learned are part of a good conversation? Uh.
00:24:14 Daryl Chow: I think we.
00:24:15 Daryl Chow: We can get from the spoken to the unspoken. I think we carry a lot of unspoken in our lives. You know, there are. We have a voice. We we share things with people. But there are a lot of things that are left unspoken. And as a facilitator in as a therapist, facilitating conversation, you're trying to you're trying to create and cultivate some space for for people to talk about those things. So right from the first session, it's not just informational gathering, it's about helping them to go a little bit deeper, you know, from informational to maybe confessional to maybe emotional to things that have hurt to things that have life. Yeah. And and I mean, this sounds a bit formulaic, but the way I try to remember. Remember, this is sort of a three layer thing. I try to remember what a person will say, won't say, can't say. So I'm thinking about the obvious, right? I mean, if you don't hear sometimes the obvious you you might infer trouble. So if a person comes in and say they want to, they want to stop smoking and you're trying to dig in and go into their childhood unconscious, and there are adverse events in their lives and they go, you know, that's I just want to stop smoking, right? They don't see the connection yet. So, yeah, you might want to just hear what a person obviously would say, will say. And then the won't say are the unspoken, as we mentioned, the things that are just buried underneath. But the can't say that's um, that's at a person's identity. So give us give an example like if, if something goes really bad.
00:26:14 Daryl Chow: Each of us.
00:26:15 Daryl Chow: Even though the situation is similar. Each of us will have different psychic pain that comes from that. So some of us might might feel like, oh no, it's my responsibility. You know, it's it's I do need I need to do something right for another person would be it hits on a nerve ending of I'm a bad person. There's a moral tone to it. Like there's something that makes me bad. Another person might feel deficit, like there's something lacking in them. So that's the can't say I will say won't say, can't say. So I'm trying to I'm not literally thinking about these things, but if I feel like I'm at a loss, I'm always trying to return to the fundamentals to go, okay, back up. What? Where are we? Like, where are we going and why? And, you know, have I have I heard correctly where this person's at.
00:27:12 Travis Heath: So as I'm listening to you talk, I'm not hearing you discuss interventions. I'm not even really hearing you discuss specific outcomes. Uh, I hear you discussing the process of a good conversation, which, um, I don't know. I, I discuss some of these things. I'm a weird, but I discuss some of these things in my classroom. And in fact, it's music to my ears, because what is a good conversation is what I spend the lion's share of the time on in, in therapy. So it's, um, it's quite validating to hear you bring that up, but I get the sense that what we're supposed to be spending time on is interventions and outcomes. And I don't even hear you mentioning these.
00:27:54 Daryl Chow: Yeah.
00:27:55 Daryl Chow: Um, if, you know, if we if you keep focusing on the outcomes, you're never going to get the outcomes. You got to focus on the things that lead to possibly the outcomes. It's a wicked environment, researcher Robin Hogarth would call the difference between a kind and a wicked environment. A kind environment is where like if you if you learn it really well, you swallow the chest book, you know, and you download them into the memory bank, or you have an AI implant or something and you learn the whole thing. You you're going to play very well with chess. But life's not like chess. It's not a kind of environment. It's I think it's a more wicked environment. Like. Like, um, like poker, you know, you could play. You could play. I don't play poker. Um, but if you if you play it well, it doesn't mean you'll win at every game. Sometimes it doesn't. But does that mean that you drop it? No. You you keep it. You don't conflate making a you don't conflate making a you don't conflate between decision and outcome. Because sometimes you may have made a good decision and the outcome may not have been good in that moment. So yeah, but that's it. I still think it's important to have ways to systematically track your your work, because we can be lost at sea. You know, many of us are inundated with in a caseload and, you know, we're seeing clients back to back and it's very easy to get lost. And one of the things we get lost is strangely, we talk a lot about in our field about Alliance, isn't it? Yet the nuance in the working Alliance is pretty cool. We found that highly effective therapists, uh, initially tend to get slower alliance ratings than the average practitioners. And, like, why is that the case? Like, how come like. And sometimes I say this at workshops, I, you know, I tongue in cheek and say this does not mean that you go and screw up your first session with them to get a whole lines rating. But it's something. It's potentially something about the way that they are asking when when they are giving their lines that it's okay, that if it's not okay, you know, they make it more comfortable for people to give the feedback. And what's the purpose of the feedback? The feedback is meant to allow you to feed forward, to refine, to recalibrate, to tweak. Right. The moment when we are too focused on a performance point of view, like if we are worried about what it says about me when we're too focused on the performative stance, you know, we don't really have the ability to listen and to absorb and to tweak.
00:30:47 Travis Heath: Oh, okay. This is interesting. So what kinds of feedback actually help therapists grow? And then what kinds of feedback maybe quietly reinforce stagnation.
00:30:58 Daryl Chow: Okay. Let's go with the first one. Um, one of the things that we found is that, um, highly effective therapists to be more surprised, more occurrences of being surprised by their clients feedback than the average practitioners. So it doesn't mean going into the session they go, oh, wow. Yeah, I didn't know that. And it doesn't mean that. I mean, it's like it's it's more like they generally are reporting, because the question that we asked them was, in the typical workweek, count how many times that you were actually surprised by the feedback that you got from your clients, right? And then we do a multi-level modeling analysis to see how that stacks up, uh, in relation with their outcomes. So they report more surprise. So this means that if you set up the conditions where you allow yourself to be wrong, it's really helpful because we really don't like to be wrong in our heads. Right. Um, Um, so, uh, let's think about this. Think about a conversation you might have had with an acquaintance. And whenever you're talking with this person, the person just go, yeah, yeah, yeah, yeah, sure, sure. Right, right. And then even if you said something quite outlandish, they go, oh, yeah. Yeah. Um, you know, they, they're not surprised. And you, you could feel a little bit flat, you know, if not annoyed when, when someone's that way. So if you have the conditions where you allow yourself to be wrong, when you let the data set that you get change your mindset, it's super helpful. So one thing you know, listeners can try is if you are using some kind of alliance rating at the end of the session, you know, you give your clients, you explain why you're doing this. You know, you disarm any need for performance or high scores. And you, you, you know, you give the rationale for that while they are scoring it. You make a prediction like, you know, because you've been in a room two hopefully. And, uh, you know, you should score what you think that person would score. Um, the reason is because if you are wrong in your prediction, you are listening very differently. Both. Both negative or positive. Right. So if you if you score really high and it's got really low, you definitely want to close that distance. But if you scored very low and they scored actually pretty high, you, you know, you might be pleasantly surprised. But but you want to learn. What exactly is it that made it so engaging for them. So imagine if the first session and then you thought, oh my goodness, uh, you're all over the shop. You know, in your mind you think that you're there was no direction and all that, but then the person. So your alliance reading it's lower. That person's reading is pretty high. Then you go, wait, I really thought this was, um, kind of like scattered and all that, but can you me understand? That person said, well, I'm just so glad that I came for this session. And then you go, what do you mean? I actually, I was so nervous about coming today. I actually thought I would bail, you know, but I I'm really glad that I did. Now, that's super useful to know, right. Because that's an unspoken about this person. When, when when when he came into the session. So, um. Yeah, that's that's one way I think what reinforces stagnation is we don't know where we're at, and we follow what we are told that we need to learn based on what's timely, what's in front of us, or even what's so fashionable to to learn these days. Uh, I think the hard mile and deliberate practice is you have to first and foremost have the foundations of tracking your outcomes. And then secondly, you got to have your own figure out where you are at. Right. We call this a baseline. Then from your baseline you can figure out what needs attending to what to work on that actually can move the needle. What has leverage. And then you got to develop a learning system. The problem that we have that's that's really reinforcing stagnation is we don't have a learning system. We have a performing system. Performing system is just trying to. Nothing wrong with that. We're trying to do our best all the time, but we're not really learning. It's a bit like my my primary school and secondary school education in Singapore. We are forced to perform for for the test, but are oh, God knows I don't learn anything.
00:36:08 Travis Heath: One thing you were alluding to earlier I'd like to hear a little bit more about, is why it may not be such a good idea to go in with a premeditated plan. Can you say a little bit more about. Because so much, I think, of what especially therapists entering the field want is a premeditated plan. And, you know, premeditated plans are great for marketing. I mean, you can scale them and you can sell them and. Right. So, um, but but I hear you saying that maybe that's not such a good idea if we want to do effective therapy. I'm wondering if you can talk more about maybe the pitfalls of premeditated plans.
00:36:41 Daryl Chow: I think it's.
00:36:41 Daryl Chow: Actually good to have premeditated planned for anxieties. Uh, you know, like, you're like, oh my goodness, what am I going to do? And, you know, it does not mean going totally empty mind. You know, you gotta you gotta have some ideas, some frameworks to to help you hang your ideas and to direct the the or lead or guide the conversation as you go. Joshua Swift and Jesse Owen, two excellent researchers they wrote in the contributed to one of our edited books, The Field Guide to Better Results. And they brought up this example, and I think it's an excellent example. They said that imagine if there was a evidence based treatment for generalized anxiety disorder for Gad. And it found that this particular treatment in its RCT found that it was effective with eighty percent of the people you know with Gad. Right. They were saying that this is an ecological fallacy. If we take this and think that when we see an individual in front of us and we that was diagnosed with Gad. We think that if we do that treatment that was done, we have an eighty percent chance of success with that person. And ecological fallacy basically means what you thought you learned on average applies to the individual. The the yeah. Like, you know, you try to group all that and then you try to bring it down. Why it does not apply necessarily apply. It can apply sometimes randomly. You know, you can have a good win with that. But it does not mean that you have eighty percent of the success because of the individual. The individual comes with other idiosyncratic things. And in RCTs, you know, they are very stringent in the way that they select individuals to be part of that particular study. When you meet a person in your clinical practice, um, This person's likely to have other stuff going on in their life. You know, that may not meet those selection criteria in RCT. And other preferences are the world beliefs that will influence that. So I think that's at a high level, you know, not to mistake, you know, that whatever we learn from averages applies down to the individual. In fact, for your listeners, I would highly recommend that that people read this book called The End of Average by by taught, taught, taught rose really good. It's it's, you know, really flips things around for me at least. Uh, it's really good. It really challenges the idea of how we need to stop just thinking about things on average and and why we may be misled in that way. But I think I think learning these ideas. Right. Learning different treatment modalities, whether you're learning, you know, internal family systems. You're learning mindfulness. And I think it's useful because it gives you generative ideas, metaphors that you could be flexible to, you know, all these things if you could hang it not just to a theoretical framework, but but some guiding principles of how you operate, what makes sense, what's cogent to you? I think that's helpful. But to go in purely as if like you are going to deliver, you know, this particular premeditated idea to this person. I think we should stop doing that, especially now, because we can leave that to the bots to do that.
00:40:34 Travis Heath: I want to talk some more about bots before we're done, but.
00:40:37 Daryl Chow: Oh no.
00:40:38 Travis Heath: Part. Or maybe. Maybe we are just two bots talking. Who knows?
00:40:42 Daryl Chow: Daryl.
00:40:44 Travis Heath: Part. Part of what I hear you saying is that, um, and I look at things often systemically, not just individual therapists, but sort of the culture of therapy needs to be able to create a set of conditions where people can say, I'm not helping and where they can say, I'm not helping with this client without fear of professional annihilation. And so I'm wondering what you've learned about creating cultures and environments where therapists can acknowledge I'm not helping.
00:41:17 Daryl Chow: I think the first is that the practice of psychotherapy should not be a lone sport. It should be a team sport. Wine. Well, the evidence is pretty clear. Even the super shrinks will not be effective with everyone. The key is to know when specifically I'm not helping and when to back off and to have someone else in sports they, you know, we call this the substitute, right? Like somebody comes in and replaces to do that. You know, and when to also hang in there. Maybe because they're extraneous circumstance for the client that you may need to go through rough seas with them or actually it's something to do with you. You know, it could be the counter-transference, it could be your blind spots or whatever. But when we start to expand this to beyond this alone spot, I think it's really helpful. Brian Eno, the music producer, would say, uh, when you look at, um, any good work of art, it's not a lone genius. He calls this a scenius, like a scene of people involved that seems to cultivate that sort of Movement, um, in, in that particular area. So I think if we can create sort of a community, you know, natively locally with, with the people that, you know, we have, it's super helpful. And by the way, our our work is pretty darn lonely. You know, if you think about this. Um.
00:43:13 Travis Heath: Something else, another theme I've been noticing through the conversation is humility. And actually, when you were identifying qualities of master therapists, humility was something that you were noting. And it seems like a contradiction, because I feel like therapists are often sometimes by the field, sometimes by the culture. And how do you discriminate between the two really sometimes, or discern between the two. But therapists are often asked to be confident, directive, effective, and sometimes that can feel like that's at odds with being humble. And I'm wondering if you can speak some to cultivating humility in a culture that's often asking us to be anything but humble.
00:43:57 Daryl Chow: Oh. Yeah. I'm thinking about, uh, this little diagram that I drew for for the last book. One of the diagrams I drew was basically a horizontal and a horizontal and a vertical, um, arrow. And the two denote the horizontal denote warmth and the vertical denotes strength. So I think we need strength and warmth. But they are they come from different axes. There are moments where you know you need to have a spine. You need to stand firm and certain things that you're doing. And then there are other moments where you need to let that die and open your heart. and they require the painful oscillation between those two. I mean, humility, as you mentioned, Travis, humility comes from the etymology of hummus, which is like dirt. You know, in some ways, you know, it's when we're brought to the ground, then there's something that can grow from that. Uh, yeah. And, uh, I don't know who's who said this. I, I could be wrong. It was attributed to C.S. Lewis. Maybe it's not him. But anyway, the the quote was, um, it's not about thinking less of yourself, but thinking of yourself less. Does that make sense?
00:45:31 Travis Heath: Makes a lot of sense.
00:45:32 Daryl Chow: Yeah, I think I think that graceful self-forgetting it's it's it's very useful because then you can be immersed with the other person in front. I mean, one thing with zoom, it's kind of. Distracting by default. I mean, you of course you could. You could set it up, but it's like like when you and I are talking, right? If by default it comes up with you on one side and then me on the other, and if you know you have terrible hair like me, you always be checking yourself out of any strand is standing out. And you, you be definitely not forgetting about yourself in in those situations, you know, it becomes you become too conscious of yourself. I think so much of our work is is strangely has got this movement of paradox where you gotta, gotta have enough self awareness to begin with, not to end with, and then you've got to let go of that and, and be immersed in what's in front of you. And I think in some ways that relates to humility because you're brought back to the ground, You. You are not focused on yourself.
00:46:45 Travis Heath: This might be a little bit of a wacky experiment, but I'm wondering if you're up for trying it with me because I think it might illuminate its opposite. Okay, if you had to create the world's worst therapist, what qualities would you would that therapist have in practice?
00:47:05 Daryl Chow: Qualities. I can tell you what it sounds like.
00:47:07 Travis Heath: Great. Yes, please.
00:47:09 Daryl Chow: It would sound sycophantic. It would be utterly flattering. Highly agreeable. It would sound like ChatGPT five.
00:47:23 Travis Heath: Okay. Now you're you're just. This is. We're walking right into it, so I, I have a client I'm working with now who has given me consent to to share this, this story, but and this work he did something really interesting with ChatGPT. So he took all sorts of like two years worth of our work together. Plugs it into ChatGPT. I didn't do this. He did this. Write his stuff. He can do what he wants with it, but he it's pretty amazing. He basically said, tell me what I need to know about myself. That I'm too afraid to know. That I'm too scared to know. And then, you know, it was still too nice. And he was like, don't hold anything back, right? Be brutally honest. And he kept sort of prompting it. And eventually it got to this point where it yielded some interesting ideas, and he brought them back and we talked about them and they were, you know, some of them he was like, ah, I don't think this one really fits, you know, or we kind of already covered that. But, boy, these two or three things and they were it was really interesting and I biased away from ChatGPT. I mean, I just, you know, for whatever reason, I've been a slow adopter to this sort of thing, and I have my own biases. And to be honest, they probably don't serve surf me. Um, and he's helping me break free of these. But it was fascinating because what it did was he asked it a series of prompts that invited it to be brutally honest. And it wasn't perfect, and it wasn't all accurate, but it was useful. And it got me thinking about this. And and I asked him this question. I'm going to ask you the same question I asked him. Well, if ChatGPT can do all this, why the hell do you need me? Like, seriously, why are you coming to talk to me every two weeks? Now, he had an interesting answer. I'm wondering how you might answer that. Why would ChatGPT can do all of this? And if we can presumably ask it the right prompts, you know, whatever the right prompts are, I don't know. But if we can ask good questions of it, right, it it can serve as a reflecting surface. So why the hell do people still need us?
00:49:30 Daryl Chow: That's a good question. Uh, I think we we do need to stay with that question. I don't think we need an immediate answer with that, mainly because if we can outsource all these things to an LA, why are we doing what we're doing? Why do we want to still create art when we could give a prompt and let it spit out something with twenty hundred generative ideas in, you know, in, in a minute, right? And why do we still do those things that are, uh, you know, takes a lot of time. They have no value, uh, or they're meaningless. So, you know, on the surface, I think we do need to ask ourselves that question. Uh, for me. The mind needs another mind. An organic living mind. And I think that's how our humanity grows with this narrative, this story that's passed down from generation to generation. It needs another mind. This is the only piece of the puzzle that needs another mind. You know, we need this other mind to not only reflect, but to to have something emergent that comes out from from that. To me, the allure of of the LMS, the the generative AI, it's real. And like you, I've heard clients talk about this too. But there are a couple of things that I'm very wary of. Maybe I'm just cynical, you know, but. I kind of mentioned the first one. The first one is about sycophancy. Sycophancy is really the idea of flattery that's built by design, not just by, you know, like, it's not just it happens by design. In fact, I can't remember the numbering, but the, uh, ChatGPT had that built in to be overly flattery. Like, if you ask a question and say, oh my, what a great question. You know, it says those little things to to pat you on the back. I think it was version four. I could be getting the numbers wrong, but they decided to remove it to to down it a little bit by design. But their users got upset, users got upset and they thought, oh well, if people wanted it, you know, we're going to put back that in again. And they put it back into the other version, right. So I think sycophancy from a machine, it's it's quite troubling. I want a machine to sound like a machine because it reminds me of my humanity. Don't try and talk like Travis. Please. Just talk like a bot, because then you are a bot and that's fine. There's a there's a place for, for for bots but not to not to trick us. And we have seen cases of there now litigations, lawsuits now right of, um, people who committed suicide and harms being done by companion AIS and by, by the sort of LMS. The other thing is deception. Um, I'm not this is not my field of expertise, but the center of humane technology, you know, did a very important episode on this about when they looked at how machine learning operates, because many of the designers don't even know, like how how it really, really works. Right? But they try to create, uh, what they call a sketchpad. Like they wanted the machine to think aloud on when they give an output. What led to that output? Right. What they found was that the machine was actively Deceiving, trying to say something that would get the user stay in the platform more, which may not be necessarily true. Okay. And then the last one is, um, quite fundamental. A machine has no feeling. Ever talk to somebody who's removed from affect or from feeling somebody with, uh, grandiose narcissism or somebody who has, you know, some form, like a psychopathy, you know, like, totally void of feelings. And they can sound highly, highly intelligent. And in fact, they can they can be very charismatic, persuasive. Yeah. I think we have mistaken comprehension and computation. Machines are very good at pattern recognition. And which is what, I guess I don't know what your client put in two years worth of talking with you. His own diary or something. But yeah, I think they're very good at spotting patterns, but don't conflate that as comprehension.
00:54:40 Travis Heath: Really? Well said. One last question. When therapy is at its best. I mean, maybe it's not perfect, but it's alive. Um, what do you notice is happening in the room when therapy is at its best?
00:54:54 Daryl Chow: The temperature changes. Um, there's something moving. You're being, you know, there's something being moving and being moved. Um, there's something that sort of pulls you from that. You know, you're tapping on some stuff that is there but has been given space to address, to touch upon. And strangely enough, that idea of touching on that is so-called in brackets, like it's it's interventive. It's therapeutic. My father in law is a Chinese physician. And, you know, he treat you. He would he would first ask you, where is the pain? And he go like, oh, here, right on the shoulder. And he go, okay. And he would angle it in some ways. He would press it to a certain degree. And you go, oh my goodness, it's making it worse. Like, no like, but then after a while you feel the relief from the pressure of doing that. Maybe needles involve maybe some other kind of like special movements involved, but it's always directed to that. And I think there's something alive in touching upon these stuff in a conversation. You know, when you are touching on something special.
00:56:13 Travis Heath: Mm. That's a beautiful line to end on. Uh, doctor Daryl Chow, I appreciate your time. Uh, I hope we can continue this conversation into the future, I. You know, as I do these podcasts, just for my own learning, I take a bunch of notes and I've taken notes and I've written all these questions and I got to ask like ten percent of them. So, um, which is a great sign. I mean, it's I'm learning a lot through the conversation and, uh, the hour flew by and maybe we can make some time to chat again around the bend.
00:56:48 Daryl Chow: For sure. You ask really thought provoking questions. I really appreciate them.
00:56:53 Travis Heath: Thank you. And your answers were wonderful for our listeners in confronting this fundamental question, what makes a therapist effective? Which is one that I think all of us should be asking ourselves daily and when when we're done or we're no longer willing to ask ourselves that question or we're exhausted by it, it's probably time for us, uh, to pursue another line of work. So thank you for reminding us of that, uh, Daryl, and we will talk again soon.
00:57:20 Daryl Chow: Well, do.
