What is good psychotherapy?

In this section, it may be helpful to think of a different sense of the word ‘good’. There is therapy that is ‘good’ in the sense of well done or competently performed, and there is ‘good’ in the sense of psychotherapy being a positive or valuable process in its own right and which brings about positive or valuable outcomes (although these may not be easy to determine) (see E ^maleficence in psychotherapy

in Chapter 9, pp. 451-2).

Good psychotherapy is competently done therapy

(See Competencies framework in Chapter 3, pp. 96-9.)

All the trainings in psychological therapy aim to help trainees achieve a level of competence, so they can safely practise the technique they have chosen to offer to patients. The training and supervision process should have ensured that a trainee has both theoretical knowledge and sufficient practical experience. The different schools of therapy have professional standards and codes of ethics that practitioners must respect (see E Psychotherapy protocols and codes in Chapter 9, pp. 448).

There are some general and specific principles of practice. The general principles are those of any health-care professional and include courtesy, kindness, punctuality, attention to administration, maintaining basic competencies, and a willingness to consult colleagues if unsure of how to proceed. Related meta-competencies include the capacity for self-reflection, lifelong learning, and tolerating uncertainty and the unexpected.

Specific features of a competently carried out therapy include:

  • • Carrying out a thorough assessment
  • • Not taking on a patient if they are better treated elsewhere
  • • Making a proper formulation and being prepared to revise it
  • • Offering a secure, predictable, and consistent intervention
  • • Setting and maintaining boundaries
  • • Engaging in supervision.
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