Three Types of Knowledge, and Why This Matters in Psychotherapy
Updates from
Frontiers of Psychotherapist Development
At the Bleeding Edge of Development, Reaping Benefit for Our Clients.
In the 02/12/2016 edition:
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Three Types of Knowledge, and Why This Matters in Psychotherapy
By darylchow on Feb 12, 2016 03:42 pm
Information does not equal to transformation.
When I was in secondary school, I had a good friend who seem to morph every time we return from our month-long school holidays. For the rest of us, we came back with grandiose updates about girlfriends – factitious or not – the latest music we’ve heard, and other raving topics. Every cycle of return to school in January and July, most of us were pimple-ridden with awkwardness. Herman had the acne, but was focused and hard-pressed for an audience.
Herman was different. He wasn’t the coolest kid. In fact, he was scrawny, somewhat of an oddball, and didn’t quite fit in. Every holiday that he came back from, he would use us as guinea pigs to test out his latest magic trick. And it was usually a flop. Cards fall of his hands, coins did not reappear as it should. And of course, this was met with testosterone mockery. At least for the start.
But after a few more vacations, we were floored. He almost seemed like he came from an apprenticeship with Houdini. His close-up card tricks became seemingly flawless. He even had our teachers pop in between classes, gasped in amazement.
As it seems, in every class, they would always be at least one smart Alec. This person repeatedly tried to call our Herman’s bluff. “Ah ha!! I saw that. You are cheating!”
What do you expect, smart Alec? Real Magic?
Here’s the thing: as noted by Seth Godin in his book Tribe, citing the great magician Jamy Ian Swiss, it’s easy to figure out how a trick is done, but the real difficult part is to develop the art of doing it. Knowing how a magic trick is done does not make you a magician. (For a good example on this, check out the magic competition TV program, Penn & Teller: Fool Us show).
The same applies for our field in psychotherapy. Knowing about a condition goes nowhere in healing a person from it.
It’s worth revisiting one of our founding fathers in psychotherapy, Carl Rogers. He said that a person “….with full knowledge of psychiatric and psychological information, with a brilliant intellect capable of applying this knowledge, is of itself no guarantee of therapeutic skill.”1
Most of our time spent learning to become better therapists remain in the “content knowledge” domain. While necessary, this isn’t sufficient. Think Herman, my magician friend, who later did evolve to become a professional closeup magician. The smart Alec will never amount to anything close to becoming a professional magician (incidentally, near the end of my secondary school, I learned that during the holidays, Herman locked himself in his room and spent several hours a day devouring magic books, practicing close-up tricks in front of his practice mirror, while the rest of of hung out and idle our time away through puberty).
Most of our time spent learning to become better therapists remain in the “content knowledge” domain. While necessary, this isn’t sufficient.
Two other types of knowledge is needed. “Process knowledge” and “conditional knowledge”. While it’s important to have a sound content knowledge of the client’s presenting concerns (e.g., depression, obsessive compulsive disorder, schizophrenia), most form of guidance that is needed in supervision and our training is more in the domains of process knowledge, that is, the moment by moment interaction and engagement between client and therapist). For the final piece, conditional knowledge (i.e., how you’d work with someone who has depression differs with someone who is depressed due to bereavement, compared with someone who is depressed with a history of domestic violence).
The real magic I saw in Herman was his skill in engaging his audience. Mind you, he was somewhat socially awkward before magic came into his life. As alluded by Jamy Ian Swiss in The New Yorker essay by Adam Gopnik, The Real Work “The method is not the trick. The method is never the trick. Once you’ve mastered the method, you’ve hardly begun the trick.” Herman had the content knowledge for the tricks of his trade, for sure. But what differentiates him from the rest who could simply walk in a magic shop and buy a canned trick, was that he became a master in the domains of process knowledge and conditional knowledge. He was every ready to improvise and adapt when the conditions change, present the same routine differently to different groups of people, while building up a superb rapport with his audience via his empathic skills.
This is why, if you are sitting with your supervisor waxing lyrical about a case formulation and the applications of different theoretical perspective, be wary that this resides largely in the domains of content knowledge. And if you are the supervisor, be wary of the slippery slope of sliding into gossip.
Quick tip: To safeguard against the above, I suggest the use of outcome and alliance measures to track progress and engagement levels. The second suggestion: Video record the seasons, and view key segments (see previous posts, Why Our Self-Assessment Might Be A Delusion of Reality and The Scandal of Clinical Supervision: How to Resolve It (Part 2 of 2)). Stop the video, and ask, what can be done differently to improve the engagement?
The real magic is in the other person’s mind. And that takes the skill of going beyond content knowledge, letting go of our need to impress, and finding ways to engage the other in a variety of situations.
Back to Adam Gopnik’s brilliant article, The Real Work: “Just as chefs know that recipes are of little value in themselves, magicians know that learning the method is only the beginning of doing the trick. What they call “the real work” isn’t the method, which anyone can learn from a book (and, anyway, all decent magicians know roughly how most tricks are done), but the whole of the handling and timing and theatrics of the effect, which are passed along from magician to magician and from generation to generation. The real work is the complete activity, the accumulated practice, the total summing up of tradition and ideas. The real work is what makes a magic effect magical.”
And yes, the ordinary magic of therapeutic engagement is often the hardest to acquire. Better to work hard at the ordinary magic than trying to fool ourselves with the next best trick.
Note:
1. Rogers, C. R. (1939). The clinical treatment of the problem child. . Boston, MA: Houghton Mifflin.
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