Definition and Criteria for the Assessment of Expertise in Psychotherapy: Development of the Psychotherapy Expertise Questionnaire (PEQ)

Therapist expertise is a complex, multifaceted, and continually evolving concept. Defining this construct and its constituent components can yield a substantial contribution to the field of psychotherapy, consequently enhancing the comprehension of the fundamental factors that underlie its effectiveness. Within this framework, the present research aimed at developing and assessing the psychometric properties of the Psychotherapy Expertise Questionnaire (PEQ), a self-report measure to assess therapist expertise. A sample of 260 psychotherapists of various theoretical orientations were involved in this research. They completed a survey that included the PEQ as well as other self-reported measures aimed at evaluating personality traits, self-efficacy, self-esteem, and insight orientation. The analysis provided evidence of a good fit for both a correlational model with eight factors and a higher-order model, where the eight subdimensions were grouped into subjective (performance; cognitive functioning; personal and relational qualities of the therapist; therapist self-assessment) and objective (experience; reputation with clients and colleagues; training and professional updating; deontological ethics and setting rules) factors. The eight dimensions, two higher-order factors, and total score all showed excellent levels of internal consistency. Furthermore, significant associations were found between PEQ scores and insight orientation, general self-efficacy, self-esteem, personality traits, and time exercising clinical practice. To conclude, the Psychotherapy Expertise Questionnaire (PEQ) is a valuable, theoretically guided, and psychometrically robust self-report measure designed to assess therapist expertise and its constitutive dimensions. This measure can have practical applications in guiding tailored training and customised supervision.

Beyond an abstract and technical conception of psychotherapy: The indispensable role of practical wisdom

The work of psychotherapy is complex and seems to resist algorithmic formulation. Psychotherapy theory, technique, and research help to manage this complexity to some degree, but clinical excellence also seems to require clinical judgment, and this judgment cuts across therapeutic theories. However, the content and process of clinical judgment remain relatively untheorized, often relegated to the “art of psychotherapy.” This article focuses on elucidating clinical judgment in terms of the neo-Aristotelian concept of practical wisdom, which includes recognizing what is salient, integrating multiple considerations, infusing emotional experience with reason, and pursuing an intervention plan with discernment and flexibility. The argument is that practical wisdom provides a rich description of the work of clinically adept therapists by more clearly portraying therapists’ decisions and activities than the general, unsystematic concept of clinical judgment or in terms of the many theories of psychotherapy.

Therapist Expertise

In this rejoinder, we respond to comments raised by Goodyear, Wampold, Tracey, and Lichtenberg; Norcross and Karpiak; Reese; and O’Shaughnessy, Du, and Davis about the definition of expertise and methods for increasing expertise. The most consensus among these authors was found for client outcomes as a criterion of expertise and practice as a mechanism for increasing expertise. Until we have better empirical evidence, however, we suggest keeping the eight criteria that we originally proposed to measure expertise (performance, cognitive processing, client outcomes, experience, personal qualities, self-assessment, reputation, credentials), as well as the four mechanisms for increasing expertise (training, practice, feedback, and personal therapy). We challenge future researchers to hone the list and determine how to weight the various criteria and mechanisms based on empirical evidence.