The Professional Self Doubt scale (PSD) is a 9-item self-report questionnaire designed to assess the level of uncertainty a therapist (e.g. psychologist, counsellor) has in their ability to help patients. While self doubt has traditionally been seen as a negative attribute, considerable evidence suggests that professional self doubt among therapists, especially when coupled with self-compassion, can lead to better outcomes. The scale can be useful in the context of supervision and training to normalise self doubt or for experienced clinicians to self-administer to engage in reflective practice.
The PSD is associated with higher patient alliance evaluations and therapeutic change (Nissen-Lie, et al., 2015). PSD has a beneficial effect with regard to early patient-rated working alliance and patient change in interpersonal distress. Due to the initially unexpected favourable effect of PSD, the factor was interpreted as indicating a therapists’ healthy self-criticism and ability to be open, sensitive, reflexive and taking responsibility for relationship struggles in therapy, and not as a measure of justified concern about one’s actual competence (Nissen-Lie, et al., 2015). However, in contrast, patients whose therapists’ experienced PSD to increase over the course of treatment were at risk of a less favourable patient progress (Odyniec et al., 2019).
Nonetheless, why self-doubt is a constructive and beneficial aspect of a therapists’ repertoire in treating clients is still an open question. With reference to this finding, Macdonald and Mellor-Clark (2014) argue that clinicians work more effectively when they are more conscious of challenges and uncertainties of their work and less blinded by their own competence: ‘Therapists who are more aware of their natural limitations, and more realistic about the likelihood of poorer client outcomes, are more alert to indications that their clients are “off-track”, enabling them more frequently to resolve barriers to therapeutic progress’.
Professional self-doubt is a factor consisting of nine items originally included in the the large-scale survey, Development of Psychotherapists Common Core Questionnaire (DPCCQ), which measures difficulties in practice by means of statements describing typical challenges in psychotherapy practice. These difficulty types were originally identified through a qualitative research process in which the researchers constructed a consensual set of experimental categories that could reliably be applied to describe accounts of difficulties they experienced as clinicians (Daviset al.,1987a). Principal component analyses on the responses provided by 4923 psychotherapists to this questionnaire yielded the PSD factor and two others (Orlinsky & Rønnestad, 2005). The PSD factor has a high internal consistency score in a general sample of therapists (Cronbach’s alpha = 0.90; Nissen-Lie et al., 2017).
Research has shown that psychotherapy trainees and therapists experience considerable professional self-doubt (e.g., trainees: M = 1.52, SD = .94; Odyniec et al., 2019; or licensed therapists; M = 1.24, SD = .70; Nissen-Lie et al., 2013). These means and standard deviations are used to create percentiles for useful comparison of a respondents score to typical patterns of responding.
A total professional self doubt average score between 0 and 5 is presented, indicating the general level of agreement on the Likert scale (0 = never, 5 = very often). This score is calculated by averaging the responses to the nine questions, with high scores indicating more professional self doubt (PSD).
Professional Self Doubt (PSD) is defined as healthy self-criticism and ability to be open, sensitive, reflexive and taking responsibility for relationship struggles in therapy.
As well as the average score, percentiles are presented in comparison to psychotherapy trainees and experienced therapists, providing a useful way to contextualise a respondents scores against typical patterns of responding. A Trainee Percentile of 50 represents average professional self doubt among people enrolled in a masters program. Likewise, an Experienced Percentile compares a respondents score against well established psychological therapists.
Percentile scores below the 10th percentile or above the 90th percentile are of particular note, and indicate that PSD signficantly interacts with work satisfaction, performance, self reflective practices and professional identity.
Moderately high levels of professional self doubt (PSD) predict better patient outcomes and may be used as an antidote to inaccurate self-appraisal (Nissen-Lie, Monsen, Ulleberg, & Rønnestad, 2013; Nissen-Lie et al., 2017). High PSD scores are associated with higher patient alliance evaluations and therapeutic change (Nissen-Lie, et al., 2015)
Among therapists, PSD, especially when coupled with self-compassion, has shown to be positively related to patient progress in treatment (Nissen-Lie et al., 2013); however, in trainees a decrease in professional doubt over treatment appears to be related to more positive patient improvement (Odyniec, Probst, Margraf, & Willutzki, 2019).
Particularly low scores in the context of training or supervision may be indicative of defensiveness, nervousness about unfavourable supervisor evaluation or concern that the scale is being used as a measure of professional competence. It is therefore important to interpret results in light of the trust established between assessor and respondent and the context in which it was administered.
The reasons why self-doubt is a constructive and beneficial aspect of a therapists’ repertoire in treating clients is still an open question. With reference to this finding, Macdonald and Mellor-Clark (2014) argue that clinicians work more effectively when they are more conscious of challenges and uncertainties of their work and less blinded by their own competence: ‘Therapists who are more aware of their natural limitations, and more realistic about the likelihood of poorer client outcomes, are more alert to indications that their clients are “off-track”, enabling them more frequently to resolve barriers to therapeutic progress’. Tracey et al. (2014) reason that PSD may ‘encompass a critical evaluation of one’s work from a disconfirming stance’ (p. 225). The constructive consequence of a self-critical stance is also consistent with the thinking of Baltes and Smith (1990) who suggested an attitude of ‘uncertainty’ as one criterion of wisdom, and with Rønnestad and Skovholt (1991), who suggested ‘awareness of the complexity of therapeutic work’ (Rønnestad & Skovholt, 2013) as a characteristic of optimal professional development.
Nissen-Lie, H. A., Monsen, J. T., & Rønnestad, M. H. (2010). Therapist predictors of early patient-rated working alliance: a multilevel approach. Psychotherapy research : journal of the Society for Psychotherapy Research, 20(6), 627–646. https://doi.org/10.1080/10503307.2010.497633
Nissen-Lie, H. A., Havik, O. E., Høglend, P. A., Rønnestad, M. H., & Monsen, J. T. (2015). Patient and therapist perspectives on alliance development: therapists’ practice experiences as predictors. Clinical Psychology & Psychotherapy, 22(4), 317–327. https://doi.org/10.1002/cpp.1891
Nissen-Lie, H. A., Monsen, J. T., Ulleberg, P., & Rønnestad, M. H. (2013). Psychotherapists’ self-reports of their interpersonal functioning and difficulties in practice as predictors of patient outcome. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 23(1), 86–104. https://doi.org/10.1080/10503307.2012.735775
Nissen-Lie, H. A., Rønnestad, M. H., Høglend, P. A., Havik, O. E., Solbakken, O. A., Stiles, T. C., & Monsen, J. T. (2017). Love Yourself as a Person, Doubt Yourself as a Therapist? Clinical Psychology & Psychotherapy, 24(1), 48–60. https://doi.org/10.1002/cpp.1977
Odyniec, P., Probst, T., Margraf, J., & Willutzki, U. (2019). Psychotherapist trainees’ professional self-doubt and negative personal reaction: Changes during cognitive behavioral therapy and association with patient progress. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 29(1), 123–138. https://doi.org/10.1080/10503307.2017.1315464
Orlinsky, D. E., & Rønnestad, M. H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth.
Rønnestad, M. H., & Skovholt, T. M. (2013). The developing practitioner: Growth and stagnation of therapists and counselors. Routledge.