Are Older Therapists Better?

The Dunning-Kruger effect is the tendency of poor performers to overstate their abilities and for top performers to understate them. The heart of the effect, on the underperforming-overstating side, is the observation that, in many fields of endeavor, the skills needed to evaluate one’s performance are the same skills needed to perform expertly. Thus, for example, you cannot evaluate expertise in punctuation unless you know how to punctuate correctly.

Using the metaphor of the spiral staircase (from my book, What Every Therapist Needs to Know), you can’t evaluate your place on the spiral staircase if you only look downwards at the people below you—including your prior selves, who all knew less than you do now. (It’s a spiral staircase because you keep encountering the same issues from a higher perspective. You climb it not to get to the top—there is no top—but to get to a higher perspective.) Further, the kinds of people who look only down the staircase don’t have much reason to keep climbing it—they feel as if they have summited, so they have less expertise than those higher up and don’t know it.

On the expert-understating side, the heart of the effect is more complex. It seems to derive from a combination of factors. Using the spiral staircase metaphor, expertise is attained by enjoying the adventure of learning: enjoying the climb and enjoying the process of solving the problems each step presents. Such people are looking upwards, not in despair at how far they have to go, but in the same way someone who loves puzzles is glad that they are not close to the end of the puzzle book they are enjoying.

Furthermore, hubris makes people claim to have already summited the spiral staircase, while humility leads them to climb it, and of course, prideful people are more likely to claim expertise they don’t have, and humble people are more likely to underestimate their own abilities. Lastly, those who are looking up the staircase and making progress are those who think they have a long way to go, so experts think they are running behind.

Does a Younger or Older Therapist Have More Expertise?

Just to be clear, I’d prefer a 25-year-old therapist who is excited about climbing the spiral staircase of expertise to a 60-year-old therapist who isn’t, because the young adventurer is likely to be further along than the old settler, and because the young adventurer is likely to be a better colleague to patients on their joint expedition to improve themselves.

Ageism plays a part in diminishing the expertise of older therapists. But first, let me say that I’ve long asked therapists to answer this question: If a young adult, someone you cared about, told you they had started therapy because they keep getting in their own way at work and in love, what percentage of people doing therapy would make you think that your friend or relative was in good hands?

I’ve noticed that the older the therapist I ask, the smaller the percentage they report. Most of my colleagues hover around 5 percent.

The upshot is that when older people claim expertise because of their age, they are usually mistaken, because most older people, like most people, just get more experience but not more expertise. A cook in a diner can get really good at putting out eggs, but without a feedback loop and without an incentive to improve, it’s unlikely to happen. And a cook in a diner will never attain expertise in fine dining techniques.

Older therapists should not be sought after because they are old. But, among therapists who are trying to get better at therapy every year (by reading, by holding their work up for scrutiny from themselves and others, by interpreting the ongoing stream of feedback they receive from patients and supervisees, and by examining the assumptions that drive their methods of self-evaluation), then older therapists will, of course, be more expert. Don’t you think a therapist should be better at therapy this year than last year?

Some therapists evaluate themselves and others according to which techniques they employ, but a better evaluation is based on their skills in pattern recognition, engagement of patients in the work of therapy, eagerness to admit and explore their mistakes, and whether the patients involved actually get better.

Dunning-Kruger Effect Essential Reads

How to Outsmart Yourself

Scientific Expertise vs. the Dunning-Kruger Effect

Biases in Our Judgments of Expertise

We base our judgments of expertise not only on expertise but also on how the individual plays the role. Biases can enter here; when I was young, there was an assumption that men were more competent than women to provide therapy to adults. Nowadays, women are often seen as more competent therapists.

White people used to be seen as more competent than people of color, but now we often hear that people of color are better suited to treat people of color. When I was young, people wanted a therapist older than themselves. Nowadays, when therapists are not seen as people to help you get better but as people to “validate” and “affirm” your “identities,” there’s a sense that a younger therapist is more likely to do that.

People who doubt themselves make better therapists because they will take responsibility for conflicts that arise in the treatment rather than blaming the patient or the patient’s parents. Self-doubters are almost by definition more likely to underestimate their abilities. Older people have often seen much more go wrong than younger people (which is called “wisdom”), and they may be less confident in their self-appraisals than those on a string of apparent successes.

Aside from biases deriving from identity categories, evaluations of expertise have to do with the way the person behaves. A major component of status play (per Keith Johnstone and Erving Goffman) across all situations is acting like an adult, in a way that a child cannot refrain from acting: not fidgeting, for example, or not attending to bodily needs. Older adults may communicate less than perfect control of their bodies, and this can lower their status and therefore the assessment of their expertise. They also may have infirmities, medications, and cautiousness when walking on ice, say, that communicate childishness in that sense.

People often assume that expert performance in one area implies expertise in another. The professional who can rattle off the page numbers of citations or the names of various theorists is assumed to be equally intelligent in other areas, including their clinical work. When people turn 70, there’s typically a rather dramatic decline in their processing speed and, often, information recall, which can lead to erroneous assumptions about therapy ability.

Further, older therapists may have trouble hearing in public spaces and may not like the way they are treated when they ask others to speak up. Older people may not keep up on the latest vocabulary, whether it’s “BIPOC” or “TF-CBT.” They often tend to care more about understanding than about signaling how much they understand.

People often perform expertise by namedropping, bragging, and humble bragging. I don’t hear my older colleagues doing these things nearly as much as my younger colleagues, partly because my older colleagues aren’t as active on social media. Also, my older colleagues are quite accomplished and are aware that in our group, it’s a bit status-lowering (i.e., childish) to brag (although it’s not to share delight).

Our group of seniors are also all better off financially than we were when young; a therapist who doesn’t need the money might be less likely to provide a service you don’t need or won’t benefit from, and more motivated for you to get better rather than to get hooked on validation and affirmation.

The Dunning-Kruger effect is itself a potential example of one bit of age-related behavior. It looks to me like Dunning was about 39 years old when he published the seminal article on the Dunning-Kruger effect. I can’t help but think that an older man, one who had already made his mark, or one who had reconciled with not making one, might have resisted naming this after himself, and might instead have done what my older colleagues do, which is to freely attribute their good ideas to older, often literary or philosophical, sources.

An older Dunning might have called it the Lao-Tzu effect (“other men are sharp and clever but I alone am dull and stupid”; “achieve results but never glory in them”; “a truly good man is not aware of his goodness”) or the Proverbs effect (“wisdom is with the humble”; “those who hate to be corrected are stupid”) or the Confucius effect ("To know that we know what we know, and that we do not know what we do not know, that is true knowledge”) or (my favorite, since a touchstone is a standard for making judgments) the Touchstone effect, after the character in As You Like It who quotes Socrates: “The fool doth think he is wise, but the wise man knows himself to be a fool.”