Dr. Randy Paterson: “Most things don’t work”

Praise publicly, criticize privately. This principle seems like such an elementary aspect of management and leadership that it should go without saying. Not so, sadly. When criticism — even nicely worded constructive criticism — is given in the presence of others, the attention of the receiver is invariably divided between the feedback being given and […]

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Praise publicly, criticize privately. This principle seems like such an elementary aspect of management and leadership that it should go without saying. Not so, sadly. When criticism — even nicely worded constructive criticism — is given in the presence of others, the attention of the receiver is invariably divided between the feedback being given and the impression being developed by the observers. We want the receiver’s full attention so that they can glean our meaning and take appropriate action. To get it we need to eliminate the sense of self-consciousness and real or anticipated humiliation. Get them alone.

Asa part of our series about “How To Give Honest Feedback without Being Hurtful”, I had the pleasure of interviewing Dr. Randy Paterson.

Randy Paterson is a Canadian psychologist, author (The Assertiveness Workbook, How to be Miserable: 40 Strategies You Already Use, How to be Miserable in Your Twenties), and vlogger (YouTube’s How to be Miserable channel). He owns and operates Changeways Clinic, one of Vancouver’s largest private outpatient clinics. He provides training in psychotherapy and practice management to mental health providers across Canada and internationally, both in-person and via online courses at his school.

Thank you so much for joining us! Our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

Inthe early 1990s, I took on a position at a Vancouver hospital as director of their depression self-management program for patients who had been recently discharged from inpatient care. Our role was to help them learn more about depression and the lifestyle changes that could help alleviate symptoms and reduce the risk of relapse. Our team quickly learned that many of these individuals were in dire need of better assertiveness skills in order to get a sense of control or agency in their own lives. I wrote a manual of communication skills that was eventually reworked for the general public and published as The Assertiveness Workbook, which has been one of the top-selling assertiveness books ever since.

In the early 2000s, I left the hospital system to found Changeways Clinic, which provides outpatient psychotherapy services to individuals experiencing a wide variety of challenges in their lives. In running the clinic I made mistake after mistake until this gave me the expertise I needed to write a manual on operating this type of business (Private Practice Made Simple). Now I offer courses and one-to-one coaching on practice management to other professionals.

What do you think makes your company stand out? Can you share a story?

Our clinic is made up of some of the most accomplished cognitive-behavioral therapists in our region. We’ve chosen to narrow our focus to the provision of CBT and closely related therapies rather than being too broad in our approach — offering anything from psychoanalysis to reiki. This has allowed our referral sources to know pretty well what their patients will receive when they come through our doors. They’re able to predict the quality of the work just by virtue of the fact that their patient is coming to Changeways, regardless of whether they are familiar with the particular clinician involved. As well, being such a large clinic with people who focus on different client concerns (depression, chronic health complaints, eating disorders, and so on) is a boon to referrers. They don’t have to remember fifteen different psychologists and their contact information in order to refer to a client. They can say to their support staff “Refer this person to Changeways; they’ll have someone who can help with this patient’s concern.”

Can you share the most interesting story that happened to you since you started your career?

Late in my time with the hospital system I was feeling quite dissatisfied with the stresses of working as a cog in a large organization. I was cycling on Saltspring Island (off the coast of Vancouver) when a deer was hit by a car coming the other way. It flew upward through the air, hitting me on my bike and landing me in hospital. I took this somewhat bizarre accident as a sign that anything can happen, and that your life can change in an instant. I think that was the push I needed to take the leap, give up a fairly secure position, and launch out on my own as the owner of my own business. Fortunately, that has worked out well.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

I was trained in a very strongly research-based program that emphasized the empirical support for various interventions. Early on in a practicum setting at a hospital, I had a client with an anxiety-related concern that I knew could benefit from progressive muscle relaxation (PMR). I knew the research literature back to front and there was no question that PMR had strong support for her concern. Somehow — and I still can’t figure out how I let this happen — I managed to get into the room with the client before realizing that I didn’t actually know how to conduct the training. I’d been taught what worked, but not how to carry it out.

Since that embarrassing experience, I’ve divided a lot of clinical information into two categories: outcome and process. And in the training I’ve given to others I’ve put a strong emphasis on the “how” of therapy. What do you say first, what concepts help the client along, which order do you do things in, and so on. I’ve been to therapy seminars that have spent the entire time discussing the studies backing up the intervention and no time at all on the practical side. I’ve opted to stress the how-to elements of therapy.

What advice would you give to other CEOs and business leaders to help their employees to thrive and avoid burnout?

I am an inveterate advice-giver; we could be here all day if I really got started. So allow me to focus on just one concept.

Managers often see themselves as “agents of change” and lament the fact that staff doesn’t welcome change with open arms. But I have the perspective of someone who talks openly and in-depth with both managers and staff within large organizations. In fact, staff often agitate in favor of a change, rather than opposing it. They tend to reject or resist change, however, when the rationale for it is poorly explained, or when change is imposed arbitrarily as a way for new managers to “put their stamp” on a team. It takes time and energy to develop a system to perform work functions, and once one has adapted to a new way of doing things it becomes much easier. In order for change to be welcomed, the eventual resumption of a relatively smooth and eventually-familiar way of doing things must be anticipated.

One of the theories of the origin of clinical depression involves learned helplessness: the sense that the events of one’s life are out of one’s own control; that we are simply pushed by currents of others’ devising. In many work environments, a sense of learned helplessness (and consequent burnout, disillusionment, or passive resistance) is inadvertently created by managers imposing change without consultation or a viable rationale other than “it’s what I want” or “it’s a part of the latest management fad.” Many of these same managers who complain about change-resistant staff would themselves be up in arms if a superior waltzed into their office and said: “I’m going to shift all your responsibilities and ways of doing things and up-end your longer-term planning — mainly because I have the power and I can.”

How do you define “Leadership”? Can you explain what you mean or give an example?

Leadership is essentially a service position and, to a great extent, a servant position. Other members of the organization actually carry out the work and function of the business (be that selling burgers, providing psychotherapy, building cars, or designing apps). The leader has a great deal of input on the tasks the organization tackles, but most of the task involves clearing the road and organizing systems so that the prime producers can get the job done.

In my work, I often talk about how to release and relieve stress. As a busy leader, what do you do to prepare your mind and body before a stressful or high stakes meeting, talk, or decision? Can you share a story or some examples?

There are dozens of stress-reduction techniques, and I’ve both used and taught many of them — from diaphragmatic breathing to cognitive restructuring to mindfulness meditation. One of the most important is to notice where you are devoting your mental energy. If you focus on “what will that other person do?” or “what if this doesn’t work?” in a worrying (rather than problem-solving) manner, increased stress is inevitable. The stress response gets activated by perceiving that a task may be beyond your capabilities to manage. If you are focussed on aspects of the situation that are objectively out of your control, you’re in effect flipping the “on” switch of stress.

The task in difficult situations is twofold: First, we need to refocus on what we can actually control ourselves: prepare for the meeting, learn your content, develop a Plan B, have a contingency scenario, and so on. Second, we need to consciously surrender control over what cannot be controlled. “Then we’ll let them do what they want.” “It might work; it might not; and I’ll survive either way.” “I can’t predict what the market will do; I can only prepare for my best guess.”

In my own case, my large psychotherapy practice was disrupted, like so many other organizations, by the onset of Covid-19. Within days of my return from a week’s vacation, our intensively face-to-face enterprise had to be completely reoriented to remote work for myself and for a great number of clinicians, many of whom were not altogether tech-savvy. It was unclear how many of our clients would want therapy delivered in this way, how long we would have to practice remotely, and whether my clinicians would manage the transition well. I had to do what I could to smooth the path for them, but then leave the uncontrollable more or less up to the fates. It was entirely possible that our fixed expenses (which actually rose during the crisis as we paid for more equipment and various online accounts) would vastly outstrip revenues and the service would eventually slide deep into the red.

As it turns out, this did not happen and we seem to have come back stronger than before: our clients stuck with us, many preferring to have their appointments in their own homes, and we have increased our capacity to offer services to the entire province rather than being restricted to those within commuting range of our office. This happy outcome might not have happened if I had spent my time fretting about what might happen rather than working through the less dramatic series of tasks to position us for what we could do under the restrictions of this time.

Ok, let’s jump to the core of our interview. Can you briefly tell our readers about your experience with managing a team and giving feedback?

These are to some extent separable questions. For many years in the hospital setting, I supervised predoctoral interns in their practice of psychotherapy. This involves a degree of, at times, micromanagement that many businesses don’t need to worry about. I have had to provide direction on all aspects of the encounter down to details of seating position, posture, the wording of questions, the time spent in silence, and how to convey attention or elicit information using pauses or shifts of expression. Students and I would watch videos of their work with clients, stopping and starting the playback and seldom getting more than ten minutes viewed in an hour’s supervision session.

The feedback in these situations involved an activity that was central to the interns’ self-image, sense of competence, and future success, and so had to be delivered both precisely and in a way that would not cause them to close up into defensiveness. I didn’t realize it at the time, but this was the useful practice to help me improve the feedback I was able to give clients when it was required, and it helped immensely later on when having to manage a team of psychologists and support staff, each of whom might be dealing with different priorities and concerns.

This might seem intuitive but it will be constructive to spell it out. Can you share with us a few reasons why giving honest and direct feedback is essential to being an effective leader?

Your question reminds me of a point I make in my courses on assertiveness and private practice management. Imagine that you are training archers. You provide them with bows, arrows, and a target fifty meters away that for some reason they cannot see. Perhaps we have blindfolded them. Each fires a thousand arrows. Are they any more accurate with the last dozen than the first?

The answer, of course, is no. They have no way of adjusting their efforts because they cannot tell what their outcomes are with each successive arrow. It’s only the knowledge of where their arrows have landed relative to the target that lets them shift to left or right, up or down.

In archery, of course, we might just remove the blindfold and let them collect their own feedback (though if we are more experienced archers we could still offer advice about footing and posture). In an organizational setting, self-assessment is almost never sufficient. The outcomes are not as readily apparent as the distance of an arrow from the mark. An employee may not have a clear idea of how a presentation went, how an email was received, whether a departing customer is satisfied, or enraged. Providing that feedback, or creating a system in which it is collected and delivered to the team member, is critical to the success of the organization and the development of the individual.

One of the trickiest parts of managing a team is giving honest feedback, in a way that doesn’t come across as too harsh. Can you please share with us five suggestions about how to best give constructive criticism to a remote employee? Kindly share a story or example for each.

Give feedback on behavior, not character. The only reason to give feedback is to produce change, and we can only change things we can control. We can change what we do, but not who we are. “Be smarter about this” is pointless feedback: what are they going to do, perform brain surgery on themselves? Likewise “be more respectful of the customer.” You are intuiting that they are not feeling this respect based solely on what you observe in their behavior, so don’t talk about the imaginary, talk about the actual. What are they doing that suggests a lack of respect?

Your feelings are irrelevant. I often observe people providing feedback that is more about the emotions of the provider than the actions of the receiver. “I just sensed that it wasn’t going well” is unhelpful because it doesn’t indicate what the individual did that might have given that impression, nor what they could do differently that would give a better one.

Focus on the goal. Behavior and performance tend to be goal-directed. We give constructive feedback when the behavior isn’t reaching the intended goal, or could reach it more effectively another way. “I think you should do it more like this” might be moderately helpful in some situations, but, “I think that if you do x, then y will happen” is almost always better because it links action to outcome. In this formula, “y” is always a statement related to the goal of the action. “If you trim the length of this email, Franklin will be more likely to read it and respond.” Or, in my own work, “If you maintain eye contact and don’t nod so soon, your client will fill in more of the details.”

Include the positive. One of the primary barriers to effective feedback is the defensiveness of the receiver. The defenses go up in response to a sense of threat, often because the receiver is imagining the backstory behind the feedback being direr than it is. A suggestion that they use spellcheck, for example, can be taken as a complete rejection of a manuscript. By providing feedback on positive elements as well as those that could use improvement, you encase the feedback within boundaries and reduce this tendency. “I really like the detail in the analysis, and the table on page 12 is crystal clear. But for the VP you need to add an executive summary at the beginning.”

Praise publicly, criticize privately. This principle seems like such an elementary aspect of management and leadership that it should go without saying. Not so, sadly. When criticism — even nicely worded constructive criticism — is given in the presence of others, the attention of the receiver is invariably divided between the feedback being given and the impression being developed by the observers. We want the receiver’s full attention so that they can glean our meaning and take appropriate action. To get it we need to eliminate the sense of self-consciousness and real or anticipated humiliation. Get them alone.

Can you address how to give constructive feedback over email? If someone is in front of you much of the nuance can be picked up in facial expressions and body language. But not when someone is remote.

How do you prevent the email from sounding too critical or harsh?

In order to reduce the sense of threat, many of us offer constructive feedback in a casual or offhand tone. This can work well, depending on the situation. But email does not convey tone! When you write it and read it back to yourself, you automatically superimpose the tone that you intended. Your reader will not — and cannot — know which of the possible tones you meant. Consequently, the key to email is clarity. Humour, for almost all emails involving corrective feedback, is out.

The best way to overcome the tone deficit in an email is to ramp up the inclusion of balancing positives, where possible. Be precise. And where possible spin positive elements forward into the corrective feedback. “Page 4 2nd paragraph makes an excellent point that I had not considered. I’d like to see this repeated in the conclusions and in the summary.”

In your experience, is there a best time to give feedback or critique? Should it be immediately after an incident? Should it be at a different time? Should it be at set intervals? Can you explain what you mean?

I think the answer depends very much on the specifics of the situation — particularly the receptivity of your receiver. If our junior lawyer is staggering out of a bruising hearing, now is almost certainly not the time. When the emotions of the recipient are activated, when there are others nearby, when the recipient is exhausted or otherwise distracted, give it some time. When none of these is the case and the feedback depends very much on both of you having a clear recollection of the details, sooner is generally better. If it depends on your memory of details but receiver receptivity is likely temporarily low due to extraneous factors, go off by yourself and make notes, then meet to discuss them later.

How would you define what it is to “be a great boss”? Can you share a story?

A great boss, for me, is one able to provide leadership without pulling rank — at least not often. It is a person who can consult with others without defensiveness, yet not become mired in indecision if consensus is impossible to reach. A good boss frames the goal and the options available, eliciting the expertise and skills of the individuals she or he has gathered into the organization (presumably selecting them precisely because they have such expertise and skills).

It is an individual who fully understands that an organization depends on those who actually carry out the day-to-day tasks of the enterprise and that without them the leader’s vision is just that: A vision. A fantasy. Not a reality. And, as I have suggested before, it is a person who can lead while supporting — viewing himself or herself as the trail-clearer whose job it is to make the task more achievable for those who will actually carry it out.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

I’m not sure how relevant this is to the topic of providing effective feedback — aside from the fact that I frequently chime in on issues related to the direction of the mental health field.

I would like to further the existing movement to de-pathologize much of the field of mental health, removing swathes of it from a disease model and placing it more firmly within a normality model. This would involve:

A recognition that much of life is inherently challenging and difficult, and that the perception that life is difficult is not, in itself, a mental illness.

An acceptance that anxiety, sadness, grief, disillusionment, disappointment, and loss are all standard human emotions and should not automatically be considered symptoms rather than reactions.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

Most things don’t work.” This idea is central, I think, to a successful life. We will date multiple people, apply for many jobs, try out many activities, consider many projects, and most of them will not work out the way we had hoped. This is why we need to try more than one thing, decatastrophize failure, and avoid getting overly attached to possibilities before their fruition.

How can our readers further follow your work online?

I have a YouTube vlog called How to be Miserable here: I also provide online courses for professionals and the public through my education site: My own website is In addition, my books The Assertiveness Workbook, How to be Miserable: 40 Strategies You Already Use, How to be Miserable in Your Twenties are all available through online booksellers.

Thank you for these great insights! We really appreciate the time you spent with this.

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