Staff Perspective: Practice makes … improvement … if we are deliberate!
Over the last year, I’ve been involved in a research project that looks at the effect of regular consultation on a therapists skill in delivering treatments like Cognitive Processing Therapy (CPT) and Cognitive Behavioral Therapy for Insomnia (CBT-I). Through the course of this project I’ve been thinking a lot about how we as therapists can improve in our craft over time. There is value in general experience, but experience alone is often insufficient to really improve.
Therapy is a unique activity. It is generally done in a highly private manner with little opportunity for feedback. In our graduate training we are observed and sometimes record sessions for review and feedback by our supervisors. Also, the level of direct observation and feedback is highly variable from one program to another, and once we graduate, this form of supervision generally ceases. Even if there is continued supervision it is often not direct observation with feedback, but a discussion of the patient with recommendations from the supervisor. However, over the course of our career, new treatments will be developed with new approaches and techniques. So how do we learn and master the skills and techniques associated with good therapy?
This is where I started to explore and learn about the concept of Deliberate Practice. Deliberate Practice is the intentional practice of specific skills, often with an expert or teachers help. It is repeated with feedback and can be a highly demanding mental activity. The concept has been made popular by the Malcolm Gladwell book Outliers. In the book, Gladwell refers to the research done by Anders Ericsson and colleague in 1993 “The Role of Deliberate Practice in the Acquisition of Expert Performance” and the “10,000 hour rule.” This rule suggests that 10,000 hours of practice in a discipline will produce expertise. However, this research is often misinterpreted and inappropriately applied. The key factor to consider is right in the name of the research article. Expertise is generally produced by high levels of deliberate practice.
So how do we engage in the act of deliberate practice in the field of psychotherapy? This is where the work of Tony Rousmaniere, Psy.D. has focused. Dr. Rousmaniere is the author of several books that focus of the topics of deliberate practice with psychotherapy and has founded Sentio University, which incorporates “skill-focused experiential Deliberate Practice training” as a central component of their educational model for an MFT program. The university also provides deliberate practice exercises that therapists can use to develop their own skill and competence in specific areas. They have developed practice exercises that focus on both general skills (validation, collaborative goal setting and providing a treatment rationale) to more model specific exercises (using CBT to work with problematic thoughts). The goal of this is to break down what we are doing into discrete components and then practice … deliberately.
Providing trauma therapy can be challenging and daunting for therapists. It requires the therapist to have a strong understanding of the theoretical framework of the treatment protocol, mastery of the foundational skills associated with the treatment and comfort working with the trauma content. But, if we start to think about the discrete components of the treatment and engage in deliberate practice, this can all become more manageable. We can start by breaking things down, first in the more general. For example, “How to explain what PTSD is”, “Answering common questions that patients have about PTSD” and “How to explain treatment options and the rationale for those treatments.” You can start by simply recording yourself, listen to it, do it again. Make sure that you are accurately describing the theory. You can chose to engage the feedback of a trusted colleague or expert in the field. From there you can apply the same process to different treatment modalities. If we take CPT as an example, start with explaining cognitive theory and answering common questions, record and repeat. Apply this to introducing stuck points, ABC worksheets, etc. Take it one step at a time, evaluate yourself, get feedback from others.
Being a therapist is a lifelong journey of learning where graduate school is just the beginning of that journey. Participating in the trainings that we provide is a fantastic step in gaining greater knowledge, but to become an expert… it takes deliberate practice. Give it a shot and let us know how we can help in your journey!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Jeff Mann, Psy.D. is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences (USU) in Bethesda, Maryland.
Over the last year, I’ve been involved in a research project that looks at the effect of regular consultation on a therapists skill in delivering treatments like Cognitive Processing Therapy (CPT) and Cognitive Behavioral Therapy for Insomnia (CBT-I). Through the course of this project I’ve been thinking a lot about how we as therapists can improve in our craft over time. There is value in general experience, but experience alone is often insufficient to really improve.
Therapy is a unique activity. It is generally done in a highly private manner with little opportunity for feedback. In our graduate training we are observed and sometimes record sessions for review and feedback by our supervisors. Also, the level of direct observation and feedback is highly variable from one program to another, and once we graduate, this form of supervision generally ceases. Even if there is continued supervision it is often not direct observation with feedback, but a discussion of the patient with recommendations from the supervisor. However, over the course of our career, new treatments will be developed with new approaches and techniques. So how do we learn and master the skills and techniques associated with good therapy?
This is where I started to explore and learn about the concept of Deliberate Practice. Deliberate Practice is the intentional practice of specific skills, often with an expert or teachers help. It is repeated with feedback and can be a highly demanding mental activity. The concept has been made popular by the Malcolm Gladwell book Outliers. In the book, Gladwell refers to the research done by Anders Ericsson and colleague in 1993 “The Role of Deliberate Practice in the Acquisition of Expert Performance” and the “10,000 hour rule.” This rule suggests that 10,000 hours of practice in a discipline will produce expertise. However, this research is often misinterpreted and inappropriately applied. The key factor to consider is right in the name of the research article. Expertise is generally produced by high levels of deliberate practice.
So how do we engage in the act of deliberate practice in the field of psychotherapy? This is where the work of Tony Rousmaniere, Psy.D. has focused. Dr. Rousmaniere is the author of several books that focus of the topics of deliberate practice with psychotherapy and has founded Sentio University, which incorporates “skill-focused experiential Deliberate Practice training” as a central component of their educational model for an MFT program. The university also provides deliberate practice exercises that therapists can use to develop their own skill and competence in specific areas. They have developed practice exercises that focus on both general skills (validation, collaborative goal setting and providing a treatment rationale) to more model specific exercises (using CBT to work with problematic thoughts). The goal of this is to break down what we are doing into discrete components and then practice … deliberately.
Providing trauma therapy can be challenging and daunting for therapists. It requires the therapist to have a strong understanding of the theoretical framework of the treatment protocol, mastery of the foundational skills associated with the treatment and comfort working with the trauma content. But, if we start to think about the discrete components of the treatment and engage in deliberate practice, this can all become more manageable. We can start by breaking things down, first in the more general. For example, “How to explain what PTSD is”, “Answering common questions that patients have about PTSD” and “How to explain treatment options and the rationale for those treatments.” You can start by simply recording yourself, listen to it, do it again. Make sure that you are accurately describing the theory. You can chose to engage the feedback of a trusted colleague or expert in the field. From there you can apply the same process to different treatment modalities. If we take CPT as an example, start with explaining cognitive theory and answering common questions, record and repeat. Apply this to introducing stuck points, ABC worksheets, etc. Take it one step at a time, evaluate yourself, get feedback from others.
Being a therapist is a lifelong journey of learning where graduate school is just the beginning of that journey. Participating in the trainings that we provide is a fantastic step in gaining greater knowledge, but to become an expert… it takes deliberate practice. Give it a shot and let us know how we can help in your journey!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Jeff Mann, Psy.D. is a Military Behavioral Health Psychologist at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences (USU) in Bethesda, Maryland.