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Better Results: Using Deliberate Practice to Improve Your Therapeutic Effectiveness

March 9, 2020 By scottdm 3 Comments

SupershrinkIn 2007, my colleagues and I published an article entitled, Supershrinks: What’s the Secret of their Success?  In it, we reported on the status of our then decade long effort to understand why some psychotherapists were consistently more effective than others.  Although the phenomenon had first been reported in the mid-1970’s by psychologist David F. Ricks, accounting for the superior effectiveness of these clinicians had eluded scholarly explanation.  Our objective was as simple: figure out what the best were doing so that the rest of us could copy it and improve our results.

After many false starts and empirical dead ends, it turned out the key was “the best of the best simply work harder at improving their performance than others do” (p. 30).  Known in the expert and expertise literature as “deliberate practice,” their efforts to improve were not merely about putting in hours, but rather spending time reaching for performance objectives just beyond their level of proficiency.  Decades of research had documented the impact of deliberate practice across a wide range of human endeavors including sports, music, surgery, teaching, computer programming, and chess.  Surprisingly, despite this extensive evidence base, until the publication of our article, the term, much less the empirically-based process, had never appeared in any study or publication about psychotherapy.

Four years passed before the next publication on the subject appeared.  In The Road to Mastery, we Road to Masteryprovided an update about our research, focusing this time on the important role environment played in successful deliberate practice.  In a number of practical applications around the world, we’d discovered that, without a supportive community, the majority failed to sustain their efforts.  Turns out, deliberate practice is hard.  In the article, we described the type of, and even places where, clinicians could get the backing they needed to persevere.

In 2015, we published the very first empirical research in a peer reviewed journal on the role of deliberate practice in psychotherapy.  During the six long years the study was being conducted, we had no idea whether our earlier work would be confirmed or discredited.  Needless to say, we were pleased and relieved when the analysis of the data revealed the most effective practitioners devoted 2.5 times more hours to deliberate practice than clinicians with average outcomes.  Further analysis showed factors long thought to influence the therapist effectiveness were shown to contribute nothing, including years of experience, gender, age, professional discipline, caseload, and theoretical orientation.

By this point, many other projects were underway.

  • A review of 40 years of outcome research seeking to determine whether the overall effectiveness of psychotherapy was stagnant, improving, or declining;
  • A study of the impact of therapist experience on effectiveness;
  • A meta-analysis comparing the impact of deliberate practice versus “mere time spent” engaged in a particular activity;
  • A study investigating whether average therapists could improve their results by engaging in deliberate practice; and
  • A randomized controlled trial investigating the impact of a specific deliberate practice activity on therapist relationship skills.

The results have challenged many long held beliefs.  More importantly, however, they’ve provided the first concrete evidence of a pathway for accomplishing what had long eluded the field — reliably improving the outcomes of individual therapists.

Taking each in order, here’s what we’ve found:

  • Despite the proliferation of treatment models, the overall outcome of psychotherapy has not improved in four decades;
  • Contrary to tradition and belief, therapist effectiveness actually declines as experience in the field increases;
  • The impact of deliberate practice on performance is twice that of “mere time spent”;
  • Engaging in deliberate practice slowly, steadily and significantly improves therapist effectiveness; and
  • Targeted deliberate practice training significantly improves the acquisition and generalization of fundamental relationship skills.

Better ResultsFor those interested in the details, click here.  Complete the form (just your name and email) and I’ll send you the eight studies referenced above!  I’ll also put you on a list to be notified when our new book, Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness, is released from the American Psychological Association.  It not only summarizes the research, but lays out in step-by-step fashion how to apply the findings in your professional development efforts.

OK, that’s it for now.  Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

ICCE FIT Deliberate Practice Intensive 2020

Filed Under: Feedback Informed Treatment - FIT

Comments

  1. Laara isrshel says

    March 11, 2020 at 1:49 am

    Thank you, thank you, thank you. I first got the priviledge of hearing you speak, as you walked the room shoeless with brown socks. It was the 90s at Seattle Pacific university. Your work, research, writing and dedication has stayed with me since then. I look forward to the next generation of your work.
    Also request finding a different source for sharing your work than Amazon. They single handedly are doing significant destruction to living wages and our economy.
    Be well

    Reply
    • Omen says

      March 11, 2020 at 12:11 pm

      “The analysis of the data revealed the most effective practitioners devoted 2.5 times more hours to deliberate practice than clinicians with average outcomes”.
      Well, that is not true. That study found that the best therapists “said” they had spent more time in certain solo activities related to the practice of psychotherapy. However, in this research there is no objective measure that supports the time spent by each participant in these activities. And, more importantly, none of the activities fit the operational definition of deliberate practice. As you well know, deliberate practice is not just about practicing alone; there has to be a coach that provides feedback, a repetition and refinement, etc.
      I am pretty sure that deliberate practice in psychotherapy can be very useful, but I think you should be honest and call things by name. The work of Chow et al, while being magnificent and stimulating, has NOT shown an association between better results and deliberate practice.

      Thanks for your blog. I hope you can provide some response to my comment.

      Reply
      • scottdm says

        March 18, 2020 at 10:43 pm

        Thanks for your comment and careful reading of the paper. You are correct. Therapists said. At the same time, therapists were blind to the purpose of the inquiry and their recall of activities ended up being tied to their results in a predictable way. More, the method used is the same as has been employed in many studies of DP; that is, recalling time spent in activities and the degree of cognitive effort involved. Doing so, I believe, the study meets the standard established in research for making the connection between DP and better results. I agree many other important questions do remain unanswered, including whether involvement in DP covaries with other factors (including, but not limited, motivation, pre-existing relationship abilities, etc.), and which form of DP activities clinicians can engage in which have the most leverage on improvement. As for the “other” elements involved (including the involvement of a coach), perhaps a closer read of the study would prove helpful. Coaching of sorts was an activity respondents could engage in as well as refinement. That said, requiring that studies of DP involve all four elements individualized learning objectives, coaching, feedback, and successive refinement — which we suggested in our recent meta-analysis — is a new and as yet largely untested assumption. To date, studies have used varying definitions; again, as we point out in our recent meta-analysis. From that same study, we do know that merely spending time is not the same as DP, although studies contain varying degrees of the four elements.

        Reply

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