Finding your Learning Edge: A Deep Dive on Deliberate Practice

October 27, 2021 By scottdm 2 Comments

Therapists want to improve. In the largest, most comprehensive survey conducted to date, 86% of clinicians reported being “highly motivated” to transcend their current level of performance (1).

No wonder the arrival of deliberate practice on the professional scene has attracted so much interest. Always hungry for guidance and direction about helping their clients, most therapists say, “Just tell me what to practice and I’ll do it.” When I tell them that’s the wrong question, confusion often follows.

Historically, the mental health professions have never suffered from a shortage of experts ready and willing to tell practitioners what to do to be effective (2, 3). The premise has, and continues to be, practice this method or that technique until proficiency is reached, and professional growth is assured. In the time since the concept was first introduced to psychotherapy in our 2007 article, “Supershrinks,” a series of books and studies have appeared mistaking repetition and rehearsal of particular methods for deliberate practice.

What do practitioners need to do instead?

Prior to embarking on a course of professional development, each must answer the question, “what do I need to target to improve my particular results?” Failing to develop a therapist-specific answer to this question, all but guarantees: (1) clinician effectiveness will remain flat, as has been seen in the field for the past 40 years; or (2) decline, as studies of individual therapist outcomes shows happens, regardless of the amount of time, money and energy invested in learning something new (4, 5, 6).

The process begins with measurement. Over the last two decades, several outcome measurement systems have been developed which provide detailed metrics capable of helping each clinician establish an evidence-based profile of their work. You can download and get started using our tools for free here.

The next step is analyzing the data you accumulate — that is, looking deeply at what, where, and with whom you excel and, more importantly, where you fall short or could make improvements. And let me offer reassurance to anyone whose first response to the words, “analyzing data,” is a combination of terror and traumatic memories from graduate school stats courses. Without exception, the procedures involved are more tedious in nature than mathematically challenging.

Not long ago, I interviewed psychotherapist Michael Harloff about his efforts to identify his “learning edge.” In the video you’ll not only hear the steps he took, and the time involved, but see and obtain a copy of the tool he created to both categorize and mine his results (the payoff was amazing, by the way). If you’ve been gathering data about your clinical performance in the hopes of setting individualized deliberate practice objectives, you won’t want to miss it!

Getting in the Deliberate Practice HABIT

July 22, 2021 By scottdm Leave a Comment

Type the words, “Old habits …” into Google, and the search engine quickly adds, “die hard” and “are hard to break.” When I did it just now, these were followed by two song titles — one by Hank Williams Jr., the other by Mick Jagger — both dealing with letting go of past relationships. Alas, in love and life, breaking up is hard to do.

Like it or not, and despite our best intentions, we often end up returning to what we know. What are generally referred to as, “habits,” researchers in the field of expert performance label, “automaticity,” literally meaning thoughts and behaviors engaged in reflexively, involuntarily or unconsciously.

The evidence shows more than 40% of what we do on a daily basis is habitual in nature; that is, carried out while we’re thinking about something else (1). While such data might generate concern for most — “that’s a lot of acting without thinking” — the expertise literature indicates its absolutely essential to improving performance. Simply put, automaticity frees up our limited cognitive resources to focus on achieving performance objectives just beyond our current abilities — a process known as deliberate practice.

So, what’s your sense? How long does it typically take for new behaviors to be executed without a high degree cognitive effort?

A. 14 days

B. 21 days

C. 36 days

D. 56 days

E. 66 days

Please jot down your answer before reading further.

Did you do it?

Now, before I provide a research-based answer, would you watch the video below? (It’s fun, I promise)

Having watched the video, would you care to change your answer? With a self-reported 5-minutes of practice per day, it took Destin 8 months to achieve automaticity on his “backwards bicycle.” His experience is far from unique. Turns out, most of us — like many of those in the video who confidently seated themselves on the bike, then failed — seriously underestimate the amount of time and effort required for establishing new, more effective habits.

Somehow, somewhere, sometime, someone asserted the road to automaticity was about 21 days (3). Research actually shows it takes, on average, three times as long and, in many instances, up to 8 months (2)! Does that latter figure sound familiar? Complicating such findings is the fact that many of the “habits” studied by researchers are relatively simple in nature (e.g., drinking a bottle of water with lunch, running 15 minutes after dinner). Imagine a more complex behavior, such as learning to respond empathically to the diverse clients presenting for psychotherapy — and, just so you know, soon to be published research shows such abilities do not improve with experience nor correlate with clinicians’ estimates of their ability — and the challenge involved in improving clinical performance becomes even more apparent.

And did I mention the sense of failure, even incompetence, that frequently accompanies attempts to establish new habits? It’s understandable why so many of our efforts to improve are short lived. Frankly, its far easier to see oneself as getting better than to actually do what’s necessary long enough to improve. The evidence, reviewed previously on this blog, documents as much (4).

In our latest book, Better Results (APA, 2020), we identify a series of evidence-based steps for helping therapists develop a sustainable deliberate practice plan. Known by the acronym A.R.P.S. (5), it includes:

Automated: If you are asking yourself when, you likely never will.
Reference point: Count your steps, not your achievements.
Playful: Give in, let go, have fun.
Support: Go alone and you won’t go far

Following these steps, we’ve found, helps clinicians maintain their momentum as they apply deliberate practice in their professional development efforts. To these, I add a precursor: Change your mindset. Yeah, I know, that results in C.A.R.P.S, meaning “to find fault or complain querulously or unreasonably; be niggling in criticizing minor errors,” but that’s precisely the point. Recalling that deliberate practice is about reaching for performance objectives just beyond our current abilities, think “small and continuous improvement” rather than “achieving proficiency and mastery.”

Reducing Dropout and Unplanned Terminations in Mental Health Services

May 12, 2021 By scottdm Leave a Comment

Being a mental health professional is a lot like being a parent.

Please read that last statement carefully before drawing any conclusions!

I did not say mental health services are similar to parenting. Rather, despite their best efforts, therapists, like parents, routinely feel they fall short of their hopes and objectives. To be sure, research shows both enjoy their respective roles (1, 2). That said, they frequently are left with the sense that no matter how much they do, its never good enough. A recent poll found, for example 60% parents feel they fail their children in first years of life. And given the relatively high level of turnover on a typical clinician’s caseload — with a worldwide average of 5 to 6 sessions — what is therapy if not a kind of Goundhog Day repetition of being a new parent?

For therapists, such feelings are compounded by the number of clients who, without notice or warning, stop coming to treatment. Besides the obvious impact on productivity and income, the evidence shows such unplanned endings negatively impact clinicians’ self worth, ranking third among the top 25 most stressful client behaviors (3, p. 15).

Recent, large scale meta-analytic studies indicate one in five, or 20% (4) of clients, dropout of care — a figure that is slightly higher for adolescents and children (5). However, when defined as “clients who discontinue unilaterally without experiencing a reliable or clinically significant improvement in the problem that originally led them to seek treatment,” the rate is much higher (6)!

Feeling “not good enough” yet?

By the way, if you are thinking, “that’s not true of my caseload as hardly any of the people I see, dropout” or “my success rate is much higher than the figure just cited,” recall that parent who always acts as though their child is the cutest, smartest or most talented in class. Besides such behavior being unbecoming, it often displays a lack of awareness of the facts.

So, turning to the evidence, data indicate therapists routinely overestimate their effectiveness, with a staggering 96% ranking their outcomes “above average (7)!” And while the same “rose colored glasses” may cause us to underestimate the number of clients who terminate without notice, a more troubling reality may be the relatively large number who don’t dropout despite experiencing no measurable benefit from our work with them– up to 25%, research suggests.

What to do?

As author Alex Dumas once famously observed, “Nothing succeeds like success.” And when it comes addressing dropout, a recent, independent meta-analysis of 58 studies involving nearly 22,000 clients found Feedback-Informed Treatment (FIT) resulted in a 15% reduction in the number people who end psychotherapy without benefit (8). The same study — and another recent one (9) –documented FIT helps therapists respond more effectively to clients most at risk of staying for extended periods of time without benefit.

Will FIT prevent you from ever feeling “not good enough” again? Probably not. But as most parents with grown children say, “looking back, it was worth it.”