Some time ago, my son had a minor obsession. Whether at the dinner table, in the car, or out for a walk, he was constantly peppering us with, “would you rather” questions? You know the ones I mean, where you are forced to choose between two equally bizarre or unpleasant alternatives?
“Would you rather always have to say everything that is on your mind or never be able to speak again?”
“Would you rather have the hiccoughs the rest of your life or always feel like you have to sneeze but not be able to?”
And finally:
“Would you rather smell like poop and not know it or know you smell like poop but others can’t smell it?”
Fast forward to today. 
I was re-reading some recent research on the use of deliberate practice (DP) for improving individual clinician effectiveness. As I’ve blogged about previously , one of the four crucial components of DP is feedback. Not just any kind of mind you, but negative feedback–in particular, immediate, ongoing information regarding one’s errors and mistakes.
Put bluntly, receiving negative feedback is hard on the ego. Despite what we may say or believe, a mountain of literature documents we all possess a strong need for social approval as well as a bias toward attributing positive traits to ourselves.
The same research shows that, beyond selective recall and well-known biases 
associated with self-assessment, we actively work to limit information that conflicts with how we prefer to see ourselves (e.g., capable versus incompetent, perceptive versus obtuse, intuitive versus plodding, effective versus ineffective, etc.).
As a brief example of just how insidious ours efforts can be, consider an email sent out by the customer service department at a Honda dealership in Richmond, Virginia.
“As you may know,” it began, “we have a wide range of services performed here at our location and strive to do the best we can to accomodate each and everyone of our customers.” A request for feedback followed, “There may be times we can not meet the needs and we would appreciate any feedback . . . for our company.”
So far so good. The company was on the way to showing its customers that it cared. It had sent a follow-up email. It thanked its customers. Most importantly, it invited them to provide the type of feedback necessary for improving service in the future.
The correspondence then ended, telling the recipient they would soon receive a survey which, “If you enjoyed or were satisfied with your recent visit and provide a 100% score you will receive a FREE oil change.”
Amazing, eh? Thanks to my long-time colleague and friend, Arnold Woodruff, for noticing the irony in the email and passing it on to me.
For whatever reason, on reading it, one of those “would you rather” questions immediately came to my mind:
“Would you rather be approved or improved?”
No waffling now. There is no in-between. I can hear my son saying, “you have to choose!”
Why not join me and colleagues from around the world who are “choosing to improve” for our two-day intensive on deliberate practice. Together with Dr. Tony Rousmaniere–the author of the new book Deliberate Practice for Psychotherapists—you’ll learn the latest, evidence-based strategies for improving your effectiveness. Register today, by clicking here, or on the image below.
Until next time,
Scott D. Miller, Ph.D.
International Center for Clinical Effectiveness
I still have many sessions after which I am unable to obtain negative feedback or worse still, sessions after which I feel or “know” I’ve done a “bad” job and because I already “know this”, don’t seek feedback at all!
I have found that one way of getting around this is to have students sitting in my sessions. I have found them very forthcoming with feedback… Today for instance, a student reviewed how there were periods where my session became “lecturey” and how on another occassion, I got confused with my rationale! It was highlighted to me that the client was noticeably disengaged during these sections. On the other hand, there were also parts of my session where my client was really engaged in a discussion that appeared reciprocal.
Despite the varying quality in my interactions with the client, I got almost full ratings on the SRS and despite three attempts at eliciting feedback, got none other than “I thought today was helpful.”
Now, if I could just motivate myself to come up with some more feedback spiels and rehearse these, or to go back and review and rehearse the rationale I messed up, or practice covering particular topics in a manner that involves my clients more, my average outcomes just might start improving!
I like the way you think.
As a parent of 12 and 8 year old kids (and a clinical social worker) I use what we call a “Start and Stop” feedback loop with my kids – “Are there things I do you’d like me to do more of (start)… things I do that you’d like me to do less of. (stop)” Like clients, with an openness on my end, they’re pretty open to giving (and receiving) feedback. As a believer in your Heroic Client / FIT approach, I figure if FIT can improve outcomes with my clients, it probably can do likewise with my children! So with respect to this post, I don’t get too hung up on / fear being “improved” by my clients by using SRS/ORS and dialogue about these tools. Their feedback helps hone my approach, and improves their outcomes, so in the end, it improves my outcomes too. Everybody wins.
Scott,
I treasure your continuing disruptive influence on the field. Let me know if and when you are in Vancouver and I will take you out to dinner.
Appreciatively,
Arden
Nice comments – nice to have a student sit in Eeuwe. Lately I have been wondering if I can take a solution focused approach to deliberate practice. As I am understanding it I am wanting to broaden my repertoire of perceptual knowledge, i.e. recognising patterns that I just respond to automatically – How much do I need to deliberate or analyse the problem versus can I try new solutions? The literature on perceptual learning is interesting in this regard.
Some years ago A clinical psychology trainer in Oxford (UK) called John Marzillier coined the term “cult of the positive” to describe the warm and cosy climate in which we grew our tender young clinicians. He feared that supervisors would avoid difficult discussions because being at all critical went against this dominant grain.
I think he was on to something important then and you are onto something important now Scott
Keep on stirring the pot!