By embracing deliberate practice you could be able to apply key concepts in outcomes measurement to an understanding of your own personal performance in your practice, as well as develop your own personal learning project to boost effectiveness in your role as a therapist. You could apply the concept of deliberate practice to better navigate your own choices in continuing professional development (CPD) opportunities and perhaps, more importantly, better use your own clinical supervision sessions in order to boost your professional performance.
Psychotherapy training invariably follows a therapeutic monoculture and a ‘schoolist’ approach, which is often non-integrative, whereby adherents of a particular orientation of therapy become entrenched in the ‘correct’ way of how therapy works. In these environments practice does not make perfect, but rather it can actually make permanent. The ‘schoolist’ approach to training can follow a normative route that spells out the trajectory of how a trainee should develop in their learning. This can entail trainees having the same orientation of therapist and supervisor whilst in training and further into their careers. This is perhaps as it should be as a trainee is learning a particular approach and, therefore, it seems appropriate that their therapist and supervisor is aligned to their way of working, particularly when still in training. However, when trainees graduate and enter the real world of working as a therapist, particularly in the private sector, there can still be an unhealthy over commitment to their own particular training modality/approach. Practically, this can mean that they stay committed to a supervisor from their own school, and their CPD is often rigidly informed by their own school or institute.
I often wonder how people develop their own excellence as a practitioner if they continue to adhere to the same perspectives of their training. For example, a ‘schoolist’ therapist will often have a similar therapist to themselves, as well as a supervisor that echoes their approach, and their CPD programme will often be heavily focused by that approach. I wonder if this style of development falls victim to the trap of practice making permanent. Rather than being open to different ways of working and fresh perspectives there can often be a rigid compliance to a perceived ‘right way’ of doing things. Why, for example, could they not seek supervision from a different approach, or find CPD opportunities that might offer them a fresh perspective? By strictly adhering to one school, there might be some form of training scars that are not being addressed. Deliberate practice, on the other hand, is not about repetition, per se, but rather it is more expansive and helps boost clinical effectiveness and personal growth.
So what is deliberate practice?
Put simply deliberate practice is essentially a methodological way of learning what to do and to do it better. Therapists invariably over-estimate their own effectiveness and measurement of their performance can be a reality check. The research shows that some therapists consistently achieve better results than their colleagues operating under the same conditions. A 5-9% differential in effectiveness is unrelated to age, gender and case-load. So, therefore, a useful question is to ask is what are the more effective therapists doing that the less effective ones are not doing.
Anders Ericsson, a Swedish psychologist, began to address this question. He had been writing about expertise in various areas of performance but no one had ever asked him about the variance associated with the performance of individual mental health practice. Ericsson had been looking at how expertise occurs in many different fields and he defined 3 types of practice, with deliberate practice being the way of working that offered most expansion:
- Naive – Like learning to drive. We undertake tasks in a casual manner. Once proficiency is achieved there is no longer a commitment to performance improvement.
- Purposeful – This is were we have a goal to judge ourselves by and we identify the steps to achieve that goal. We repeatedly undertake tasks to achieve said goal.
- Deliberate – Dedicating time in your week reaching for objectives and performance improvement which might be just above your current ability. Proficiency is not the target. When you are seeing a supervisor from your own approach the tendency is that your performance is related to what you ‘should’ be doing, rather than what you ‘could’ be doing. It will get you through your accreditation hearings but will it really boost your performance. If you are doing what you are meant to be doing then you will most likely receive a pass. But how could you identify your performance edge? What could be your personal learning objectives plan? Successful refinement can come about from performance feedback and the repetition of learning feedback and this is often not addressed in standard supervisory relationships.
How to start the process of deliberate practice?
Deliberate practice tends to be amongst a select few of new buzz words in counselling and psychotherapy circles without a great deal of freely available resources to help navigate a potentially complex area. A good starting place is to have a flexible and open attitude to de-construct your practice and to be receptive to greater levels of feedback from the people you work with. Allowing yourself to be feel de-skilled is probably a good place to start. Useful questions might be: why do you use the interventions you make, which theories do you hold, how does your own personal experience of therapy as a patient inform your practice, where is your emphasis in the way you work and how do you assess new people.
- MEASURE – Need for measurement. There are many simple tools that can help with measurement but first it might be that you acknowledge that your existing practice needs to be re-examined. Allowing yourself to be feel de-skilled is probably a good place to start.
- MAP – Lay out in a step by step manner how you work. Why do you do the things you do?
- MODIFY – Allow feedback to inform you what works, and what doesn’t work. Perhaps you do less well with particular people or particular presenting issues. Why might these be? Could you target a personal learning plan to address your performance edge?
Clinical practice is within the four walls of the consulting room. Automaticity is probably required IN the room with the people you are seeing, when you want to go with the flow. Seeking to do things differently in the moment is not deliberate practice. Rather, deliberate practice is what happens outside the four walls of your practice. How do you prepare for sessions, how do you assess patients, what do you do post session, how do you identify your own specific learning needs, how to target CPD opportunities specifically related to your performance edge (rather than selecting CPD units just because your institute stipulates them), and how to more creatively use clinical supervision? Purposeful practice might have a number of these features, but deliberate practice is not about picking one skill and doing it over and over again.
Deliberate practice is specifically targeting an area of your personal performance that needs improvement. You know this from detailed feedback from the people you work with. You might recruit a coach of some sort who would help you to boost your performance so that you can improve your outcomes and ultimately your effectiveness. Think of the analogy of performing on a stage. Deliberate practice is not just concerned with the time on stage but rather how you prepare for the performance, what you do backstage, what you do after the show and how you follow up the issues that were presented during the performance. Useful questions might be how you can boost your performance by addressing particular aspects of your time on stage.
Another useful analogy could be that of a tailor. Top performing practitioners will be like the tailor who wants to know if your suit really fits. They will want to know where the tight bits are, or where the length is not quite right, and their ongoing work will be focused on that feedback so that the suit ends up fitting more comfortably. The tailor is welcoming detailed feedback and does not defensively object to hearing what works and what does not work. Indeed, such feedback helps the tailor to do their job more effectively.
I was trained in an integrative way and I believe that I benefited from an open enquiry perspective where there was an absence of a ‘schoolist’ approach and a stereotypical chart that represented a normative trajectory of development for a trainee. But even here there was no real attention to outcomes measurement or what other schools were doing, even other transpersonal integrative schools for that matter, who were deemed ‘foreign’. Therapists tended to stick to a particular way of working and there was also a misconceived belief that experience was the same as effectiveness. I recall supervisors saying, for example, that they were practising for decades when asked about their own supervision training (and, therefore, by implication knew what they were doing by virtue of having such experience). I have found that such attitudes tend to pervade the counselling and psychotherapy world, that because of extensive experience there is, therefore, no need for outcomes measurement. The implied assumption can be that as therapists they are making the right interventions and working in a ‘correct’ way without really asking how the experience is for the patient.
Are you looking to boost your professional performance and keen to know more about the concepts of deliberate practice? Watch this space for upcoming CPD training opportunities in this area.
Noel Bell is a UKCP accredited psychotherapist based in London.
