Deliberate Practice (and Why it Matters to Pluralistic Therapy)

Alexander Vaz (ISPA-University Institute, Portugal)

Deliberate Practice (DP) is a training philosophy that represents one of the most evidence-based methods we know of to improve ‘performance’ in an effective and reliable manner. Decades of research have demonstrated that lengthy engagement in DP is associated with expert performance across a variety of professions. What sets DP apart from other training methods is a rigorous sequence of ongoing performance assessment, tailored goal-setting, and systematic skill-building informed by expert feedback. The principles of DP systematically target an experiential or ‘procedural’ type of learning that seems to define top performers. These core principles are:

  • Ongoing observation of performance (through video or audio recording; or live performance in the moment).
  • Expert feedback on the observed performance.
  • Agreeing of small, concrete learning goals, derived from observation and expert feedback.
  • Setting up exercises that target these goals through repetitive behavioural rehearsal.
  • Assessing and adjusting the difficulty of these exercises to fit the current capacity of the trainee. As a rule of thumb, exercises should be challenging but not overwhelming in difficulty in order to maximize procedural learning over time.

How does this apply to psychotherapy? Psychotherapy expertise has traditionally been judged by length of experience and reputation of the therapist. And yet, over 50 years of outcome research have found that the therapist’s years of experience is not a good predictor of clinical outcomes. This means that we need to rethink our ideas about what constitutes a psychotherapy expert. To quote Goodyear et al., we could say that ‘psychotherapy expertise should mean superior outcomes and demonstrable improvement over time’. Some recent authors (Rousmaniere, Vaz, Miller, Wampold, etc.) consider that one of the most promising means to achieve this is through ongoing psychotherapy deliberate practice. Importantly, recent research supports that DP is an effective way to improve clinical skills and therapy outcomes. As a training methodology, it can be used to systematically train important clinical skills such as empathic interventions, alliance rupture-repair skills, and decreasing therapist’s experiential avoidance.

Deliberate Practice is not a substitute for high-quality psychotherapy training, supervision, workshops and other professional investments such as the therapist’s own therapy or a commitment to self-care. DP is best seen as complementary to all of these. While more traditional training and supervision methods help us to effectively learn models and theory, the principles of DP help us consolidate key learnings from declarative knowledge to a more experiential or procedural level. Integrating DP into your personal and professional development, with the help of a coach, is a hard but rewarding way to systematically improve key clinical skills.

Pluralistic therapists have become increasingly interested in DP because of the parallels between the two approaches. Like pluralism, DP emphasises going beyond any one ideology about how best to help clients to focus on the concrete actuality of what works. It also shares, with pluralism, the emphasis on learning from feedback—from clients or otherwise—to help therapists improve their work. The 2020 Pluralistic Conference in Dublin will have some of the first presentations on the interface between pluralism and DP: do come and join the discussion.

If you think you might enjoy, and benefit from, online DP consultations focused on common factors variables (e.g., empathy, alliance, etc.) and/or management of your own experiential & relational avoidance, please contact Alex Vaz at: alexmagvaz@gmail.com

(This blog is adapted from www.alexandrevaz.com/aboutdp)