‘Therapeutic Expertise’? Deliberately Curious From a Pluralistic Perspective!
Kerry-Jayne Lambert, University of Roehampton (email@example.com)
Deliberate practice (DP) is argued to be at the ‘cutting edge’ of counselling and psychotherapy. It is a set of training methods aimed to support therapists to improve their clinical performance by isolating and focusing on specific skill subsets. This is considered similar to other fields promoting high levels of performance training such as premier football teams, where a football coach or ‘expert’ will work closely with players on specific skills, such as ‘dribbling’ or ‘marking an opponent’ as separate activities during practice sessions. Specific practice skills might be more necessary for certain players than others and therefore targeted accordingly during practice by repeatedly using specific methods, aimed to increase improvement. DP, similar to pluralistic therapy, is argued to emphasise working beyond any one ideology about how best to support clients to achieve change, emphasising learning through opportunities for therapist feedback including therapeutic role-play or an audio-recording from a therapeutic session, to help develop and improve effective outcomes.
It is argued therapists benefit from methods of DP training to help improve clinical effectiveness that aim to ‘break through’ the potential for a ‘competency plateau’ by engaging in continuous, gradual, skill-based processes that aim to develop standards of ‘psychotherapeutic expertise’ (Vaz & Rousmaniere, 2022). This requires the opportunity for therapists to be able to observe and reflect on work undertaken at the same time as receiving ‘expert feedback’ from an ‘expert coach’. Opportunities for repetitive behavioural rehearsal using both expert guidance as well as solo practice are considered important, alongside continuous assessment of performance based on client outcome measures.
Research into the effectiveness of DP in the field of counselling and psychotherapy has highlighted that therapists who achieve effective client outcomes are reported to have engaged in DP almost three times as often as other therapists in the sample (Chow et al., 2015) identifying a potential pathway for improving therapists’ performance that keeps practice ‘live’ and ‘relevant’ to identified training needs/goals. Despite decades of studies identifying DP to be associated with high standards of performance across a variety of professions, it is in the last decade that its potential for improving therapeutic performance has been considered with outcome data largely based in the USA and parts of Europe. Despite large number of counselling and psychotherapy-based training programmes within the UK, opportunities to train using DP are not widely employed, with skill-building tasks often incorporated as part of a specific teaching models, for example skill-building role plays, rather than a specific DP training culture. Even though professional bodies stipulate the requirement for ongoing professional development post-training there are few opportunities for therapists to continue to practice and refine clinical skills in an organised or professionally ‘meaningful’ way.
A recent mixed-method study by Julia McLeod (2021) explored the use of DP during the initial stages of counsellor training, having acknowledged current literature speaks mostly to the challenging and complex nature of the process of acquiring therapeutic competencies rather than specifically to the learning strategies used or sustained by trainees to develop competence. The study identified a number of important areas for additional insights to be gained into DP including differences between individual learner’s multi-cultural competencies, and the influence of DP exposure on later phases of a therapist’s career. Given that DP continues to remain largely unknown or, at best, in early stages of infancy in the UK, further opportunities to understand the attitudes and opinions of counsellors and psychotherapists towards its methods, from a post-training perspective feel important, particularly given its emphasis on working to standards of clinical ‘expertise’. Currently there is limited research to generate a deeper, richer understanding of DP from qualified and experienced practitioners working in the field.
Registration bodies in the UK set high standards for practice based on agreed criteria, in order for trainees to reach required levels of clinical competency, which most would agree are both rigorous and demanding. Given more recent initiatives such as the SCoPEd framework (Scope of Practice and Education), that aims to categorise practitioners into three ‘skill-based’ columns of practice, questions have been raised, for example about what constitutes differences between ‘practice standards’ of counsellors and psychotherapists at each corresponding level of ‘expertise’ identified, generating active and ongoing debates about what constitutes therapeutic experience, expertise, and opportunities for ongoing skill-development. Currently expectations for ongoing continued professional development is largely ambiguous within the field and equally working environments, which are not necessarily specifically related to clinical outcomes.
My name is Kerry-Jayne, and I am currently a third-year counselling psychology student at the University of Roehampton and in the process of recruiting participants to take part in my research. I am aware that this is not the first blog shared in this forum on DP, with many of you having probably read Alexander Vaz overview on 7th November 2019. I initially became interested as part of my PsychD training in the process of how counsellors, psychotherapists, and psychologists develop and maintain required standards of clinical practice post-training, given years of therapeutic outcome research data telling us that therapists’ ‘years of experience’ is not a good predictor of clinical outcomes.
I would value the opportunity to meet with experienced pluralistic practitioners working with a minimum of five clients in the field, who are accredited with a registering body, including BACP, BPC, UKCP, and who have not yet experienced methods of DP. I will provide additional information in the form of a short video (25-30min) which will initially provide an overview of DP, including its implementation within the field of counselling and psychotherapy, key principles considered necessary to train as an ‘expert’, and examples of what a session might look like between an ‘expert/therapist’ in practice. We can then explore together what training in methods of DP might elicit for you as a pluralistic practitioner from both a practitioner and supervisory perspective when considering working to levels of ‘clinical expertise’.
If you are an experienced pluralistic practitioner and willing to offer some time to share your thoughts with me…
PLEASE EMAIL ME, KERRY-JAYNE LAMBERT, AT firstname.lastname@example.org to contribute to this research
Please also find below the participant information form which explains more about the project and contact details.