Figure 1 - uploaded by Johannes Larsson
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Flow chart. Note: Flow of participants through the trial. DP ¼ deliberate practice. DLM = didactical learning methods. ITT ¼ intention-to-treat.
Source publication
A large body of research identifies therapist expressed empathy as one of the most important predictors of psychotherapy outcome. Deliberate practice (DP) is an effective method to improve skills in many fields. We asked if DP also can be used to enhance the skill of expressing empathy. Objective: The aim was to compare the efficacy of DP to didact...
Contexts in source publication
Context 1
... also had to be fluent in English. See Figure 1 for flow of participants at each stage of the trial. ...
Citations
... For all that, findings reported in the extant DP literature offer an additional interpretation for the pattern of change graphically depicted in Figure 2. In particular, consistent with the improvement observed in Trials 1 through 4, the greatest gains typically happen early in training (Proctor & Vu, 2006). Similarly, a recent study found that the DP group, compared to a didactic training group, improved novice trainees' responses early on in empathy skills (Larsson et al., 2023). According to A. Ericsson and Pool (2016), "When you first start learning something new, it is normal to see rapid-or at least steady-improvement." ...
... There are notable differences between the present study and Larsson et al. (2023). First, Larsson et al. included novice trainees who have yet to start clinical training, whereas participants in the present study included therapists of different levels of experience (M: 11.6 years; SD: 9.37). ...
In the last decade, deliberate practice (DP)—a process of formally and systematically training for performance objectives just beyond an individual’s current ability—has emerged as a promising approach for enhancing therapeutic effectiveness. In view of the paucity of prospective studies, an experimental design with a series of challenging clinical vignettes was developed to test whether DP could improve, as well as generalize therapist ability to manage challenging encounters in therapy. When results from a pilot study showed promise for increasing participants’ skills, a multicenter, unblinded randomized controlled trial was conducted to assess the use of DP as a training framework. Seventy-two participants (39 in experimental group, 33 in control group) were randomly assigned to an experimental or control group, with the former receiving ongoing feedback to guide DP and the latter limited to engaging in self-reflection. On average, participants in the DP condition not only improved, but were also able to generalize newly acquired knowledge and skills to novel, challenging clinical scenarios. By contrast, no change was observed among participants in the control condition. A review of the extant literature shows this to be the first study to include all four components of DP in psychotherapy training: (1) individualized learning objectives based on an assessment of the performer’s baseline ability, (2) targeted feedback, (3) successive refinement, and (4) guidance from a coach. Caveats and implications for training are discussed and explored.
... First, it is possible that some therapists find deliberate practice difficult to grasp (McLeod, 2022), which will ultimately make it difficult for them to engage in it. Further, the attrition in some of the studies, including the resignation of up to 40% of all therapists on staff (Goldberg, Babins-Wagner, et al., 2016), points to the idea that deliberate practice might be perceived as too demanding (i.e., Larsson et al., 2023;Mahon, 2022;Newman et al., 2022). These factors coupled with the fact that deliberate practice is still inconsistent with the field of psychotherapy's culture may eventually lead to a drift in application (Fadde & Jalaeian, 2018;McHugh & Barlow, 2010). ...
Interest in deliberate practice for psychotherapy skills has expanded considerably over the past several years with the publication of several how-to guides for therapists and empirical studies. A few recent publications have highlighted the potential limitations of deliberate practice for psychotherapy skills development, but these writings have primarily focused on empirical studies. Further, how-to guides often give minimal space to the potential limitations of deliberate practice for psychotherapy skills development and infrequently discuss the limitations of empirical studies. The current article seeks to synthesize conceptual and empirical writings on deliberate practice for psychotherapy skills in order to draw attention to areas that need further consideration. Specifically, we raise a series of unanswered questions warranting deeper reflection by the field. In discussing each question, we review the current literature on the topic. When relevant, we draw from the larger literature on deliberate practice and the expert performance approach to help make recommendations for research and practice. The article concludes by acknowledging the benefits of deliberate practice for psychotherapy (e.g., the production of novel training resources), while also noting the need for therapists to temper their expectations regarding results and utilize available resources to ensure a proper understanding of the model prior to implementation.
... Yet, there is promising preliminary evidence that deliberate practice may improve outcomes (Chow et al., 2015;Clements-Hickman & Reese, 2020;Goldberg, Babins-Wagner, et al., 2016;Hill, Anderson, et al., 2020;Mahon, 2023;Nurse et al., 2024;Rousmaniere, 2019;Westra et al., 2021). Small-scale randomized controlled trials of deliberate practice interventions for therapists suggest it is possible to improve intrapersonal skills, even after a brief training (Larsson et al., 2023;Olsson et al., 2024). Within the context of MCO training for psychotherapists, an example of deliberate practice would be rehearsing potential responses to a client's comment about their ethnic background and receiving feedback afterward from a supervisor with MCO expertise. ...
The value of skillfully adopting a multicultural orientation (MCO) in psychotherapy has been increasingly recognized. Deliberate practice methods may be helpful in developing this capacity, but limited opportunities for practice and feedback exist. The present study provided an initial test of the feasibility, usability, and acceptability of a self-guided, web-based deliberate practice tool designed to support the development of therapists’ MCO: MCO Deliberate Practice Online (MCO-O). This tool included brief didactic instructions along with opportunities to practice responding to video vignettes of actors portraying clients discussing cultural topics in psychotherapy. A sample of therapists and trainees (n = 287) visited the MCO-O website and consented to the study. Recruitment through emails to listservs and a webinar was highly feasible. Quantitative ratings of usability were modest. Quantitative metrics of acceptability were also modest, with a minority of participants (18.8%) visiting the MCO-O website more than once and 51.2% of participants viewing two or more of the video vignettes. Younger participants found the MCO-O website more usable, and having MCO-O assigned was associated with watching more videos, when controlling for participant demographics. Qualitative themes included a mixture of positive feedback along with critiques and confusion regarding the MCO-O website. Taken together, results highlight the potential of this approach along with important limitations. Ultimately, it may prove difficult for therapists and trainees to engage in self-guided MCO training, particularly if using software tools that have not undergone extensive (and potentially resource intensive) user experience testing and development.
... Since the seminal study based on pre-post outcomes was published, DP has been used in a variety of control trials, in university settings, and with trainees during workshops (Anderson et al., 2009;Larsson et al., 2023;McLeod, 2022;Murphy et al., 2020;Newman et al., 2022;Perlman et al., 2020;Rosén, 2019;Young et al., 2023). Much of the research to date has focused on quantitative methods in order to demonstrate efficacy and effectiveness. ...
... Much of the research to date has focused on quantitative methods in order to demonstrate efficacy and effectiveness. DP has been shown to be more effective in the development of empathy than traditional workshop methods (Larsson et al., 2023). Ogles et al. (2023) demonstrated that DP could be used to successfully train therapists in ethical situations using simulated case scenarios. ...
Purpose
Deliberate practice (DP) is an emerging concept in counselling and psychotherapy research that can be used to effectively help practitioners develop a host of therapy skills and processes. However, to date, no studies have examined its use in naturalistic settings with professionally qualified practitioners.
Methods
A qualitative descriptive approach using content analysis was employed with a purposive sample of international practitioners who were using DP in naturalistic settings. The sample consisted of therapists ( N = 6) from five different countries, identifying as male ( N = 5) and female ( N = 1).
Results
Six categories were developed from qualitative interviews: (1) motivation for engaging in DP; (2) the impact of definition and operationalisation; (3) what to practice; (4) how to practice DP; (5) use of supports to develop DP; and (6) the emotional impact of DP. Deliberate practice is still in its infancy, and its definition may not translate into psychotherapy without modification. Participants described using DP to develop a host of psychotherapy skills and processes, and found support structures such as supervision and peers as helpful in the DP process. However, DP was also described as challenging to practice and it can cause those engaging in it to feel vulnerable and distressed. Implications are discussed for practice and future research.
Conclusion
Deliberate practice is an emerging method used by practitioners to improve their skill acquisition. However, a lack of consensus on its key features may limit the extent of its dissemination and utility to practitioners in naturalistic settings. Further research should seek to provide a definition of DP more consistent with the practice of psychotherapy, and how to operationalise DP using methods that are inclusive for all practitioners whilst acknowledging the potential impact it can have on their sense of self.
Background
Empathic communication is a key therapeutic skill in psychotherapy. However, questions regarding the most effective and suitable teaching methods to support development in this area remain. Preliminary evidence has supported deliberate practice (DP) as an emerging approach for enhancing therapeutic skills, such as empathic communication; however, little is understood about its acceptability from a trainee perspective.
Aims
Eleven fourth‐year psychology undergraduate students were interviewed about their experience of receiving online group‐based DP training for empathic communication.
Materials & Methods
Reflexive thematic analysis was used to analyse interview transcripts.
Results
Participants described observing improvements in their use of empathic communication, including attitudinal and behavioural changes and shifts in self‐awareness. Participants also described valuing self‐observation and the personalised, iterative nature of the DP model in supporting their learning. Nevertheless, DP was also experienced as challenging by some trainees, who reflected that it provoked initial feelings of uncertainty and anxiety.
Discussion
This study highlights that undergraduate students may benefit from group DP training that fosters psychological safety and seeks to mitigate potential challenges, can be customised to their individual skill level and is incorporated alongside other learning approaches.
Conclusion
Future research is encouraged to build on these findings by examining the impact of DP on objective measures of empathic communication.
