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The Role of Deliberate Practice in the Development of Highly Effective Psychotherapists

Psychotherapy
Authors:
Daryl Chow at International Center for Clinical Excellence; Henry Street Centre (Western Australia)
Daryl Chow
  • International Center for Clinical Excellence; Henry Street Centre (Western Australia)
Scott D. Miller at International Center for Clinical Excellence
Scott D. Miller
  • International Center for Clinical Excellence
Jason Seidel at Colorado Center for Clinical Excellence
Jason Seidel
  • Colorado Center for Clinical Excellence
Robert Kane at Curtin University
Robert Kane
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Little empirical research exists about highly effective psychotherapists, and none about the factors that mediate the acquisition and maintenance of superior performance skills (e.g., Ericsson, 1996, 2006; Ericsson, Krampe, & Tesch-Romer, 1993). In the full sample, a 3-level multilevel modeling (Level 1: clients; Level 2: therapists; Level 3: organization types) of practitioner outcomes was used to examine the contribution of the therapist to treatment effectiveness. Consistent with prior research, in the full sample (n = 69 therapists; n = 4,580 clients) it was found that therapist effects explained 5.1% of the variance in outcome, after adjusting for initial severity. Therapist gender, caseload, and age were not found to be significant predictors. In a subsample of therapists, the relationship between outcome and therapist demographic variables, professional development activities, and work practices was analyzed (n = 17 therapists, n = 1,632 clients). Therapist characteristics (e.g., years of experience, gender, age, profession, highest qualification, caseload, degree of theoretical integration) did not significantly predict client-reported outcomes. Consistent with the literature on expertise and expert performance, the amount of time spent targeted at improving therapeutic skills was a significant predictor of client outcomes. Further, highly effective therapists indicated requiring more effort in reviewing therapy recordings alone than did the rest of the cohort. Caveats and implications for clinical practice, continuing professional development, and training are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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... Similarly, Barrett-Naylor et al. (2020) concluded that while training can increase the likelihood of improvements in practice, substantial time investment is necessary for maximum benefit. Moreover, Chow et al. (2015) demonstrated that patients of therapists who dedicate more time to DP tended to experience better therapy outcomes. In a recent review, Mahon (2023) emphasized that these findings support incorporating DP into clinical training. ...
... Furthermore, many studies only examined individual skills: For example, Newman et al. (2022) examined communication skills such as paraphrasing, clarification, and reflecting feelings. Other studies investigated the effects of DP training on empathy in training candidates (e.g., Perlman et al., 2020), on managing ambivalence and resistance (e.g., Westra et al., 2021), or on symptom change (e.g., Chow et al., 2015). ...
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... The remaining two studies assessed the relationship between time spent in deliberate practice and client outcomes. Chow et al. (2015) found that therapists who dedicated more time to learning activities achieved better outcomes. By contrast, a replication study by Janse et al. (2023) found no such association. ...
... Barrett-Naylor et al. (2020) No No No No No Chow et al. (2015 No a Operationalization adequacy required fidelity to the definitions as outlined in Figure 2. b A-Deliberate practice for skill competency and retention, as defined by Vaz and Rousmaniere (2022); B-Deliberate practice for supervision and professional development, as defined by Rousmaniere (2024) and Vaz and Rousmaniere (2022). c research was the parent study for Di and Shukla et al. (2021). ...
A Systematic Review of Deliberate Practice in Psychotherapy: Definitions, Operationalization, and Preliminary Outcomes
Article
Full-text available
  • Mar 2025
Deliberate practice has been introduced to psychotherapy training to improve therapist performance. The emerging empirical evidence supporting the positive impacts of deliberate practice is complicated by confusion regarding how deliberate practice should be operationalized and applied in the psychotherapy context and wider debate about its role in developing expertise. This systematic literature review aimed to appraise and synthesize the preliminary evidence available regarding the role of deliberate practice in improving psychotherapy outcomes. We searched MEDLINE, EMBASE, APA PsycInfo, CINAHL, Web of Science, reference lists of articles, and other sources (last checked June 2023). Quantitative English language studies that examined deliberate practice interventions in psychotherapy contexts were included. Two authors independently extracted study data and assessed quality using the relevant Joanna Briggs Institute critical appraisal checklist. Randomized controlled trials were further appraised using the Cochrane risk of bias tool. Discrepancies were resolved through discussion with a third author (Stephen Arthey). Twenty studies were included. There was wide variability in how deliberate practice had been operationalized, and only three studies met the contemporary definition that experts in the field have clarified. Significant methodological limitations impacted the reliability of studies, and the evidence was too preliminary to support or refute its use. Further research is required to establish whether deliberate practice is an effective means of improving psychotherapy outcomes. This should include increased fidelity to contemporary operationalizations, more robust methodology, and more reliable measures of long-term client outcomes.
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... Indeed, individuals who perform at the highest levels on one task are not necessarily also better at other tasks 9,25,27,31,32 , because experts acquire task-specific knowledge through extensive training, study and experience 9,33 . Research on expert learning has been dominated by the deliberate practice framework [34][35][36][37][38][39][40] . According to this framework, expertise requires purposeful, goal-directed, repetitive practice and feedback, aimed at improving task-relevant skills. ...
... For example, general qualifications in forensic pathology do not necessarily provide information about superior performance on a specific task, such as accurately distinguishing between self-inflicted versus other-inflicted stab wounds 6 . Similarly, years of experience might have little or no genuine relationship to superior performance 30,34,36,152,153 . ...
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... While provisional evidence suggests that higher levels of overall participation in CPD activities may be related to higher levels of professional achievement, accomplishment, and competence (Taylor & Neimeyer, 2022), only one study to date links it to more favorable clinical outcomes (Chow et al., 2015), per se. Additionally, more targeted, large-scale studies that have examined the expected behavioral outcomes of CE in relation to its stipulated objectives have sometimes failed to provide any evidence in favor of its impact. ...
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Article
Full-text available
  • Apr 2025
Continuing education (CE) has historically been the primary avenue by which continuing competence of the workforce has been facilitated. Currently, CE is undergoing a period of reappraisal as more is learned about what helps to maintain competence. Efforts have been directed toward (a) aligning CE methods with its objectives, (b) positioning CE as an evidence-based enterprise that articulates with, and is responsive to, knowledge gains and skills application, (c) maximizing the responsiveness of CE to the evolution of social and cultural, as well as empirical, developments, and (d) broadening the understanding of CE to include experiences outside of traditional classrooms, in recognition of the principles of adult learning. Consistent with these objectives, this study examined the extent to which the 11 creditable continuing professional development (CPD) activities proposed by the Association of State and Provincial Psychology Boards were perceived by a sample of 668 practicing psychologists as contributing to the maintenance of their competence. Results revealed wide variability, with some activities (e.g., formal CE and peer consultation), being perceived as significantly greater contributors to competence than others (e.g., serving on professional boards or conducting patient outcome assessments). Significant differences, however, were found across demographic groups, suggesting that various CPD activities may contribute differentially to perceived professional competence for different individuals. The implications and limitations of these findings are discussed in relation to developing a rational system of CPD that is responsive to knowledge gains and maintenance of competence, as well as individual differences within the field of professional practice.
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... Deliberate practice (DP) is a well-established method of performance enhancement originally applied to a number of areas, such as chess, sports and medicine, but has only been applied to psychotherapeutic work in the last decade [20]. Ericsson [21] describes deliberate practice as the engagement in a practice-based activity, often designed by a teacher or coach, with the central aim of improving a specific element of performance. ...
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Article
Full-text available
  • May 2024
The work of psychotherapy demands much of those who engage in it. Compassion provisioned by therapists requires varying competencies, yet remains a highly embodied and enactive endeavour. Therapist skill can be cultivated in this area and enhanced through a variety of body-mind trainings, including various forms of therapist personal practice. However, much clinical training/continued professional development centres on education workshops, emphasising knowledge above skill. Given this we present feasibility data from two deliberate practice/procedural learning, martial arts-based radically embodied compassion workshops aimed at enhancing therapist courage. Our findings show that conducting such training is feasible, with those attending able to participate in each practice. Participant self-report suggests the workshops can result in significant personal benefit, are able to deepen attendee understanding of compassion focused therapy and lead to an enhanced sense of how to apply it. Via self-report pre, post and 3-month after the workshops, significant beneficial changes in overall total clinical distress tolerance as well as specifically in absorption (the level of attention absorbed by distressing emotions) were shown. Beneficial changes were also noted in experiential acceptance and in total general equanimity pre and post workshops. We discuss limitations of the current study and potential future work that could follow from it, before concluding that training in this way represents an important first step in delineating a novel approach to therapist self-development. Practices drawn from traditional martial arts may be well suited to providing the context, relational safety and necessary skills for therapist development, in terms of enhanced distress tolerance and management of the self, to occur.
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... While session-level fidelity reviews with psychometrically validated tools are well-suited to clinical trial research and are associated with improved client outcomes (e.g., Chow et al., 2015), this approach to real-world CBT CQI is both impractical and illsuited to public behavioral health and training settings. Behavioral rehearsal approaches like deliberate practice have been identified as an alternative approach to fidelity assessment (Cross et al., 2011), particularly as a means of measuring therapeutic competence in community settings through the use of standardized patient scenarios (Beidas et al., 2014(Beidas et al., , 2016. ...
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Article
Full-text available
  • Mar 2025
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Article
  • Mar 2025
  • PSYCHOTHER PSYCH MED
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Deliberate practice for ethics training among novice undergraduates
Article
  • Mar 2025
  • ETHICS BEHAV
Ethics training is an important integrative theme in the American Psychological Association guidelines for the psychology undergraduate major. Similarly, preparation for ethical research and clinical practice are central to training health service psychologists. With the move toward competence-based education, skill-based assessment and training are needed to extend the usual didactic instruction in ethics. In this study, we examined the use of deliberate practice as a form of competence-based education in comparison to control groups for the training of 63 novice undergraduates to handle basic ethical situations in therapy. We found that students’ ability to respond to simulated therapy clients improved in the deliberate practice group, but not in the case discussion or motivational interviewing control groups. Findings suggest that basic and focused applied ethics’ skill training can be effectively used early in a student’s training.
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Article
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Chapter
Full-text available
  • Mar 2016
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Article
Full-text available
  • Dec 1996
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Article
Full-text available
  • Jul 1993
The theoretical framework presented in this article explains expert performance as the end result of individuals' prolonged efforts to improve performance while negotiating motivational and external constraints. In most domains of expertise, individuals begin in their childhood a regimen of effortful activities (deliberate practice) designed to optimize improvement. Individual differences, even among elite performers, are closely related to assessed amounts of deliberate practice. Many characteristics once believed to reflect innate talent are actually the result of intense practice extended for a minimum of 10 years. Analysis of expert performance provides unique evidence on the potential and limits of extreme environmental adaptation and learning.
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Article
Full-text available
  • Jan 2008
Assessment in clinical psychology typically relies on global retrospective self-reports collected at research or clinic visits, which are limited by recall bias and are not well suited to address how behavior changes over time and across contexts. Ecological momentary assessment (EMA) involves repeated sampling of subjects' current behaviors and experiences in real time, in subjects' natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. EMA studies assess particular events in subjects' lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. We discuss the rationale for EMA, EMA designs, methodological and practical issues, and comparisons of EMA and recall data. EMA holds unique promise to advance the science and practice of clinical psychology by shedding light on the dynamics of behavior in real-world settings.
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Article
  • Jan 2005
As one of the great inventions of the last half of the 20th century, counseling offers great hope and promise. Yet for counseling practitioners, within this hope and promise, there is confusion about how to help and what constitutes mastery and expertise. It is like being in a fog and searching for mastery. And it matters because the counselor's contribution to counseling outcome is significant. Factors in counselor mastery and expertise are explored.
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Therapist Success and Its Determinants
Article
  • Jun 1985
  • ARCH GEN PSYCHIAT
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