Daryl Chow , MA, Ph.D. (Psych)daryl@darylchow.com

A System of Practice Practice, Supervision and Training

AIM:

Improving therapistsvs.

Improving the individual therapist.

Photo by Annie Spratt

In order for deliberate practice to happen, we need

A System of Practice.

LearningPerforming

Practice Supervision Training

THE CONFLICT

Feeling Satisfied vs Actual Improvement

Clinical Practice

Therapist Profile

{Experience}

{Gender}

{Age}

{Profession}

{Qualification}

not significant

Therapists’ Healing Involvement

14

Healing Involvement (HI) was a significant component in therapist practices.

Chow, D. (2014). The study of supershrinks: Development and deliberate practices of highly effective psychotherapists. . (PhD), Curtin University, Manuscript submitted.

Orlinsky, D. E., & Ronnestad, M. H. (2005). How psychotherapists develop: A study of therapeutic work and professional growth. Washington: American Psychological Association.

Therapists’ Healing Involvement

15

Therapists with higher HI self-ratings had poorer client outcomes.

Chow, D. (2014). The study of supershrinks: Development and deliberate practices of highly effective psychotherapists. . (PhD), Curtin University,

Healing Involvement

16

The Illusion of Validity

Self-Assessment Bias

Chow, D. (2014). The study of supershrinks: Development and deliberate practices of highly effective psychotherapists.(PhD), Curtin University, Australia.

Percentage of Children Using The Skill

PE

RC

EN

TAG

E

0

22.5

45

67.5

90

AGE

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

ReadingWritingASKING QUESTIONS

Percentage of Therapists Development

PE

RC

EN

TAG

E

0

22.5

45

67.5

90

Years of Clinical Experience

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

Clinical PracticeAttending TrainingsClinical Improvement

Psychotherapists value and invest in professional development,

but we are not improving.

Clinical Supervision: Who would you pick?

Clinical Supervision

7 Deadly Sins with Traditional Clinical Supervision

1.Too much theory-talk;

2. Pad-on-the-back;

3. Lack of monitoring progress;

7 Deadly Sins with Traditional Clinical Supervision

4. Lack of monitoring engagement level in supervision;

5. Not analysing the game;

6. Overemphasis on the Self and not the impact on client; and

7. Lack of focus on therapist’s learning objectives.

Three Types of Knowledge, in Frontiers of Psychotherapist Development blog Chow, D. (2017). The practice and the practical: Pushing your clinical performance to the next level. Prescott, David S [Ed]; Maeschalck,

Cynthia L [Ed]; Miller, Scott D [Ed] (2017) Feedback-informed treatment in clinical practice: Reaching for excellence (pp 323-355) x, 368 pp Washington, DC, US: American Psychological Association; US, 323-355.

TRAINING

ContentKnowledge

ProcessKnowledge

Condiitional Knowledge

ContentKnowledge

Three Types of Knowledge, in Frontiers of Psychotherapist Development blog Chow, D. (2017). The practice and the practical: Pushing your clinical performance to the next level. Prescott, David S [Ed]; Maeschalck,

Cynthia L [Ed]; Miller, Scott D [Ed] (2017) Feedback-informed treatment in clinical practice: Reaching for excellence (pp 323-355) x, 368 pp Washington, DC, US: American Psychological Association; US, 323-355.

TRAINING

The Resolution:

Create Better Designs

The best form of standardisation is customisation

VISIONARYMANAGER

PRACTITIONER

A System of Practice

PRACTITIONER

A System of Practice

Blackbox Thinking for Psychotherapists

Blackbox Thinking for Psychotherapists

Blackbox Thinking for Psychotherapists

Practice Supervision Training

Coaching For Performance Coaching For Development

Micro

Traditional case-by-case

discussion

Improving the outcomes for

specific cases

Focus is on the client

Macro

Establishing an ongoing learning

and development plan

Improving therapist’s overall

effectiveness

Focus is on the therapist

The Taxonomy of Deliberate Practice Activities in Psychotherapy (TDPA, Chow & Miller, 2015)

“One Client at a Time” “One Therapist at a Time” “One Agency at a Time”

Chow, D. (2017). The practice and the practical: Pushing your clinical effectiveness to the next level. In D. Prescott, C. Maeschalck, & S. D. Miller (Eds.), Reaching for Excellence: Feedback-Informed Treatment in Practice: APA.

Miller, S. D., Hubble, M., & Chow, D. (2017). Professional development: An Oxymoron? In T. Rousmaniere, R. K. Goodyear, S. D. Miller, & B. Wampold (Eds.), The Cycle of Excellence: Using Deliberate Practice in Supervision, Training, and Independent Practice (pp. 23-47). River Street, Hoboken, NJ 07030, USA: Wiley Press.

1. Review the taxonomy.

2. Rate each area.

3. Rank the Top 3.

4. Narrow Down to One

Taxonomy of Deliberate Practice Activities

Themes Activities

Structural: “The

Sandwich”

How do you start a first session?

How do you start a subsequent session?

How do you close a session?

How do you elicit feedback?

How do you integrate the use of feedback measures into therapy?

How do you prepare for a planned termination?

Taxonomy of Deliberate Practice ActivitiesThemes Activities

Alliance: The Impact Factor

How do you deepen client’s emotional experiencing? (see Experiencing Scale)

How do you promote emotional engagement/bond/ real-relationship? How do you provide a rationale for a particular method of working?

Motivation How do you work with a client’s level of motivation?

How do you increase homework compliance?

Alliance Difficulties

How do you deal with alliance rupture?

How do you deal with an angry client? How do you deal with a client who is feeling hopeless?

Therapist: The Use of the Self

How do you regulate your anxiety in a difficult interaction with your clients?

How do you activate reflective functioning in-session with your clients (vs being reactive and rational)?

The Law of Diminishing Returns

NUMBER OF GOALS (in addition to BAU stuff)

GOALS ACHIEVED WITH EXCELLENCE

2-3 1-2 0

Accountability in Professional Development

Activities

Practice Supervision Training

The Difficult Conversations in Therapy (DCT) Randomised Clinical Trial

Chow, D., Lu, S., Tan, G., Kwek, T., & Miller, S. D. (nd). A Randomized Clinical Trial of the difficult conversations in therapy (DCT): Can therapists learn from an environment of self-reflection, feedback and successive refinement? (Manuscript in preparation).

Deliberate Practice

Ericsson, K. A. (2006). The Influence of experience and deliberate practice on the development of superior expert performance. In K. A. Ericsson, N. Charness, P. J. Feltovich & R. R. Hoffman (Eds.), The Cambridge handbook of expertise and expert performance. (pp. 683-703). Cambridge: Cambridge University Press.

Ericsson, A. K. (1996). The acquisition of expert performance: An introduction to some of the issues. In K. A. Ericsson (Ed.), The road to excellence: The acquisition of expert performance in the arts and sciences, sports, and games (pp. 1-50). Mahwah, N.J.: Lawrence Erlbaum Associates.

Ericsson, K. A., Krampe, R. T., & Tesch-Romer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363-406.

1213

1617 17

0

5

10

15

20

25

T1 T2 T3 T4 T5

Facilitative Interpersonal Skills Total Scores

1 2 3 4 5 6 7 8 9 10 AVERAGE

DCT Pilot Study

T1 T2 T3 T4

T5 T6 T7 T8

DCT RCT: Feedback Group

T1 T2 T3 T4

T5 T6 T7 T8

DCT RCT: Control Group

Facilitative Interpersonal Skills Scores

10

15

20

25

30

T1 T2 T3 T4 T5 T6 T7 T8

16.57

18.57

20.81 21.16 21.68 21.96 22.52 22.17

18.7119.57

1617 17.57 18.14 18.14

16.17

Control GrpFeedback Grp

T1 T2 T3 T4 T5 T6 T7 T8

Note: Full dataset has yet to be analyzed.

Self-Ratings (0-10)

2.5

4.375

6.25

8.125

10

TrialsT1 T2 T3 T4 T5 T6 T7 T8

5.215.42

5.71 5.635.88

6.18

6.636.47

5.67

6.6

5.25

4.8

5.67

6.5 6.6

5.2

Control GrpFeedback Grp

T1 T2 T3 T4 T5 T6 T7 T8

Level of Difficulty (0-10)

2.5

4.375

6.25

8.125

10

Trials

T1 T2 T3 T4 T5 T6 T7 T8

4.43

5.55.25

7.4

55.33 5.5

6.67

5.23

6.396.65

7.26

6.55 6.6 6.56

7.25

Feedback GrControl Grp

T1 T2 T3 T4 T5 T6 T7 T8

Feedback Group:

Control Group:

Improvement in 1st Scenario

(T1 to T4)

58%

0%

Generalised Improvement (T1 to T8)

76%

ProcessKnowledge

Condiitional Knowledge

ContentKnowledge

Three Types of Knowledge, in Frontiers of Psychotherapist Development blog Chow, D. (2017). The practice and the practical: Pushing your clinical performance to the next level. Prescott, David S [Ed]; Maeschalck,

Cynthia L [Ed]; Miller, Scott D [Ed] (2017) Feedback-informed treatment in clinical practice: Reaching for excellence (pp 323-355) x, 368 pp Washington, DC, US: American Psychological Association; US, 323-355.

Process

Condiitional

Content

Three Types of Knowledge, in Frontiers of Psychotherapist Development blog Chow, D. (2017). The practice and the practical: Pushing your clinical performance to the next level. Prescott, David S [Ed]; Maeschalck,

Cynthia L [Ed]; Miller, Scott D [Ed] (2017) Feedback-informed treatment in clinical practice: Reaching for excellence (pp 323-355) x, 368 pp Washington, DC, US: American Psychological Association; US, 323-355.

Proobblem Child.reatment of the re~ Carl Rogers, 1 rrr11993399,, pp. 22884 TTheee CC i al Trhe Clinical Tr

#2. The quality of the feedback determines

the quality of the learning.

LearningFeedback

Performance Feedback

#3. Self-Reflection is Not Enough

Methods/Techniques

Develop First Principles Before The Methods , Daryl Chow, MA, Ph.D. (Psych)

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Practice Supervision Training

A System of Practice

1. Therapeutic Attempts 2. Mistakes

3. First Principles4. Refinement

5. Generalise

darylchow.com/ace

The Taxonomy of Deliberate Practice Activities in Psychotherapy (TDPA, Chow & Miller, 2015)

“One Client at a Time” “One Therapist at a Time” “One Agency at a Time”

Chow, D. (2017). The practice and the practical: Pushing your clinical effectiveness to the next level. In D. Prescott, C. Maeschalck, & S. D. Miller (Eds.), Reaching for Excellence: Feedback-Informed Treatment in Practice: APA.

Miller, S. D., Hubble, M., & Chow, D. (2017). Professional development: An Oxymoron? In T. Rousmaniere, R. K. Goodyear, S. D. Miller, & B. Wampold (Eds.), The Cycle of Excellence: Using Deliberate Practice in Supervision, Training, and Independent Practice (pp. 23-47). River Street, Hoboken, NJ 07030, USA: Wiley Press.

We are highly inaccurate in assessing our client outcomes.

Do not value what you measure, measure what you value.

Use the measures not as admin paperwork, but to inform and guide the clinical work.

You are 3 persons in 1: Practitioner, Manager, & Visionary

Practitioner bias

Use the measures with every client as a conversational tool

Seeing is learning and reinforcing of reality, make your progress visible to you and your client.

What’s thestory?

How effectiveam I?

How effectiveare we as a team?

What's missing? How am I performing? What does the data say that I should be improving upon?

This is my baselineperformance.

This is when I willre-evaluate myperformance

Figure out your Comfort Zone, Learning Zone and Panic Zone.

Work on the Lead (process). Not the Lag (Outcomes).

DP framework: Coach, Learning Objective, Feedback, Repetition

Figure out the “What” before the “How”.

1) Monitor outcomes2) Use TDPA3) Watch recordings of sessions

Marry the Macro (data & TDPA) with the Micro (client outcomes & recordings).

Incorporate a feedback informed approach to coaching.

- One client at a time- One therapist at a time- One agency at a time

Climate control vs.Command & ControlIs this working? This is where you

need to be!

with Daryl Chow , MA, Ph.D. (Psych) darylchow.com

3rd Launch, 11th of June’18.

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