Role Play in Training for Clinical Psychology Practice_ Investing to Increase Educative Outcomes

Clinical Psychology Supervision Observation Report Dianne Allen p.1

Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes

ROLE PLAY IN TRAINING FOR CLINICAL PSYCHOLOGY

PRACTICE: INVESTING TO INCREASE EDUCATIVE

OUTCOMES

Dianne Allen, 2006

Contents ROLE PLAY IN TRAINING FOR CLINICAL PSYCHOLOGY PRACTICE: INVESTING TO INCREASE

EDUCATIVE OUTCOMES ................................................................................................................................... 1 Abstract: ................................................................................................................................................................. 2 INTRODUCTION .................................................................................................................................................. 2 CONTEXT OF DISCUSSION TO FOLLOW (Methodology) ................................................................................. 2 OBSERVATION AND EVALUATION OF ROLE PLAY USE IN A CLINICAL SUPERVISION PRACTICE .... 5

General Overview: .............................................................................................................................................. 5 Example 1 – first exposure to role play ................................................................................................................ 5 Example 2 – first opportunity to play therapist role ............................................................................................. 6 Examples 3-5 – demonstration, practice and gradual handover to trainees ........................................................... 7 Example 6 – role play work developed from observation of a trainee‟s video of a case session ............................ 7 Example 7 and 8 – what is involved in cognitive restructuring to bring change .................................................... 8 Evaluation ........................................................................................................................................................... 9

CONSIDERING THE NATURE OF THE ROLE PLAY AS AN EDUCATIVE OPPORTUNITY ....................... 10 Table 1: Roles and Responses and Potentials for Learning available in the Role Play as a part of a Group

Supervision Session ....................................................................................................................................... 11 Stopping and immediate debriefing ................................................................................................................... 13 Fluidity in practice ............................................................................................................................................ 13

WHERE IS CURRENT RESEARCH ON USE OF ROLE PLAY IN PROFESSIONAL TRAINING UP TO? ..... 13 Other Professional Training Literature............................................................................................................... 14 Clinical Training Literature ............................................................................................................................... 14 Clinical Psychology Training Literature ............................................................................................................ 14

RECOMMENDATIONS ...................................................................................................................................... 15 Acknowledgements: .......................................................................................................................................... 17

BIBLIOGRAPHY ................................................................................................................................................. 18



Abstract: A qualitative study of the use of role play work, in a year’s clinical group supervision

sessions as part of clinical practice education, is evaluated for recommendations about

how to make more of this time-intensive learning/teaching strategy.

Keywords: Role play, Clinical Psychology, reflective work

INTRODUCTION

Enacting a skill is a significant part of learning a practice skill. But learning-by-doing,

and learning-from-experience, a different but related process, to be more effective, need some

educative tool supports. Using role play, engaging in an as-if therapy session, operating as-if

therapist or client, as a part of clinical training, and for the clinical psychologist, is one such

experiential learning support. Working with the experience, using some structuring to guide

observation and to extend the reflective work to capture the participants‟ and observers‟ learning

is another support to the experiential learning that is happening. The following examination

draws on (1) observations of the use of as-if activity in group supervision sessions undertaken as

part of a clinical psychology post-graduate course, (2) post-session evaluation and (3) ongoing

scholarship around the more effective use of role play and reflective work, to suggest ways of

increasing the learning outcomes from this time-intensive method.

CONTEXT OF DISCUSSION TO FOLLOW (Methodology)

One strand of the field of qualitative research of practice seeks to open up a conversation

between practitioners – the writers and the readers – with a view to enunciating and developing

valid practice understanding. Such an approach recognises (1) the particulars of practice

(Toulmin, 1996); (2) the necessity of building a consistent and reasonable fit between the nature

of the phenomenon being investigated (ontology of clinical psychology practice), how it is

known (epistemology), how what can be known of its nature is found (methodology) in a way

that is consistent with its purpose (axiology) (Heron & Reason, 1997) and where the practice

investigation involves inquiry to learn, by evaluating practice with a view to improving that

practice for the individual practitioner (Allen, 2005). Such an approach uses story telling to tap

abductive connections between practitioners, to build a broader, evidence-based, coherent

understanding of the practice being examined (Bateson, 1979; Mezirow, 1991; Schon, 1991).



To engage in this kind of inquiry about practice involves then: (1) specific practice description

and evaluation, (2) talking about the practice and explicating aspects of the practice, (3)

exploring areas for possible improvements, (4) sharing such work with others to draw in the

benefits of their experience and evaluative assessments in order to engage in the kind of

collaborative inquiry that allows them to build better evidence-based models of practice.

In the case of clinical psychology practice, practice-focused scholars recognise (1) the

universe of one between client and therapist (Schon, 1983), (2) the systemic nature of their

interactions (Bateson, 1972), and (3) a need to learn to work with a variety of models to help the

client (who also works with a variety of models, learnt in a variety of ways) to form the effective

and experienced practitioner (Norcross & Goldfried, 2005 and also Argyris‟s (1993, p.260) idea

of the „overdetermining causality‟ of the manager seeking effectiveness, being „precisely

sloppy‟). Furthermore, for clinical psychology, an additional layer of reflexivity arises: clinical

psychology is a practice steeped in conversation, with its communication modes and as a

dialogic enterprise. The person of the practitioner, and how they express attitudes, to the person

of the client, the nature of the client‟s current dilemmas, and the context of the client‟s lived

imperatives and then how they develop a collaborative investigative relationship to facilitate

actionable problem solving for the client, is part and parcel of the clinical psychologist‟s

practice expertise. Knowledge of psychological conditions and technique in diagnosis, skill in

case conceptualisation and therapeutic interventions without appropriate attitudinal and

relational inputs results in ineffective practice (APA, 2006; Nelson & Neufeldt, 1998; Whiston

& Coker, 2000).

The argument, then, for supporting role play work as a potent component of clinical

psychology training is built as follows. Firstly, clinical psychology practice involves a

significant proportion of learning by doing, and of a complex professional practice. Such

learning-by-doing can be enhanced by intentional use of reflective processes (Kressel, 1997;

Boud et al, 1985). Secondly, clinical psychology practice includes the use of the person as part

of the practice, especially individual skills in interpersonal interactions. Consequently, good

clinical psychology practice is associated with developed self-awareness, so to improve clinical

psychology practice involves self-reflective work (APA, 2006; Graham, 2003; Gonsalvez et al,

2002; Milne, 2002; Nelson & Neufeldt, 1998; Neufeldt, 1999; Rose et al, 2005). Thirdly, the

practice of clinical psychology is based in communication skills and interpersonal skills,

developed since birth, and for language, conversation and meaning making, its origins lie in



early-life learning and may include learning coloured by emotional content. To improve such

learning, by undertaking change, may involve engaging with that well-established, learned

response, and contesting original learning and its emotional content. Fourthly, the „action‟ of

clinical psychology practice is a combination of conversing, and inquiring by conversing, and

using conversing dialogue to challenge thinking patterns to generate change. Since it is a

„communicative‟ endeavour, it will need to be investigated using techniques capable of dealing

faithfully with that kind of phenomenon. Role play, by engaging the participants in interactive

conversation, related to how they interact when endeavouring to deal with a particular issue, in a

specific context, provides an opportunity to try applying knowledge, and learn the skill or

technique, while also potentially raising sensitivity to any attitude change that might need to be

involved, and then, to practise modifying responses (Bell, 2001; van Ments, 1999). With

appropriate awareness of the potential of role play to deliver on these four, and interactive,

dimensions, a trainer can develop supportive structures to assist the trainee utilize experience by

attending to this knowledge-skill-relational-attitudinal complex in a more self-aware and

intentional way.

Role playing, where the trainee clinical psychologist is acting as-if therapist or client, or

able to observe another acting as-if therapist or client, and which draws on the trainee‟s

observations of the responses of their clients in actual therapy sessions, provides the experience

of trying out how they understand the conduct of therapy. Demonstration of the same/relevant

processes by an experienced practitioner, including explication of the steps and practitioner

reasoning in diagnostic questioning, case conceptualisation and testing, then design and

application of therapeutic intervention, followed by opportunities to practice, and supported by

relatively immediate feedback, allows the trainer and trainee to work more intentionally with

modeling and learning-by-doing. Structuring reflective work to tap such learning, and

including identifying the affective as well as the cognitive and the behavioural components,

begins the process of making much more of this learning experience, increasing its efficiency as

a learning vehicle.



OBSERVATION AND EVALUATION OF ROLE PLAY USE IN A CLINICAL SUPERVISION PRACTICE

General Overview:

A recent collaboration between a clinical psychology supervisor working within the

Cognitive Behaviour Therapy arena (P-Supervisor) and a specialist educator who was looking to

develop reflective practice in professional formation education, resulted in observations of, and

discussion around, role play and other experiential learning that was available in a post-graduate

coursework group supervision session, and how present practices might be improved. The

observations and post-course trainee evaluations highlighted that when video review or case

discussions indicated a trainee‟s need to work on the skill element of the practice, the recourse

the supervisor used, to mount a role play, was appreciated by the trainees. Over two semesters,

involving 20 sessions observed, role plays were the primary vehicle for skill learning on 13

occasions, representing approximately 20% of the total group supervision time. In three role

plays the trainees played the role of therapist while the trainee with the case difficulty played the

role of the client. In one role play the supervisor took the role of client, while the trainees

shared the role of therapist. In nine role plays the supervisor took the role of therapist, while

the trainee with the case difficulty, or a volunteer, took the role of client (always playing

another‟s part, not playing themselves, with one exception: when the issue was the trainee

therapist‟s experience of resistance to a client‟s proposed solution.)

Example 1 – first exposure to role play

At the first observed session of the first semester, the „fresher‟ group of trainees

(students with limited or no practice experience, and/or just beginning formal postgraduate

studies) developed objectives for the semester that included „knowledge‟ and „skills‟. The P-

Supervisor indicated that to focus on skills would involve working with case material,

undertaking role plays, observing and providing feedback to video records of the trainees

operating as therapists. Arrangements were made for one of the trainees to bring a video of

their therapy practice to the next session. By way of example, in the second half of that session,

one of the trainee‟s case concerns was used as an opportunity for a role play. The P-Supervisor

undertook the role of therapist, the trainee with the case concern played the role of the client, the

remainder of the class observed. The role play was broken into two parts, the first stage some

diagnostic work, and the second stage some therapeutic work. In the break in the middle, the P-



Supervisor dismissed the „client‟ from the room and engaged with the observers about

diagnosis, and about possible therapy. The P-Supervisor also indicated some of his own

practice thinking – what was the possible diagnosis and why, and what would be his next steps:

in testing the diagnosis and in the development of an appropriate therapy activity. At the end of

the role play there was debriefing, at a number of levels. The observers were asked for their

responses to what they had observed. The trainee in the client role was asked for their response

to the experience and invited to make comments of their experience of the therapeutic processes

from the „client‟ perspective. The P-Supervisor reiterated for the observers, and disclosed for

the client role player, what he was doing before the break and after the break, and linked it back

to the material of the course: lectures on techniques, on theory; the prospective practice work

with clients and video records for learning about practice, from the clinical psychologist‟s point

of view; discussions associated with case conferences, etc.

Example 2 – first opportunity to play therapist role

In the second observed session in the first semester the P-Supervisor tapped material and

issues raised in the faculty-wide Case Conference held just before the group supervision session.

The P-Supervisor offered to play the client while the trainees undertook the therapist role, in

turns, around the group. Each trainee was involved in asking questions, either the questions

that were in their mind, or in some cases apparently building on the material developed from

previous trainee questions. At the end, the P-Supervisor debriefed with some feedback about

his observations of their process, including the diagnosis (stated as such) that the trainees were

watching themselves and being too hard on themselves, remarking that psychotherapy is like a

magnifying glass with a capacity to enlarge their awareness of their own practice and behaviour,

and indicating that general questioning skills were appropriate, and that what he considered was

lacking was „consolidation‟, a skill to be learned. The P-Supervisor then explored the cognitive

behaviour therapy approach of what is the message?, what is the belief?, that has come through

to them as therapists, from their questions and his answers as client. One of the trainees queried

whether the role play was a time-efficient way of learning this material.



Examples 3-5 – demonstration, practice and gradual handover to trainees

Again, in the first semester, at the seventh observed session, a trainee role played their

case concern client with general anxiety disorder, while the P-Supervisor undertook the therapist

role in an extended demonstration of fluid conduct of his therapeutic approach.

At the eighth observed session, the other trainees role played the therapist with a trainee

role playing their client, where the trainee was wanting help with how to help the client change

behaviour, while the P-Supervisor observed, and used strategic interventions to clarify what

stage of the process the trainees were up to (exploring the BASIC-P to clarify what change was

wanted), to review where the trainees had progressed to, and help them to shift focus on to

exploring affect, examining and then clarifying the antecedents. When the P-Supervisor judged

that the trainees had exhausted these he suggested a shift of models and demonstrated the

method of using questions to challenge the barrier.

In the ninth session where the trainee had a case involving panic attacks and was wanting

to know more about how to use Socratic questioning to challenge intermediate beliefs, the P-

Supervisor demonstrated, froze the action to explain the process to that point, then offered the

role of therapist to any takers (there were none), continued the process, including using role play

as a therapeutic device with the „client‟ (trainee with the case concern). Discussion elicited that

the P-Supervisor‟s fluid execution represented 25 years experience with this kind of area, and

his observation that with the trainee‟s present training and two years experience they would be

much further along in their practice than he was at the same time, and exhibiting much of this

fluidity.

Example 6 – role play work developed from observation of a trainee’s video of a case session

In the first observed session of the second semester (with a different group of trainees,

but including two trainees who had been with the supervisor in semester one), the P-Supervisor

used the material presented in a trainee‟s therapy session video to work some more with one of

the general trainee learning objectives – how to use Socratic questioning to progress the matter.

The trainees were given time to think about the kinds of Socratic questioning they would use.

Then the P-Supervisor took the therapist role while the trainee played their case client role. The



P-Supervisor was called away from the session. One of the trainees shared her awareness of the

P-Supervisor‟s process: focusing on one Socratic question and going at it by a variety of ways.

Other trainees took up the therapist role, each one exploring what was on their agenda, with the

role played client. In the wrapping debrief the P-Supervisor suggested that the trainees go back

to their own videos of therapy sessions, and use the “I Spy” method to identify, in the session,

when they could have asked a Socratic question to move the session on. The P-Supervisor

indicated that the therapist may well have to ask many questions, many times, to help people

change.

Example 7 and 8 – what is involved in cognitive restructuring to bring change

In the seventh observed session of the second semester the trainees took turns in

operating as-if the therapist to identify and test intermediate beliefs for a trainee working as-if

her client who was presenting for stress management. The P-Supervisor set the scene by

examining where the case presenter was experiencing difficulty and setting the role playing

therapists the task of working with self esteem while trying to test intermediate beliefs. When

each trainee had contributed, the P-Supervisor took a turn in the therapist role to test another

trainee‟s summarising metaphor, and to examine how important the responsibility causing the

stress was to self-identity. The P-Supervisor then invoked a time-out from the role play to give

evaluative feedback on the contributions of the role playing therapists, positively affirming the

quality of the questions asked, the different tacks taken to examine the client‟s cognitions and

then to ask the trainees for an enunciation of their perception of the intermediate beliefs. Each

trainee, including the one playing the client role who had brought the case concern to the group

examination, was asked to enunciate what they saw as the intermediate belief. When that

information was gathered the P-Supervisor asked whether they found it helpful to write it down,

and followed through with some commentary on Judith Beck‟s case conceptualisation approach.

The effective work in the role play was then identified and reaffirmed, together with the

evaluation that what was not happening, or not happening efficiently, was what the P-Supervisor

called „consolidation‟: the process of having an enunciated, hypothesised intermediate belief and

to be testing it „using sticks of dynamite and blasting away at it‟. A trainee then sought

additional enunciation of what was meant by „consolidation‟, relating it to her enunciated head

knowledge of four stages of Socratic questioning. The P-Supervisor elaborated, and applied the

material back to the instance they had been working with, stating out the kinds of intermediate

beliefs that they might focus such Socratic questioning on to help the client change those



intermediate beliefs, and re-iterating that one question, alone, is most frequently not enough to

shift the ground on such a belief. The P-Supervisor then summarised the learning to date and

suggested the next steps in therapy for the case presenting trainee. The case presenting trainee

then asked explicitly „how would you go about that?‟ for the issue of helping the client to

change (cognitive restructuring). The P-Supervisor now took the role of therapist and played

out the kind of summarising, questioning and revisiting a suite of metaphors related to the

intermediate belief („I am a failure if I don‟t get the board to change‟) with more testing

questions that brought the client role playing trainee to the point where they recognised their

guilty thoughts, and from the early case information had indicated the client was learning how to

have some success with dealing with guilty thoughts. At the wrap, the trainee trying to clarify

what was happening and how it fitted the „four stages‟ model that was queried earlier, asked

about that again and was informed that the whole discussion was „consolidation‟, and that the

next session would involve much the same process of attempting to dismantle that belief until

the change came and the stress coming from that intermediate belief was relieved, when the

therapist could then start work on other beliefs.

Evaluation

The above examples and description indicate some of the „flavour‟ of the use of role play

in these group supervision sessions. Doing a role play in the first session helped set the

expectations for „doing role plays‟ as part of the group supervision process. Using the case

conference contextual briefing, and the P-Supervisor playing the client, forcing the trainees to

role play the therapist in the second session, ensured the engagement of the trainees, equitably,

in the therapist role, and by the second session. Later sessions provided graduated

demonstrations of expertise in different parts of the therapeutic approach, and after

demonstration, and explanation in some cases, allowed for trainee trial of observed learning, but

not necessarily immediately. Time pressures mean that the trialling that followed needed to be

staggered over a number of group supervision sessions. Sometimes the observation of such

modelled learning occurred during the review of videotapes of clinical practice. When, during

the second semester, the P-Supervisor was unexpectedly called away from a role play, the

trainees demonstrated a capacity to recognise and articulate process, and to continue the role

play, thereby testing their facility with the process.

As mentioned earlier, the trainees appreciated the practitioner‟s recourse to the role play

as the skill modelling approach. At the beginning one trainee queried the use of role play as a



time-efficient way of learning this material. The P-Supervisor was surprised to be shown how

much time was spent in his group supervision sessions on this aspect, and like this trainee, had

an overarching concern that he make the whole experience an efficient learning process, and

was uncertain about the level of participation of all trainees, and was aware, at times, of

inadequate emphasis on identifying learning, or the level of learning possible from the session.

One level of debriefing between the educator and the supervisor used an analysis of the

observed scripts of the supervisor when engaged in each of the intentional learning elements of

the sessions. Comparing the role play instances with videotaped trainee clinical sessions and

discussions of trainees‟ case issues, showed that, by comparison with the framing of the learning

from the videotaped trainee clinical sessions, there was much less intentional learning structure

given to the trainees to help them draw out some of the learning possible from the role play.

Discussion of this observation, and questioning some more about what was informing the P-

Supervisor‟s practice with the role play work, elicited further sharing about the nature and

experience of fluid practice.

CONSIDERING THE NATURE OF THE ROLE PLAY AS AN EDUCATIVE OPPORTUNITY

The role play, in the group supervision session context described above, allowed for a number of

different combinations of experience and opportunities for observation as conveyed in Table 1.

The trainee can play a role – either therapist or client

The trainee can observe a role played – either therapist or client

The trainee can observe a peer playing the role of either therapist or client

The trainee can observe the supervisor playing the role of either therapist or client

The supervisor can play a role – either therapist (showing particular practice strategies)

or client (showing particular psychological profiles, both straightforward and more

complex)

The supervisor can observe the trainees playing in a role – either therapist or client



Table 1: Roles and Responses and Potentials for Learning available in the Role Play as a part of a Group Supervision Session

Roles

Played:

Participant Observer

Client Therapist

Trainee Clinician

(Client from Case) Responses drawn from client, and so observed by trainee

during case session

Beginning development of

„pattern‟ of condition (May request a stop to process

to allow for querying of

understanding of what „seeing‟,

for checking of naming steps and stages)

Experienced Clinician Demonstrates experienced

moves

Can enunciate moves if

requested

Demonstrates constellation of moves in fluid process

May choose to stop process for

intentional direction of

attention, for naming steps and stages

Other Trainee Clinicians Observation of client responses –

building understanding of „pattern‟ of

response in case condition

Observation of therapist moves –

building understanding of process: assessment, therapeutical interventions,

fluidity of process with experience

(May request a stop to process to allow

for querying of understanding of what „seeing‟, for checking of naming steps

and stages)

Trainee Clinician

(Client from Case) As above

Trainee Clinician Demonstrates novice moves Demonstrates intentional

moves to achieve practice

goals – assessment and/or

therapeutic intervention

Experienced Clinician Observation of trainee awareness and capabilities demonstrated in role of

client or of therapist

Focus of observation for training role:

affirming sound practice; questioning practice for learning goals

May choose to stop process for

intentional direction of attention, for

naming steps and stages, for asking for trainee therapist practice thinking or

„client‟ response to therapeutic step

enacted

Other Trainee Clinicians As above

Experienced Clinician

(Composite Client

responses from practice

knowledge) Responses drawn from many

clients, and typical response pattern available for trainee

observation of pattern of

response

Trainee Clinician As above

Other Trainee Clinicians As above

In such role plays a variety of aspects of clinical psychology practice are enacted. At a

diagnostic level, the role play can expose the typical exchanges of a client with a particular

condition, and more and less effective techniques for gathering relevant diagnostic information

about that condition. Where the trainee plays the client role, and of their own case concern, the

trainee is mobilising their observations of the client in the case, though they may not always

recognise the significance of such information, and how to develop it into an appropriate case

conceptualisation. At the therapeutic level, the role play can highlight more and less effective

interchanges for different stages of the therapeutic process, as well as client strategies for

frustrating such therapeutic moves. For the trainee operating as the therapist, the role play

presents an opportunity to test moves in basic skill learning, or in developing a different



approach needed to build additional flexibility in practice. When the trainee operates as the

client, there is an opportunity for the trainee to experience the process „from the other side‟,

another important experience. Indeed, in one instance the supervisor taking the therapist role

invoked „role play‟ as a therapeutic strategy with the client. The trainee playing the client role

then experienced how valuable „role playing‟ can be, in either developing insight of the „other

party‟s point of view‟, and/or how a client might be moved out of a stuck position, to see their

problem differently.

As an educational vehicle, the role play can operate with any one of the various stages of the

development of a fully effective practice, especially when such a practice is inherently complex

and hedged about with the uncertainties and ambiguities of interpersonal interchange:

The demonstration of the first steps

The demonstration of the whole

The learning of the parts of the whole

The learning of the whole

Demonstrating the difference between novice, competence and expertise

Working on developing a practitioner‟s comfort in the whole and with a developing

routinisation of approach

Undertaking first steps in flexibility of approach

Learning to be self-critical about a point in practice and its theoretical underpinnings

One of the difficulties of endeavouring to make the most of an experiential learning instance

is just how much is available for observation and for learning, and where to focus attention, as

the above analysis shows. When a role play is conducted in the group context, the group can be

mobilised to assist with the task of observation of what is quite complex.

Another part of learning how to learn from experience is realising that other kinds of

formal learning usually involve pre-structured material (theorising is one mechanism of

structuring evidence into some sort of coherent story); and that the task of a learner working

with their own experience is the task of developing a coherent story of such experience –

looking for the patterns amidst a host of data, some of which is „noise‟ – not significant to the

task at hand (Kressel, 1997).



Stopping and immediate debriefing

Since the role play is an educative tool, in an educational context, it is within the

province of the supervisor, or the trainee, whether playing a role, or observing, to halt the

activity, and engage in questioning and/or debriefing about the material presented to that point.

Such liberty is used when a supervisor is demonstrating, and seeking to consciously identify

parts of the process, naming them, perhaps describing them, and/or talking about their own

thinking during the process. Such liberty may be used by the trainee, if willing to engage in this

way, and offered permission to do so, to question what is happening, to confirm their

observations, to clarify any confusion, to test their recognition of elements, to ask for an

explanation of the process and the practitioner thinking informing such process.

Fluidity in practice

Again, in debriefing with the supervisor, the educator asked about the nature of stopping

and starting, and for practitioner reasoning about that. The supervisor expressed discomfort

with too much stopping and starting, since that can risk the effectiveness of the process.

Stopping to unpack process, especially with the „client‟ role player present, can alert the „client‟

to the expected next response. In clinical practice, the therapist is a bit like a person working at

night, with only a torch for light, in an unknown house of many rooms, looking for something

that is there. It is not known where the something is, and it might be found at any time. The

process is one of persistent and systematic exploration, room by room, and recognition of the

significant that leads up to the discovery of the something. There is no knowing which

particular set of questions is to yield that find. Furthermore, part of the discovery process is in

the fluidity of practice itself, and this needs to be demonstrated. Fluidity cannot happen while

deliberate stoppages are invoked.

WHERE IS CURRENT RESEARCH ON USE OF ROLE PLAY IN PROFESSIONAL TRAINING UP TO?

In general terms there is very little recent research into the use of role play in

professional training. As Yardley-Matwiejczuk (1997) tracks the history of earlier exploration

of role play, she reports the early (1970‟s to 1980‟s) flush of activity drying up when critiques

relating to „ecological validity‟ coincided with the epistemological shifts and critiques that have

reinvigorated qualitative research methods. In the absence of research, there are a few useful



guidebooks on how, why, and when to use role play as an educative tool, and as part of the

experiential learning repertoire (see Bolton & Heathcote, 1999; Errington, 1997; van Ments,

1999; Yardley-Matwiejczuk, 1997).

Other Professional Training Literature

Role play, as an educative tool in training in activities related to other professions,

appears mostly for management, marketing, language learning, conflict resolution, negotiation,

cross-cultural activities, interpersonal and communications aspects of any professional practice

and as an aspect of simulations in business and engineering where the complex interactions and

responsiveness of the professional to a changing dynamic is the capability being addressed

(Errington, 1997; van Ments, 1999). Here recent research includes that of where the use of role

play in the simulation that has moved to the online platform, using computer capabilities for

multiplayer gaming, over time, as a significant resource for such learning (Bell, 2001).

Clinical Training Literature

Compared with the clinical psychology application, evaluation of the use of role play in

clinical training for nursing, medicine, and social work has a slightly larger reported corpus.

Themes that are addressed in this literature include the building of practice-relevant

communication skills in the service of diagnostic and therapeutic activity, especially in building

an effective therapeutic/professional relationship with the patient/client, both of which are

significant to the practice of clinical psychology, and so have lessons for clinical psychology

practitioners and trainers. Like van Ments and Errington, recent publications are focused on

better use of the role play as a training strategy (see, for example Joyner & Young, 2006).

Clinical Psychology Training Literature

A basic scan of the current journal literature on the use of role play in working at skill

development for clinical psychologists, shows a fairly thin engagement of the field with this

process. The material falls into two main categories: dealing with issues that might be related

to using this experiential tool in the context of clinical psychology training [Pomerantz, 2003,

and see literature cited there]; and reporting on the use of the role play in providing a

standardised context for skill assessment. Within the first of these categories, a recent theme

relates to who might play the client, pointing to risks where the clinical psychology students are



called on to play the client and what alternatives might allow an instructor, and a class, to work

through and around such a problem (Osborn et al, 2004; Pomerantz, 2003; Shepard, 2002).

In summary, the efficacy of the use of role play in professional and clinical training

tends to be taken for granted. In reporting „best practice‟, most educators focus on the

debriefing or post-activity reflective work required to enunciate and consolidate the learning.

Van Ments and Errington speak of the time required for this, and indicate ratios of 1:1:1 or 1:2:3

as appropriate commitments of time for preparation: role play: debriefing.

More practitioner discussion, working with rich practice descriptions and engaging in

evaluations against educative criteria, focused on the practitioner capabilities sought to be

developed in clinical psychology trainees, is needed.

RECOMMENDATIONS

Given the above observations, evaluation and analysis, and inputs from the literature, the

following are areas where more intentional educative inputs would enhance the learning

available in using role play in clinical practice training (ie emphasis is on the debriefing to

enhance the learning experience van Ments, Errington):

1. Provide time for more emphasis on reflective work:

end of session formal time and structured approach;

beginning of session formal time and structured approach;

session minuting and minuter‟s reflections on the learning outcomes structured towards

the learning objectives negotiated (or theorised), and rotated through the group; [so peer

practice and peer review, contributing towards learning from and with peers]

encouragement to engage in written personal reflective work on session experience

between sessions – pro-formas for such reflective work issued;

occasions provided for sharing from or about that reflective work during the semester.

2. Provide opportunities in the session for more emphasis on reflective work in the group form:

recognising that many peer inputs in the group sessions represents outcomes of

„reflective work‟ („Reflection is a cognitive process with a number of phases, focused on

coming to a conclusion for the purpose of action, with various activities designed to

survey and test premises and argument, and where judgment is exercised and

understanding developed by the interaction of „facts‟ and „meaning‟ for the inquirer

(Dewey, 1933, pp.102-118, p.4, p.12, p.77, p.165)‟);



capturing reflective work in the session minuting (important insights shared by peers)

3. Provide exercises for helping the student work with their case material at the two levels:

the formal case reporting of practice records;

the unreported documentation of the self-study of practice (possible development for

clinical practice assessment?)

4. Provide resources for developing an individual‟s reflective work:

time and practice in the sessional time, including preparation for peer review (the

rotational, shared minuting and post session learning objectives reflection work)

pro-formas for different approaches for use at different stages of the semester

o basic pro-forma for first four sessions (eg personal: Reaction/ Elaboration/

Contemplation)

o pro-forma for diagnostic work on own practice (eg Affect, Behaviour, Cognitions

= practice actions)

o pro-forma for reviewing reflections gathered over the first four weeks, second

four weeks, and third four weeks, using the basic, or self-directed pro-forma, and

shifting the focus, and deepening the reflective potential (eg identifying recurrent

themes; identifying negative surprises; identifying departures from routine or

recommended process (Kressel, 1997); or Smyth‟s critical structure for

confronting culture-based assumptions (Smyth, 1996))

discussion, and trials, about other ways of reflecting and processing information, and

self-awareness on preferred processing approach and implications for differences in style

of practice

5. Use additional resources for developing the group reflective work:

deBono‟s six hats (deBono, 1985)

handing over „time-out decision making‟ (when to stop and explain or discuss action;

when to take the action steps more slowly, with explanatory asides) to the students

capturing the student-expressed insights into practice in the minuting process

6. Use the individuals in the group to share the observational load: each observer focus on a

different aspect; all look for „getting warm‟; each observer then formally contributes to the

debrief about their particular focus; use this a couple of times, changing the particular focus

amongst the group so that observers gradually learn to „see‟ more of the whole complex

An instance – In Cognitive Behaviour Therapy there is a mnemonic for practice: “ABC”. It

refers to Affect, Behaviour, Cognitions. In working with a role play situation, a debrief could



be developed around the use of Affect, Behaviour and Cognitions to explore the application and

relevance of these to the therapeutic stance displayed in the as-if therapist‟s practice (analysis at

the practical/technical level). A separate and relevant approach could be taken to address the

self in the practice: what is the practitioner‟s Affect, Behaviour, Cognitions, and how are these

impacting in the practice situation? (There are now at least three „cuts‟ of reporting: (1) the as-if

therapist can report their contemporary self-awareness; (2) observers can report their

observations of practitioner Affect, Behaviour, Cognitions [observation of another practitioner

for signs and testing inferences with contemporary self-awareness reported]; (3) observers can

report on their own experience of similar therapeutic instances to reflectively abduce and

develop personal self-awareness in these three categories, and work some more on the personal

efficacy implications for their professional practice effectiveness).

Acknowledgements: I wish to acknowledge and thank Dr Craig Gonsalvez, and the students of his Group Supervision for Clinical

Psychology practice classes in 2006, at University of Wollongong masters classes, for access to the sessions

observed, for sharing in thinking about reflective practice, in practice, and for post-session professional discussions

and analysis review.



BIBLIOGRAPHY

Allen, D. (2005). Contributing to Learning to Change: Developing an action learning peer support group of professionals to investigate ways of improving their own professional practice. Unpublished M.Ed.(Hons), University of Wollongong, Wollongong. (http://ro.uow.edu.au/theses/288/)

American Psychological Association, & APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-Based Practice in Psychology. American Psychologist, 61(4), 271-285.

Argyris, C. (1993). Knowledge for Action: A Guide to Overcoming Barriers to Organizational Change. San Francisco: Jossey Bass.

Bateson, G. (1972). Steps to an Ecology of Mind. Aylesbury, Bucks.: International Textbook Co. Bateson, G. (1979). Mind and Nature. New York: EP Dutton. Bell, M. (2001). A case study of an Online role play for academic staff. Paper presented at the Meeting at

the Crossroads. Proceedings of the 18th Annual Conference of the Australian Society for Computers in Learning in Tertiary Education., Melbourne: Biomedical Multimedia Unit, The University of Melbourne.

Bolton, G., & Heathcote, D. (1999). So you want to use role play?: a new approach in how to plan. Oakhill: Trentham Books.

Boud, D., Keogh, R., & Walker, D. (Eds.). (1985). Reflection: Turning Experience into Learning. London: Kogan Page.

DeBono, E. (1985). Six Thinking Hats. London: Penguin. Dewey, J. (1933). How We Think: a Restatement of the Relation of Reflective Thinking to the Educative

Process ( c.1933 (original 1910) ed.). Boston: DC Heath. Errington, E. (1997). Role-Play. Jamison Centre, ACT: Higher Education Research and Development

Society of Australasia, Inc. Gonsalvez, C. J., Oades, L. G., & Freestone, J. (2002). The Objectives Approach to Clinical Supervision:

Towards Integration and Empirical Evaluation. Australian Psychologist, 37(1), pp.68-77. Graham, L. F., & Milne, D. L. (2003). Developing Basic Training Programmes: A Case Study Illustration

Using the Delphi Method in Clinical Psychology. Clinical Psychology and Psychotherapy, 10, 55-63.

Heron, J., & Reason, P. (1997). A participatory inquiry paradigm. Qualitative Inquiry, 3(3), 274(221). Joyner, B., & Young, L. (2006). Teaching medical students using role play: Twelve tips for successful

role plays. Medical Teacher, 28(3), 225-229. Kressel, K. (1997). Practice-Relevant Research in Mediation: Toward a Reflective Research Paradigm.

Negotiation Journal, 13(2), 143-160. Mezirow, J. (1991). Transformative Dimensions of Adult Learning. San Francisco: Jossey-Bass. Milne, D. L., & James, I. A. (2002). The observed impact of training on competence in clinical

supervision. British Journal of Clinical Psychology, 41, 55-72. Nelson, M. L., & Neufeldt, S. A. (1998). The Pedagogy of Counseling: A Critical Examination. Counselor

Education and Supervision, 38(2), 70-88. Neufeldt, S. A. (1999). Training in reflective processes in supervision. In E. Holloway & M. Carroll (Eds.),

Training Counselling Supervisors: Strategies, Methods and Techniques (pp. 92-105). London: Sage.

Norcross, J. C., & Goldfried, M. R. (2005). The Future of Psychotherapy Integration: a Roundtable. Journal of Psychotherapy Integration, 15(4), 392-471.

Osborn, C. J., Dean, E. P., & Petruzzi, M. L. (2004). Use of Simulated Multidisciplinary Treatment Teams and Client Actors to Teach Case Conceptualization and Treatment Planning Skills. Counselor Education and Supervision, 44(2), 121-134.

Pomerantz, A. M. (2003). Who Plays the Client? Collaborating with Theater Departments to Enhance Clinical Psychology Role-Play Training Exercises. Journal of Clinical Psychology, 59(3), 363-368.

Rose, M., Best, D., & Higgs, J. (Eds.). (2005). Transforming Practice through Clinical Education, Professional Supervision and Mentoring. Edinburgh: Elsevier.

Schon, D. A. (1983). The Reflective Practitioner. New York: Basic Books. Schon, D. A. (Ed.). (1991). The Reflective Turn: Case Studies in and on educational practice. New York:

Teachers College Press. Shepard, D. S. (2002). Using Screenwriting Techniques to Create Realistic and Ethical Role Plays.

Counselor Education and Supervision, 42(2), 145-158. Smyth, J. (1996). Developing socially critical educators. In D. Boud & N. Miller (Eds.), Working with

experience: animating learning (pp. 41-57). London: Routledge.

http://ro.uow.edu.au/theses/288/



Toulmin, S. (1996c). Concluding Methodological Reflections: Elitism and democracy among the sciences. In S. Toulmin & B. Gustavsen (Eds.), Beyond theory: changing organizations through participation (pp. 203-226). Amsterdam: John Benjamins.

van Ments, M. (1999). The Effective Use of Role-play: Practical Techniques for Improving Learning ( 2nd ed ed.). London: Kogan Page.

Whiston, S. C., & Coker, J. K. (2000). Reconstructing Clinical Training: Implications from Research. Counselor Education and Supervision, 39(4), 228-253.

Yardley-Matwiejczuk, K. M. (1997). Role play: theory and practice. London: Sage.

Documents

Role Play in Training for Clinical Psychology Practice_ Investing to Increase Educative Outcomes