The impact of a deliberate practice workshop on therapist demand and support behavior with community volunteers and simulators.

Abstract

The present study used a newly developed simplified coding system, the Therapist Demand and Support Code, to examine specific therapist behaviors in the context of a previously conducted training trial on Deliberate Practice (DP). The parent trial randomized trainees to a DP workshop or its Traditional, more didactic counterpart (Westra et al., 2020). In both groups, trainees were taught to use Support, rather than Demand, for managing ambivalence and resistance, with the DP group having more feedback and practice. In this study, 68 trainees interviewed both an ambivalent community volunteer and an ambivalent simulator 4 month post workshop. The DP group was found to exhibit significantly fewer Demand behaviors than the Traditional group, with the latter also being significantly quicker to use Demand in the interviews. Moreover, the simulator evoked significantly greater Demand from therapists, regardless of the Training group, suggesting the simulators were more resistant. Although therapist use of Support was equal for community volunteers across training groups, Traditional workshop trainees decreased Support when interviewing the more resistant simulators, whereas DP trainees increased their Support with this same group. This is consistent with findings that DP trainees were more appropriately responsive, making fewer Demands following interviewee counterchange talk and using more Support at these times. These results provide some initial validation of the simplified therapist behavior coding system and offer further evidence for the benefits of DP workshop training for managing resistance. Clinical Impact StatementQuestion: This study examines how receiving deliberate practice training impacts therapist levels of support with real people and simulators. Findings: Clinicians should consider evaluating future continuing education workshops for their compliance with deliberate practice training. Meaning: Training should integrate the use of both simulators and real people in explicitly testing training impact because the difficulty of simulators can be increased to promote consistency in clinical skill application. Next Steps: Future training and research should explicitly evaluate the impact of deliberate practice and consider developing less complex process coding systems for easier adaptation to a training context.

How students use deliberate practice during the first stage of counsellor training

“…Within the field of deliberate practice of therapy skills, although a distributed approach to accessing expertise underpins the study by Chow et al. (2015), the predominant trend has been to espouse an apprenticeship model in which the learner is guided by a single authoritative coach (e.g., Anderson et al., 2019; Di Bartolomeo et al., 2020; Di Bartolomeo et al., 2020; Hill et al., 2019; Miller, Chow, et al., 2020; Miller et al., 2020; Rousmaniere, 2016; Shukla et al., 2020; Westra et al., 2020). Findings of the present study showed that students made use of multiple sources of expertise, including peers, experienced therapists (e.g., course tutors and videos of master therapists) and research evidence (e.g., measures of competence in specific skills), in a manner consistent with analyses of distributed expertise within communities of practice (Damasceno, 2018; Lave & Wenger, 1991).…”

“…Within the domain of psychotherapy, Rousmaniere (2016, 2018) has described a model of deliberate practice in which clinical supervision focused on enabling the supervisee to address skill deficits highlighted in client feedback. In studies of training workshops in specific skills, deliberate practice of modelled responses has resulted in higher level trainee skill improvement, compared with outcomes when deliberate practice was not used (Anderson et al., 2019; Di Bartolomeo et al., 2020; Di Bartolomeo et al., 2020; Hill et al., 2019; Shukla et al., 2020; Westra et al., 2020). A further pattern of deliberate practice of therapy competencies comprises self‐practice in which practitioners develop competence in therapy concepts and interventions through spending time applying these tools to issues in their own life (Bennett‐Levy, 2019; Bennett‐Levy & Finlay‐Jones, 2018).…”

The predictive value of patient, therapist, and in‐session ratings of motivational factors early in remote cognitive behavioural therapy for severe health anxiety

“…The level of detail offered by the CICS means that it may be a suitable tool to support the growing psychotherapy training technique of deliberate practice, by providing feedback that is sufficiently specific to help therapists identify key, individualized micro‐skills that require practice and improvement (Miller, Hubble, & Chow, 2020). Deliberate practice has been used to improve patient motivation through therapist training to address ambivalence and resistance, which can improve outcomes in CBT for anxiety disorders (Shukla, Di Bartolomeo, Westra, Olson, & Shekarak Ghashghaei, 2020; Westra et al., 2020). This training method might be further enhanced with detailed evaluation of in‐session patient activation using the CICS.…”

Interviewing and Counseling Skills—Beginnings: The Initial Interview

“…In one study of undergraduates, those who participated in a computer-based instructional sequence, where they were shown models of optimal and poor therapeutic responses, demonstrated signifi cant improvements in their facilitative interpersonal skills compared to those who only viewed videos about what contributes to successful engagement and creativity in work . Several other studies have demonstrated that this type of intentional practice improves facilitative interpersonal skills and other related counseling skills ( Elliot et al, 2018 ;Goldberg et al, 2016 ;Perlman et al, 2020 ;Shukla et al, 2020 ;Westra et al, 2020 ). You can engage in your own form of deliberate practice by following the steps in Box 5.4 .…”