Daryl Chow , MA, Ph.D. (Psych)[email protected]
A System of Practice Practice, Supervision and Training
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,
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
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
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
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
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.
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Methods/Techniques
Develop First Principles Before The Methods , Daryl Chow, MA, Ph.D. (Psych)
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Methods/Techniques
Theoretical Orientations
First Principle
Develop First Principles Before The Methods , Daryl Chow, MA, Ph.D. (Psych)
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A System of Practice
1. Therapeutic Attempts 2. Mistakes
3. First Principles4. Refinement
5. Generalise
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!