In this introductory article we provide a brief overview of what Deliberate Practice is and why it matters for psychotherapists. We then present the Sentio Supervision Model, a 7-step Deliberate Practice supervision approach developed by the Sentio Marriage and Family Therapy (MFT) program that helps trainers integrate comprehensive skill building into clinical supervision.

What is Deliberate Practice?

Deliberate Practice is a series of research-based learning principles that studies have shown to predict the development of professional expertise across multiple fields (Ericsson, 2018, 2008). In short, it is not enough to attend lectures or read about your field to become a master surgeon, basketball player, violinist and, yes, psychotherapist (Vaz & Rousmaniere, 2021). Instead, trainees from these fields need both conceptual and active procedural-experiential skills training to achieve expertise. Deliberate Practice is an evidence-based training approach to facilitate this integration.

Here’s how pioneering expertise researcher K. Anders Ericsson summarized the key Deliberate Practice principles:

Analyzing a review of laboratory studies of learning and skill acquisition during the last century, we found that improvement of performance was uniformly observed when people were given tasks with well-defined goals, were provided with feedback, and had ample opportunities for repetition. These deliberate efforts to increase one’s performance beyond its current level involve problem solving and finding better methods to perform the tasks. When a person engages in a practice activity (typically designed by teachers) with the primary goal of improving some aspect of performance, we called that activity deliberate practice. (Ericsson, 2003, p. 67)

In our own “translation” of these principles (Goldman et al., 2021; Vaz & Rousmaniere, 2022), we emphasize the major distinction between conceptual versus procedural learning in psychotherapy, and how both are necessary for clinical expertise. The table below provides a clear distinction between these two learning activities.

Table 1. Comparing routine performance, conceptual learning, and deliberate practice (used with permission from Vaz & Rousmaniere, 2022)

Why does this matter for psychotherapists?

A growing number of prominent psychotherapy researchers and authors now suspect that Deliberate Practice (DP) could be a missing “key ingredient” to foster clinical mastery (Anderson & Perlman, 2020; Boswell et al., 2020; McLeod & McLeod, 2022; Miller et al., 2020; Norcross & Karpiak, 2017; Wampold et al., 2019). Over 15 published studies from independent research teams around the world have shown that DP training outperforms our field’s “training as usual” methods for clinical skills acquisition (for reviews, see Nurse et al., 2024, and Mahon, 2023). Research on this is still in its infancy, so we expect to see rapid growth in the number and quality of studies in the near future. (For an up-to-date list of DP in psychotherapy papers, see here).

Despite the widespread enthusiasm and preliminary positive findings for the use of Deliberate Practice in psychotherapy training, most interested parties – supervisors, therapists and trainees – still struggle with how to actually implement DP in a rigorous and consistent fashion. In other words, the field is sorely missing concrete and trainable guidelines to implement DP in various clinical settings.

Sentio’s Deliberate Practice Supervision Model

One team that has been making strides in developing DP guidelines and procedures is Sentio. The Sentio Marriage and Family (MFT) MA program is a 20-month hybrid online and in-person program that provides a fast-track to becoming licensed as a LMFT in California. The Sentio Marriage and Family Therapy program adopts a novel strategy for training therapists, employing small groups and maintaining a low ratio of students-to-faculty. This setup enables personalized and intensive mentorship right from the start. Importantly, this program is the first to our knowledge that systematically integrates Deliberate Practice skill building into every course and class meeting. This means that every week, Sentio trainees receive rigorous conceptual and procedural-experiential training, as both are essential to develop clinical competency.

As part of Sentio’s mission to disseminate open-source resources on Deliberate Practice, its team has developed the first step-by-step Deliberate Practice supervision model. The Sentio Supervision Model (SSM) is a 7-step approach that helps trainers integrate three supervision-enhancing methods into every supervision session: (1) the use of routine outcome monitoring, (2) the use of therapy recordings in supervision, (3) personalized Deliberate Practice skills training (Haggerty & Hilsenroth, 2011; Lambert et al., 2018). We should note that this DP supervision approach can also be used if trainee’s have no client outcome or therapy recordings available – these are very helpful augments to DP supervision, but not necessary to carry out its main steps.

Below is a summary of the main steps in the Sentio Supervision Model:

For a video primer on Deliberate Practice supervision, see here.

Conclusion

While Deliberate Practice might seem straightforward at first, we have found that it requires considerable effort and training on part of the supervisor to implement DP supervision effectively. Also, different clinical supervisors and trainees will, of course, have different needs that should be accommodated for within the broad structure of this supervision model.

In the next articles in this series, we will present supervisors’ and trainees’ experiences with Deliberate Practice supervision. You will hear from experienced supervisors about their transition from facilitating “supervision as usual” to DP supervision; and from trainees’ experiences and challenges in engaging in DP supervision. These reports will be coupled by videos showcasing DP supervision in action.

We look forward to you joining us in the articles in this series.

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Alexandre Vaz, PhD

Alexandre Vaz, Ph.D. is the Director of Training at the Sentio Counseling Center. He is co-editor of two book series: The Essentials of Deliberate Practice (APA Books) and Advanced Therapeutics, Clinical and Interpersonal Skills (Elsevier). He has held multiple committee roles for the Society for the Exploration of Psychotherapy Integration (SEPI) and the Society for Psychotherapy Research (SPR). Dr. Vaz is founder and host of Psychotherapy Expert Talks, an acclaimed interview series with distinguished psychotherapists and therapy researchers. He is a licensed clinical psychologist in Portugal.