Psychotherapy Articles

Psychotherapy Articles

Deliberate Practice Supervision Series from the Sentio Marriage and Family Therapy Program

Editor’s Note: Welcome to our series on Deliberate Practice for the Psychotherapy Bulletin. Our goal for this series in the Bulletin of the Society for the Advancement of Psychotherapy (American Psychological Association Division 29) is to inspire clinical supervisors, trainees and licensed professionals to integrate Deliberate Practice into their work. Each article in this series will present a trainee and supervisor’s perspective in engaging in Deliberate Practice supervision, following the novel Sentio Supervision Model. Readers will learn about the potential benefits and challenges of integrating Deliberate Practice skill building into traditional clinical training; and will have access to videos showing real trainers and trainees engaging in Deliberate Practice activities.

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)

Activity Definition Examples
Routine performance Performing work as usual Providing therapy
Conceptual learning Learning activities without repeated rehearsal/practice and feedback Attending lectures

Reading about psychotherapy theory, models, and research

Deliberate practice Repetitive rehearsal of specific skills with ongoing corrective feedback Repeated behavioral roleplaying of a specific clinical skill (e.g. empathic understanding)

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:

SENTIO SUPERVISION MODEL (SSM)
Steps Brief description Example
Step 1. Check Trainee’s Outcome Data If outcome data is available, focus the supervision on the client whose outcomes signal that they are the most distressed or at risk of clinical deterioration. Mary and her supervisor notice that her client Joe is flagged by an outcome measure as being particularly at risk of deterioration. Because of this, they choose to focus on this client for supervision.
Step 2. Review Supervision Preparation Form Trainees complete a Preparation Form prior to each supervision that elicits preliminary ideas from the trainee on what the focus of supervision could be. Mary wrote in her preparation form that her client Joe tends to get angry at her when she asks about his feelings. She says she doesn’t know how to address this.
Step 3. Identify a Client Challenge At this stage, supervisor and supervisee collaborate to agree on a challenging and observable client behavior that needs to be more effectively addressed in session. As Mary and her supervisor look at her therapy recording, they indeed notice that Joe is getting angry after being asked about his feelings. They agree to focus supervision, at least for now, on addressing this challenge.
Step 4. Identify a Therapist Deficit After identifying a client challenge, the supervisor helps the trainee see what they are doing in session that is not working or keeping therapy stuck. The supervisor noticed and reflected back to Mary that when her client Joe gets angry in session, she looks anxious and quickly changes the subject. The supervisor points out that this therapist behavior in session is part of what might be keeping therapy stuck.
Step 5. Identify a Learning Goal The supervisor and trainee collaborate to identify a concrete clinical skill to more effectively address the identified client challenge. Mary’s supervisor proposes to address the identified client challenge by doing an alliance repair intervention. Specifically, Mary could point out that she notices her client’s frustration and, instead of quickly changing the subject, she could nonjudgmentally invite the client to elaborate on his frustration.
Step 6. Behavioral Rehearsal The supervisor guides the trainee to repeatedly practice the identified skill in vivo. For each round of rehearsal, the supervisor provides brief, actionable feedback to refine the trainee’s intervention. The supervisor asks Mary to imagine she is in front of her angry client right now and invites her to try intervening with the proposed alliance repair skill. With each of her attempts, the supervisor provides feedback on how to better her intervention.
Step 7. Assign Deliberate Practice Homework The supervisor proposes a solitary practice homework, if possible using a video recording of the client challenge to repeatedly keep practicing the same skill that was practiced during supervision Mary’s supervisor ends the supervision session saying: “Use the therapy recording with Joe to repeat the same exercise we just did for at least 10-minutes until your next session with this client or our next supervision.”

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.

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.

Cite This Article

Rousmaniere, T., & Vaz, A. (2024, March). Deliberate practice supervision series from the Sentio Marriage and Family Therapy Program. Psychotherapy Bulletin, 59(2). 12-16.

References

Anderson, T., & Perlman, M. R. (2020). Therapeutic interpersonal skills for facilitating the working alliance. In J. N. Fuertes (Ed.), Working alliance skills for mental health professionals. New York: Oxford.

Boswell, J. F., Constantino, M. J., & Goldfried, M. R. (2020). A proposed makeover of psychotherapy training: Contents, methods, and outcomes. Clinical Psychology: Science and Practice27(3).

Ericsson, K. A. (2003). Development of elite performance and deliberate practice: An update from the perspective of the expert performance approach. In J. L. Starkes & K. A. Ericsson (Eds.), Expert Performance in Sports: Advances in Research on Sport Expertise. New York: Human Kinetics.

Ericsson, K. (2008). Deliberate practice and acquisition of expert performance: a general overview. Academic emergency medicine, 15(11), 988-994.

Ericsson, K. A. (2018). The differential influence of experience, practice, and deliberate practice on the development of superior individual performance of experts. In K. A.

Ericsson, R. R. Hoffman, A. Kozbelt, & A. M. Williams (Eds.), The Cambridge handbook of expertise and expert performance (pp. 745–769). Cambridge University Press.

Goldman, R. N., Vaz, A., & Rousmaniere, T. (2021). Deliberate practice in emotion-focused therapy. American Psychological Association.

Haggerty, G., & Hilsenroth, M. J. (2011). The use of video in psychotherapy supervision. British Journal of Psychotherapy, 27(2), 193-210.

Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55(4), 520.

Mahon, D. (2023). A scoping review of deliberate practice in the acquisition of therapeutic skills and practices. Counselling and Psychotherapy Research, 23(4), 965-981.

McLeod, J., & McLeod, J. (2022). Counselling Skills: Theory, Research and Practice 3e. McGraw-Hill Education (UK).

Miller, S. D., Hubble, M. A., & Chow, D. (2020). Better results: Using deliberate practice to improve therapeutic effectiveness. American Psychological Association.

Norcross, J. C., & Karpiak, C. P. (2017). Our best selves: Defining and actualizing expertise in psychotherapy. The Counseling Psychologist, 45(1), 66-75.

Nurse, K., O’shea, M., Ling, M., Castle, N., & Sheen, J. (2024). The influence of deliberate practice on skill performance in therapeutic practice: A systematic review of early studies. Psychotherapy Research, 1-15.

Vaz, A., & Rousmaniere, T. (2021). Reaching for Expertise: A Primer on Deliberate Practice for Psychotherapists. Seattle, WA: Sentio University.

Vaz, A., & Rousmaniere, T. (2022). Clarifying Deliberate Practice for Mental Health Training. Seattle, WA: Sentio Marriage and Family Therapy Program. https://drive.google.com/file/d/1MFdWU-fRl-2EKN2rdvFsExPcJ8-O0C_A/view

Wampold, B. E., Lichtenberg, J. W., Goodyear, R. K., & Tracey, T. J. (2019). Clinical Expertise. In S. Dimidjian (Ed.), Evidence-Based Practice in Action: Bridging Clinical Science and Intervention (pp. 152-166). Guilford Publications.

 

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