Mastering the Inner Skills of Psychotherapy

A Book Review

Mastering the Inner Skills of Psychotherapy: A Deliberate Practice Manual”

Author: Tony Rousmaniere, Psy.D.

Purchase the book here.

Competency in psychotherapy appears to generally follow a fairly prototypical growth curve (Callahan & Watkins, 2018). Via life experience or other learning, some incremental gains in basic competencies (e.g., caring for others) begin even before formal training (Hatcher and Lassiter, 2007). Empirical evidence suggests that formal training encapsulates a period of accelerated growth in a range of specialized competencies (e.g., conducting evaluations, treatment planning, clinical decision making) (Price, Callahan, & Cox, 2017). However, no significant growth in broad psychotherapy expertise is typically evident after terminal degree attainment (Tracey, Wampold, Lichtenberg, & Goodyear, 2014). Taken together, the implications are concerning. A psychologist with marginal competency in their early career can be expected to do marginally competent work thereafter. Over the course of their career, thousands of lives may be impacted by their marginal competency. Although most states require continuing education, the review by Tracey and colleagues seems to indicate that such efforts yield little benefit in isolation. The public deserves better. But what can be done?

In studying highly effective psychotherapists, Chow and colleagues (2015) reported that those demonstrating the most expertise spent more time critically reviewing recordings of their own clinical work; an expertise development activity referred to as deliberate practice. To engage in deliberate practice, the individual must be able to access the foundational and functional skills associated with competency across four inter-related areas (Fouad et al., 2009). Attainment of competency in these areas varies in terms of difficulty (Price et al., 2017). In order of difficulty they are: self-care (both personal health and well-being so that effective professional functioning is assured), reflective practice (general self-awareness, self-monitoring, reflection-on-action in professional practice as well as reflection-in-action, and use of resources to enhance reflectivity), professional identity as one who uses professional development resources (e.g., literature, supervision), and self-assessment (routine monitoring and evaluation of practice outcomes, broad accuracy in self-assessment of own competency).

In his new book, Dr. Rousmaniere facilitates incorporation of each of these essential elements while providing readers with structured deliberate practice exercises for independent use by those seeking to improve their expertise in psychotherapy. As capacity for reflective practice is broadened, he introduces more advanced deliberate practice exercise and describes how to use tracking as feedback that influences individual training strategies.

Written clearly and succinctly, the book is highly readable and organized so that it is attainable to beginning psychotherapists or those still in training. One might question whether such individuals can benefit when they have so much left to learn about psychotherapy more broadly. A recent study by Cooper and Wieckowski (2017) would suggest they can. In their study of very novice trainees (mostly 1st year students), deliberate practice exercises were used to help trainees sustain their focus on problematic interpersonal patterns in a therapist-client exchange and trainees reported finding those exercises to be helpful and meaningful.

The text is so approachable there is risk the book will be overlooked as a tool for more seasoned psychotherapists. Yet, it is exactly those individuals who are perhaps most likely to benefit. Individuals who no longer regularly receive clinical supervision for their work will find that they may become their own, highly skilled, source of feedback on their professional work. The brevity of the text makes it ideal for an established professional to quickly digest each chapter in small increments of time, putting into place needed elements (e.g., routine tracking of outcomes) and developing a feasible and efficient training strategy that can be used to guide completion of deliberate practice exercises and incorporate consistent methods into their practice.

Peppered with appropriate, timely, and empirical citations throughout, the book never succumbs to pedantic prose. Rather, it is highly relatable. Those needing help in broadening their capacity for reflective practice will find activities that stretch them and foster needed growth, while those who find themselves a harsher critic than any external supervisor and feel tempted to avoid tracking outcomes will find opportunities for professional development that bring solace and renewed self-efficacy. What is not found in the book is an allegiance to theoretical orientation or training models as pathways to expertise. As astutely noted by Wachtel (2011), when matters of identity are so strongly focused that they foster tribalism mentalities, tunnel vision has a tendency to emerge that deflects the field’s attention away from careful consideration of evidence. Dr. Rousmaniere’s book is an evidence-based addition to expertise development that adeptly avoids such mis-steps.

Jennifer L. Callahan, PhD, ABPP, earned her doctoral degree in clinical psychology from the University of Wisconsin–Milwaukee and completed her internship and postdoctoral training at Yale University School of Medicine. She holds board certification in clinical psychology and is a fellow of Division 29 (Psychotherapy) of the American Psychological Association. She is a former President of the Society and currently a professor in the Department of Psychology at The University of Texas at Dallas.

Cite This Article

Callahan, J. L. (2018, September). Mastering the inner skills of psychotherapy: A book review [Web article] [Review of the book Mastering the inner skills of psychotherapy: A deliberate practice manual, by T. Rousmaniere]. Retrieved from


Callahan, J. L. & Watkins, Jr., C. E. (2018). Evidence-based training: The time has come. Training and Education in Professional Psychology, 12, 211-218. doi: 10.1037/tep0000204

Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. T., Thornton, J. A., & Andrews, W. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52, 337-345. doi: 10.1037/pst0000015.supp (Supplemental)

Cooper, L. D. & Wieckowski, A. T. (2017). A structured approach to reflective practice training in a clinical practicum. Training and Education in Professional Psychology, 11, 252-259. doi: 10.1037/tep0000170

Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P., Madson, M. B., & … Crossman, R. E. (2009). Competency benchmarks: A model for understanding and measuring competence in professional psychology across training levels. Training and Education in Professional Psychology3, S5-S26. doi: 10.1037/a0015832

Price, S. D., Callahan, J. L., Cox. R. J. (2017). Psychometric investigation of competency benchmarks. Training and Education in Professional Psychology, 11, 128-139. doi: 10.1037/tep0000133

Tracey, T. J., Wampold, B. E., Lichtenberg, J. W., & Goodyear, R. K. (2014). Expertise in psychotherapy. American Psychologist, 69, 218-229. doi: 10.1037/a0035099

Wachtel, P. L. (2011). Inside the session: What really happens in psychotherapy. Washington, DC: American Psychological Association. doi: 10.1037/12321-000


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