Why deliberate practice might not the be best way to advance psychotherapy.
I have this idea. For the past two years I've been trying different ways to express this idea, but for the life of me, it won't come out right.
So I'm just going to say it. Deliberate practice might be the wrong way to advance the field of psychotherapy.
Psychotherapy has a massive problem. Outcomes haven't improved in 40 years, rates of mental illness haven't decreased in 20 years, no model outperforms another model, and most therapists help 50% of clients of which only 20% experience recovery
Our field's way of fixing this has been a series of alphabet weekend certificate trainings. Which, the research is also clear, doesn't work. Going to another weekend training will basically do nothing to help your sessions.
What actually works? A process called deliberate practice. It's not complicated and is exactly what it sounds like. Deliberately practicing therapy microskills, over time, improves your abilities as a therapist. It is not a novel idea. Any athlete or musician knows this. Deliberate practice isn't new to the world. It's just new to therapy.
So psychotherapy as a field is in shambles and the fix is a process of deliberate practice. If we could all meet with a coach once per week, review our tape and practice micro skills we'd have a generation of expert therapists.
So why am I saying that deliberate practice might be wrong?
Because no other field advances like this. Deliberate practice is this idea that we should try harder. And that works for the individual practitioners. But that idea isn't what advances fields.
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I've had this idea for a while, but it really struck me after stumbling across this Steve Jobs quote.
“I think one of the things that really separates us from the high primates is that we’re tool builders.
I read a study that measured the efficiency of locomotion for various species on the planet. The condor used the least energy to move a kilometer. And, humans came in with a rather unimpressive showing, about a third of the way down the list. It was not too proud a showing for the crown of creation.
So, that didn’t look so good.
But, then somebody at Scientific American had the insight to test the efficiency of locomotion for a man on a bicycle.
And, a man on a bicycle, a human on a bicycle, blew the condor away, completely off the top of the charts. And that’s what a computer is to me.
What a computer is to me is it’s the most remarkable tool that we’ve ever come up with, and it’s the equivalent of a bicycle for our minds.”
Jobs is talking about the unique human ability to create tools. Think about it. Just about every profession has advanced by using tools. To do otherwise is, well, kind of absurd.
Imagine you wanted to be the world's best physician. You could develop an entire deliberate practice regimen to learn to tell temperatures by hand. You could develop a protocol to warm your hands to the right temperature, do research and find the best spot for identifying temperature on the human body, and then test your skills in giving an accurate reading of temperature against an external measuring stick. Or you could just give the kid a thermometer.
Tools work for two reasons. First they standardize our performance. They make it easy for us to do the same thing again and again. They make us consistent. And consistency is super important for outcomes. The other reason tools work is they simplify the task.
And over all, simple interventions work better than complex ones.
The other day I was listening to a podcast about women's health. The guest was talking about how many women have stopped taking the pill because the pill often causes anxiety and depression. Instead they are now using natural contraceptive methods, things like lowering their body fat and tracking their cycle.
Then she let slip that she's known many women who've used these natural methods and some of them have ended up with accidental pregnancies.
Well of course! The pill is a simple solution to contraception. Tracking your cycle and trying to manage your body fat percentage is really complex. In an ideal world, or in a lab, tracking your cycle or managing body fat works to prevent pregnancy, but in the real world it's just easier to take a pill.
I think the same thing is probably true for therapy. For all that I've seen DP work in my own caseload and as much as it matches the research, working on DP may not be the most effective way to improve the field of psychotherapy.
We may need to focus much more on tools, technologies and innovations which help people resolve specific issues. For instance things like TMS for depression, or the Safe and Sound music therapy for trauma, or neurofeedback for ADHD. These sort of brain based tools are probably where we need to be focusing most of our energy if we're wanting to move the field forward.
That is, when it comes to problems of the mind, we can train harder or we can just build a bicycle.
Jordan (the Counselor).
If you liked this post, consider reading this next. I think you'll like it ;) It's about the big mistake everyone makes with money.
Jordan Harris, Ph.D., LMFT-S, LPC-S, received his Doctor of Philosophy in Marriage and Family Therapy from the University of Louisiana Monroe. He is a licensed professional counselor and a licensed marriage and family therapist in the state of Arkansas, USA. In his clinical work, he enjoys working with couples. He also runs a blog on deliberate practice for therapists and counselors at Jordanthecounselor.com.