Improve Clinical Decision-Making
One of the greatest challenges in concrete practice of psychotherapy skills, is the connection between theory and practice. Too often students and supervisees will complain that they know the theory all too well, but don’t know how to implement the theory in session. This is true in the case of Deliberate Practice as well, where skills are often practiced in isolation, without improving our ability to decide when to use each skill. This trainer is designed, using the Three Step Question (TSQ) developed by Dan Sacks, to bridge that gap.
The benefits of practice with the TSQ
By practicing in session decision making, you will be achieving a number of things. Firstly, as mentioned above, you will be a master of translating theory into interventions, as well as recognizing what’s happening in session and conceptualizing therapeutic moment.
Secondly, your speed and quality of decision making will greatly improve. Use the three step question slowly here at first, and when i becomes more intuitive you can use it in real-time during therapy sessions, when you need to make a clinical decision about the best intervention or direction for therapy.
The third and last point related to psychotherapy integration. Using the TSQ for decision making makes it much easier to integrate interventions from different psychotherapy models into your work. Read more on this benefit further down the page below the trainer.
How to use the trainer
To begin with, as always, let the trainer know you are ready. The trainer will then ask you for your preference as far as a theoretical model goes. The trainer is capable of working with popular theoretical orientations, such as CBT, EFT, psychodynamic etc. within these, you can ask for more specific models, such as CBT with a more behavioral focus, or Relational Psychodynamic. If you go too specific, the trainer might not be effective.
Following this intro, the trainer will guide you through practice. Feel free to interact with the trainer as you would do with a teacher. If you are stuck, as for an example or explanation. If you feel the trainer has made a mistake, feel free to point it out. These interactions will help the trainer better fit the practice to your needs. Enjoy!
(first time?? read the ‘how to get the best out of practice’!)
TSQ for psychotherapy integration in supervision and training
Seeing the argument
Looking at the dots, what do you see? a tree? a house? a flame? perhaps a clown? or none of the above. When connecting the dots, there is an infinite number of possible stories we can tell. This is what happens in therapy, We have some facts, client behaviors that we can observe, and then we tell a story - our case conceptualization, our theory.
Now look at the image below. Who is right? The argument could be endless… It’s a TREE! no! it’s clearly a house! you get the point.
Empirical Therapy with N=1
This is where it gets so important to put the story aside and focus on the dots. We both agree the client is avoiding his emotions? We both agree it would be better if he become more in touch with his emotions? It doesn’t matter so much if i call it a defense mechanism, experiential avoidance, or ambivalence. I can clearly describe where i belive the client is, and where i would like him to be. Then, i can choose a relevant intervention. Following the intervention, i can ask - can i see the change i expected in the client? If the answer is yes - excellent. keep moving ahead with the process. If the answer is no - let rethink, is he not where i thought he was? was this the wrong intervention? or did i not execute it well enough?
Once we have a clear map of what intervention we chose, in a concrete therapy moment, we can then empirically assess our performance, constantly learning and refining our clinical choices. Try it, you won’t regret it!
