what

What is:

Deliberate Practice

TL;DR: Deliberate Practice incorporates the following components:

  1. Conscious cognitive effort - pay attention to practice

  2. Moment by moment difficulty adjusting - Practice should be neither easy nor overwhelming. It should be achievable with effort and teacher guidance.

  3. Deliberate - practice should have a clear performance goal. Knowing the outcome of ideal performance allows for adjustments if rehearsal does not lead to the best results.

  4. Feedback - incorporating immediate corrective feedback means the skill is learned correctly. Practice makes skills permanent, we want to make sure the permanent skill is performed correctly.

What it looks like

The Process of Deliberate Practice goes from observing real life performance, to practice and back again. Here is a quick breakdown of the process.

By observing performance we recognize our specific skill deficits. This can be done by video recording therapy sessions and watching them with a supervisor. If recordings are not a possibility, role plays can be used to simulate performance in specific clinical moments.

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The supervisor will then provide feedback and guidance, with modeling of ideal performance and specific ideas for effective practice.

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The practice drills are then rehearsed in solitary practice based on the supervisors guidance. The skill is repeated again and again, until achieving a sense of mastery in the practiced skill.

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We then transition back to real life performance, meeting our next patients in the clinic. The relevant clinical challenge should be easier, performed at a higher level with greater comfort and fluidity, like a prima ballerina.

The Science of Practice

Deliberate Practice is what elite performers do between performances. To better understand Deliberate practice, we are best looking the types of practice that are not Deliberate Practice.

The first and most basic form, one that we often implement, is mindless practice. This is what we are doing when repeating a skill without conscious attention. If I just sit and strum my guitar, without cognitively thinking about performance, my skill is Autonomous, and practice can be mindless. This kind of practice has very little impact on skill improvement.

The next kind of practice is termed purposeful practice. In purposeful practice we are now investing cognitive effort in an attempt to improve a skill. Perhaps I’m focused on accurately playing a string of notes on my guitar, while gradually increasing speed. In this case, I will see improvements in my performance until the skill becomes easy, at which point I can start rehearsing it mindlessly, taking me back to the stagnation of mindless practice.

So we can already see one major component in deliberate practice: cognitive effort. To keep improving, I need to constantly bring my rehearsal into a space where I am challenging my current abilities. This is done by breaking skills into small components, and as soon as one skill becomes easy, I either make practice harder (e.g. playing faster or a more complex string of notes) or transition to the next sub-skill (e.g. adding vibrato to my fingering when playing the notes).

The above image represents the difference in process between standard practice and deliberate practice. Standard practice is usually a combination of purposeful practice that transitions into mindless practice once the skill is acquired at a sufficient level. This stage of learning stagnation is called Arrested development. Deliberate practice on the other hand, involves constantly updating learning goals and difficulty levels, thus breaking learning into a cycle of excellence where every step builds on the previous skill achieved.

from Purposeful to Deliberate Practice

We are now much closer to what we are looking for, but still missing one last component. Deliberate Practice, unlike purposeful practice, has a model performance to work with. This is usually achieved with a coach, who guides skills and knows what ideal performance looks like. A coach using deliberate practice guides students as to which micro-skill needs to be practiced, with which practice routines, for best results. The coach will also give a representation of ideal performance as a point of reference for the student. This process is then necessarily followed by monitoring of progress in light of ideal performance. In psychotherapy this is achieved through a number of channels.

The most fundamental option is outcome monitoring, as is done in Feedback informed Therapy (FIT). When monitoring therapy components that measure and predict treatment quality, we can constantly adjust performance to better fit the model of ideal therapy. Another way of monitoring performance involves role-play feedback. In role play with friends and colleagues, skills can be assessed as if they were real. Our role play partner can tell us if our reflection felt empathic, or if our validation made them feel heard. This is not suitable for all therapy skills, but is extremely useful with a wide array of important ones. Verbal clarity, persuasiveness, empathy and validation are just a few to mention. A third, and promising way of monitoring skills in light of ideal performance involves the observation of micro-markers. These markers are client behaviors that serve as clues as to whether an intervention achieved it’s goal or not. Is the client using more change talk, is his body posture more engaged, did he stop replying with ‘yes but’ and instead stop to think? All of these are useful measures. 

The role of Feedback

The key to understanding practice lies in the understanding of feedback and its vital role in learning. Behaviors are learned through a process of trials and feedback. If we think of a child learning to walk, the toddler will stand up and take a step. If he falls, the fall serves as feedback - the attempted step was ineffective. If he stays up, the feedback is that the last step was a good step. without feedback, the child’s brain would not learn which movements to prioritize over others. The same is true for basketball. If the ball falls into the basket, it’s a positive reinforcement. If the shot is missed, the learning is that a different chain of motor movements should be attempted. It has become common-knowledge that without corrective feedback, learning is greatly limited.

Based on this, we would expect practice to lead to constant improvement in results. And yet, in many fields, including psychotherapy, professionals reach a state of Arrested development. This can be explained by looking at the function of habits. A learned behavior, once rehearsed, becomes fluent and automatic. The benefit of this Automaticity is the conservation of cognitive effort, with attention turning to other tasks. The downside of Automaticity is that automatic behaviors, often termed autonomous skills, are not sensitive to feedback, and thus do not change, even when corrective feedback is available.

Thus feedback in deliberate practice needs not only to be excellent feedback, it need to be used correctly. Good feedback is immediate and actionable. Good feedback is followed by behavioral implementation of the feedback through rehearsal. Rehearsal must involve conscious attention to the task at hand. Without concentrated attention, performance remains habitual, insensitive to feedback, and thus stubborn and unchanging. A powerful example of arrested development can be seen in the study by Goldberg et. al, 2016, a study that has been replicated since.

In this study, outcome data collected over 18 years showed no improvement in treatment results, as can be seen below.

In this image, each line represent the performance of one therapist, over a period of 18 years. The average change in outcomes is very near zero, and not in any way significant. This suggests that despite a wealth of experience acquired over these years, skills remain habitual and professionals tend to get stuck in arrested development. And yet not all therapists are the same. some of the therapists in the study improved, while others deteriorated. Hence, the question, what path can lead us to be the former and not the latter. Deliberate Practice is currently the most promising path out of stagnation and into professional growth. If that’s what you have come for, you are in the right place.

References:

  • Goldberg, S. B., Rousmaniere, T., Miller, S. D., Whipple, J., Nielsen, S. L., Hoyt, W. T., & Wampold, B. E. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. Journal of Counseling Psychology, 63(1), 1–11. https://doi.org/10.1037/cou0000131

  • Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Random House. Amazon books link (this is not an affiliate link and I make no profit from it)

  • Anders Ericsson, K. (2008). Deliberate practice and acquisition of expert performance: a general overview. Academic emergency medicine, 15(11), 988-994. https://doi.org/10.1111/j.1553-2712.2008.00227.x

  • 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. https://doi.org/10.1080/10503307.2024.2308159

  • de Jong, K., Conijn, J. M., Gallagher, R. A., Reshetnikova, A. S., Heij, M., & Lutz, M. C. (2021). Using progress feedback to improve outcomes and reduce drop-out, treatment duration, and deterioration: A multilevel meta-analysis. Clinical psychology review, 85, 102002. https://doi.org/10.1016/j.cpr.2021.102002