What I’ve realised over the last couple of weeks

Deliberate Practice coaching is still awesome. I had the second session on July 30th and I enjoyed it more than I did the first time. The focus of the session centred around goal setting with clients, more specifically, shifting goal elicitation from focusing on symptom change instead to how a client’s life will be different if therapy works. As I did the first coaching session – I had a strong sense that my skills had started to develop as we finished the session, or at least a clearer path to further development had opened up. This is thanks to the behavioural rehearsal Nathan had taken me through and the subsequent discussion we had on the underlying principles. That sense of development I experienced has again shown itself, in my eyes, to be a key difference to the kind of supervision sessions I’m used to. In coaching, focusing literally on one skill not only makes it easier to concentrate, but really helps to “squeeze more out of the orange” so to speak. Where in the supervision I’ve had in the past, I would have a few subjects to bring up, therefore the focus would jump around to different topics and I would come away with one or two things that I would really remember at the end of 60 minutes. Skills and principles would predominantly be discussed and not practiced; even if a skill were practiced it would typically not be as thorough and micro-focused as behavioural rehearsal is in coaching. Same goes for the professional development courses I have done so far. That’s just my personal experience though and don’t get me wrong I still really enjoy the other kind of supervision, where the focus tends to be on sharing knowledge. I guess I’m finding in coaching that the kind of experience gained is something I have missed in my professional development to now. On top of that, the process of trying to find the current edge of my ability and develop beyond it can be really challenging. The process becomes a lot friendlier knowing there’s someone else to help me make my way through it.

What I’ve managed to do since my last post

I have been trialling providing the DP reaction scale to clients for all sorts of situations; to measure how challenging they find homework, to help break down goals and to monitor mental strain. I’ve also given it to some new clients at a first session to see if it’s useful in debriefing on how their homework went (e.g. if it was too difficult) later on. I’m really keen to see how they find it and if it works for them… or doesn’t.

My task from the second coaching session was to practice eliciting a clients goals in their own words, using some of the principles Nathan and I discussed. I have concentrated on finding opportunities to do this in sessions with clients, with a particular attention to how their lives would change “if the therapy works”, as opposed to the focal point being how symptoms will change. That has turned into more often engaging in guided exploration with clients to identify their values. I had planned to use a film analogy that I learnt from ACT to explore therapy goals (which I have used at times in the past), which essentially asks: “if you were filmed after the therapy had worked, hypothetically, how would we see you behaving differently in that film, compared to now, what would you be doing differently?”. However, I have not brought this up with clients I am already well established with, as I worried they might find this strange to suddenly go back to, so instead I have offered to explore values with them, where relevant. I thought that might be a more natural way to bring up the filming question after some values had been established, i.e. “if the therapy helps you to connect with these values, how would you be behaving differently when you’re connected to these values? What would we see you doing differently?”. In saying that, I’ve had some clients give SRS feedback along the lines of “I’m not sure where this is going” or “I’m not sure where I want therapy to head”, when commenting on goals and therapy direction. For those clients in a next session we agreed to discuss values or I’ll plan to bring up the ACT filming analogy. I’ve had some new clients start up in the last week, so in their second session I’ll be looking for opportunities to bring up therapy goals and the filming analogy.

This takes me to how I plan to practice the above outside of sessions – through solitary deliberate practice. To start, I will be working on how I introduce goal setting with clients and how I want to engage in guided exploration with them on their goals; again going from the goal focus being on symptom change, instead to how they want life to change. The relevance of me working on these skills was very, very, apparent in the second coaching session. Case and point; Nathan asked me to go through my client list and speak to how many of the client’s goals I could remember in their own words and not mine. In short, I quickly realised and said that for about 90% of my clients I would not be able to put their goals to their own words. I then saw that as evidence to why I wanted to improve my goal setting skill, as I tend to remember client goals in psych speak and symptom-focused language.

A good amount of my thought then has gone into creating a system for solitary DP and behavioural rehearsals. Firstly, I needed a process on what steps my solitary DP would include when I do it and how to reflect on each practice session. Once again, the DPforTherapists website has been incredibly helpful (https://www.dpfortherapists.com/dp-forms), as in that link the two forms I will use are:

1. The Solitary DP worksheet – which will act as steps to follow during the practice session.
2. The DP Therapist Diary form – to reflect on the practice session afterwards and consolidate what I learnt.

Fortunately for me, their website also has a page with suggested instructions on how to practice certain skills, with one link containing tips on practicing goal setting with solitary DP (https://www.dpfortherapists.com/instructions).

Secondly, I started to think about how I can go beyond reading a client’s statements in solitary DP, to ways I could hear them instead; in the interest of getting closer to real sessions. There’s a few different means of doing this I thought about, I’ll elaborate on those in a future post, but there’s one I want to get out there today, as it’s the one I’ll try first, which is – using text to voice AI to speak the client lines for me.

I found some really cool programs designed to act as a virtual voiceover, instead of an actual person, for various forms of content creation. They are similar to Google Translate or the dictation in Microsoft Word, but these kinds of programs go much further in important areas like voice quality, as in sounding more like a human voice than a robot voice.

Here are the programs I landed on:

1. Murf: has great voice quality, lots of voice options and tools to modify voice pattern, but it only allows 10 minutes worth of text conversion for free: https://murf.ai/
2. Lovo: similar perks to Murf in that I can enter numerous ‘lines’ of dialogue into the program and play them one at a time as I’m ready, also it doesn’t limit the free version to text conversion time but instead by the number of times you download the converted text. I don’t need to download what I make, just hear it, so hopefully I can use this one for a while: https://www.lovo.ai/
3. IBM: A tech demo that’s more limited in voice options than the two above but still works really well and is easy to use: https://www.ibm.com/demos/live/tts-demo/self-service/home

I think Lovo is my front runner at the moment, because it has the most free access. I’ve tested the programs and I think they work well, though it’s pretty eye-opening hearing how depressed my computer is. If anyone knows how to do behavioural activation with a computer – let me know? So now all there is to do is see how these programs go acting as the client in my solitary DP exercises.

Where to next?

I think that’s a good start – the process I will trial includes practicing solitary DP for 10 minutes once a week, with the following steps:

1. Fill out the ‘My Focus’ section of the solitary DP worksheet.
2. Create a small learning goal that is specific enough, I’m thinking: “elicit goals with the client by exploring how their lives will improve if the therapy works, invite the client to talk about this by raising it myself, including an explanation of the ACT filming analogy”
3. Note down some principles to keep in mind and consider them one at a time as I’m ready in the rehearsals (e.g. reflecting the client’s words back as close as possible, not using psych jargon; reframing symptom language to how life will change; talking about approach goals instead of avoidance goals and making goals specific, but not too specific).
4. Write down some specific moves for how I will enact the learning goal:
   • Say to the client: “I’m curious with everything that has brought you to see me, I’m wondering what you would like to get out of therapy, your goals so to speak, would you be open to talking about that?”
   • If client agrees, say: “How I encourage people to think about this is consider an analogy, which is: “if we filmed you after the therapy worked, hypothetically, how would we see you behaving differently in the film, compared to now, what would you be doing differently?”
   • Let the client provide their answer
   • Say: “Now what you’re saying and exactly how you’re saying it right now is incredibly important, these are our goals, so I want to take a moment to write down what you’re saying”
   • Me: Take a moment to pause and write down the client’s goals, while asking about one of the goals again, “now the second thing you said, I’m stuck on the exact words you used, what was that again?” (idea being to show the client not only how important the goals are, but also the importance of client’s perspective on them)
5. Pick a principle to focus on while enacting the above.
6. Practice ‘Round 1‘ of the exercise/specific moves.
   • Using the reaction scale from my previous post to tell me if I need to adjust the difficulty level of the exercise
   • While focusing on the principle I picked
7. Practice each round until I feel comfortable with the difficulty level of the exercise.
8. Once I’m ready to go up in difficulty, in the following round, I pick an additional principle to improvise on.
9. Complete no more than 6 rounds or finish at 10 mins; whichever comes first.
10. I can then up the difficulty in future by making the client’s statements more challenging (e.g. maybe the client has less to say at first when I first ask about goals, so then I need to use another principle or question to illicit more information).
11. Cool down.
12. Complete The DP Therapist Diary form to reflect.

I think engaging in solitary DP behavioural rehearsals will help me to keep my focus more consistently on the main stretch goal I am targeting at the moment – which again is improving my goal setting with clients. I’ll let you know how it all goes. Who knows – maybe I’ll start video recording the solitary DP sessions, or would that be crazy?

Till next time and as always – thanks for reading.

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