In this post I am going to attempt to start a war that no one has asked me to start, but I think it’s one we need to have.
I have had an interesting desire that has intensified over the last few months. To the point now that I’m metaphorically chomping at the bit. It’s a desire to have someone actively disagree with my Deliberate Practice efforts or Deliberate Practice itself. It’s like I’m looking for an adversary.
It’s a fairly strange strategy on my part. My lead theory is that I’m doing my best to imitate a strategy that Michael Jordan reportedly employed. He would apparently make up that an upcoming opponent had slighted him or his team in some way, as a way of firing himself and his teammates up. I think I have the same intention here. But let’s be real, it could also be because I’m trying to prove myself.
Someone mentioned in passing that Barry Duncan disagrees with Deliberate Practice being an answer to better therapist outcomes. I did my research and found Barry’s blog. Low and behold, it’s true – Barry has what would seem like an alternative theory to therapist outcome improvement.
I want to say nice and early, that in providing my counterargument to Barry, here in this post, I will be heavily getting into semantics. The reason being that I fear therapists who have little to no idea about Deliberate Practice will see Barry’s arguments and feel convinced to steer well clear from anything related to Deliberate Practice. In my belief, he is unintentionally steering them away from discovering processes that could be very helpful.
Despite my reasoning, it’s very important to remember that the semantics don’t matter at the end of the day. So long as we’re improving as therapists (assuming that you want to), it doesn’t matter what we call the process. One lesson I have learnt is that there are many different ways to improve client outcomes, so long as you’re targeting how to get better ar building stronger therapeutic alliances or other common therapy factors.
For his part, Barry’s main argument is that therapist development and outcome improvement comes from two things. Things that he argues are separate from Deliberate Practice. Firstly, to see your client as your best teacher. The idea being that client’s are the best people to help you improve the therapy you are providing, given that they are the person receiving it. He puts forward big research to support this too. A 2005 study of 11000 therapists found that 97% of therapists agreed that their client is their best teacher (Orlinsky & Rønnestad, 2005). I support the idea that clients are amongst our best teachers, but how many therapists are actually putting that belief into practice, let alone mastering putting into practice?
It’s similar to how many therapists understand that the therapeutic relationship and common factors of therapy are hugely important to better outcomes, but how much time do those same therapists spend in practising getting better at those factors?
It’s one thing to say what’s important, it’s another thing to actually do it. I’ve learnt that lesson time and time again through my journey. The amount of times that I thought my processes for aligning with a clients goals were as solid as they could be, only to find there was much more room to grow. There’s always more that can be squeezed out of the common factors lemon.
Barry’s second point is that we need to use routine outcome measurement tools to guide us with clients. To help understand what is working and what isn’t for a client. The argument here being that we learn best by addressing our approaches with clients who are not improving. Again, something I agree with immensely.
However, I will say quickly that contextualising a client’s score on an outcome measure is extremely important as well. A score on a questionnaire cannot tell the whole story alone. In fact, I know of therapists that will cease therapy with client’s just because they are not improving on the chosen outcome measurement tool. They have their stated reasons, but it’s a strategy that I very strongly disagree with.
The thing is, what Barry sees as separate to Deliberate Practice, I see as fundamental parts of Deliberate Practice.
Therefore, my intention here is to look at Barry’s argument across a series of his blog posts and break them down and make some counterarguments. It’s important to note that Barry isn’t here to provide any counter points back to me, so please make sure to consider that as you read this post. A big part of me hopes that Barry will see this, but my point is that I’m going to have to take certain liberties and assumptions in order to respond to Barry’s arguments. Liberties and assumptions that may be incorrect. I’m happy to be corrected.
To be clear, I have no intention to make an adversary out of Barry. I have immense respect for any therapist that is passionate about obtaining improved outcomes.
While Barry has written here and there about Deliberate Practice for a while, I will be mostly referring to points he raises in this article he wrote in 2020.
That’s enough introduction and context, let’s get on with the show.
Barry’s views on Deliberate Practice
Defining Deliberate Practice
Barry’s core argument, that Deliberate Practice is not an answer to therapist development, boils down to how he defines Deliberate Practice. So let’s start with Barry’s definition of Deliberate Practice. As a heads up, I’m going to be nitpicky as hell, because I think it’s important to be as specific as possible.
In describing Deliberate Practice in June 2020, Barry wrote:
“A lot of recent attention has been paid to “deliberate practice” as a method to improve therapist performance. It is defined as individualized training activities specifically designed, usually by a supervisor, to improve aspects of an individual’s performance through repetition and successive refinement.”
Barry Duncan
Ok, I agree with just about all of that. I’ll start off with a quick nitpick, training activities are designed by a coach, preferably not a supervisor. There’s actually a big difference.
But there are bigger issues at play. This is a guess on my part, but it seems like Barry has been referring to the definition of Deliberate Practice as it was first put forward by K. Anders Erikson. Who was the person that first described Deliberate Practice after studying musicians, athletes, chess masters and many other fields of performance.
The thing is, that definition that Barry has been referring to was first coined in 1996. That’s 27 years ago, people. Only three years after I was born! It’s old. The issue with old things is that time changes almost everything. This includes how Deliberate Practice can be defined in applying it to therapists. For example, there are therapists that agree that procedural learning via behavioural rehearsals are a crucial part of their Deliberate Practice efforts, but I’m not one of them.
Barry is right so long as you use the definition of Deliberate Practice from 1996. I agree in the belief that it’s a definition that doesn’t apply well to therapists who want to get better at therapy. Of course, what works for musicians, athletes and chess masters etc will not directly translate to what works for us as therapists.
What I believe Barry is missing, is that the definition of Deliberate Practice has evolved since it was first described. How do I know that? Because I have evolved it. I’m not saying I have evolved it for everyone, just myself so far. I’m the only one using my definition of Deliberate Practice – because it exists in my head alone – at least in full.
My broader point is that definitions evolve. Therefore criticism needs to evolve as well. How I define Deliberate Practice is fairly different to how it was first described. Procedural learning is said to a crucial ingredient, but it’s hard to describe how I would be engaging in learning the traditional way – given that my preferred way of practising is very, very cognitive.
Basically, I spend hours reflecting and ‘playing with’ the various mental representations I have in my head for what I see as good therapy. I also spend an inordinate amount of time mentally rehearsing and improvising therapy situations (both real and imagined), I mean A LOT. It’s what my brain likes to do whenever it’s idle. Is that procedural learning in the traditional sense? No, I don’t think it is.
In fact, one of my brain’s favourite pastimes when I can’t sleep is to pretend I’m trying to do therapy with Donald Trump or even Vladimir Putin. Talk about tough customers!
It all feels very akin to LinkedIn post I came across recently, by Kaye Frankcom, that was sharing something four time Olympic Psychologist, Graham Winter had said in a magazine article. Graham said that in times of volatility, the best decisions are drawn from well-prepared mental models. In high stakes environments we need to have already decided on our choices and then select one at the decision point.
I felt very validated by that post. It spoke to my brain’s penchant for rehearsing conversations, especially in therapy. I can see how normally such rehearsals would be problematic, what if what I rehearse doesn’t happen? I would be thrown off, but I rehearse so often from so many different angles that it’s like I’m prepared for twelve different outcomes.
Clients sometimes commend my memory for things they have said months ago. What they don’t know is that my memory isn’t exceptional. I just mentally revisited that thing they said dozens of time over those few months.
So when do I most often engage in these reflections and rehearsals? On my way to and from work. Either driving in the car or on the train.
It’s like what I practice in my head, naturally comes out in a therapy session, once it’s ready.
Further to my own beliefs about Deliberate Practice, I don’t believe having a coach is absolutely necessary to success. I believe that quick reactivity and a high level of responsiveness to feedback is part of what is helping me improve as a therapist over the last four years.
As recently as 2024, Barry has argued that in order to improve, we need to treat our clients as teachers and use routine outcome measurement.
Yes, I would agree with Barry that seeing your client as a teacher is crucial, as well as using routine outcome measurement to alter the therapy approach. But I personally see those two things as crucial parts of Deliberate Practice. A crucial part of Deliberate Practice is feedback after all. What he is referring to are two great sources of feedback.
In saying that, too much emphasis on seeing the client as our teacher will have its own issues as well. What if the client doesn’t want to teach us? Let’s say they fully expect us to teach them. What do we do then? We are also collaborative problem solvers alongside our clients. Clients don’t pay us to be our teachers.
However, when it does work, treating your client as your teacher has all the four core ingredients of Deliberate Practice. In doing so you get feedback, even potentially coaching on how to work with them, which then leads to you designing individualised learning objectives for yourself to better attend to that client, which then leads to you engaging in successive refinement as a result of making mistakes or gathering new information.
I think to me, what others see as alternative pathways to development as a therapist (e.g. Feedback Informed Treatment), I just see as a part of Deliberate Practice, not separate. I haven’t yet seen a single long term skill that doesn’t involve all four core components of Deliberate Practice (except maybe a coach). It’s not to say it doesn’t exist, but I just haven’t heard of any such examples.
The argument that therapy is not a performance like music or sports
There’s also a point in one of his posts, where Barry argues that therapy is not like a sports or musical performance. I know many people who would disagree with that statement. Because while therapy is not exactly like sports or music, it is still a performance. I think of how many of us put on a therapist mask with clients. To me, having a mask on is performance. It’s a mask we can never fully take off, therefore are always performing, at least to some degree.
Plus given the reactive nature of a therapy session, where things change moment to moment, we are required to respond to a client very quickly, often without the benefit of slow thinking (which I think my penchant for internal rehearsal outside of sessions is so massively beneficial).
The opposite to performance, at least in my eyes, is observation. Observation means being that coach on the sideline with the play by play clipboard. We cannot do observational well in a therapy session, it takes too long and too much cognitive effort is required (again, I’ve learnt the hard way).
Let’s take the commonly used Experiencing Scale. It categorises client statements from 1-7. It’s a fancier play on stages of change. The idea is that the therapist attempts to suss out which category a client is best falling into by assessing their statements and then refining their responses to the client as a result, in the hopes of encouraging the client to a deeper stage.
There’s no way I could effectively track clients like that, especially for those that are very tangential. That sounds like a bit of a nightmare to me. If I was to try using such a scale in session I would be in migraine country.
Additionally, If you become too observational in a therapy session you can risk losing connection with your client, because it would pull you out of the moment.
Sure, you could practice using the experiencing scale via behavioural rehearsals outside of sessions, but who has consistent time for that?
My tone is clearly become fairly cynical, but props to you if you can make it work. I just personally think there are easier ways – like lots and lots of targeted thinking.
Back to Barry, he points out another perceived issue in applying Deliberate Practice to therapists:
Barry Duncan
“Derived from studies of experts in sports, music, and medicine, deliberate practice involves repetitive cycles of skill-building activities selected on the basis of their abilities to help individuals make gradual improvements in performance.”
This is true, those in fields of performance, such as athletes, often have to repeat a skill. A soccer player may have to practise a correct passing technique that works for them over and over again to lock it in and make it a habit. Barry argues that this is not good for therapists, repetition in that way doesn’t fit therapy given the idiosyncratic and dynamic nature of our clients and the therapy process itself. I do agree with this as well, for the most part, but again I don’t see such repetition as essential for therapists either.
Finally, Barry argues that Deliberate Practice focuses far too much on microskills. Which means that therapists using it could be focusing on skills that are potentially not all important for improving outcomes and lend to over-simplifying therapy as a process, which is obviously incredibly complicated. Barry writes:
Deliberate Practice is too reductionist
“Deliberate practice is inherently reductionistic and, at best, applicable to beginning-level counseling skills. A mountain of research suggests that psychotherapy is not easily reduced down to discreet skills that translate into increased benefit for clients. Although it has been proposed that deliberate practice should focus on therapists’ intrapersonal and interpersonal skills, it remains unclear the extent to which these qualities ultimately relate to client outcomes.”
Barry Duncan
“As if it wasn’t enough for some to reduce psychotherapy to a set of models and techniques applied mechanistically to client problems and diagnoses, deliberate practice seeks the same with the unique relational, discovery, and cultural contexts of psychotherapy.”
At least when it comes to the pursuit of better outcomes, I agree that Deliberate Practice does not work well when you apply it to therapy skills and techniques. But not all who engage in Deliberate Practice apply it that way. I have found great power in Deliberate Practice when applying it to very foundational skills in therapy, like listening better to my clients. I mean, just look at the gradual improvement in my outcome statistics over the last four years…
To me Deliberate Practice is less about the ‘processes’ and ‘systems’ you build or the skills you target. In my mind, it’s more about the mindset it encourages, more than anything else.
Which rightly or wrongly I refer to as a scientist’s mindset, that in my mind includes:
- A desire to innovative.
- A strong muscle of curiosity.
- Being led by what works.
- Trying to prove yourself wrong. Carrying hope of proving a desired theory to be true, but always seeking to disprove it as well – looking to be wrong.
- An appreciation that others know something you don’t.
- Being prepared for the unexpected.
- Being open minded, especially to feedback.
- Stubbornness to pursue an idea in the face of doubt from others.
- A penchant for an inordinate amount of overthinking (workable obsession).
- Being led by data (both quantitative and qualitative), while also appreciating wider context when interpreting that data.
- Being willing to test current or commonly held assumptions, especially those that don’t provide supporting evidence.
- A willingness to fail – a fanatical belief in trial and error.
- A willingness to look at something from as many angles as possible.
- A patience and persistence to keep trying in the face of repeated failure.
- An understanding that the subjective is just as important as the objective.
- An acceptance that it’s best to move with human nature and not against it.
I have no idea if that would fit with a widely accepted view of what a scientist’s mindset is, that’s just how I see it.
Essentially, it’s a belief I have that until we are willing to be wrong, we can never be sure of finding what is right.
The reason I lean on the idea of a scientist’s mindset, is because I have learnt that there are many routes to improving one’s outcomes as a therapist, so long as you focus on foundational skills and common factors. Some need a coach to help them improve, some don’t. Some use behavioural rehearsals (very targeted mini roleplays), some don’t. Some are very behavioural in how they practise, some use a much more cognitive style. There’s not much agreement on exactly what Deliberate Practice needs to entail, but that just may mean it can come in a variety of forms.
In conclusion
We can’t treat definitions as if they are frozen in time. They are always evolving, because human beings are always evolving. It’s one of the reasons why I think therapy will always be a soft science, because what’s true for people today, may not be true tomorrow. The human race does evolve slowly, but it’s too fast for us to keep up with easily in research.
If we go off old definitions, it means we are treating Deliberate Practice as unchangeable and static, not as the dynamic system it truly can be.
Here’s my brutally honest take: I think there are no valid criticisms at present of Deliberate Practice, as it exists today, to warrant the conclusion that it cannot act as a form of therapist development.
As always, while I think I’m right, I can’t know if I am. I guess there’s two possible interpretations for what I’m arguing today. Either a) what I see as Deliberate Practice, isn’t DP, but something else. B) I’m still talking about Deliberate Practice, but it has simply evolved beyond its original definition coined by K Anders Ericson.
I think I’m leaning towards hypothesis B at this point. As the scientist turned orchestral Timpanist, Jason Haaheim, once told me – scientific theories are always evolving over time.
I know I’m talking myself up with a big game when I talk about my own Deliberate Practice efforts, but I really want to put everything out on the table. If anyone wants to go toe to toe with me on Deliberate Practice, just know that I’m all in. I am open to one day being pushed off this hill, but you’re going to have to put up a strong fight.
Yes, I do all this because a part of me does enjoy tooting my own horn, but I also really care immensely about helping my clients get better faster. I’m also concerned that while many therapists understand what is most important in better outcomes, they are not actually practising those elements as well as they could be. Yes we understand, but are we improving?
Understanding is only half the battle.
I don’t mean to come across like I have the one true answer to being a master therapist. Deliberate Practice isn’t about finding one way that applies to all. It’s about learning to master your own style of therapy.
I want to be clear that this is all being written in good faith. I am very interested in creating discourse, this means disagreeing with some of the big names in our field. Yes I want alternative views to open up my thinking, this is crucial, but I also believe you can disagree with an alternative view and still learn from it.
I so enjoy writing these ‘fight the power’ pieces because thinking about alternative views helps to both consolidate and open up parts of my own thinking – and that’s what I love. You could even say I’m addicted to that feeling. So, I chase it often. Reading Barry’s posts, even though I disagree with some of his views, has helped give me an idea on how to better align with my clients. It’s a small idea and may not work, but I’ll write about it once I try it. Not until 2025, this is my year of reflection and consolidation! It’s an idea that may reduce my initial assessments with clients to 5-10 minutes (assuming they and others are safe) – meaning I’d have far more time for collaborative problem solving with clients.
That’s why I love alternative views, it leads me to even greater ideas.
To be fair to Barry, he probably hasn’t seen Deliberate Practice work well when applied to therapists. This is something I hope to help change. Because effective Deliberate Practice doesn’t overlook what some therapists say about getting better outcomes, it includes it.
Barry, if you ever read this. I hope this piece opens up your thinking, as your posts helped to open up mine. In the words of Obi Wan Kenobi – “Your move”.
Deliberate Practice Psych 