Why levelling up in ACT requires deliberate practice

My graduate school training at Lesley University was rooted in the philosophy of “self-as-instrument” with regards to the process of therapeutic change; that is to deeply know and effectively make use of oneself in evoking behavioural changes through the therapeutic relationship. Many years later, I continue to embrace and find this orientation helpful, albeit it has evolved to become an open, aware, and engaged self that is aiming to shape psychological flexibility within therapeutic encounters.  

Psychological flexibility, or “the ability to contact the present moment more fully as a conscious human being, and to change or persist in behaviour when it serves valued ends,” (Biglan, Hayes, & Pistorello, 2008) is the overarching aim of acceptance and commitment therapy (ACT).  

While textbooks, workshops, webinars, and other training resources abound, the actual implementation of ACT in the clinical context can remain elusive for many practitioners. Just as a musician is not expected to skilfully play an instrument at performance time without having spent dozens, if not hundreds, of hours strategically practicing with the instrument beforehand, it would make sense that therapists aspiring to become skilful clinicians would benefit from strategic practice opportunities outside of therapy to increase their competency; and this is exactly what preliminary research is suggesting (Goldberg et al., 2016; Chow et al., 2015; Westra et al., 2020).  

In fact, a longitudinal study (4.73 years) examining the clinical outcomes of 6591 patients for 170 therapists found that years of experience alone did not predict better outcomes, and on the whole, effectiveness actually decreased slightly over time (Goldberg et al., 2016). That is, without purposeful practice, our skill level is inclined to worsen over the years! So, if we value providing effective care for our clients (and patients), how might we go about developing a practice regimen that can support such ongoing aspirations?

We can turn to the work of the late K. Anders Ericsson, author of Peak: Secrets from the New Science of Expertise, who coined and defined the term “deliberate practice” as “engagement in structured activities created specifically to improve performance in a domain” (Ericsson, Krampe, & Tesche-Romer, 1993). 

In his lifelong study of human performance, skill mastery and expertise across different professional domains (e.g. music, chess, sports, surgery), he discovered core behavioural patterns common to expert performers, which can be summarised by the following functional definition: focusing intently on practice activities designed to improve specific skills that are just beyond one’s comfort zone while receiving and incorporating timely feedback from a coach.  

The on demand recorded workshop, Level Up in ACT: Fidelity training – become an elite ACT practitioner, is designed to provide such a personalised training experience for participants. Clinicians will have opportunities to practice targeting the improvement of clinical ACT skills that lie just outside of their existing competence level, or within their “growth edge”, as measured through self-assessment with the ACT-FM (Fidelity Measure). This 25-item instrument, developed at the University of Leeds with input from expert ACT trainers and clinicians, functions to assess both fidelity and competency within four domains of the ACT model: therapeutic stance and the three pillars of openness, awareness, and engagement. The ACT-FM will serve as a guide for deliberate practice while a functional feedback loop will be established to promote in-the-moment learning and shaping of behaviour for both client and clinician.  In addition, processes from evolutionary science, including variation, selection, retention and context sensitivity, will be mapped onto the ACT pillars as a means of deepening and aligning one’s clinical approach with the process-based movement in contextual behavioural science. To this end, attunement to ACT and evolutionary processes will allow for tuning up self-as-instrument.

 

About our guest blog

Our guest blogger Lou Lasprugato is a firm believer in the principle of “practice makes perfect”. Here he explains his thinking about why ACT practitioners need to constantly evaluate and how they can measure their performance to progress from experienced to outstanding or elite practitioner.

 

References:

Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. T., Thornton, J. A., & Andrews, W. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52(3), 337.

Goldberg, S. B., Babins-Wagner, R., Rousmaniere, T., Berzins, S., Hoyt, W. T., Whipple, J. L., … & Wampold, B. E. (2016). Creating a climate for therapist improvement: A case study of an agency focused on outcomes and deliberate practice. Psychotherapy, 53(3), 367.

Westra, H. A., Norouzian, N., Poulin, L., Coyne, A., Constantino, M. J., Hara, K., … & Antony, M. M. (2020). Testing a deliberate practice workshop for developing appropriate responsivity to resistance markers. Psychotherapy (Chicago, Ill.).

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.

Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt.

Ericsson, K. A., Krampe, R. T., & Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological review, 100(3), 363.

O’Neill, L., Latchford, G., McCracken, L. M., & Graham, C. D. (2019). The development of the Acceptance and Commitment Therapy Fidelity Measure (ACT-FM): A delphi study and field test. Journal of Contextual Behavioral Science, 14, 111-118.

 

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