Deliberate Practice – History and research

The study of what distinguishes top professionals from their peers is a topic of undeniable interest to both scientists and the general community. More recently, the study of "expertise" has made considerable progress and has had a major impact on how we understand and train our professionals. As this field of investigation is very extensive and in continuous expansion, we will focus on the most relevant contributions to psychotherapeutic practice and, first of all, one of its pioneering figures: Professor and researcher K. Anders Ericsson of Florida State University.

 

K. Anders Ericsson

Over the past decades, Ericsson and colleagues have investigated high performers in areas as varied as sports, chess or music. These studies seek to understand who are the professionals considered "experts" in their area, and how they achieved such a high performance. [1, 2] Based on this line of research, several common factors among "experts" from different areas have been proposed, such as the fact that they have a superior decision-making capacity both at the level of deliberate and intuitive decisions. [3] 

The most studied and common quality of higher performance professionals is the existence of "deliberate practice". That is, these professionals spend more time identifying specific areas where their performance fails, seeking the support of other professionals, reflecting on the feedback they get, and developing, rehearsing, executing and evaluating plans in order to improve their performance by monitoring their progress over time. The deliberate practice is theorized as one of the main characteristic factors of professionals of superior performance. [41, 5, 6]

Numerous studies have demonstrated the validity of this construct for a wide range of professional activities, supporting the hypothesis that deliberate practice is intrinsically linked to the development of superior performance. [17, 8, 9, 10, 11, 12, 13, 14, 15, 16] 

Figure 1 represents a typical curve of the established relationship between the number of hours spent in professional practice and the performance of the professional.

 

Figure 1. The impact of deliberate practice on violinists (Ericsson, 2006)[4]

 

Even in the case of naturally gifted children, both physically and psychologically, they tend to achieve superior performance gradually, involving prolonged amounts of deliberate practice over many years. Achieving this performance requires hundreds if not thousands of hours of deliberate practice. Malcolm Gladwell popularized, in his Outliers book, the "10,000-hour training rule”, referring to the supposed mean time required to dominate any work area. However, available research tells us that the number of hours spent deliberately and that are necessary to achieve superior performance varies significantly across areas of work. [4]

 

 

Studies of expertise and deliberate practice have recently come to the attention of important psychotherapy researchers who, over the past few years, have been questioning the importance of these constructs in the psychotherapeutic context. [17, 18, 19, 20

 

The first study investigating the impact of deliberate practice on psychotherapeutic performance was in 2015. Chow and colleagues [21] evaluated the relationship between clinical outcomes of a sample of therapists with a set of professional and personal variables, including the existence and amount of deliberate practice. As in previous studies, sex, age and years of clinical experience were not significantly related to clinical outcomes. [22, 23, 24] On the other hand, and similar to the results reported in specialized literature  [1, 4], the amount of time that therapists spent in deliberate practice activities was a significant predictor of final clinical outcomes.

 

The cumulative impact of deliberate practice on clinical efficacy, as studied by Chow et al.can be seen in Figure 2. In this study, therapists in the upper quartile of efficacy invested, on average, almost 2.8 times longer in activities of deliberate practice than other professionals. Note the direct relationship between deliberate practice of therapists and outcomes.

 

 

Figure 2. Relation between hours of practice and outcomes (Chow et al., 2015)[21]

 

This pioneering study provides preliminary evidence of the importance of deliberate practice as a valuable construct to explain the great variability of outcomes among therapists, as well as their potential for future training and supervision in psychotherapy. [231720]

Another study by Goldberg et al. longitudinally investigated the impact of monitoring clinical outcomes and deliberate practice on the overall effectiveness of a sample of therapists. [25] The data collected over 7 years relates to 153 therapists and the 5128 patients they followed. Unlike prior studies with the same conditions except the use of deliberate practice  [22], the therapists in this study have tended to consistently improve their clinical efficacy over the years. These results provided additional support for the importance of the therapist's deliberate practice as a mediator of clinical outcomes. However, the study of deliberate practice in psychotherapy is so recent that we can only consider these results as preliminary data.

 

Two manuals by Tony Rousmaniere have already been published as potential protocols for the implementation of deliberate practice in psychotherapeutic contexts. [26, 27] Readers are also invited to view the following interview with the author of these manuals: https://youtu.be/eR5OQ_mWros

 

Click on the following icon to begin establishing a routine of deliberate practice in psychotherapy 

 

 

 

Books:

  • Ericsson, K. A., Charness, N., Feltovich, P. J., & Hoffman, R. R. (Eds.). (2006). The Cambridge handbook of expertise and expert performance. Cambridge University Press.
  • Ericsson, A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt.
  • Rousmaniere, T. (2016). Deliberate Practice for Psychotherapists: A Guide to Improving Clinical Effectiveness. Taylor & Francis.
  • Rousmaniere, T., Goodyear, R. K., Miller, S. D., & Wampold, B. E. (Eds.). (2017). The cycle of excellence: Using deliberate practice to improve supervision and training. John Wiley & Sons.

 

Articles (click to download):

[1] 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.

[2] Ericsson, K. A., Charness, N., Feltovich, P. J., & Hoffman, R. R. (Eds.). (2006). The Cambridge handbook of expertise and expert performance. Cambridge University Press.

[3] Moxley, J. H., Ericsson, K. A., Charness, N., & Krampe, R. T. (2012). The role of intuition and deliberative thinking in experts’ superior tactical decision-making. Cognition, 124(1), 72-78.

[4] Ericsson, K. A. (2006). The influence of experience and deliberate practice on the development of superior expert performance. In K. A. Ericsson, N. Charness, P. J. Feltovich, & R. R. Hoffman (Eds.), The Cambridge handbook of expertise and expert performance (p. 683–703). Cambridge, UK: Cambridge University Press.

[5] Ericsson, K. A., Nandagopal, K., & Roring, R. W. (2009). Toward a science of exceptional achievement. Annals of the New York Academy of Sciences, 1172(1), 199-217. 

[6] Ericsson, K. A., & Charness, N. (1994). Expert performance: Its structure and acquisition. American psychologist, 49(8), 725.

[7] Krampe, R. T., & Ericsson, K. A. (1996). Maintaining excellence: deliberate practice and elite performance in young and older pianists. Journal of experimental psychology: general, 125(4), 331.

[8] F. Helsen, W., Hodges, N. J., Winckel, J. V., & Starkes, J. L. (2000). The roles of talent, physical precocity and practice in the development of soccer expertise. Journal of sports sciences, 18(9), 727-736.

[9] Dunn, T. G., & Shriner, C. (1999). Deliberate practice in teaching: What teachers do for self-improvement. Teaching and teacher education, 15(6), 631-651.

[10] Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic medicine, 79(10), S70-S81.

[11] Charness, N., Tuffiash, M., Krampe, R., Reingold, E., & Vasyukova, E. (2005). The role of deliberate practice in chess expertise. Applied Cognitive Psychology, 19(2), 151-165.

[12] Keith, N., & Ericsson, K. A. (2007). A deliberate practice account of typing proficiency in everyday typists. Journal of Experimental Psychology: Applied, 13(3), 135.

[13] McGaghie, W. C., Issenberg, S. B., Cohen, M. E. R., Barsuk, J. H., & Wayne, D. B. (2011). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Academic medicine: journal of the Association of American Medical Colleges, 86(6), 706.

[14] Hashimoto, D. A., Sirimanna, P., Gomez, E. D., Beyer-Berjot, L., Ericsson, K. A., Williams, N. N., ... & Aggarwal, R. (2015). Deliberate practice enhances quality of laparoscopic surgical performance in a randomized controlled trial: from arrested development to expert performance. Surgical endoscopy, 29(11), 3154-3162.

[15] Platz, F., Kopiez, R., Lehmann, A. C., & Wolf, A. (2014). The influence of deliberate practice on musical achievement: a meta-analysis. Frontiers in psychology, 5.

[16] Hunt, E. A., Duval-Arnould, J. M., Nelson-McMillan, K. L., Bradshaw, J. H., Diener-West, M., Perretta, J. S., & Shilkofski, N. A. (2014). Pediatric resident resuscitation skills improve after “rapid cycle deliberate practice” training. Resuscitation, 85(7), 945-951.

[17] Miller, S. D., Hubble, M. A., Chow, D. L., & Seidel, J. A. (2013). The outcome of psychotherapy: yesterday, today, and tomorrow. Psychotherapy, 50(1), 88-97.

[18] Tracey, T. J., Wampold, B. E., Lichtenberg, J. W., & Goodyear, R. K. (2014). Expertise in psychotherapy: An elusive goal?. American Psychologist, 69(3), 218.

[19] Hill, C. E., Spiegel, S. B., Hoffman, M. A., Kivlighan Jr, D. M., & Gelso, C. J. (2017). Therapist expertise in psychotherapy revisited ψ. The Counseling Psychologist, 45(1), 7-53.

[20] Goodyear, R. K., Wampold, B. E., Tracey, T. J., & Lichtenberg, J. W. (2017). Psychotherapy expertise should mean superior outcomes and demonstrable improvement over time. The Counseling Psychologist, 45(1), 54-65.

[21] 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.

[22] 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.

[23] Wampold, B. E., & Brown, G. S. J. (2005). Estimating variability in outcomes attributable to therapists: a naturalistic study of outcomes in managed care. Journal of consulting and clinical psychology, 73(5), 914.

[24] Anderson, T., Ogles, B. M., Patterson, C. L., Lambert, M. J., & Vermeersch, D. A. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of clinical psychology, 65(7), 755-768.

[25] 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.

[26] Rousmaniere, T. (2016). Deliberate Practice for Psychotherapists: A Guide to Improving Clinical Effectiveness. Taylor & Francis.

[27] Rousmaniere, T., Goodyear, R. K., Miller, S. D., & Wampold, B. E. (Eds.). (2017). The cycle of excellence: Using deliberate practice to improve supervision and training. John Wiley & Sons.

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