(PS5-C52) The Role of Deliberate Practice in Clinical Skill Development: Application of a Multiple Baseline Design

Introduction: The deliberate practice framework, designed by experts to improve aspects of individual performance through repetition and refinement (Ericsson, Krampe, & Tesch-Romer, 1993), can improve psychotherapy training by encouraging lifelong learning (Clements-Hickman & Reese, 2020). Building valid and reliable systems for training and feedback based on this method will be critical to extend its value to psychotherapy skill development (Atkins et al., 2014; Westra & Constantino, 2019; Young & Maack, 2021). The current study is a pilot trial of one such method, which was implemented as a multiple baseline design (MBD) in a small group of undergraduates with no prior experience in the techniques examined. 

Method: Three inexperienced undergraduates (all female; ages 21, 22, and 24) were provided with the Unified Protocol (UP; Barlow et al., 2018) and asked to record therapy role-plays delivering a module of their choice. Two trained assistants rated videos using the Cognitive Therapy Rating Scale (CTRS; Young & Beck, 1980) as a coarse metric of CBT competence. Lack of structure or guidance for role-play exercises was purposive to enunciate differences in baseline and intervention phases of study, given the assumption that participants would not exhibit particularly skillful performance prior to feedback. Undergraduates were randomized to receive feedback from the last author after their 2nd, 3rd, or 7th role-play exercise (effectively relegating the last participant to an extended baseline). This feedback focused only on specific exercises to improve particular, narrowly-defined behaviors and included no reference to theory, research, or broader conceptual issues. The study includes 20 videos produced by the participants over a period of approximately 3 months to enable examination of differences in baseline and intervention phases. 

Results: All sessions were double-coded by independent raters using the CTRS, and reliability between ratings was high (ICC = 0.76). To simplify this pilot study, only the first author’s CTRS ratings were used to reflect role-play therapists’ performance at each time point. If accepted, data will eventually be presented graphically, but can be summarized here to indicate a strong impact of feedback on performance in terms of subsequent CTRS scores (which were ubiquitously low at onset, as expected). By the end of this sequence, one participant achieved several consecutive CTRS scores approximately indicative of overall CBT competence for a practicing professional (35, 35, and 37). 



Discussion: Based on CTRS scores, participants gained skill as they conducted brief, focal, deliberate practice exercises, despite having had no prior training. The noted increase in general performance scores suggests potential for future application of this training method and additional research applying the deliberate practice method to learning psychotherapy.