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Podcast #282: Mike Christensen on Deliberate Practice: Was David Right All Along?

Rhonda and I are thrilled to welcome Mike Christiansen, head of TEAM-CBT in Canada. Mike is a fantastic clinician and teacher, and an old beloved friend. Today he talks about the impact of David\u2019s work that is finally being felt and appreciated by innovators in the field of psychiatry and psychology.

Rhonda begins the broadcast by reading a really touching endorsement from a young man in Turkey whose life was changed by David\u2019s work after he came close to suicide.

One of the key\u2019s was David\u2019s statement that we are disturbed, not by events, but by our thoughts about them.\u201d Of course, that incredible idea goes back all the way to the Greek philosopher, Epictetus, nearly 2,000 years ago. It is so basic that most people don\u2019t \u201cget it,\u201d but once you do, it can be mind-blowing. The young man ended his note to David by saying that, \u201cLife is beautiful now. Thank you!\u201d

Mike described a similar enlightenment experience when he was doing counseling, and first attended one of David\u2019s intensive workshops in Canada. He knew that his training did not provide him with the tools to make much of an impact on his patients. He was excited by what he learned, and subsequently attended many of David\u2019s workshops, and became certified in TEAM-CBT.

Mike now teaches from around the world at the Feeling Good institute in Mt. View, California. He teaches a highly acclaimed 12 week introductory course in TEAM. If you are looking for some in depth training, Rhonda and I would STRONGLY recommend this class.

Mike described a vitally important new direction in psychotherapy called \u201cDeliberate Practice,\u201d and is co-authoring a book on this topic with Maor Katz, MD, head of the Feeling Good Institute, and two pioneers in deliberate practice, Tony Rousmaniere & Alex Vaz.

Essentially, Deliberate Practice refers to two things. First, therapists must use rating scales, like the ones David has created, to assess patients progress in multiple dimensions, as well as their perceptions of therapist empathy and helpfulness, at every single session. This keep therapists on their toes, and gives them a crystal clear picture of their effectiveness or lack of effectiveness with every patient at every session. Although this can often be painful for the therapist, it can transform the therapist\u2019s clinical skills and turn every patient into the finest teacher the clinician has ever had!

Second, deliberate practice refers to refined training tools for therapists to practice on an ongoing basis, not only when learning therapy for the first time, but throughout your entire career. The key is doing short, role plan exercises that focus on specific tools, like the Five Secrets of Effective Communication during the E = Empathy step of TEAAM, or the \u201cInvitation Step\u201d at the start of A = Assessment of Resistance, or the Externalization of Voices during M = Methods.

And here\u2019s the most important part. After the role play, the student is given a letter grade plus specific feedback on what she or he did right and what needs improvement. Then you do repeat role reversals until the student gets an A.

David compares this to the type of training a professional athlete might receive to improve his or her skills at basketball or any sport. However, this also requires great motivation and courage on the part of those who are learning and teaching, because every error is highlighted\u2014there\u2019s no hiding! That\u2019s why the philosophy of learning in the spirit of \u201cjoyous failure\u201d is crucial to survival and success!

Rhonda, Mike, and David demonstrated this strategy several times, focusing on the Invitation Step of the Assessment of Resistance with an \u201ceasy\u201d as well as a more \u201cchallenging patient. Sure enough, grades below an A WERE received, and errors WERE pointed out.

And, in addition, grades of A were fairly readily achieved, showing that this type of \u201cdeliberate practice\u201d definitely DOES work.

During the podcast I took the opportunity to vent some of my frustrations with the field, and Mike and Rhonda kindly didn\u2019t point out that I probably sounded like a half-demented loony. But I do feel strongly about this topic, and extremely proud of the amazing work that Mike is doing on so many levels.

Most therapists resist rating scales. One of my students did a survey for his PhD research, and it seemed like only a small percent (less than 5%) of the psychologists he polled who advertise in the Psychology Today website are using ratings scales to track patient progress. To me, this is both unethical, anti-scientific, and totally unacceptable.

Therapists have endless excuses for resisting, and all of the excuses are spurious. For example, they think patients won\u2019t be honest, but the big problem is that the overwhelming majority of patients ARE honest, and therapists don\u2019t want to hear the truth bout their errors and ineptitude.

I do not support, but rather condemn, therapists who refuse to use rating instruments. To me, this is the \u201cunforgivable sin\u201d in our profession. I also believe that the use of valid and highly reliable rating instruments will eventually be required for licensure, and the \u201cscience resisters\u201d will soon be a thing of the past.

The field of psychotherapy definitely needs to move into the data-driven scientific era, and leave the current \u201cschools of therapy,\u201d which compete like religions, or even cults, behind, just as physics and astronomy broke away from the Catholic Church during the Copernican Revolution hundreds of years ago.

So, Mike is definitely working on the cutting edge, and he\u2019s just awesome! If you get the chance to take one of his TEAM-CBT classes, jump on it! He will connect with you intellectually, emotionally, and, if I can use a politically incorrect word, spiritually!

Warmly, David, Rhonda & Mike