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Every field has people who are clearly at the top of their game, people who are in the middle or average, and people who shouldn’t be in the profession or who perform very poorly. And everyone wants to be part of that star-performer, top 10% group. Do we know how to get there? Surprisingly, yes. There is a lot of research on “supershrinks” (those rated in the top 10%) and how they differ from other therapists. The outcome of that research applies equally well no matter what role you have.
What it boils down to is that the best therapists, social workers, and clinicians actively practice the basics, and try to get as good as they can. The worst rated therapists, spend far less time on their own professional development.
Chow et. al. (2015) examined a variety of elements to discover what were related to therapeutic outcome. Consistent with what we’re taught in school (that therapeutic modality is responsible for very little change), Chow and colleagues found no relationship between gender, caseload, age, degree, and other elements affected outcome.
What they did find is that the highest performing therapists spent the most amount of time working on their clinical skills. The top performers spent an average of 7 hours a week engaged in deliberate practice. The lowest performing therapists spent around 20 minutes a week engaged in this same kind of work.
Deliberate practice (Ericsson, Krampe & Tesch-Romer, 1993) is a term coined by Psychologist K. Anders Ericsson. He has spent his career studying experts, and found deliberate practice capable of explaining prodigies in music, sports, and even medicine. Malcolm Gladwell’s pop-psych book Outliers: The Story of Success made the case that individuals we see as different simply get more opportunities to practice their skills. Unfortunately he missed the “practice” in deliberate practice, and what most people took away from the book was that you needed 10,000 hours of practice – no matter good or bad, and this is obviously not the case.
Applying Deliberate Practice to Social Work
As a social worker or other clinician, it’s important to make sure that you practice the basics:
- Read books on basic counselling techniques like Intentional Interviewing and Counseling
- Video or audiotape yourself (with client consent) and discuss clips in supervision
- Complete training courses in your chosen therapeutic modality and continue to expand
In addition to engaging in this practice, you must perform outcome based measurement. This involves empirical tools to assess your client’s progress throughout counselling or therapy. By doing this kind of assessment, you can begin to understand what elements are working in your sessions and which ones are not.
Scott D. Miller, the expert in supershrinks, has developed the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS). These are standardized rating scales that clinicians can use to track their client’s outcome over time. You can read more by Scott D. Miller in this presentation.
Daryl Chow (who co-authored that study above about supershrinks spending 7 hours a week on deliberate practice) also authored his thesis (Chow, 2014) on the same topic. During that thesis, he wrote that “compared with their peers, therapists’ self assessment of effectiveness was not correlated with actual outcomes, in spite of the use of outcome measures in their clinical practice.” Essentially, we don’t know when we’re doing well or not doing well, and it’s important to use rating scales and continuing to take feedback in order to improve.
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):337-45. doi: 10.1037/pst0000015