Latest / Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D. / The Paradox of Clinical Experience (Frontiers Friday #236) ⭕️

Transcript

The Paradox of Clinical Experience (Frontiers Friday #236) ⭕️ · Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D.

0:00
SPEAKER_00: Let's talk about clinical experience.
0:05
SPEAKER_00: There is a recent paper by Sadeed Zimbal and Dennis Kavigan that I want to talk
0:09
SPEAKER_00: about today and for us to examine the impact of our clinical experience
0:15
SPEAKER_00: on client outcomes.
0:18
SPEAKER_00: And in this new study, we're going to unpack, we're going to unpick a little bit from this.
0:24
SPEAKER_00: A recent survey of about 176 therapists found that over a third that were unsure
0:31
SPEAKER_00: or did not believe that more clinical experience leads to better outcomes.
0:38
SPEAKER_00: We shouldn't be surprised given the various studies that confirm their suspicions.
0:44
SPEAKER_00: Simon Goldberg and colleagues found that on average,
0:48
SPEAKER_00: clinical experience not only plateaued,
0:52
SPEAKER_00: But had a slight decline of outcomes over time.
0:57
SPEAKER_00: That means that instead of improving in terms of their performance, they get worse on average.
1:04
SPEAKER_00: There was even a replication study in Germany that found similar results As
1:09
SPEAKER_00: the Canadian sample that Goldberg had found.
1:12
SPEAKER_00: And in our original SuperShrink study that was based on a sample of UK therapists,
1:17
SPEAKER_00: we also found that clinical experience was not a significant predictor
1:22
SPEAKER_00: to performance.
1:24
SPEAKER_00: In the recent Sadeed Zumbul and Dennis Klaverian study really caught my attention.
1:29
SPEAKER_00: And this 2026 paper is titled Therapist Training Experience and Client Outcomes.
1:36
SPEAKER_00: A within-person analysis of hours of experience,
1:40
SPEAKER_00: client order, initial client distress, and treatment length.
1:46
SPEAKER_00: We're going to look into this.
1:48
SPEAKER_00: When we read a peer-reviewed journal article,
1:51
SPEAKER_00: most of us are idea abstract and maybe skim through the discussion section.
1:54
SPEAKER_00: And for the purposes of understanding and clarity about
1:58
SPEAKER_00: the experience-outcome relationship,
2:00
SPEAKER_00: we will have to get into the weeds because the conclusions
2:04
SPEAKER_00: that are drawn can vary differently.
2:08
SPEAKER_00: I'll walk you through in detail what this new study found,
2:11
SPEAKER_00: how it differed from previous studies,
2:14
SPEAKER_00: and why I came to a slightly different conclusion.
2:25
SPEAKER_00: So let's ask the question, does experience impact client outcome?
2:31
SPEAKER_00: In Zumbo and Kavigan's study,
2:33
SPEAKER_00: it's compelling because it's the first study to look Not only at
2:38
SPEAKER_00: the between-person association of experience outcome relationship,
2:44
SPEAKER_00: but importantly, also the within-person level of analysis.
2:51
SPEAKER_00: Now, what does this mean?
2:52
SPEAKER_00: So let's kind of understand this terminology before we go further.
2:56
SPEAKER_00: Between-person association basically means comparing different people to each other
3:03
SPEAKER_00: at a certain point in time.
3:05
SPEAKER_00: A within-person association tracks the same person across time.
3:12
SPEAKER_00: Now this is an important distinction.
3:15
SPEAKER_00: Sometimes completely opposite findings can occur if you muddle these up.
3:21
SPEAKER_00: Take an extreme example on the relationship between alcohol intake and IQ.
3:26
SPEAKER_00: The between-person analysis,
3:28
SPEAKER_00: that means comparing different persons at a single time point,
3:31
SPEAKER_00: might yield a positive relationship, i.e.
3:35
SPEAKER_00: higher IQ people tend to drink more.
3:38
SPEAKER_00: Yet, at the within-person analysis, would show up that drinking impairs your IQ.
3:47
SPEAKER_00: This type of ecological fallacy is called Simpson's paradox.
3:52
SPEAKER_00: I don't think it's got anything to do with Homer.
3:55
SPEAKER_00: Even though both Goldberg's and Jermis study,
3:58
SPEAKER_00: the replication study,
4:00
SPEAKER_00: both examine the data longitudinally, It was still a between-person analysis.
4:08
SPEAKER_00: This is the case because only a static pre-post measure of,
4:13
SPEAKER_00: in this case,
4:14
SPEAKER_00: the outcome question of 45 was employed as the outcome variable for each client.
4:19
SPEAKER_00: So the pre and the post, the first and the last.
4:22
SPEAKER_00: As opposed to dynamically tracking the session by session continuous trajectory
4:27
SPEAKER_00: within the same client over time, within each of the clients over time.
4:33
SPEAKER_00: A second consideration of the difference between Goldbergs and Jermis,
4:38
SPEAKER_00: let's call this G&G,
4:40
SPEAKER_00: and Zumbo and Klovykens,
4:42
SPEAKER_00: let's call this ZK, is how clinical experience was calculated.
4:47
SPEAKER_00: In both G and G studies,
4:49
SPEAKER_00: experience was calculated by the number of years-slash-days in the profession and
4:54
SPEAKER_00: the cumulative cases.
4:56
SPEAKER_00: ZK argued that the mere passage of time may not be a reliable indicator of experience.
5:04
SPEAKER_00: So in the paper it says,
5:06
SPEAKER_00: a licensed professional who has not regularly seen clients over
5:11
SPEAKER_00: the years have more experience than a trainee seeing five clients per week.
5:15
SPEAKER_00: Well, fair enough.
5:17
SPEAKER_00: ZK proposed a different way to operationalize experience.
5:21
SPEAKER_00: Instead of tracking elapsed time since seeing the first client,
5:25
SPEAKER_00: they based their analysis on the actual number of hours Indirect client contact
5:32
SPEAKER_00: under clinical supervision.
5:35
SPEAKER_00: So this is a very important feature that is direct client contact
5:39
SPEAKER_00: and has got supervision involved plus In order to track the within-personal level
5:45
SPEAKER_00: of analysis,
5:46
SPEAKER_00: ZK have outcome measured at every 8th session of the OK45 compared
5:53
SPEAKER_00: to G&G's pre-imposed outcomes.
5:56
SPEAKER_00: So, where did they find such a cohort?
5:59
SPEAKER_00: Where in the world could they find such a cohort to measure so frequently
6:03
SPEAKER_00: at every 8th session and how long did that go for?
6:06
SPEAKER_00: Well, in a counseling service in a major US university,
6:10
SPEAKER_00: They had a 16-year pool of data consisting of 129 clients seen
6:19
SPEAKER_00: by 45 doctoral-level therapists with at least their third year of doctoral training,
6:24
SPEAKER_00: With an average age of 28 and a caseload of 4-5 clients per therapist.
6:31
SPEAKER_00: So unlike both G&G's studies, ZK's cohort of therapists are more homogenous.
6:38
SPEAKER_00: They delivered a psychodynamic approach to therapy.
6:42
SPEAKER_00: Treatment length averaged about 60 sessions.
6:46
SPEAKER_00: Well, that's quite big, right, with standard deviation of 35 or so sessions.
6:51
SPEAKER_00: And this is a big, and they were clinically supervised, as I mentioned.
6:56
SPEAKER_00: So there was clinical supervision involved in their case by a total number
7:02
SPEAKER_00: of 16 supervisors,
7:04
SPEAKER_00: With individual weekly supervision,
7:07
SPEAKER_00: 60 minutes of that, and bi-weekly group supervision of 120 minutes.
7:13
SPEAKER_00: This is extraordinary.
7:15
SPEAKER_00: So what they have is a homogenous group doing psychodynamic work
7:19
SPEAKER_00: With pretty intense focus of longitudinal care for each client.
7:24
SPEAKER_00: And on top of that, they have supervision, individual, as well as group supervision.
7:31
SPEAKER_00: So fantastic.
7:33
SPEAKER_00: This is a rare cohort and it's very interesting to see what they would find.
7:37
SPEAKER_00: We'll return to this piece about supervision as well.
7:40
SPEAKER_00: But for now, let's get to the results of what Zcare found.
7:45
SPEAKER_00: Here's what they found regarding the experience-outcome relationship.
7:51
SPEAKER_00: Therapist training experience was associated with reduced client distress on
7:57
SPEAKER_00: the OQ45,
7:59
SPEAKER_00: with an effect size of Coensley 0.3, which is about small to moderate effect.
8:05
SPEAKER_00: That's great news.
8:07
SPEAKER_00: The experience on client outcome was moderated by client's initial distress levels.
8:14
SPEAKER_00: So that means that the therapist's training experience was more impactful
8:19
SPEAKER_00: for clients who started with higher distress levels and moderated
8:24
SPEAKER_00: by treatment length.
8:27
SPEAKER_00: As therapists gained more experience,
8:29
SPEAKER_00: they took shorter amount of time to achieve good outcomes on average.
8:35
SPEAKER_00: Contrary to expectations,
8:37
SPEAKER_00: Interaction between client order and therapist trainees' hours
8:41
SPEAKER_00: of experience did not predict client outcomes.
8:45
SPEAKER_00: In other words,
8:46
SPEAKER_00: if a given therapist saw 50 clients,
8:48
SPEAKER_00: let's say,
8:50
SPEAKER_00: One would expect to get better outcomes with your 50th client compared
8:54
SPEAKER_00: with your first.
8:55
SPEAKER_00: As we look at each of these three findings,
8:58
SPEAKER_00: bear in mind that most previous studies found either no relationship
9:04
SPEAKER_00: or negative association between therapist experience and client outcomes.
9:09
SPEAKER_00: So first, the statistical method employed arguably made a real difference.
9:15
SPEAKER_00: They analyzed the actual time spent in client interaction rather than
9:20
SPEAKER_00: the mere passage of time, as we've mentioned earlier, or the number of cases.
9:25
SPEAKER_00: In addition,
9:26
SPEAKER_00: given the similarities between therapists in Z-Case study compared
9:31
SPEAKER_00: with previous experience outcome studies,
9:33
SPEAKER_00: there were fewer confounding factors to contend with.
9:39
SPEAKER_00: Second, Regarding the moderating factor of clients' initial distress levels,
9:44
SPEAKER_00: as measured by the OQ45 at the start,
9:47
SPEAKER_00: this result seems to suggest that most experienced practitioners were more impactful
9:53
SPEAKER_00: for clients with more distress.
9:56
SPEAKER_00: This makes sense.
9:57
SPEAKER_00: And as the researchers point out, is consistent with past research.
10:03
SPEAKER_00: That difference between therapists or what we call therapist effects are larger
10:08
SPEAKER_00: with clients with higher baseline severity.
10:12
SPEAKER_00: So if a client comes in with more distress at the start,
10:16
SPEAKER_00: it seems to make greater difference between who you're seeing.
10:20
SPEAKER_00: So regarding the moderating factor of the treatment length,
10:24
SPEAKER_00: It would be misleading to conclude that briefer work is better
10:28
SPEAKER_00: than longer-term sessions.
10:30
SPEAKER_00: Rather, it's possible that as experience increased, these therapists became more efficient.
10:38
SPEAKER_00: It's also possible to imagine that clients who engage
10:41
SPEAKER_00: in further sessions might have entrenched difficulties,
10:45
SPEAKER_00: which needed more time to work with, as the researchers highlighted.
10:51
SPEAKER_00: Finally, And this is the important piece of the puzzle.
10:55
SPEAKER_00: As the authors put it,
10:57
SPEAKER_00: there was no interaction between client order and therapist trainees' hours
11:04
SPEAKER_00: of experience in predicting client outcomes.
11:08
SPEAKER_00: Now, what does this mean?
11:10
SPEAKER_00: Let's go into what they say in the paper.
11:13
SPEAKER_00: It says that client order...
11:17
SPEAKER_00: Captures the intuitive expectation that a trainee is likely
11:23
SPEAKER_00: to achieve better outcomes with their 10th or 50th client than with the 1st or 5th.
11:31
SPEAKER_00: ZK initially hypothesized that there would be an association
11:35
SPEAKER_00: between therapist training experience and client improvement.
11:40
SPEAKER_00: Such that the relationship will be stronger for the later clients.
11:44
SPEAKER_00: So it looked like clinical experience only helped with that specific client
11:49
SPEAKER_00: and didn't make them better at future months.
11:54
SPEAKER_00: Now recall that this was a psychodynamic cohort with an average of about 60 over sessions.
12:01
SPEAKER_00: This is much more longer than the typical number of sessions seen
12:05
SPEAKER_00: in various naturalistic settings from about four to six sessions or maybe
12:10
SPEAKER_00: a little bit more in private practice, but still.
12:13
SPEAKER_00: Much lower than 60 sessions.
12:15
SPEAKER_00: Given the average length of treatment,
12:18
SPEAKER_00: I suppose what this means for the ZK study is that the yield
12:22
SPEAKER_00: of experience only benefited those really specific cases.
12:28
SPEAKER_00: But why would experience translate to specific kinds and not generalize to others?
12:35
SPEAKER_00: Isn't the point of experience meant to be the transfer and generalization of skills?
12:43
SPEAKER_00: This is where the details are really important from this study.
12:47
SPEAKER_00: As you might recall,
12:48
SPEAKER_00: all the therapists' trainees were not only receiving individual and groups
12:54
SPEAKER_00: of vision,
12:55
SPEAKER_00: weekly and biweekly respectively,
12:57
SPEAKER_00: whilst they were seeing their clients,
13:00
SPEAKER_00: Their sessions were also recorded and reviewed with their clinical supervisors.
13:05
SPEAKER_00: So this is spectacular.
13:07
SPEAKER_00: There's individual,
13:08
SPEAKER_00: there's group,
13:09
SPEAKER_00: and then there's recordings involved for them to look into the specifics of
13:13
SPEAKER_00: the conversation.
13:15
SPEAKER_00: Now, this is really an important component.
13:18
SPEAKER_00: If you are a clinical supervisor,
13:20
SPEAKER_00: how often do you actually review session recordings with your supervisees?
13:26
SPEAKER_00: If you are receiving supervision,
13:28
SPEAKER_00: do you have such a practice with your supervisor,
13:31
SPEAKER_00: aside from the mandate during your postgraduate training?
13:35
SPEAKER_00: This is why in our workshops for clinical supervisors,
13:39
SPEAKER_00: I recommend them to review not only session recordings,
13:43
SPEAKER_00: but using a particular method called the Impact of Session Grid to break down
13:48
SPEAKER_00: the therapy hour into specific components,
13:50
SPEAKER_00: specific acts,
13:52
SPEAKER_00: specific chunks,
13:53
SPEAKER_00: zooming in only on specific interactional patterns,
13:57
SPEAKER_00: highlighting significant markers and potential areas to work on.
14:01
SPEAKER_00: Coupled with monitoring outcomes session by session.
14:05
SPEAKER_00: Because going into the weeds alone is not going to be useful if you don't have
14:09
SPEAKER_00: the overall picture of where the unfoldings of the therapy is going session
14:15
SPEAKER_00: by session.
14:16
SPEAKER_00: So I'm also going to put in the description below for some resources to look into
14:21
SPEAKER_00: the impact of session grit.
14:23
SPEAKER_00: I've also taken some parts from another course that I had called Structure
14:27
SPEAKER_00: and Impact and make it freely available to all of you to look through on how
14:31
SPEAKER_00: to review your session recording.
14:36
SPEAKER_00: Now, when we don't specifically coach for performance,
14:40
SPEAKER_00: that is by zooming in on specific nature of the therapeutic conversation
14:45
SPEAKER_00: and help increase the odds
14:47
SPEAKER_00: for good outcomes whilst systematically tracking client outcomes,
14:51
SPEAKER_00: it's very easy to discuss about endless things and get caught up with our theories
14:58
SPEAKER_00: and wide-ranging explanations and still not make a dent in improving clients' lives.
15:06
SPEAKER_00: And I'm also going to put a link to a piece that I've written called
15:09
SPEAKER_00: The Seven Mistakes of Clinical Supervision.
15:12
SPEAKER_00: The first one is that we become explainaholics.
15:15
SPEAKER_00: We just love to explain stuff with our theories, but not really get to the heart of it.
15:21
SPEAKER_00: But wait, let's get back to ZK's study.
15:24
SPEAKER_00: ZK's study seems to suggest something that we can easily brush off.
15:30
SPEAKER_00: Supervising therapists,
15:32
SPEAKER_00: even with in-depth details,
15:35
SPEAKER_00: encompassed by session recordings,
15:38
SPEAKER_00: reviewing and reflecting on specifics, doesn't generalize.
15:43
SPEAKER_00: It can help improve the success rate.
15:48
SPEAKER_00: This is a real issue.
15:56
SPEAKER_00: This is highlighted by the educational researcher Robert Haskell in his book,
16:00
SPEAKER_00: Transfer of Learning.
16:03
SPEAKER_00: He says that if you can only perform a set of tasks in its original circumstances,
16:09
SPEAKER_00: this should be considered merely as training If you can gain knowledge and skills
16:15
SPEAKER_00: and the ability to adapt them to a range of unfamiliar situations,
16:20
SPEAKER_00: this should be called education.
16:24
SPEAKER_00: So Haskell really makes a difference between training and education.
16:28
SPEAKER_00: His book, Transfer of Learning, has been great.
16:33
SPEAKER_00: Really impactful to me.
16:35
SPEAKER_00: You know,
16:36
SPEAKER_00: I've not read something as impactful compared to let's say the last
16:39
SPEAKER_00: of my head was something like Keonis Eriksson's work and I've real Obsession
16:45
SPEAKER_00: with this topic right now and I hope to do more about this topic of transfer
16:50
SPEAKER_00: of learning.
16:50
SPEAKER_00: I mean, usually we think of learning as transfer, isn't it?
16:53
SPEAKER_00: That you have some inputs and then you're able to translate that into the real world.
17:00
SPEAKER_00: But it seems like as much as we want that to happen,
17:03
SPEAKER_00: learning seems to be just taking in inputs in what we do,
17:07
SPEAKER_00: but doesn't really apply in the real world.
17:11
SPEAKER_00: We're going to talk a bit more about this in Frontiers
17:13
SPEAKER_00: of Psychotherapist Development down the line.
17:16
SPEAKER_00: So in other words,
17:17
SPEAKER_00: while you coach for performance in clinical supervision,
17:21
SPEAKER_00: it's also important to zoom out and coach for development.
17:26
SPEAKER_00: So here's a distinction that I make between Coaching for Performance and Coaching
17:31
SPEAKER_00: for Development.
17:32
SPEAKER_00: And I talk a lot about this with clinical supervisors.
17:36
SPEAKER_00: Coaching for Performance is when you go one side of the lens into the micro.
17:41
SPEAKER_00: You are focused on the case by case level.
17:44
SPEAKER_00: You are trying to improve the outcomes on a specific case.
17:49
SPEAKER_00: The focus is on the client.
17:53
SPEAKER_00: Coaching for Development,
17:54
SPEAKER_00: on the other hand,
17:55
SPEAKER_00: on the other lens,
17:56
SPEAKER_00: you zoom out,
17:57
SPEAKER_00: you take the macro view,
17:59
SPEAKER_00: and you're trying to establish an ongoing,
18:02
SPEAKER_00: sustainable learning and developmental plan that specifically To the therapists,
18:09
SPEAKER_00: trying to improve their overall effectiveness.
18:13
SPEAKER_00: The focus is on the therapists.
18:17
SPEAKER_00: Different from coaching for performance.
18:20
SPEAKER_00: Now, it is not that one is better than the other.
18:24
SPEAKER_00: You need the undulating process of moving between these two worlds.
18:28
SPEAKER_00: Getting caught up in either coaching for performance or coaching
18:32
SPEAKER_00: for development is not the answer.
18:35
SPEAKER_00: If you're too abstracted and focused solely on the development of the therapist,
18:40
SPEAKER_00: while not anchored in one's actual caseload and reality,
18:44
SPEAKER_00: the person that they meet, you end up being too removed and detached from reality.
18:50
SPEAKER_00: Now, on the flip side,
18:52
SPEAKER_00: if you're too zoomed in and focused on coaching for performance,
18:58
SPEAKER_00: you run the risk that learning doesn't actually transfer.
19:03
SPEAKER_00: You miss the bigger picture.
19:05
SPEAKER_00: Real learning needs to be paired with instruction for generalizability.
19:12
SPEAKER_00: So in Zumbel's and Kavigan's 2026 study,
19:16
SPEAKER_00: if we were to examine this from
19:18
SPEAKER_00: a learning perspective using Haskell's classification regarding transfer
19:24
SPEAKER_00: of learning,
19:24
SPEAKER_00: we can see that therapists and trainees were able to transfer learning Only up to
19:31
SPEAKER_00: a certain point,
19:32
SPEAKER_00: level two or three at most,
19:35
SPEAKER_00: in terms of Haskell's classification,
19:38
SPEAKER_00: and unable to extend that to far or creative transfer,
19:43
SPEAKER_00: So let's take a look at Robert Haskell's classification of transfer of learning
19:48
SPEAKER_00: and he classifies them into six different possible levels.
19:52
SPEAKER_00: Level one and two is basically an application of learning the skill in
19:57
SPEAKER_00: the same context in a reflexive way.
20:00
SPEAKER_00: Level three is when there's a context transfer applying in slightly different
20:06
SPEAKER_00: but similar contexts.
20:08
SPEAKER_00: Level 4 is what he calls near transfer, applying to moderately different situations.
20:17
SPEAKER_00: Level 5, Haskell would call far transfer, applying to quite different situations entirely.
20:25
SPEAKER_00: And finally,
20:26
SPEAKER_00: Level 6,
20:28
SPEAKER_00: he would call Creative or Inventive or Displacement Transfer,
20:35
SPEAKER_00: which means generalizing novel solutions from prior learnings.
20:46
SPEAKER_00: So back to Zumbull and Kovigen's 2026 study.
20:50
SPEAKER_00: If we were to examine this from a learning perspective,
20:54
SPEAKER_00: using Haskell's 1-6 level of classification regarding transfer of learning,
20:59
SPEAKER_00: we can see that therapists trainees were able to transfer learning only up to
21:05
SPEAKER_00: a certain point, like level 2, 3, or maybe 4 at most.
21:10
SPEAKER_00: 4 is where there's near transfer.
21:14
SPEAKER_00: And unable to extend too far or creative transfer, that is levels 5 and 6.
21:22
SPEAKER_00: Let's look into Haskell's distinction again between training and education briefly,
21:28
SPEAKER_00: as this might provide us some clarity about this issue with generalizing
21:33
SPEAKER_00: from clinical experience into improvement over time.
21:38
SPEAKER_00: Training model is case-specific.
21:40
SPEAKER_00: Protocol adherence,
21:42
SPEAKER_00: technique application in familiar contexts,
21:46
SPEAKER_00: likely producing levels 2 or 3 transfer of learning.
21:50
SPEAKER_00: An education model is where there's explicit teaching of underlying principles,
21:58
SPEAKER_00: targeted practice of transferring learning across different case types and contexts.
22:04
SPEAKER_00: Building abstract conceptual frameworks that generalizes likely produces levels 4,
22:12
SPEAKER_00: 5, and hopefully 6 transfer of learning.
22:17
SPEAKER_00: So in short, we have to get to the micro so that we can get to the macro.
22:24
SPEAKER_00: If we really want to get better, coaching for performance also needs coaching for development.
22:39
SPEAKER_00: So here's my different conclusion about ZK's study.
22:44
SPEAKER_00: So there were other aspects of ZK's study that I'm curious about,
22:49
SPEAKER_00: likely due to space that were not addressed.
22:52
SPEAKER_00: Now we know in peer-reviewed publications we are really hard-pressed for space
22:56
SPEAKER_00: so we have to remove things to be able to I just focus on the main thing.
23:00
SPEAKER_00: But here are a couple of stuff that were on my mind.
23:03
SPEAKER_00: Was there a difference between the 45 therapists in the cohort
23:07
SPEAKER_00: or what we would call therapist effects?
23:10
SPEAKER_00: Why this is a question I have in my mind?
23:12
SPEAKER_00: Because,
23:13
SPEAKER_00: you know, I mean,
23:13
SPEAKER_00: most studies that we have seen that they found therapist effects to range
23:18
SPEAKER_00: from anything from five to nine percent of the variability of client outcomes.
23:22
SPEAKER_00: Much more than treatment effects of 0 to 1%.
23:25
SPEAKER_00: So therapists' differences are a known thing between cohorts.
23:30
SPEAKER_00: But however, in this study, the caseload was about 4.5 clients per therapist.
23:34
SPEAKER_00: So I'm not sure if that's too small for such an interclass correlational study of
23:40
SPEAKER_00: the coefficient.
23:42
SPEAKER_00: Second one was, were there differences between the 16 supervisors?
23:45
SPEAKER_00: Yes.
23:47
SPEAKER_00: Again, not too sure because it's sort of nested in this hierarchy on supervisors,
23:53
SPEAKER_00: therapists, and then clients.
23:55
SPEAKER_00: The clients per therapist might be too small.
23:57
SPEAKER_00: Who knows?
23:59
SPEAKER_00: Were therapists feedbacking and discussing with the clients using the graphs of
24:04
SPEAKER_00: the OQ45 at every eighth session of measurement?
24:08
SPEAKER_00: I'm thinking about this because to be able to discuss about a client's progress
24:13
SPEAKER_00: in real time in a dialogical fashion is really important and really useful.
24:19
SPEAKER_00: You have to decide, are we on track and continue?
24:22
SPEAKER_00: Or are we off track?
24:23
SPEAKER_00: Do we need to change some things?
24:25
SPEAKER_00: Do we miss talking about some stuff that are really important or certain approaches
24:29
SPEAKER_00: that didn't really sit well?
24:30
SPEAKER_00: Now, in addition,
24:32
SPEAKER_00: if we know the degree of differences between therapists,
24:35
SPEAKER_00: I would also be curious to know if there were some therapists who were better able
24:40
SPEAKER_00: to generalize their learnings to other cases.
24:44
SPEAKER_00: Now, much like Simon Goldberg's study that showed that on average,
24:48
SPEAKER_00: most don't improve over time,
24:50
SPEAKER_00: there was actually a specific piece of information that was stated in the study
24:54
SPEAKER_00: that stated 39% actually did improve.
24:58
SPEAKER_00: With experience over time.
25:01
SPEAKER_00: Now even though on average it seems that there was a decline,
25:04
SPEAKER_00: the minority actually did improve in that study.
25:08
SPEAKER_00: Now back to ZK's paper again.
25:10
SPEAKER_00: ZK's paper was framed as an examination between the effects of experience on client outcomes.
25:19
SPEAKER_00: Now I wonder if it's not actually about clinical experience per se.
25:26
SPEAKER_00: If experience was to bear fruit It would be something like the following.
25:31
SPEAKER_00: It would be experience, leading to learning, leading to transfer of learning, or generalization.
25:41
SPEAKER_00: The authors of the book,
25:43
SPEAKER_00: The Myth of Experience,
25:45
SPEAKER_00: Emery Sawyer and Robin Hogarth,
25:48
SPEAKER_00: points out that experience can be defined in three fundamental ways.
25:54
SPEAKER_00: And here's what they call it.
25:56
SPEAKER_00: Process, Product, and Personal.
26:00
SPEAKER_00: Experience is a process that we go through.
26:04
SPEAKER_00: Experience is also a product of what we get from it directly from an experiential,
26:11
SPEAKER_00: personal, preferential level.
26:14
SPEAKER_00: However,
26:15
SPEAKER_00: in most situations we are operating in what Suyen Hogarth calls
26:21
SPEAKER_00: a wicked learning environment.
26:24
SPEAKER_00: Compared to a kind learning environment,
26:26
SPEAKER_00: a wicked one is where the resulting lessons are constantly shifting.
26:31
SPEAKER_00: The feedback loop isn't as tight as one would wish.
26:34
SPEAKER_00: The objectives can shift across time.
26:37
SPEAKER_00: Thus, our experience is,
26:39
SPEAKER_00: in Sawyer and Holgarth's words,
26:42
SPEAKER_00: constantly subject to In particular,
26:50
SPEAKER_00: there are two crucial questions that can be invaluable to us grappling
26:56
SPEAKER_00: with wicked learning environments.
27:00
SPEAKER_00: 1.
27:01
SPEAKER_00: Is there something important missing from my experience that I need to uncover
27:08
SPEAKER_00: if I hope to fully understand what is happening?
27:15
SPEAKER_00: 2.
27:16
SPEAKER_00: What irrelevant details are present in my experience that I need to ignore
27:24
SPEAKER_00: to avoid being distracted from what is happening?
27:29
SPEAKER_00: Think of the difference between chess and poker.
27:33
SPEAKER_00: The former is bounded in a kind learning environment,
27:37
SPEAKER_00: whereas poker is mixed with skill and luck within a wicked environment.
27:44
SPEAKER_00: You can make a good decision in poker and still lose the game.
27:51
SPEAKER_00: Returning to ZK's study in question,
27:55
SPEAKER_00: look at the atypical and intense features of weekly
27:59
SPEAKER_00: and bi-weekly group supervision using session recordings and the findings
28:04
SPEAKER_00: that experience transfer only within clients and not to other clients seen later on.
28:15
SPEAKER_00: In addition,
28:16
SPEAKER_00: given what we know of the existing literature on experience and outcome,
28:21
SPEAKER_00: the bleak absence of positive findings in clinical supervision on client outcomes,
28:27
SPEAKER_00: and the issues of transfer of learning,
28:30
SPEAKER_00: I wonder if this is more of a study on the effects of being in
28:34
SPEAKER_00: a rich training environment as opposed to a study about the relationship
28:39
SPEAKER_00: between experience and outcome.
28:42
SPEAKER_00: Well, the researchers did in fact point this out in the conclusion.
28:46
SPEAKER_00: Here's what it says.
28:48
SPEAKER_00: A study suggests that a training environment characterized by observation
28:54
SPEAKER_00: and feedback can increase the relationship between therapist's experience
29:00
SPEAKER_00: and client outcome.
29:03
SPEAKER_00: If it were to be a study about clinical experience,
29:06
SPEAKER_00: perhaps if the same group of therapists monitored the outcomes for three years
29:13
SPEAKER_00: after their traineeship period.
29:16
SPEAKER_00: I suspect that would be a more appropriate representation of clinical experience.
29:22
SPEAKER_00: But of course, this makes such a study really difficult, long-term to follow up.
29:28
SPEAKER_00: Would therapists still systematically track their outcomes?
29:31
SPEAKER_00: Would researchers be able to follow up with them?
29:34
SPEAKER_00: As a thought experiment,
29:36
SPEAKER_00: imagine if the same therapist trainees keep Their client contact hours removed
29:43
SPEAKER_00: the intense supervision with session recordings used and replaced it
29:47
SPEAKER_00: with generic weekly check-ins is what most normally supervisors would do,
29:52
SPEAKER_00: or even clinical supervision as usual without the review of recordings.
29:57
SPEAKER_00: From a research perspective, what if there was a control group?
30:03
SPEAKER_00: What do you think we would find?
30:05
SPEAKER_00: As the saying goes, more research is to be done.
30:09
SPEAKER_00: For now,
30:10
SPEAKER_00: We must ask ourselves,
30:13
SPEAKER_00: what levels of transfer of learning should we expect from ourselves
30:19
SPEAKER_00: in our professional development efforts?
30:23
SPEAKER_00: Here's Robert Haskell.
30:27
SPEAKER_00: When we learn from history, if indeed we do, it involves transfer.
30:34
SPEAKER_00: What do you think about the influence of clinical experience and client outcome?
30:40
SPEAKER_00: In your own clinical practice.
30:43
SPEAKER_00: Love to hear from you.
30:45
SPEAKER_00: Thanks for listening.
30:51
SPEAKER_00: On the 26th and 27th of November,
30:53
SPEAKER_00: I'll be running a special workshop here in Western Australia, Perth.
30:58
SPEAKER_00: Some of you have asked, why Perth?
31:00
SPEAKER_00: Why not somewhere like Melbourne or Sydney?
31:03
SPEAKER_00: For a long time, I felt compelled to do something more local and home ground.
31:09
SPEAKER_00: Day 1 of the training on the 26th is for clinical supervisors and those aspiring to be.
31:14
SPEAKER_00: Day two is for all therapists which is a day of reflection and renewal.
31:20
SPEAKER_00: Day two is called the inner and outer life of therapists
31:24
SPEAKER_00: and day one is called reigniting clinical supervision.
31:28
SPEAKER_00: And you could join us here and I hope that you will be able to participate with us
31:33
SPEAKER_00: in this particular special two-day workshop held on 26th and 27th of November 2026.