Latest / Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D. / The Difficult Conversations in Therapy (DCT) Project. Frontiers Friday #207 ⭕️

Transcript

The Difficult Conversations in Therapy (DCT) Project. Frontiers Friday #207 ⭕️ · Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D.

• 0:01
  SPEAKER_00: Welcome to this new episode of Frontiers Radio for the frontiers of psychotherapist development.
• 0:09
  SPEAKER_00: My role is to help psychotherapists develop at their leading edge and help them become deep learners.
• 0:17
  SPEAKER_00: In today's episode, I'll be talking a bit about
• 0:21
  SPEAKER_00: a study that is finally published after many years of working at it and trying to
• 0:26
  SPEAKER_00: get it out into the peer review process and being released.
• 0:31
  SPEAKER_00: So this is about the study called the Difficult Conversations in Therapy Project.
• 0:38
  SPEAKER_00: So finally,
• 0:39
  SPEAKER_00: my colleagues and I can report that this study,
• 0:42
  SPEAKER_00: Improving Responses to Challenging Scenarios in Therapy,
• 0:46
  SPEAKER_00: is now published.
• 0:47
  SPEAKER_00: You can see in the show notes to get the link to the study is an open access study
• 0:53
  SPEAKER_00: and there are relevant supplementary materials in there as well.
• 0:57
  SPEAKER_00: Now, what took us so long?
• 1:00
  SPEAKER_00: What can we learn from this study?
• 1:02
  SPEAKER_00: What are the direct implications for you?
• 1:07
  SPEAKER_00: I'll explain a little down below and I'll tell you what I've learned from the DCT project as well.
• 1:14
  SPEAKER_00: If you want to cut to the chase, you can read the paper yourself.
• 1:18
  SPEAKER_00: Again, it's open access.
• 1:20
  SPEAKER_00: And there's a strange little fact.
• 1:21
  SPEAKER_00: I'm going to talk about this, uh, later on in this podcast.
• 1:26
  SPEAKER_00: And if you want to listen to a conversation that Scott Miller and I had on this study,
• 1:31
  SPEAKER_00: you can watch his video where we spoke about this study in Scott's top performance
• 1:36
  SPEAKER_00: YouTube channel.
• 1:37
  SPEAKER_00: You could see also the links below.
• 1:40
  SPEAKER_00: If you are curious about the video vignettes that was used in the DCT study,
• 1:46
  SPEAKER_00: you can check them out in the link as well.
• 1:50
  SPEAKER_00: What follows in this episode is me trying to break this down,
• 1:54
  SPEAKER_00: give a little context and my personal takeaways from this project.
• 1:59
  SPEAKER_00: And they are organized by five chapters.
• 2:02
  SPEAKER_00: First one is on the main findings.
• 2:04
  SPEAKER_00: The second is about surprising findings.
• 2:07
  SPEAKER_00: The third is the uniqueness about this study,
• 2:11
  SPEAKER_00: the evolution of the DCT study,
• 2:14
  SPEAKER_00: and what I've learned from this project.
• 2:17
  SPEAKER_00: So first, the main findings.
• 2:21
  SPEAKER_00: In a sentence,
• 2:22
  SPEAKER_00: the therapists who participated in this study significantly improved their ability
• 2:27
  SPEAKER_00: to handle difficult conversations with clients.
• 2:30
  SPEAKER_00: In this experimental design of a deliberate practice protocol,
• 2:33
  SPEAKER_00: participants were randomized into a control and a feedback group.
• 2:39
  SPEAKER_00: All participants watched a series of challenging scenarios in this randomized controlled trial.
• 2:47
  SPEAKER_00: The control group were not given any feedback and were told to reflect and improve
• 2:53
  SPEAKER_00: their responses through the eight trials.
• 2:55
  SPEAKER_00: The feedback group were provided individualized, principle-based feedback, i.e.
• 3:00
  SPEAKER_00: not so much as what to say, but how to think.
• 3:04
  SPEAKER_00: They were encouraged to formulate their responses in their own style and voice.
• 3:10
  SPEAKER_00: No surprise that on average participants in the DP group improved.
• 3:16
  SPEAKER_00: Now, what was striking is that no change was observed among the participants in the control condition.
• 3:23
  SPEAKER_00: The control group showed no significant improvement between any of the trials.
• 3:30
  SPEAKER_00: And some of the surprising findings.
• 3:34
  SPEAKER_00: Part of the fun of any study is to have unexpected findings, and here's three of them.
• 3:40
  SPEAKER_00: Transfer of learning.
• 3:42
  SPEAKER_00: Transfer of learning is seen as the holy grail in the education and learning sciences literature.
• 3:49
  SPEAKER_00: Although transfer of learning is universally recognized as fundamental to all learning,
• 3:55
  SPEAKER_00: yet the current evidence suggests that it seldom happens in instructional settings.
• 4:04
  SPEAKER_00: With regards to the lack of transfer in learning,
• 4:08
  SPEAKER_00: Robert Haskell says,
• 4:10
  SPEAKER_00: without exaggeration,
• 4:12
  SPEAKER_00: there is an educational scandal.
• 4:15
  SPEAKER_00: When you look at the graph,
• 4:16
  SPEAKER_00: when you,
• 4:17
  SPEAKER_00: when you can see in the post in one of our sub stack links,
• 4:21
  SPEAKER_00: uh,
• 4:21
  SPEAKER_00: talking about this DCT study,
• 4:23
  SPEAKER_00: you notice that in,
• 4:25
  SPEAKER_00: out of the eight trials,
• 4:26
  SPEAKER_00: trial four and five and eight highlights the uniqueness about transfer happening.
• 4:34
  SPEAKER_00: For instance, participants were given a hopelessness clinical vignette to watch in trial one.
• 4:41
  SPEAKER_00: Bear in mind there are eight trials.
• 4:43
  SPEAKER_00: And in trial two and three, they watched the same vignette and did their best to respond.
• 4:50
  SPEAKER_00: And then in trial four, a different client was presented, but still a hopelessness scenario.
• 4:58
  SPEAKER_00: Then in trial five, an entirely different theme was provided.
• 5:03
  SPEAKER_00: For instance, a reluctant client.
• 5:07
  SPEAKER_00: Participants then repeated the scenario in trial six and seven.
• 5:11
  SPEAKER_00: And then just to mess things around in trial eight,
• 5:15
  SPEAKER_00: we provided a similar theme of reluctant client,
• 5:18
  SPEAKER_00: but a different client,
• 5:21
  SPEAKER_00: not the same scenario,
• 5:22
  SPEAKER_00: like a different person.
• 5:24
  SPEAKER_00: This is where it got interesting.
• 5:26
  SPEAKER_00: For the DP group,
• 5:28
  SPEAKER_00: they not only maintained their ability in trials three and four,
• 5:32
  SPEAKER_00: but they also were able to transfer learning into an entirely different clinical
• 5:38
  SPEAKER_00: presentation when you see from trial four to five.
• 5:44
  SPEAKER_00: And here's the other thing that we ask in the study.
• 5:47
  SPEAKER_00: We got participants to rate the experience of difficulty and performance in each step of the trials.
• 5:55
  SPEAKER_00: So they had their own self ratings about how difficult the scenario was and what
• 6:00
  SPEAKER_00: they think their own assessment of their performance was.
• 6:03
  SPEAKER_00: And here's what we found.
• 6:05
  SPEAKER_00: there was no significant correlations between their performance and self-rating of
• 6:11
  SPEAKER_00: difficulty and performance.
• 6:15
  SPEAKER_00: And at trial five, participants in the DP group rated the task significantly more difficult.
• 6:21
  SPEAKER_00: This is the group that was getting feedback.
• 6:23
  SPEAKER_00: They found it more difficult, especially at trial 5.
• 6:26
  SPEAKER_00: Even though they improved in their responses,
• 6:29
  SPEAKER_00: say in trial 2,
• 6:31
  SPEAKER_00: self-rated performance of the DP group was significantly worse than the controls in
• 6:37
  SPEAKER_00: trial 2.
• 6:39
  SPEAKER_00: Note, in trial two is where the first time they receive constructive feedback.
• 6:47
  SPEAKER_00: And what about attrition rates?
• 6:49
  SPEAKER_00: And this is quite typical in any sort of trials that happen.
• 6:53
  SPEAKER_00: And it turns out that overall attrition for the control group was about 33%,
• 7:00
  SPEAKER_00: and the overall attrition for the feedback group was 48%.
• 7:05
  SPEAKER_00: I initially predicted that the feedback group would actually have lesser dropouts
• 7:09
  SPEAKER_00: than the controls,
• 7:12
  SPEAKER_00: but however,
• 7:12
  SPEAKER_00: it would turn out to be the opposite.
• 7:15
  SPEAKER_00: Now, on hindsight, you know, hindsight is always 20-20, and this makes sense.
• 7:19
  SPEAKER_00: It was challenging to be continuously pushed,
• 7:22
  SPEAKER_00: if you really think about this,
• 7:23
  SPEAKER_00: if you're one of the participants,
• 7:25
  SPEAKER_00: You continuously push towards your growth edge.
• 7:28
  SPEAKER_00: Each step of the trials, the control group won challenge in the same way.
• 7:33
  SPEAKER_00: They will not challenge a push to go beyond the usual or push beyond their automatic responses.
• 7:39
  SPEAKER_00: They engaged only in their own self-reflection.
• 7:43
  SPEAKER_00: Now, three, the uniqueness about the study.
• 7:46
  SPEAKER_00: This is perhaps the first study that does not include a captive audience of
• 7:50
  SPEAKER_00: graduate students or workshop attendees.
• 7:52
  SPEAKER_00: In our sample,
• 7:54
  SPEAKER_00: we have 72 practicing therapists from all over the world devoting their own time
• 8:00
  SPEAKER_00: over the course of two weeks to the study protocol.
• 8:04
  SPEAKER_00: The average number of years of clinical practice or in clinical practice was about
• 8:10
  SPEAKER_00: 11.6 years with the standard deviation about nine.
• 8:13
  SPEAKER_00: And second,
• 8:15
  SPEAKER_00: instead of providing formulaic or template responses,
• 8:19
  SPEAKER_00: participants were provided principle-based feedback by focusing on principles
• 8:23
  SPEAKER_00: rather than specific methods or techniques.
• 8:26
  SPEAKER_00: This allowed participants the maneuverability to not only apply their own style,
• 8:32
  SPEAKER_00: but also generalize this into other related contexts.
• 8:36
  SPEAKER_00: And if you look at the Substack polls,
• 8:38
  SPEAKER_00: I give some examples taken from the supplementary material of what the
• 8:43
  SPEAKER_00: principle-based feedback are.
• 8:45
  SPEAKER_00: And I can highlight two of them in relations to the use of empathic responses.
• 8:51
  SPEAKER_00: One of them is about explicit and implicit emotions.
• 8:55
  SPEAKER_00: So what usually when we give such feedbacks,
• 8:58
  SPEAKER_00: because we want people to disentangle between what is explicit,
• 9:03
  SPEAKER_00: meaning what's most overt,
• 9:04
  SPEAKER_00: what's very clear and what's underneath that emotion.
• 9:09
  SPEAKER_00: So for example,
• 9:09
  SPEAKER_00: if somebody is really angry,
• 9:12
  SPEAKER_00: we,
• 9:13
  SPEAKER_00: you know,
• 9:13
  SPEAKER_00: the explicit emotion is often the heat of the anger,
• 9:18
  SPEAKER_00: but there's often something else underneath.
• 9:21
  SPEAKER_00: It could be disappointment.
• 9:22
  SPEAKER_00: It could be hurt.
• 9:25
  SPEAKER_00: And the trouble is sometimes we do the sequence wrongly.
• 9:28
  SPEAKER_00: We do the implicit first before the explicit.
• 9:32
  SPEAKER_00: So some of the feedback that we gave were related to making sure that we address
• 9:38
  SPEAKER_00: what's over it,
• 9:39
  SPEAKER_00: what's explicit in the room before going under the hood.
• 9:43
  SPEAKER_00: So that's one example of that.
• 9:46
  SPEAKER_00: So if you want to see more, you could go to the appendix tree of the supplementary materials.
• 9:50
  SPEAKER_00: We gave a list of all the principle-based feedback that we used.
• 9:56
  SPEAKER_00: Next,
• 9:57
  SPEAKER_00: perhaps logically seen as a limitation of our study,
• 10:00
  SPEAKER_00: participants provided written responses to each of the scenarios,
• 10:04
  SPEAKER_00: not verbal responses.
• 10:06
  SPEAKER_00: As many of our peer reviewers pointed out that they saw this as a significant constraint of the study.
• 10:14
  SPEAKER_00: I think so, but I also think that potentially it isn't.
• 10:18
  SPEAKER_00: Why?
• 10:19
  SPEAKER_00: I would argue that writing down your responses longhand forces you to slow down and
• 10:26
  SPEAKER_00: think about what you're actually saying.
• 10:29
  SPEAKER_00: In addition,
• 10:31
  SPEAKER_00: providing on-the-spot verbal responses might tip the learner into a kind of
• 10:37
  SPEAKER_00: performing mode instead of staying in their zone of proximal development.
• 10:44
  SPEAKER_00: This is speculation on my part,
• 10:46
  SPEAKER_00: and it might be worth testing this out in the future,
• 10:49
  SPEAKER_00: but take note that in our pilot study before this particular RCT,
• 10:54
  SPEAKER_00: we had 10 participants and we have therapists verbally respond while we transcribe
• 10:59
  SPEAKER_00: their words.
• 11:02
  SPEAKER_00: Four, the evolution of the DCT study.
• 11:05
  SPEAKER_00: Now, this is more of a backstory.
• 11:07
  SPEAKER_00: I mean, this idea was kind of seeded when Scott Millen and I first met K. Anders Ericsson in 2010.
• 11:14
  SPEAKER_00: Ericsson was given a keynote address at a conference in Kansas City.
• 11:18
  SPEAKER_00: And one of the things he said in passing about other professional domains was the
• 11:23
  SPEAKER_00: idea of developing an archive.
• 11:26
  SPEAKER_00: of various scenarios that one might face so that others could learn from them.
• 11:33
  SPEAKER_00: I was transfixed with the idea.
• 11:37
  SPEAKER_00: Not only this sort of archive didn't exist in our field,
• 11:40
  SPEAKER_00: but as a clinician,
• 11:41
  SPEAKER_00: this sort of high-acuity,
• 11:43
  SPEAKER_00: low-occurrence or halo events were rarely practiced
• 11:49
  SPEAKER_00: I would benefit from this too.
• 11:51
  SPEAKER_00: We have the content knowledge about these sort of psychotherapeutic hello events,
• 11:55
  SPEAKER_00: but not actually the process and conditional knowledge on how to actually address
• 12:00
  SPEAKER_00: them in conversation.
• 12:02
  SPEAKER_00: And I talked about more on this in Front is Friday number 138,
• 12:06
  SPEAKER_00: if you're interested to look at more about this three types of knowledge between
• 12:10
  SPEAKER_00: the content process and conditional knowledge.
• 12:15
  SPEAKER_00: A few years since that initial idea,
• 12:17
  SPEAKER_00: Sharon Liu,
• 12:18
  SPEAKER_00: my colleague,
• 12:18
  SPEAKER_00: and I formalized the study difficult conversations in therapy idea,
• 12:23
  SPEAKER_00: lodged an IRB to conduct a pilot study in the hospital institution that we were
• 12:29
  SPEAKER_00: both working in.
• 12:30
  SPEAKER_00: We had 10 clinicians who volunteered for the study.
• 12:33
  SPEAKER_00: They responded to a single challenging vignet based off an actual clinical scenario.
• 12:38
  SPEAKER_00: We call it the angry Annie scenario.
• 12:42
  SPEAKER_00: And we got one of our colleagues who had acting skills to help us out.
• 12:47
  SPEAKER_00: We transcribed every single of the 50 odd responses in real time.
• 12:51
  SPEAKER_00: And before long,
• 12:52
  SPEAKER_00: Sharon and I noticed that there was a recurring pattern about the way participants
• 12:57
  SPEAKER_00: responded to the DCTs and thought that it might make more sense to provide a chunk
• 13:02
  SPEAKER_00: type of feedback based as far as possible on principles agnostic to treatment modalities.
• 13:11
  SPEAKER_00: In a heated situation in one of the DCTs,
• 13:15
  SPEAKER_00: in the main DCT that we use in the pilot study,
• 13:17
  SPEAKER_00: we soon realized that therapists had difficulty responding with disarming by agreement,
• 13:24
  SPEAKER_00: addressing the explicit before the implicit emotions and explicating the target of
• 13:29
  SPEAKER_00: clients' emotions.
• 13:30
  SPEAKER_00: And these were some of the core feedback that we gave.
• 13:33
  SPEAKER_00: Again, feel free to look at the supplementary materials for more about them.
• 13:39
  SPEAKER_00: And even though the simulation was artificial,
• 13:42
  SPEAKER_00: some clinicians actually had a visceral reaction to the videos.
• 13:47
  SPEAKER_00: We pondered at that stage if the IRB clearance still stands.
• 13:51
  SPEAKER_00: In any case,
• 13:52
  SPEAKER_00: across five trials of a single scenario and switching to a variant of a similar
• 13:58
  SPEAKER_00: situation at trial five,
• 14:00
  SPEAKER_00: we found that therapies on average improved their responses over time in this
• 14:05
  SPEAKER_00: particular pilot study.
• 14:08
  SPEAKER_00: So after the pilot, we were hopeful.
• 14:11
  SPEAKER_00: We gained some traction and other researchers joined us for the follow-up study and
• 14:16
  SPEAKER_00: began enlisting clinicians internationally.
• 14:20
  SPEAKER_00: Time passed.
• 14:21
  SPEAKER_00: We got audited with lots of paperwork to file.
• 14:25
  SPEAKER_00: We got clearance.
• 14:26
  SPEAKER_00: I left my job in Singapore.
• 14:29
  SPEAKER_00: We did the write-up.
• 14:31
  SPEAKER_00: More stats gurus like Adam Jones.
• 14:34
  SPEAKER_00: in the US and psychiatrist Jeffrey Tan came on board to help us out as well with the analysis.
• 14:42
  SPEAKER_00: And meanwhile, Jeffrey and Sharon got married and babies were born.
• 14:47
  SPEAKER_00: Masters completed by one of our co-researchers, Tammy.
• 14:53
  SPEAKER_00: And given that I was not an academic in an academic setting,
• 14:57
  SPEAKER_00: I still really wanted to see it through and get the study published.
• 15:01
  SPEAKER_00: And believe me, we have been trying for a long time since probably like 2018.
• 15:05
  SPEAKER_00: And frankly,
• 15:07
  SPEAKER_00: besides our slowness in completing the manuscript,
• 15:10
  SPEAKER_00: I really wasn't quite sure why we were knocked back several times.
• 15:16
  SPEAKER_00: One journal held onto our submission for several months and later said that they
• 15:20
  SPEAKER_00: didn't have any relevant peer reviewers for our study.
• 15:23
  SPEAKER_00: And for other journals,
• 15:24
  SPEAKER_00: many of the feedback were constructive,
• 15:26
  SPEAKER_00: and we kept doing our best to address each reviewer's concerns,
• 15:30
  SPEAKER_00: made modifications based on the feedback,
• 15:32
  SPEAKER_00: and then yet failed to pass through the process.
• 15:36
  SPEAKER_00: By this time,
• 15:37
  SPEAKER_00: I thought out loud with my collaborators that it's so silly,
• 15:42
  SPEAKER_00: you know,
• 15:42
  SPEAKER_00: to invest so much time to get this one thing published.
• 15:45
  SPEAKER_00: And yet,
• 15:47
  SPEAKER_00: when it's published,
• 15:48
  SPEAKER_00: very few people would read the study,
• 15:50
  SPEAKER_00: given that it will be behind some kind of paywall.
• 15:54
  SPEAKER_00: I mean, unless you're reading this because you are in a university of some sorts.
• 16:01
  SPEAKER_00: Why should funded studies be behind paywalls?
• 16:05
  SPEAKER_00: Shouldn't everyone be allowed to read any study if they choose to?
• 16:10
  SPEAKER_00: And in the show notes, I've attached a particular documentary called The Internet's Own Boy.
• 16:17
  SPEAKER_00: It's about the story of Aaron Schwartz that's relevant to this point.
• 16:20
  SPEAKER_00: So feel free to check it out if you're interested.
• 16:23
  SPEAKER_00: Anyway, we agreed.
• 16:25
  SPEAKER_00: Let's publish it in a journal that will be open access.
• 16:29
  SPEAKER_00: Jeffrey said to me,
• 16:30
  SPEAKER_00: sure, it will cost us a few thousand dollars.
• 16:33
  SPEAKER_00: And I thought, what?
• 16:35
  SPEAKER_00: A few thousand dollars to make something free when it's already been a funded study?
• 16:40
  SPEAKER_00: I mean,
• 16:41
  SPEAKER_00: I had no idea that researchers had to pay a range between 1,005 to 3,000 per paper
• 16:46
  SPEAKER_00: for it to be open access.
• 16:48
  SPEAKER_00: I mean, how naive of me.
• 16:50
  SPEAKER_00: Thankfully,
• 16:51
  SPEAKER_00: Jeffrey and Sharon could secure funds from the Institute of Mental Health,
• 16:55
  SPEAKER_00: thanks to IMH for funding us to get it open access,
• 16:59
  SPEAKER_00: and to get the article freely accessed by anyone who is interested.
• 17:05
  SPEAKER_00: So I've come to the sixth and final point about why I'm making this episode.
• 17:10
  SPEAKER_00: I'm going to share with you what I've learned from being involved in this DCT project.
• 17:15
  SPEAKER_00: I thought it might be useful to share my takeaways and discoveries and see how this might apply for you.
• 17:21
  SPEAKER_00: So the first one is
• 17:24
  SPEAKER_00: Who benefited the most from this study?
• 17:27
  SPEAKER_00: I think Sharon and I did.
• 17:29
  SPEAKER_00: We analyzed hundreds of responses and we couldn't help ourselves but also
• 17:34
  SPEAKER_00: vicariously learn from other clinicians as they work towards each of the learning
• 17:38
  SPEAKER_00: edge while they're responding to the challenging scenarios.
• 17:42
  SPEAKER_00: Number two, self-reflection is necessary but not sufficient.
• 17:48
  SPEAKER_00: This is why the majority in the control group didn't improve in their responses.
• 17:52
  SPEAKER_00: Self-reflection alone needs to be paired with specific inputs by someone who knows
• 18:00
  SPEAKER_00: how you do what you do.
• 18:02
  SPEAKER_00: Three, focus on the micro to get to the macro.
• 18:07
  SPEAKER_00: Most education and training efforts start with the macro by introducing the
• 18:12
  SPEAKER_00: theories before drilling down to the specifics.
• 18:16
  SPEAKER_00: Borrowing from the Renaissance man,
• 18:18
  SPEAKER_00: the Uber researcher,
• 18:19
  SPEAKER_00: George Waitzkin,
• 18:20
  SPEAKER_00: it makes more sense to start from the minimal specifics and then inductively go
• 18:27
  SPEAKER_00: bottom up,
• 18:28
  SPEAKER_00: get to the governing principles.
• 18:31
  SPEAKER_00: Number four, the quality of the feedback will determine the quality of the learning.
• 18:38
  SPEAKER_00: The type of feedback really matters.
• 18:41
  SPEAKER_00: In order to circumvent performing through the tests and performance anxiety,
• 18:46
  SPEAKER_00: we made the decision to not provide the scores to participants during the process
• 18:51
  SPEAKER_00: of the study.
• 18:53
  SPEAKER_00: And that is, we didn't tell them how well they performed each step of the way.
• 18:57
  SPEAKER_00: Instead,
• 18:58
  SPEAKER_00: We focused on providing learning feedback.
• 19:03
  SPEAKER_00: This is why while clients feedback,
• 19:06
  SPEAKER_00: the ones that you get session by session can be really useful for us to adapt and
• 19:10
  SPEAKER_00: calibrate to each person.
• 19:12
  SPEAKER_00: It is not the same as getting individualized feedback from a supervisor or coach
• 19:17
  SPEAKER_00: who knows where you are at.
• 19:20
  SPEAKER_00: and where you need to grow.
• 19:23
  SPEAKER_00: You could take another example from our previous release on Front is Friday 202,
• 19:28
  SPEAKER_00: where peer feedback seems to make things worse,
• 19:33
  SPEAKER_00: even when we're trying to engage in deliberate practice.
• 19:37
  SPEAKER_00: Where do you get your learning feedback from?
• 19:40
  SPEAKER_00: And five, principles, not methods.
• 19:47
  SPEAKER_00: Here's a quote by E. Chen Yishu from the 11th century.
• 19:52
  SPEAKER_00: One has to investigate the principle in one thing or one event exhaustively.
• 20:00
  SPEAKER_00: Things and the self are governed by the same principle.
• 20:04
  SPEAKER_00: If you understand one, you understand the other.
• 20:08
  SPEAKER_00: For truth within and the truth without are identical.
• 20:13
  SPEAKER_00: Principles help organize the mind into a hierarchical mental representation of ideas.
• 20:18
  SPEAKER_00: In some ways, it's a bit like chunking when you're trying to improve your memory.
• 20:24
  SPEAKER_00: Once you hit on a first principle, techniques and methods abound.
• 20:29
  SPEAKER_00: And for more on principles, you could see some of the links provided in the show notes.
• 20:33
  SPEAKER_00: I've talked extensively about why it's important to develop first principles before
• 20:37
  SPEAKER_00: getting to the methods.
• 20:40
  SPEAKER_00: Six, this is the last point on illusion of understanding.
• 20:45
  SPEAKER_00: Anytime you try to break things down into its component parts,
• 20:49
  SPEAKER_00: do not be surprised that at first it seems like you know less than you do.
• 20:55
  SPEAKER_00: This is called the illusion of explanatory depth.
• 21:00
  SPEAKER_00: This is important to know because if you are going to attempt to overcome
• 21:04
  SPEAKER_00: automaticity and your okay plateau,
• 21:07
  SPEAKER_00: you have to face your IOED demons.
• 21:12
  SPEAKER_00: So that's it for today.
• 21:14
  SPEAKER_00: That's all we're going to talk about from the Difficult Conversations in Therapy project.
• 21:19
  SPEAKER_00: I'm glad the paper's released.
• 21:20
  SPEAKER_00: Feel free to check it out.
• 21:22
  SPEAKER_00: We'd love to hear your thoughts around this study.
• 21:25
  SPEAKER_00: There's definitely things that can be refined and improved and even replicated or
• 21:30
  SPEAKER_00: test out to see other sort of things that may happen when we remove certain components.
• 21:36
  SPEAKER_00: But at large,
• 21:38
  SPEAKER_00: what we tried to do was to have all the four bona fide components of DP that we
• 21:42
  SPEAKER_00: argued for as a working definition of deliberate practice,
• 21:46
  SPEAKER_00: which is a coach giving individualized feedback with learning feedback
• 21:53
  SPEAKER_00: delivered in terms of their principles and not just repetition, but successive refinement.
• 22:01
  SPEAKER_00: Thanks for listening and stay tuned for more episodes.
• 22:04
  SPEAKER_00: Feel free to check out our Substack as well.
• 22:07
  SPEAKER_00: That is at darylchow.substack.com.
• 22:10
  SPEAKER_00: That is D-A-R-Y-L-C-H-O-W dot Substack.
• 22:16
  SPEAKER_00: That's S-U-B-S-T-A-C-K.com.
• 22:20
  SPEAKER_00: We release different sort of ideas every Friday,
• 22:25
  SPEAKER_00: and we are going to talk about other stuff related to deliberate practice,
• 22:29
  SPEAKER_00: things to help you at your growth edge.