Latest / Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D. / Seven Ways Deliberate Practice Can Go Wrong. Frontiers Friday #206 ⭕️

Transcript

Seven Ways Deliberate Practice Can Go Wrong. Frontiers Friday #206 ⭕️ · Frontiers of Psychotherapist Development Podcast by Daryl Chow, Ph.D.

• 0:00
  SPEAKER_00: This is a talk that I gave a couple of weeks ago in early October 2014.
• 0:04
  SPEAKER_00: It's on the topic of the seven mistakes that we see in deliberate practice.
• 0:10
  SPEAKER_00: And the organizers and committee members were kind enough to allow me to record this.
• 0:15
  SPEAKER_00: Unfortunately, we couldn't do the video recording.
• 0:19
  SPEAKER_00: And when I finally could get that all set up,
• 0:22
  SPEAKER_00: I was kind of embarrassed for a camera to be pointing at me all the time.
• 0:25
  SPEAKER_00: However, we've got the audio recorded nice and well.
• 0:29
  SPEAKER_00: We've also got visuals that represent
• 0:32
  SPEAKER_00: most of what the talk is about.
• 0:33
  SPEAKER_00: So if you're listening to this on the podcast,
• 0:36
  SPEAKER_00: feel free to swap into the substack to look at the video or where it's linked to
• 0:41
  SPEAKER_00: the YouTube channel.
• 0:43
  SPEAKER_00: Once again, thanks to the committee members from ACP for allowing me to put this up.
• 0:49
  SPEAKER_00: I hope you enjoy.
• 0:50
  SPEAKER_00: And if you'd like to stay tuned to Frontiers of Psychotherapist Development,
• 0:54
  SPEAKER_00: go to darrylchow.substack.com.
• 0:58
  SPEAKER_00: That's D-A-R-Y-L-C-H-O-W.substack.com.
• 1:04
  SPEAKER_00: Thanks for listening.
• 1:10
  SPEAKER_00: It's very hard to sit down and your good friend is talking about you to other
• 1:14
  SPEAKER_00: people in front of you there.
• 1:18
  SPEAKER_00: Just take it, yeah.
• 1:21
  SPEAKER_00: How are you?
• 1:23
  SPEAKER_00: Good.
• 1:24
  SPEAKER_00: You know, it's been 14 years I've lived in Perth.
• 1:29
  SPEAKER_00: I'm originally from Singapore.
• 1:31
  SPEAKER_00: And I think after 14 years, I finally got this thing about the greeting of, how are you?
• 1:39
  SPEAKER_00: And I think it's amazing.
• 1:40
  SPEAKER_00: It's a really good thing when you ask somebody, how are you?
• 1:43
  SPEAKER_00: And you know why?
• 1:44
  SPEAKER_00: I think it's like a verbal ping pong.
• 1:49
  SPEAKER_00: You know, somebody asks, how are you?
• 1:52
  SPEAKER_00: Ping.
• 1:53
  SPEAKER_00: And you go, good, thanks.
• 1:55
  SPEAKER_00: Pong.
• 1:55
  SPEAKER_00: And how are you?
• 1:57
  SPEAKER_00: Yeah, busy, busy.
• 1:59
  SPEAKER_00: Yeah, good.
• 2:00
  SPEAKER_00: Ping, and then Pong.
• 2:01
  SPEAKER_00: You know, how many of you have been to Singapore before?
• 2:05
  SPEAKER_00: Yeah?
• 2:06
  SPEAKER_00: So in Singapore, where my home country is from, we don't ask about your feelings.
• 2:11
  SPEAKER_00: We don't care about your feelings.
• 2:12
  SPEAKER_00: We don't ask, how are you?
• 2:13
  SPEAKER_00: We say, have you eaten?
• 2:14
  SPEAKER_00: No.
• 2:16
  SPEAKER_00: Have you eaten?
• 2:17
  SPEAKER_00: You laugh.
• 2:18
  SPEAKER_00: My wife,
• 2:19
  SPEAKER_00: you know,
• 2:19
  SPEAKER_00: when we call each other,
• 2:20
  SPEAKER_00: usually if I'm at practice and she'll call me and pick up the phone or I call her
• 2:24
  SPEAKER_00: and the first thing we go,
• 2:26
  SPEAKER_00: have you eaten?
• 2:27
  SPEAKER_00: What's the lunch?
• 2:28
  SPEAKER_00: I remember like the first time I came here and then I went up to Tandy and I was
• 2:35
  SPEAKER_00: greeting her like,
• 2:35
  SPEAKER_00: hey,
• 2:36
  SPEAKER_00: hey,
• 2:36
  SPEAKER_00: I said,
• 2:36
  SPEAKER_00: hi,
• 2:37
  SPEAKER_00: have you eaten?
• 2:39
  SPEAKER_00: And then she's like, what?
• 2:40
  SPEAKER_00: I was like, have you?
• 2:42
  SPEAKER_00: Oh, right, yeah, okay.
• 2:45
  SPEAKER_00: Yeah.
• 2:47
  SPEAKER_00: So today, I hope that we're gonna talk a little bit about this whole deliberate practice business.
• 2:53
  SPEAKER_00: And how many of you are familiar with this term, deliberate practice?
• 2:58
  SPEAKER_00: Yeah.
• 2:59
  SPEAKER_00: And this is the first time I'm talking about this in this particular format.
• 3:04
  SPEAKER_00: I'm not going to poo-poo at the idea,
• 3:07
  SPEAKER_00: but I'm really just trying to highlight some distinctions,
• 3:09
  SPEAKER_00: some things around that.
• 3:11
  SPEAKER_00: And it's going to be really important for us to see these things as clearly as possible.
• 3:16
  SPEAKER_00: And if I could say this,
• 3:20
  SPEAKER_00: how many of you have like,
• 3:22
  SPEAKER_00: I don't know,
• 3:22
  SPEAKER_00: more than 10 years of clinical experience?
• 3:25
  SPEAKER_00: More than 10 years.
• 3:26
  SPEAKER_00: Yeah, how many of you are less than seven?
• 3:31
  SPEAKER_00: Yeah, less than five?
• 3:33
  SPEAKER_00: Okay, yeah.
• 3:35
  SPEAKER_00: You know,
• 3:35
  SPEAKER_00: when I first began,
• 3:36
  SPEAKER_00: the thing that I was really worried about,
• 3:41
  SPEAKER_00: and this was about 2004,
• 3:42
  SPEAKER_00: 2005,
• 3:42
  SPEAKER_00: I was still working in Singapore,
• 3:45
  SPEAKER_00: This was my question.
• 3:47
  SPEAKER_00: I was really concerned if I'm worth my salt,
• 3:51
  SPEAKER_00: if I'm just deluded,
• 3:53
  SPEAKER_00: if you know,
• 3:53
  SPEAKER_00: like,
• 3:54
  SPEAKER_00: you know,
• 3:54
  SPEAKER_00: thing about in clinical practice,
• 3:56
  SPEAKER_00: we go into this room,
• 3:57
  SPEAKER_00: we sit down,
• 3:58
  SPEAKER_00: we meet somebody,
• 3:59
  SPEAKER_00: and then,
• 4:00
  SPEAKER_00: you know,
• 4:00
  SPEAKER_00: in the privacy of everything else,
• 4:02
  SPEAKER_00: we go back and then we tell our supervisor how things went,
• 4:05
  SPEAKER_00: right?
• 4:06
  SPEAKER_00: It's kind of scary.
• 4:07
  SPEAKER_00: But the thing that I was very worried about, about this idea of if I'm any good,
• 4:14
  SPEAKER_00: is this thing about performing.
• 4:20
  SPEAKER_00: Now,
• 4:20
  SPEAKER_00: I don't know if this is a Singaporean thing,
• 4:23
  SPEAKER_00: but for those of you who know anything about Singapore,
• 4:26
  SPEAKER_00: we love performing.
• 4:29
  SPEAKER_00: We want to beat everybody else in anything else,
• 4:32
  SPEAKER_00: like from your primary school results to we must have the first F1 race in the
• 4:37
  SPEAKER_00: world in the night.
• 4:39
  SPEAKER_00: We want to make sure that we're the best airport and blah, blah, blah.
• 4:41
  SPEAKER_00: Even life expectancy, we want to beat everybody when I outlive you.
• 4:44
  SPEAKER_00: You know, and I went back after the whole... Remember COVID?
• 4:50
  SPEAKER_00: You remember this thing called COVID?
• 4:51
  SPEAKER_00: Yeah, yeah.
• 4:51
  SPEAKER_00: We went back after COVID, and then I saw this kindergarten girl in her uniform.
• 4:58
  SPEAKER_00: Right at the back has a slogan.
• 5:01
  SPEAKER_00: It says, Pride in Performance.
• 5:04
  SPEAKER_00: It's like kindergarten, like Pride in Performance.
• 5:08
  SPEAKER_00: Yeah, but my wife says that I left Singapore, but I have not left Singapore.
• 5:11
  SPEAKER_00: And me, I'm still concerned about if I'm any good.
• 5:14
  SPEAKER_00: So it's 1992.
• 5:14
  SPEAKER_00: I'm in my dad's Honda Civic.
• 5:19
  SPEAKER_00: And we're driving there.
• 5:22
  SPEAKER_00: My mom's with us.
• 5:23
  SPEAKER_00: We're coming out of the car.
• 5:24
  SPEAKER_00: We're going to meet the principal.
• 5:26
  SPEAKER_00: It's not because I won some kind of award, not because there's some kind of merit thing.
• 5:29
  SPEAKER_00: You know, there's a lot of sort of stuff in Australia.
• 5:31
  SPEAKER_00: But no, it's not because of that.
• 5:33
  SPEAKER_00: It's because I'm dumb.
• 5:34
  SPEAKER_00: We're going to meet the principal.
• 5:36
  SPEAKER_00: And my dad's not coming out of the car.
• 5:39
  SPEAKER_00: He's too afraid to come out of the car.
• 5:40
  SPEAKER_00: So my mom and I leaves.
• 5:42
  SPEAKER_00: We go and meet Mrs. Ng.
• 5:44
  SPEAKER_00: And we sit down.
• 5:46
  SPEAKER_00: And while we're there, Mrs. Ng greets us, opens the door.
• 5:49
  SPEAKER_00: And as soon as you walk into the principal's office, I mean, mind you, it's a boys' school.
• 5:54
  SPEAKER_00: So you could smell like...
• 5:56
  SPEAKER_00: It's like you can smell talcum powder and boys' sweat all mixed into one, and then you sit down.
• 6:04
  SPEAKER_00: And she greets her.
• 6:05
  SPEAKER_00: She smiles.
• 6:06
  SPEAKER_00: She's very friendly.
• 6:08
  SPEAKER_00: She's really nice.
• 6:09
  SPEAKER_00: And then my mom, if you met Mary, my mom,
• 6:12
  SPEAKER_00: Most people of that era are called Mary for some reason, even the Chinese.
• 6:16
  SPEAKER_00: She's called Mary, and Mary, if you met her, she's like the natural therapist.
• 6:22
  SPEAKER_00: I could pale in comparison with her.
• 6:24
  SPEAKER_00: She opens, you talk to her, you could tell her your life history.
• 6:27
  SPEAKER_00: So anyway, Mary, my mom just starts saying,
• 6:30
  SPEAKER_00: Hi, thanks for meeting with us.
• 6:33
  SPEAKER_00: We just thought to ask something with you, you know, if it's okay.
• 6:38
  SPEAKER_00: And that's time in 1992 that I was in secondary two.
• 6:44
  SPEAKER_00: Secondary two, what's the equivalent?
• 6:45
  SPEAKER_00: Year nine?
• 6:48
  SPEAKER_00: Year nine?
• 6:49
  SPEAKER_00: And you could tell I'm counting because I'm in year nine.
• 6:53
  SPEAKER_00: I failed Chinese and I failed math.
• 6:55
  SPEAKER_00: I mean, which Chinese fail Chinese and math?
• 6:57
  SPEAKER_00: That's me.
• 6:58
  SPEAKER_00: So...
• 7:00
  SPEAKER_00: But I'm on the cups.
• 7:01
  SPEAKER_00: I'm on the threshold.
• 7:03
  SPEAKER_00: I was just 1% short of getting promoted to this thing called the express stream.
• 7:12
  SPEAKER_00: Now, don't let the semantics catch you off guard.
• 7:14
  SPEAKER_00: In Singapore, you have the gifted.
• 7:16
  SPEAKER_00: You have the express.
• 7:17
  SPEAKER_00: So the gifted and express, these two groups, they spend about four years in high school.
• 7:23
  SPEAKER_00: And then you have the normal stream.
• 7:26
  SPEAKER_00: Normal.
• 7:26
  SPEAKER_00: Normal.
• 7:28
  SPEAKER_00: I was in a normal stream, right?
• 7:30
  SPEAKER_00: So I was just like 1% to become, you know, into this next group.
• 7:35
  SPEAKER_00: So anyway, my mom says, we're wondering if you could help us.
• 7:38
  SPEAKER_00: Mrs. Lin says, yeah, sure.
• 7:41
  SPEAKER_00: Sure, what is it?
• 7:42
  SPEAKER_00: You know, my son, Daryl, and then Mrs. Lin turns and looks at me, and she looks up and down.
• 7:46
  SPEAKER_00: She's kind of scrutinizing me, right?
• 7:48
  SPEAKER_00: I mean...
• 7:49
  SPEAKER_00: If you think about at that age,
• 7:51
  SPEAKER_00: how we present ourselves,
• 7:52
  SPEAKER_00: my hair was a bit like a Jimi Hendrix sort of thing,
• 7:54
  SPEAKER_00: and I was really messy and all that.
• 7:56
  SPEAKER_00: But anyway,
• 7:57
  SPEAKER_00: so my mom says,
• 7:58
  SPEAKER_00: we're thinking if you could promote,
• 8:00
  SPEAKER_00: if you could look into the fact that maybe Daryl could go to the express stream.
• 8:03
  SPEAKER_00: It's just like 1% short.
• 8:06
  SPEAKER_00: And then Mrs. Ng says, yes, I can help you.
• 8:09
  SPEAKER_00: And my mom perks up.
• 8:11
  SPEAKER_00: I'm still, like, adding nonchalant about the whole thing.
• 8:14
  SPEAKER_00: And then she says, yeah, I can help you.
• 8:15
  SPEAKER_00: And my mom says, oh, great, thank you very much.
• 8:17
  SPEAKER_00: Thank you very much for helping us.
• 8:19
  SPEAKER_00: I can help you.
• 8:20
  SPEAKER_00: And then my mom says, oh, what do we need to do?
• 8:23
  SPEAKER_00: And Mrs. Sun says, if you donate to the school building fund.
• 8:29
  SPEAKER_00: Do you know, I have two sisters and one mother, which means I have three mothers.
• 8:34
  SPEAKER_00: For the first time in my life at that time, I was decisive.
• 8:39
  SPEAKER_00: And not that I was smart, I was just, I was pissed.
• 8:43
  SPEAKER_00: So I said, no, we're not doing it.
• 8:46
  SPEAKER_00: Then my mom, no, no, no, no, it's okay.
• 8:48
  SPEAKER_00: How much?
• 8:51
  SPEAKER_00: And then she said, well, well.
• 8:52
  SPEAKER_00: And then Mrs. Ng looks at me and she knows that I was kind of like upset with the whole idea.
• 8:56
  SPEAKER_00: She said, oh, but look at this young punk.
• 8:58
  SPEAKER_00: Look at his hair.
• 8:59
  SPEAKER_00: I mean, what's my hair got to do with it?
• 9:02
  SPEAKER_00: But anyway, I'm bringing up this thing because
• 9:07
  SPEAKER_00: After that, I mean, I went on.
• 9:08
  SPEAKER_00: I had to serve national service and blah, blah.
• 9:11
  SPEAKER_00: And then I went to uni and all that.
• 9:12
  SPEAKER_00: Things were good.
• 9:13
  SPEAKER_00: But I've got to tell you,
• 9:14
  SPEAKER_00: for a long time,
• 9:16
  SPEAKER_00: in this Chinese body of mine,
• 9:18
  SPEAKER_00: was always focused about performing.
• 9:21
  SPEAKER_00: Because I only realized this about 5,
• 9:24
  SPEAKER_00: 10 years ago,
• 9:25
  SPEAKER_00: that when you overemphasize on performing,
• 9:28
  SPEAKER_00: it really impedes deep learning.
• 9:34
  SPEAKER_00: Does this make sense?
• 9:36
  SPEAKER_00: An overemphasis on performance,
• 9:38
  SPEAKER_00: according to people in the learning sciences,
• 9:40
  SPEAKER_00: would argue that it impedes any sense of real learning.
• 9:45
  SPEAKER_00: In general,
• 9:47
  SPEAKER_00: in the scheme of things,
• 9:49
  SPEAKER_00: that's what we're going to be talking about,
• 9:51
  SPEAKER_00: this particular distinction,
• 9:53
  SPEAKER_00: and why it's not just lip service.
• 9:56
  SPEAKER_00: I'm sure many of you who go to PDs and stuff, we say, we all value what?
• 10:04
  SPEAKER_00: We all value learning.
• 10:05
  SPEAKER_00: We all value developing.
• 10:06
  SPEAKER_00: Of course, right?
• 10:08
  SPEAKER_00: But to really,
• 10:10
  SPEAKER_00: really push towards this in a very personal way,
• 10:13
  SPEAKER_00: towards this direction,
• 10:15
  SPEAKER_00: it's going to challenge your identity.
• 10:19
  SPEAKER_00: It's going to challenge your identity.
• 10:23
  SPEAKER_00: Okay.
• 10:28
  SPEAKER_00: So with that,
• 10:29
  SPEAKER_00: we're gonna talk about,
• 10:32
  SPEAKER_00: not the 1990s radiohead creep,
• 10:35
  SPEAKER_00: we're gonna talk a bit about concept creep.
• 10:38
  SPEAKER_00: Yesterday we talked about this in our newsletter,
• 10:40
  SPEAKER_00: and on the funnest Friday,
• 10:41
  SPEAKER_00: we talked about that in a while,
• 10:42
  SPEAKER_00: but this idea is not mine,
• 10:44
  SPEAKER_00: this idea is from,
• 10:46
  SPEAKER_00: From somebody over east, his name is Nick Haslan.
• 10:49
  SPEAKER_00: Nick Haslan has this term, he calls it concept creep.
• 10:51
  SPEAKER_00: Concept creep is basically the idea when a definition expands two directions.
• 10:56
  SPEAKER_00: It expands vertically, which means the milder and milder situations get more inclusive.
• 11:01
  SPEAKER_00: And then it expands horizontally.
• 11:03
  SPEAKER_00: The categories get expanded more and more.
• 11:05
  SPEAKER_00: And he argues that there are a couple of things that get expanded and has phenomena of concept creep.
• 11:13
  SPEAKER_00: Things like trauma, bullying, prejudice, racism.
• 11:18
  SPEAKER_00: All these things get expanded.
• 11:20
  SPEAKER_00: Now,
• 11:20
  SPEAKER_00: this is not nowhere near so severe,
• 11:22
  SPEAKER_00: but concept creep is important because it means that when we talk about something,
• 11:26
  SPEAKER_00: are we talking about the same thing?
• 11:29
  SPEAKER_00: Do we mean the same thing?
• 11:30
  SPEAKER_00: Are we really saying it in a precise way?
• 11:33
  SPEAKER_00: And this is going to be important for our discussion because I want to talk about
• 11:37
  SPEAKER_00: the mistakes that we make.
• 11:38
  SPEAKER_00: But before we talk about the mistakes, I want to highlight what it is before we sort of chip it away.
• 11:44
  SPEAKER_00: And, you know, while Tom, Tom is here today.
• 11:46
  SPEAKER_00: Hi, Tom.
• 11:47
  SPEAKER_00: Tom, Emma is going to talk about things that are of substance.
• 11:52
  SPEAKER_00: No pun intended.
• 11:54
  SPEAKER_00: I'm going to talk about things that are a little bit more invisible.
• 11:57
  SPEAKER_00: I'm going to try and make it more visible.
• 12:00
  SPEAKER_00: I've got nothing else to give other than try to speak on some things that are not there.
• 12:06
  SPEAKER_00: This is a picture from Officeworks.
• 12:08
  SPEAKER_00: And, you know, the thing about deliberate practice is that, like this biker, everyone else
• 12:20
  SPEAKER_00: is doing it wrong.
• 12:25
  SPEAKER_00: Everyone else is doing it wrong.
• 12:40
  SPEAKER_00: And we're gonna find a way.
• 12:42
  SPEAKER_00: We're gonna find a way of not just beating the pack.
• 12:48
  SPEAKER_00: But we're gonna find a way so that it makes sense to each of you, each of us in this process.
• 12:56
  SPEAKER_00: So jump back about 10 years ago,
• 12:59
  SPEAKER_00: when I was first doing my doctoral in Curtin,
• 13:02
  SPEAKER_00: one of the things that we were trying to do was we wanted to study highly effective therapists.
• 13:07
  SPEAKER_00: We really wanted to examine that.
• 13:09
  SPEAKER_00: And Scott Miller,
• 13:10
  SPEAKER_00: my friend and mentor and collaborator,
• 13:12
  SPEAKER_00: he had this article in 2007,
• 13:16
  SPEAKER_00: and he was talking about this idea that he first stumbled upon,
• 13:20
  SPEAKER_00: this K.
• 13:21
  SPEAKER_00: Anders Ericsson,
• 13:22
  SPEAKER_00: who studied a lot of people in developing expertise in other fields,
• 13:26
  SPEAKER_00: like music,
• 13:28
  SPEAKER_00: chess,
• 13:28
  SPEAKER_00: scrabble,
• 13:29
  SPEAKER_00: sports,
• 13:30
  SPEAKER_00: you know,
• 13:30
  SPEAKER_00: all kinds of domains,
• 13:32
  SPEAKER_00: except
• 13:33
  SPEAKER_00: our field, except our field.
• 13:35
  SPEAKER_00: There was zero information about that.
• 13:38
  SPEAKER_00: So the first question we had to ask was, where did we find these highly effective therapists?
• 13:43
  SPEAKER_00: So when we combed through the literature, the thing that we found was there was something about that.
• 13:49
  SPEAKER_00: They call that the master therapists.
• 13:52
  SPEAKER_00: So if you look through the literature, it's talking about master psychotherapists.
• 13:56
  SPEAKER_00: But David Alinsky from the University of Chicago,
• 13:58
  SPEAKER_00: he argued that,
• 13:59
  SPEAKER_00: but these,
• 14:00
  SPEAKER_00: how do we define them as master therapists?
• 14:04
  SPEAKER_00: And it turns out that those things were basically peer nominations.
• 14:10
  SPEAKER_00: So if you guys all gathered around and then say,
• 14:13
  SPEAKER_00: hey,
• 14:14
  SPEAKER_00: Dwayne's the master therapist,
• 14:17
  SPEAKER_00: and he would be nominated as that,
• 14:19
  SPEAKER_00: right?
• 14:19
  SPEAKER_00: I mean, he's probably a pretty good therapist.
• 14:21
  SPEAKER_00: But it's basically in the study, it is... I just don't know.
• 14:28
  SPEAKER_00: But the thing is, we thought that was kind of strange, like it was just based on peer nomination.
• 14:33
  SPEAKER_00: So we thought, okay, how do we then find the people who are really effective?
• 14:39
  SPEAKER_00: And by that,
• 14:40
  SPEAKER_00: we meant,
• 14:40
  SPEAKER_00: okay,
• 14:41
  SPEAKER_00: so let's confirm if in this situation,
• 14:43
  SPEAKER_00: this therapist is really good,
• 14:45
  SPEAKER_00: let's confirm.
• 14:46
  SPEAKER_00: And turns out that was a real difficult thing to find.
• 14:50
  SPEAKER_00: And I thought, oh no, I've got no way to study this.
• 14:54
  SPEAKER_00: And then in Kansas City of all places,
• 14:57
  SPEAKER_00: In Kansas City, I bumped into my friend, Bill Andrews, who's a dentist.
• 15:03
  SPEAKER_00: He's a dentist who turned to become from a dentist, turned to a therapist, which is a weird change.
• 15:08
  SPEAKER_00: And he said, oh yeah, I heard your presentation.
• 15:11
  SPEAKER_00: I can help you.
• 15:12
  SPEAKER_00: I was like, yeah, how?
• 15:14
  SPEAKER_00: He said,
• 15:14
  SPEAKER_00: well,
• 15:14
  SPEAKER_00: I have this network of people in the UK,
• 15:18
  SPEAKER_00: the Practice Research Network,
• 15:19
  SPEAKER_00: that has got outcomes worth of five years.
• 15:22
  SPEAKER_00: of data, i.e.
• 15:24
  SPEAKER_00: they have been collecting outcomes systematically one client at a time for five years.
• 15:30
  SPEAKER_00: I thought, shit, thank you very much.
• 15:35
  SPEAKER_00: And that's how the project began.
• 15:37
  SPEAKER_00: We started to study,
• 15:38
  SPEAKER_00: we interviewed people,
• 15:39
  SPEAKER_00: we talked with them,
• 15:40
  SPEAKER_00: and we wanted to find out a little bit more about the development and the work practices.
• 15:44
  SPEAKER_00: So in short,
• 15:46
  SPEAKER_00: some of the things that we found,
• 15:48
  SPEAKER_00: now this is,
• 15:49
  SPEAKER_00: I'm throwing it forward to tell you a little bit about not just what we found,
• 15:52
  SPEAKER_00: it's a consolidation of everything that we've known so far.
• 15:54
  SPEAKER_00: The profile of a highly effective therapist.
• 15:57
  SPEAKER_00: It's somebody who is more psychologically minded than biological.
• 16:02
  SPEAKER_00: It doesn't mean that the person doesn't believe in the effects of having coffee in the morning.
• 16:06
  SPEAKER_00: It just means that the person tends to have construction,
• 16:11
  SPEAKER_00: psychological theories to explain certain things.
• 16:14
  SPEAKER_00: For example,
• 16:14
  SPEAKER_00: if somebody is depressed,
• 16:16
  SPEAKER_00: they may have a formulation of how self-criticalness may impact them rather than serotonin,
• 16:24
  SPEAKER_00: hypothesis, right?
• 16:25
  SPEAKER_00: They have that sort of view.
• 16:26
  SPEAKER_00: And the ability to elicit negative feedback.
• 16:30
  SPEAKER_00: This one is kind of interesting because when we looked at this,
• 16:35
  SPEAKER_00: highly effective therapists tend to get lower alliance ratings initially compared
• 16:41
  SPEAKER_00: to the average practitioner.
• 16:45
  SPEAKER_00: Just think about that.
• 16:47
  SPEAKER_00: on average,
• 16:48
  SPEAKER_00: highly effective therapists,
• 16:50
  SPEAKER_00: if they're monitoring the working alliance,
• 16:52
  SPEAKER_00: their scores from the working alliance,
• 16:56
  SPEAKER_00: on average compared to the average practitioners,
• 16:59
  SPEAKER_00: lower.
• 17:01
  SPEAKER_00: Very interesting.
• 17:02
  SPEAKER_00: They seem to be able to elicit negative feedback.
• 17:05
  SPEAKER_00: So okay, what is it about the way, like how come, right?
• 17:09
  SPEAKER_00: So another piece is that they have skills in handling challenging situations.
• 17:17
  SPEAKER_00: And especially when it's more difficult,
• 17:22
  SPEAKER_00: which means rarer,
• 17:23
  SPEAKER_00: but they seem to have the ability to do that.
• 17:26
  SPEAKER_00: They also are more critical.
• 17:27
  SPEAKER_00: They have more what my colleague in Netherlands called professional self-doubt.
• 17:33
  SPEAKER_00: Not personal self-doubt.
• 17:36
  SPEAKER_00: Professional self-doubt, meaning they're never quite fully certain.
• 17:40
  SPEAKER_00: They don't pretend to be like the confident expert who knows everything.
• 17:45
  SPEAKER_00: There's always this room for unknowing.
• 17:48
  SPEAKER_00: And they are also more surprised by the feedback that they get.
• 17:53
  SPEAKER_00: So it's not like everything they go, oh, we are, I'm surprised.
• 17:57
  SPEAKER_00: No, it's not that.
• 17:58
  SPEAKER_00: It just means that when they get feedback,
• 18:00
  SPEAKER_00: the way that when we studied this,
• 18:02
  SPEAKER_00: they reported more times where the original idea and conception that they have of
• 18:08
  SPEAKER_00: their client
• 18:10
  SPEAKER_00: is altered, is changed.
• 18:14
  SPEAKER_00: They're not hyper-fixated on their worldview about things.
• 18:17
  SPEAKER_00: They're willing to let it be altered.
• 18:20
  SPEAKER_00: And then finally,
• 18:21
  SPEAKER_00: the thing that,
• 18:21
  SPEAKER_00: based on the study that we did,
• 18:23
  SPEAKER_00: the thing that gets emphasized a lot,
• 18:27
  SPEAKER_00: unfortunately,
• 18:29
  SPEAKER_00: They spend a lot of time in deliberate practice, i.e.
• 18:33
  SPEAKER_00: they spend a lot of time doing things to sort of ponder,
• 18:36
  SPEAKER_00: work at their edge,
• 18:38
  SPEAKER_00: which we will talk a bit about that.
• 18:39
  SPEAKER_00: And the difference is quite drastic.
• 18:41
  SPEAKER_00: If you look at the amount of time they spend,
• 18:43
  SPEAKER_00: the second,
• 18:44
  SPEAKER_00: third,
• 18:44
  SPEAKER_00: fourth quartile spends about 2.5,
• 18:45
  SPEAKER_00: 2.6 hours per week outside of therapy working and stuff.
• 18:50
  SPEAKER_00: But when you look at the highly effective therapists,
• 18:52
  SPEAKER_00: the top quartile,
• 18:54
  SPEAKER_00: they spend way more time doing that.
• 19:00
  SPEAKER_00: I've got to say, as an Asian, spending time outside doing this, it's a given.
• 19:05
  SPEAKER_00: It's like homework.
• 19:06
  SPEAKER_00: When,
• 19:06
  SPEAKER_00: you know,
• 19:07
  SPEAKER_00: 7.30,
• 19:07
  SPEAKER_00: ABC comes out,
• 19:09
  SPEAKER_00: this thing about the go-to-bed,
• 19:12
  SPEAKER_00: you know,
• 19:12
  SPEAKER_00: that's the time we start to study.
• 19:14
  SPEAKER_00: You know, that's the time that we, you know.
• 19:17
  SPEAKER_00: So it's not rocket science.
• 19:19
  SPEAKER_00: In fact, K. Ernest Erikson has found this in other fields.
• 19:23
  SPEAKER_00: The amount of time spent is pretty clear.
• 19:27
  SPEAKER_00: Here's his definition of what deliberate practice is.
• 19:32
  SPEAKER_00: on this would say it is individualized training activities.
• 19:37
  SPEAKER_00: I emphasize individualized training activities,
• 19:39
  SPEAKER_00: especially designed by somebody,
• 19:41
  SPEAKER_00: a coach or a teacher,
• 19:42
  SPEAKER_00: who has specific aspects of an individualized performance through successive refinement.
• 19:49
  SPEAKER_00: Successive refinement.
• 19:50
  SPEAKER_00: To receive maximal benefit from the feedback,
• 19:52
  SPEAKER_00: individuals have to monitor their training with full concentration,
• 19:55
  SPEAKER_00: and it's effortful and it's limited.
• 19:58
  SPEAKER_00: And it's limited because there's only that much you can push yourself at a given time.
• 20:03
  SPEAKER_00: So if you take what he's saying,
• 20:07
  SPEAKER_00: basically what my colleagues and I conceptualized is that we would argue that we
• 20:10
  SPEAKER_00: need some clear definitions.
• 20:11
  SPEAKER_00: Because unfortunately, through the years, Erickson unfortunately also has passed away a few years ago.
• 20:18
  SPEAKER_00: He has never been quite succinct or clear about what that is.
• 20:21
  SPEAKER_00: And there's a lot of argument going on about how do we define this.
• 20:25
  SPEAKER_00: And this is relevant to where we might make mistakes.
• 20:29
  SPEAKER_00: So there are four pillars.
• 20:33
  SPEAKER_00: There are four pillars in deliberate practice so far, if we unpack from what he said.
• 20:38
  SPEAKER_00: The first one is individualized.
• 20:42
  SPEAKER_00: individualize this domain.
• 20:44
  SPEAKER_00: It has to be specific to you, to me.
• 20:47
  SPEAKER_00: It has to be very specific to that.
• 20:49
  SPEAKER_00: Second,
• 20:50
  SPEAKER_00: it has to be an environment of not just performing feedback,
• 20:54
  SPEAKER_00: how well you're doing,
• 20:55
  SPEAKER_00: you're doing it well,
• 20:56
  SPEAKER_00: you're doing it right,
• 20:57
  SPEAKER_00: more than that.
• 20:58
  SPEAKER_00: It has to be about some feedback that's nuanced to help you learn.
• 21:01
  SPEAKER_00: That's the second domain.
• 21:05
  SPEAKER_00: And it's not practice makes perfect.
• 21:08
  SPEAKER_00: Magician Michael Omar says practice makes permanent.
• 21:13
  SPEAKER_00: Repetition makes permanent.
• 21:14
  SPEAKER_00: It's successive refinement, meaning, okay, if I figure out what this I need to work on, what's a tweak?
• 21:21
  SPEAKER_00: What's a single little tweak I can take to step there?
• 21:24
  SPEAKER_00: And then from here, what's the next tweak I need to do to step the next step?
• 21:28
  SPEAKER_00: Successive refinement.
• 21:30
  SPEAKER_00: And finally,
• 21:30
  SPEAKER_00: the fourth domain is that it has to be guided by somebody who knows your work the
• 21:36
  SPEAKER_00: way you do what you do,
• 21:39
  SPEAKER_00: right?
• 21:40
  SPEAKER_00: Not
• 21:41
  SPEAKER_00: like some kind of standard that you have to do is just based on what you need to evolve and work in.
• 21:47
  SPEAKER_00: Another way of putting it, you know, we say we've got to get our comfort zone.
• 21:49
  SPEAKER_00: It's a very common saying, right?
• 21:51
  SPEAKER_00: You've got to get our comfort zone, get our comfort zone, but get it to where?
• 21:55
  SPEAKER_00: Get to where?
• 21:56
  SPEAKER_00: I would say there's one area that we need to be careful of is not to our panic zone
• 22:00
  SPEAKER_00: where it gets too much.
• 22:02
  SPEAKER_00: We need to get towards each of our learning zone, each of our zone-approximal development.
• 22:08
  SPEAKER_00: Okay.
• 22:10
  SPEAKER_00: How's that so far?
• 22:13
  SPEAKER_00: Okay, do yourself a favor.
• 22:16
  SPEAKER_00: In your note,
• 22:17
  SPEAKER_00: if you don't mind,
• 22:17
  SPEAKER_00: so far what's been said,
• 22:19
  SPEAKER_00: I would like you to just put down one,
• 22:22
  SPEAKER_00: one little note to yourself.
• 22:25
  SPEAKER_00: Could be something we said, but a private thought that you have, that you're thinking.
• 22:29
  SPEAKER_00: And then could you box it up for a second?
• 22:31
  SPEAKER_00: We're going to look at a little bit more at this seven ways of things that we can have mistakes on.
• 22:39
  SPEAKER_00: I'm not sure how useful this road sign is.
• 22:44
  SPEAKER_00: And my hope is that the seven other points here might be a little bit more useful
• 22:50
  SPEAKER_00: on where we could go wrong.
• 22:51
  SPEAKER_00: Because if we could see that, then we could just keep our eyes on the path.
• 22:55
  SPEAKER_00: I mean, the first one is pretty important.
• 22:58
  SPEAKER_00: And once you hear it, it's hard to unhear it because it gets quite obvious after the fact.
• 23:03
  SPEAKER_00: Deliberate practice is not clinical practice.
• 23:06
  SPEAKER_00: You and I are in a field where when we say practice, it means the real thing.
• 23:14
  SPEAKER_00: It means the real thing.
• 23:16
  SPEAKER_00: And if you kind of visualize the therapy box, we have certain methodologies and therapeutic approaches.
• 23:23
  SPEAKER_00: We have a certain nomenclature,
• 23:24
  SPEAKER_00: the way we diagnose and label,
• 23:26
  SPEAKER_00: so that we get a hang of what we're dealing with,
• 23:29
  SPEAKER_00: right?
• 23:29
  SPEAKER_00: This little therapy box in here.
• 23:31
  SPEAKER_00: Kind of important, kind of, but deliberate practice is where it's outside of that.
• 23:41
  SPEAKER_00: It's everything outside of that.
• 23:43
  SPEAKER_00: Everything outside of that that makes the difference.
• 23:46
  SPEAKER_00: In fact, if you think about clinical practice, it's kind of like this little graph.
• 23:50
  SPEAKER_00: With time, you increase with experience.
• 23:55
  SPEAKER_00: And then if you,
• 23:56
  SPEAKER_00: like most of you who go through some years in clinical practice,
• 24:00
  SPEAKER_00: you might recall,
• 24:01
  SPEAKER_00: especially those who are under five years,
• 24:02
  SPEAKER_00: you might recall going through this period,
• 24:04
  SPEAKER_00: this valley of doubt.
• 24:06
  SPEAKER_00: You're not so sure, what in the world am I doing?
• 24:10
  SPEAKER_00: But then if you hang on long enough,
• 24:11
  SPEAKER_00: you start to pick up,
• 24:12
  SPEAKER_00: there's a sense of competency arising from that.
• 24:16
  SPEAKER_00: But the evidence of this is that if you look at the intersection between experience,
• 24:23
  SPEAKER_00: confidence, competence, the outcomes actually plateaus quite easily.
• 24:29
  SPEAKER_00: In fact, in one of the largest study done in Calgary, Canada, they found something that's quite sobering.
• 24:37
  SPEAKER_00: 75 therapists involved over 17 years' worth of outcome data.
• 24:41
  SPEAKER_00: They found that outcomes on average decline over time.
• 24:46
  SPEAKER_00: Meaning to say that the more experienced therapists actually have poorer outcomes as time went on.
• 24:57
  SPEAKER_00: Tom, you're nodding.
• 25:01
  SPEAKER_00: Yeah,
• 25:02
  SPEAKER_00: I don't know about you,
• 25:03
  SPEAKER_00: but when I first heard about this,
• 25:05
  SPEAKER_00: it was kind of scary to think about how Anders Eriksson talks about this.
• 25:10
  SPEAKER_00: His assessment of the plateau was correct,
• 25:12
  SPEAKER_00: but the graph actually tilts a little bit more downwards in decline.
• 25:19
  SPEAKER_00: So when somebody says that they have 20 years of experience,
• 25:23
  SPEAKER_00: it actually means one year of experience repeated 19 more times.
• 25:30
  SPEAKER_00: Practice makes perfect.
• 25:35
  SPEAKER_00: So it looks a bit more like this.
• 25:36
  SPEAKER_00: Number two, DP is not model-specific.
• 25:40
  SPEAKER_00: Deliberate practice is not model-specific.
• 25:44
  SPEAKER_00: If you survey the landscape in psychotherapy,
• 25:47
  SPEAKER_00: literature,
• 25:48
  SPEAKER_00: outcomes,
• 25:48
  SPEAKER_00: books,
• 25:49
  SPEAKER_00: and all that,
• 25:50
  SPEAKER_00: all you have to do,
• 25:51
  SPEAKER_00: right,
• 25:51
  SPEAKER_00: just go to Amazon,
• 25:52
  SPEAKER_00: type this in.
• 25:54
  SPEAKER_00: And if you haven't seen it yet, there's a whole proliferation of books in the last two, three years.
• 26:03
  SPEAKER_00: There's DP for schema therapy.
• 26:05
  SPEAKER_00: There's DP for CBT.
• 26:06
  SPEAKER_00: There's DP for EFT.
• 26:07
  SPEAKER_00: There's DP for, you know, all this sort of stuff.
• 26:10
  SPEAKER_00: And I think it's interesting.
• 26:12
  SPEAKER_00: It's interesting.
• 26:13
  SPEAKER_00: But my colleagues and I are worried.
• 26:16
  SPEAKER_00: We're worried that we are backing up the same cycle that we have had in the last 50,
• 26:23
  SPEAKER_00: 60 years,
• 26:24
  SPEAKER_00: that we are still doing the same thing.
• 26:27
  SPEAKER_00: How many of you have seen this graph before?
• 26:30
  SPEAKER_00: Yep.
• 26:31
  SPEAKER_00: Yep.
• 26:33
  SPEAKER_00: So this is a graph by Michael Lambert and his colleague,
• 26:35
  SPEAKER_00: and they kind of looked at what are the things that contribute to outcomes.
• 26:40
  SPEAKER_00: When they did this in the late 1990s, this was an estimate.
• 26:45
  SPEAKER_00: They suspected based on what they thought might be.
• 26:49
  SPEAKER_00: So right now, we have an update of this.
• 26:53
  SPEAKER_00: Right now, we have something that's an update of this.
• 26:56
  SPEAKER_00: It's based on a whole accumulation of work thanks to people like Bruce Wample from Wisconsin.
• 27:01
  SPEAKER_00: If you want to geek out,
• 27:02
  SPEAKER_00: you could check out his book,
• 27:03
  SPEAKER_00: The Great Psychotherapy Debate,
• 27:05
  SPEAKER_00: version number two.
• 27:06
  SPEAKER_00: Look at the edition number two to look at that.
• 27:08
  SPEAKER_00: And in summary, it looks a bit like this.
• 27:10
  SPEAKER_00: If you look at the treatment effects,
• 27:11
  SPEAKER_00: you want to zoom in and see what are some of the things contributing for outcomes,
• 27:15
  SPEAKER_00: right?
• 27:15
  SPEAKER_00: Alliance matters a lot,
• 27:17
  SPEAKER_00: as we know,
• 27:18
  SPEAKER_00: but there's a bit of nuance,
• 27:19
  SPEAKER_00: as I mentioned about highly effective therapists,
• 27:21
  SPEAKER_00: that if you look at it over time,
• 27:23
  SPEAKER_00: the trajectory is different.
• 27:24
  SPEAKER_00: Highly effective therapists tend to have a gradual increase of alliance.
• 27:28
  SPEAKER_00: Doesn't mean go screw it up at the first session,
• 27:31
  SPEAKER_00: doesn't mean that,
• 27:32
  SPEAKER_00: but what they do is they improve their engagement over time,
• 27:36
  SPEAKER_00: as opposed to high engagement throughout.
• 27:40
  SPEAKER_00: And then you look at expectancy,
• 27:41
  SPEAKER_00: meaning how much do you believe and what you do,
• 27:43
  SPEAKER_00: whether you're doing MI,
• 27:44
  SPEAKER_00: you're doing metacognitive,
• 27:46
  SPEAKER_00: you're doing mindfulness,
• 27:47
  SPEAKER_00: a schema.
• 27:47
  SPEAKER_00: If you believe and you convey that, that's potent.
• 27:51
  SPEAKER_00: That's really potent.
• 27:53
  SPEAKER_00: And the lion's share of the impact of treatment outcomes seems to be on therapist effects, right?
• 28:00
  SPEAKER_00: Therapist effects accounts for about 5% to 9%,
• 28:03
  SPEAKER_00: meaning who is the treatment provider matters more than the approach itself.
• 28:09
  SPEAKER_00: Treatment itself, 0 to 1% of outcomes.
• 28:19
  SPEAKER_00: 0 to 1% of outcomes.
• 28:21
  SPEAKER_00: Now, when you began, think about when you first began.
• 28:26
  SPEAKER_00: most of us want to cling on to some modality, right?
• 28:30
  SPEAKER_00: We want to hold on to something to give us some sense of like what to do and structure.
• 28:36
  SPEAKER_00: But ultimately, I think what we're all after is some kind of scaffold, some kind of structure in that.
• 28:42
  SPEAKER_00: Because structure,
• 28:43
  SPEAKER_00: we tend to conflate models and structure as the same thing,
• 28:46
  SPEAKER_00: but structure has a scaffold.
• 28:48
  SPEAKER_00: Structure creates impact, impact creates engagement, engagement creates outcome.
• 28:53
  SPEAKER_00: But if you were to ask yourself to think about what exactly is structure,
• 28:57
  SPEAKER_00: fundamentally structure has three things.
• 28:59
  SPEAKER_00: Structure is an understanding at any given moment.
• 29:04
  SPEAKER_00: Where are you?
• 29:06
  SPEAKER_00: Where are you going?
• 29:08
  SPEAKER_00: Why?
• 29:10
  SPEAKER_00: Just these three.
• 29:11
  SPEAKER_00: Where are you with your clients?
• 29:15
  SPEAKER_00: Where are you going?
• 29:17
  SPEAKER_00: What's the general direction?
• 29:18
  SPEAKER_00: If you're more CBT-ish, you're behaviorless, you think about goals and all that, sure.
• 29:22
  SPEAKER_00: But more even existentially, you think about where am I going in my life?
• 29:28
  SPEAKER_00: That's two.
• 29:28
  SPEAKER_00: And why?
• 29:30
  SPEAKER_00: What's the why behind all of that?
• 29:35
  SPEAKER_00: And we got to ask,
• 29:36
  SPEAKER_00: well,
• 29:36
  SPEAKER_00: how come when it comes to PDs,
• 29:39
  SPEAKER_00: continuing education,
• 29:40
  SPEAKER_00: licensing and all that,
• 29:41
  SPEAKER_00: how come this doesn't make us a better therapist?
• 29:44
  SPEAKER_00: These things don't impact an outcome.
• 29:46
  SPEAKER_00: And I would argue one of the things that is lacking is that it lacks a sense of specific,
• 29:51
  SPEAKER_00: like something like you mentioned,
• 29:53
  SPEAKER_00: something of your own desire,
• 29:54
  SPEAKER_00: a certain directiveness that has an influence on client outcomes.
• 29:58
  SPEAKER_00: And I'm going to talk about three domains that's important.
• 30:01
  SPEAKER_00: But first, I want to talk about bank robbers,
• 30:04
  SPEAKER_00: DJs and preachers.
• 30:08
  SPEAKER_00: Overlaps.
• 30:09
  SPEAKER_00: I love Venn diagrams.
• 30:10
  SPEAKER_00: The bank robbers and the DJs, everyone on the floor.
• 30:14
  SPEAKER_00: Preacher and the DJ, are you with me?
• 30:18
  SPEAKER_00: And the bank robber and the preachers, give me your money.
• 30:23
  SPEAKER_00: And all three of them, put your hands up.
• 30:30
  SPEAKER_00: I think that when it comes to training, there are three knowledge that we need to hold.
• 30:36
  SPEAKER_00: The three knowledge, one is, the first one I call it content knowledge.
• 30:40
  SPEAKER_00: Content knowledge just means the information.
• 30:42
  SPEAKER_00: Do you have information about certain psychopathology,
• 30:46
  SPEAKER_00: certain presentation,
• 30:48
  SPEAKER_00: certain clinical abnormality or things that related to interpersonal issues that
• 30:54
  SPEAKER_00: you face with your clients and also in their lives,
• 30:57
  SPEAKER_00: I mean?
• 30:58
  SPEAKER_00: But content knowledge is not enough.
• 31:01
  SPEAKER_00: Information is not transformation.
• 31:04
  SPEAKER_00: Because if it is, what we need is some self-help books, right?
• 31:10
  SPEAKER_00: Second is process knowledge.
• 31:12
  SPEAKER_00: Process knowledge means given what we know, how do we have conversation about it in therapeutic settings?
• 31:21
  SPEAKER_00: How do we engage somebody through the conversational reality of therapy?
• 31:27
  SPEAKER_00: And then finally, conditional knowledge means if the conditions change.
• 31:33
  SPEAKER_00: So you might have somebody that you're meeting, let's say presents with anxiety.
• 31:40
  SPEAKER_00: And you have a certain frame, a certain blueprint of how you work with them.
• 31:44
  SPEAKER_00: But what if the person's feeling anxious and depressed because of self-criticalness?
• 31:49
  SPEAKER_00: How would you work with them?
• 31:50
  SPEAKER_00: But if the person presents the same symptoms, how would you work with them?
• 31:54
  SPEAKER_00: It was because of bereavement.
• 31:59
  SPEAKER_00: You could hear your mind going in a different direction there, right?
• 32:02
  SPEAKER_00: That's conditional knowledge.
• 32:05
  SPEAKER_00: It means if the sort of permutations change, what do we do with that?
• 32:10
  SPEAKER_00: And someone once said this.
• 32:13
  SPEAKER_00: He said,
• 32:14
  SPEAKER_00: a full knowledge of psychiatric and psychological information with a brilliant
• 32:17
  SPEAKER_00: intellect capable of applying this knowledge is in and of itself no guarantee of
• 32:23
  SPEAKER_00: therapeutic skill.
• 32:25
  SPEAKER_00: This was said by somebody in the 1930s, and he was only in his 30s when he said this.
• 32:34
  SPEAKER_00: This was none other than Carl Rogers.
• 32:39
  SPEAKER_00: Man, it's almost, what, 90, 80 over a year since that time?
• 32:43
  SPEAKER_00: Yeah, pretty long time, isn't it?
• 32:46
  SPEAKER_00: Next, number three, DP is not reflective practice.
• 32:49
  SPEAKER_00: Sometimes,
• 32:50
  SPEAKER_00: you know,
• 32:51
  SPEAKER_00: I'm not trying to,
• 32:52
  SPEAKER_00: like,
• 32:53
  SPEAKER_00: chew on the importance of semantics,
• 32:55
  SPEAKER_00: but reflection is necessary but not sufficient.
• 33:01
  SPEAKER_00: Reflection is necessary but it's not sufficient.
• 33:04
  SPEAKER_00: Why?
• 33:05
  SPEAKER_00: Why?
• 33:06
  SPEAKER_00: Homer would tell you this,
• 33:08
  SPEAKER_00: Stephen Walfish,
• 33:09
  SPEAKER_00: the late Stephen Walfish,
• 33:10
  SPEAKER_00: when he asked private practitioners how effective they thought they were,
• 33:14
  SPEAKER_00: most of them rated themselves about the 80th percentile,
• 33:16
  SPEAKER_00: which breaks the bell curve.
• 33:18
  SPEAKER_00: And we thought,
• 33:19
  SPEAKER_00: okay,
• 33:20
  SPEAKER_00: let's kind of replicate this in our study,
• 33:22
  SPEAKER_00: and we asked people that we knew of the outcomes,
• 33:25
  SPEAKER_00: and it turns out their own self-assessment has got no correlation with their actual performance.
• 33:31
  SPEAKER_00: Their own reflection of their own work is not tied into reality.
• 33:38
  SPEAKER_00: And just a few weeks ago, we just released a study in China.
• 33:42
  SPEAKER_00: We did the same thing with Chinese therapists.
• 33:45
  SPEAKER_00: Turns out that our humility and modesty as Asians has no impact on our self-assessment bias as well.
• 33:52
  SPEAKER_00: We Chinese were also inflated.
• 33:55
  SPEAKER_00: To look at the difference in self-assessment, so again, quartiles.
• 33:59
  SPEAKER_00: I know I failed in math.
• 34:01
  SPEAKER_00: There should be a fourth quartile,
• 34:02
  SPEAKER_00: but we don't have a fourth quartile because there was not enough therapists to
• 34:06
  SPEAKER_00: represent the people who were the least effective.
• 34:08
  SPEAKER_00: I think you know why that is.
• 34:10
  SPEAKER_00: So we thought it's not fair to compare.
• 34:12
  SPEAKER_00: But when we compared the highly effective to the average practitioners,
• 34:16
  SPEAKER_00: this is what we found of their own view of how effective they are.
• 34:20
  SPEAKER_00: The highly effective therapists thought they were about the 72nd percentile.
• 34:27
  SPEAKER_00: And the other two groups thought they were doing about the same.
• 34:34
  SPEAKER_00: So there is limits to our own capacity to see things.
• 34:39
  SPEAKER_00: We did a study as well when we tried to, we called it the difficult conversations in therapy in 2015.
• 34:45
  SPEAKER_00: We did a pilot study.
• 34:46
  SPEAKER_00: We put through therapies through difficult situations.
• 34:49
  SPEAKER_00: They watched a video and they had to try and respond.
• 34:51
  SPEAKER_00: And then we helped them with giving them specific feedback.
• 34:54
  SPEAKER_00: Seems that generally people do improve.
• 34:56
  SPEAKER_00: But we thought, okay, let's do a bit of a randomized study.
• 34:58
  SPEAKER_00: So this paper is about to be released in the next week or two.
• 35:02
  SPEAKER_00: It's taken years to get this out.
• 35:04
  SPEAKER_00: But this is what we found in a randomized situation.
• 35:08
  SPEAKER_00: We had a control group,
• 35:09
  SPEAKER_00: meaning the control group was just asked to see various difficult clinical scenarios,
• 35:15
  SPEAKER_00: and they did their best to respond.
• 35:17
  SPEAKER_00: And they had to do their own self-reflection process.
• 35:20
  SPEAKER_00: They had to do their own self-reflection.
• 35:23
  SPEAKER_00: And in that process, by the way, it's two weeks long.
• 35:26
  SPEAKER_00: It's two weeks long.
• 35:26
  SPEAKER_00: They said a lot of time to chew on it.
• 35:29
  SPEAKER_00: The other group that you're about to see, they were given feedback.
• 35:34
  SPEAKER_00: They were not given performance feedback.
• 35:39
  SPEAKER_00: They were given little nuance,
• 35:41
  SPEAKER_00: some principle-based feedback about how to think about the situation and respond in
• 35:45
  SPEAKER_00: their own unique ways.
• 35:47
  SPEAKER_00: This is what we found.
• 35:50
  SPEAKER_00: The group in the control group, the red, over different scenarios, they scored this way.
• 35:58
  SPEAKER_00: And the group that was getting the feedback, they improved.
• 36:02
  SPEAKER_00: This was not, again, it's not a surprising thing.
• 36:06
  SPEAKER_00: What was surprising was that when it came to scenario four and scenario eight, we changed the scenarios.
• 36:17
  SPEAKER_00: We gave them a totally new scenario,
• 36:19
  SPEAKER_00: meaning what they learned from here,
• 36:21
  SPEAKER_00: they were able to transfer that into a different situation.
• 36:26
  SPEAKER_00: Next, number four, DP is not purposeful practice.
• 36:32
  SPEAKER_00: DP is not purposeful practice.
• 36:34
  SPEAKER_00: So what is purposeful practice?
• 36:37
  SPEAKER_00: A good way maybe we can compare this with the triangle,
• 36:41
  SPEAKER_00: it is guided by someone,
• 36:43
  SPEAKER_00: a teacher,
• 36:44
  SPEAKER_00: who runs a curriculum,
• 36:45
  SPEAKER_00: but the curriculum is course learning objective.
• 36:48
  SPEAKER_00: It is not specific to your learning objective.
• 36:55
  SPEAKER_00: It's based on your results, it's based on the performance, and it's about doing more, reps.
• 37:03
  SPEAKER_00: There's nothing wrong with purposeful practice because we do need that,
• 37:06
  SPEAKER_00: especially in teaching situations,
• 37:09
  SPEAKER_00: especially when you're beginning,
• 37:10
  SPEAKER_00: you may need some of that,
• 37:11
  SPEAKER_00: but there is a distinction.
• 37:13
  SPEAKER_00: Because if you see this, you might recall this.
• 37:15
  SPEAKER_00: They are a little bit different, isn't it?
• 37:17
  SPEAKER_00: It's individualized.
• 37:18
  SPEAKER_00: The feedback is more nuanced.
• 37:20
  SPEAKER_00: It's successive tweaking, right?
• 37:22
  SPEAKER_00: Because all of us need to figure out a way to be able to do something that's unique to us, right?
• 37:28
  SPEAKER_00: You don't want to end up in this comparatition.
• 37:32
  SPEAKER_00: And like any kind of path, this is the path that's created.
• 37:37
  SPEAKER_00: We are asked to go a certain way.
• 37:40
  SPEAKER_00: But if you let people have their way, they're not going to take it that way.
• 37:46
  SPEAKER_00: They're going to find their own way to deal with that.
• 37:50
  SPEAKER_00: So it's important that while we're thinking that we find a way, things do catch up.
• 37:57
  SPEAKER_00: We've got to always be tweaking and adjusting with each person and not thinking
• 38:01
  SPEAKER_00: that that's the only one way,
• 38:03
  SPEAKER_00: the be all and the end all.
• 38:04
  SPEAKER_00: Next, DP is not about you.
• 38:07
  SPEAKER_00: You know, one time this girl, I mean, she comes from the Irish family.
• 38:12
  SPEAKER_00: In the Irish family, they sing and they dance a lot.
• 38:15
  SPEAKER_00: It's not a unique thing.
• 38:17
  SPEAKER_00: But one day,
• 38:19
  SPEAKER_00: the cousins and aunties and uncles came over,
• 38:20
  SPEAKER_00: and the mom went to Sarah and said,
• 38:22
  SPEAKER_00: hey,
• 38:22
  SPEAKER_00: Sarah,
• 38:23
  SPEAKER_00: come on over.
• 38:23
  SPEAKER_00: Come out from your room.
• 38:25
  SPEAKER_00: She's about eight, nine, and she said, take out your guitar and come and sing for us.
• 38:29
  SPEAKER_00: And Sarah says, no.
• 38:30
  SPEAKER_00: And mom says, why not?
• 38:33
  SPEAKER_00: Just take your guitar, come and sing for us.
• 38:34
  SPEAKER_00: No, I'm not doing that.
• 38:36
  SPEAKER_00: Why are you not doing that?
• 38:38
  SPEAKER_00: All these aunties and uncles and cousins, I don't see them often.
• 38:40
  SPEAKER_00: What you do is kind of embarrassing.
• 38:42
  SPEAKER_00: And they go back and forth and arguing.
• 38:43
  SPEAKER_00: And the mom lost it.
• 38:45
  SPEAKER_00: And the mom just stamped her foot down and said, Honey, it's not about you.
• 38:51
  SPEAKER_00: Just take your guitar, come out here and sing for us.
• 38:55
  SPEAKER_00: Flash forward 20 years later, she's a singer.
• 38:58
  SPEAKER_00: And she's on stage.
• 38:59
  SPEAKER_00: And the spotlight, Dwayne knows this, you're a performer, right?
• 39:01
  SPEAKER_00: The spotlight's all on who?
• 39:05
  SPEAKER_00: On her, the performer, right?
• 39:07
  SPEAKER_00: It's on the performer.
• 39:09
  SPEAKER_00: But she just unconsciously remembers what her mom says.
• 39:13
  SPEAKER_00: Honey, it's not about you.
• 39:15
  SPEAKER_00: It's not about you.
• 39:17
  SPEAKER_00: Because when you're there for a concert, you're there for the audience.
• 39:20
  SPEAKER_00: You're there for the people.
• 39:21
  SPEAKER_00: It's not about you.
• 39:22
  SPEAKER_00: It's about them.
• 39:23
  SPEAKER_00: It's how you help them have a great moment.
• 39:26
  SPEAKER_00: Any of you have done any training in public speaking before?
• 39:30
  SPEAKER_00: you know there's what you have here what's that I suddenly lost the term there's a
• 39:36
  SPEAKER_00: group all over the world that trains in public speaking there you go Toastmasters
• 39:41
  SPEAKER_00: Toastmasters one of them I know sometimes they would say okay stand in front of the
• 39:45
  SPEAKER_00: mirror get ready to deliver your speech and do that right and do that that's
• 39:49
  SPEAKER_00: probably the worst advice you could give because why
• 39:55
  SPEAKER_00: Because it's not about you, yes.
• 39:57
  SPEAKER_00: You become too self-conscious.
• 40:00
  SPEAKER_00: You become overly focused about you.
• 40:03
  SPEAKER_00: And that's not the point.
• 40:04
  SPEAKER_00: And the way that we can get away from this de-emphasis of focus is we focus on the client,
• 40:09
  SPEAKER_00: get as close as possible to their evolution one session at a time.
• 40:13
  SPEAKER_00: Do not get detached from their outcome.
• 40:15
  SPEAKER_00: The only way to do that is to be systematic about that.
• 40:18
  SPEAKER_00: And in terms of the deliberate practice effort, it's very easy to get good at an instrument.
• 40:26
  SPEAKER_00: It's very easy to get good at an instrument.
• 40:28
  SPEAKER_00: It's much harder to get good at the song craft.
• 40:33
  SPEAKER_00: Are you with me?
• 40:35
  SPEAKER_00: It's very easy.
• 40:36
  SPEAKER_00: You just practice the scales.
• 40:37
  SPEAKER_00: You just play the thing, right?
• 40:39
  SPEAKER_00: You just practice, and you work on those little things.
• 40:41
  SPEAKER_00: Because it's a kind environment, that's what they call it.
• 40:44
  SPEAKER_00: It's very easy work.
• 40:45
  SPEAKER_00: But you try to improve at writing a good song.
• 40:48
  SPEAKER_00: You try to be the next Adele or Taylor Swift.
• 40:50
  SPEAKER_00: Forget it.
• 40:51
  SPEAKER_00: It's really hard.
• 40:52
  SPEAKER_00: It's really, really difficult.
• 40:55
  SPEAKER_00: So we need to be systematic on the way that we do it.
• 40:57
  SPEAKER_00: The way that we can, and we talk about this in a couple of our publications, is there are four steps.
• 41:04
  SPEAKER_00: The first thing that we need to do is to be able to integrate client outcome measures as a base.
• 41:10
  SPEAKER_00: And once you have that, you can develop your baseline, meaning on aggregate,
• 41:16
  SPEAKER_00: not just with one client at a time, but on aggregate, how are you doing?
• 41:19
  SPEAKER_00: And then number three,
• 41:20
  SPEAKER_00: you could figure out what's a leverage,
• 41:23
  SPEAKER_00: what's something that you can work on that's a bang for the buck,
• 41:25
  SPEAKER_00: that has general improvement,
• 41:27
  SPEAKER_00: that has an impact on other people,
• 41:29
  SPEAKER_00: not just one client,
• 41:31
  SPEAKER_00: and you can develop a learning system that's sustainable over time to be able to do that.
• 41:39
  SPEAKER_00: Next, DP needs guidance.
• 41:44
  SPEAKER_00: DP needs guidance.
• 41:47
  SPEAKER_00: This is a common question that I get asked when we run the intensive workshops,
• 41:51
  SPEAKER_00: they ask,
• 41:51
  SPEAKER_00: so can I do this on my own?
• 41:53
  SPEAKER_00: I think that's the aim, of course.
• 41:55
  SPEAKER_00: The aim is independence, right?
• 41:57
  SPEAKER_00: I mean, you don't want them to be always dependent on somebody, but they can go and evolve to that.
• 42:03
  SPEAKER_00: But first, you have to start with some kind of guidance.
• 42:06
  SPEAKER_00: Why?
• 42:07
  SPEAKER_00: When we survey and we ask people,
• 42:08
  SPEAKER_00: what is the single biggest challenge that people face in the professional development,
• 42:12
  SPEAKER_00: people who are the edge of working in deliberate practice,
• 42:16
  SPEAKER_00: This is what they say.
• 42:19
  SPEAKER_00: There are a couple of people who said the difficulty in work-life balance.
• 42:22
  SPEAKER_00: Some talk about self-doubt, as we mentioned.
• 42:26
  SPEAKER_00: But many of them don't know what to work on,
• 42:30
  SPEAKER_00: don't know what exactly they need to focus and work on,
• 42:33
  SPEAKER_00: because there's so many things that you could be working on.
• 42:36
  SPEAKER_00: But if you chase two rabbits, you catch none.
• 42:41
  SPEAKER_00: Very important for us to be able to focus and to figure out what actually has leverage.
• 42:46
  SPEAKER_00: Then let's turn to our signature pedagogy, clinical supervision.
• 42:51
  SPEAKER_00: Really important, really important in our development.
• 42:54
  SPEAKER_00: But this is what we found in the studies looking at the impact of clinical supervision on client outcome.
• 43:00
  SPEAKER_00: And there are studies that have been done about this with large sample size, right?
• 43:04
  SPEAKER_00: They found that supervision variance explained about less than 1%, in fact, about 0.8% to 0.9%.
• 43:10
  SPEAKER_00: of client outcome.
• 43:13
  SPEAKER_00: And as if they couldn't trust the Canadians,
• 43:15
  SPEAKER_00: the Americans did the same replication study,
• 43:18
  SPEAKER_00: and they found that supervision accounts for zero percent of the variance in client outcome.
• 43:26
  SPEAKER_00: Right?
• 43:26
  SPEAKER_00: Why is that the case?
• 43:27
  SPEAKER_00: Why is that the case?
• 43:29
  SPEAKER_00: And if you stop to think about this,
• 43:31
  SPEAKER_00: Edward Watkins,
• 43:32
  SPEAKER_00: Jr.,
• 43:33
  SPEAKER_00: he would say that if we cannot show that supervision affects patient or client outcomes,
• 43:40
  SPEAKER_00: then how can we justify the amount of time,
• 43:43
  SPEAKER_00: money,
• 43:43
  SPEAKER_00: and spend in that domain of emphasis?
• 43:47
  SPEAKER_00: Curious case in point, one of the world's greatest coach, his name is John Wooden, basketball coach.
• 43:54
  SPEAKER_00: He won the Medal of Honor when Obama was president.
• 43:57
  SPEAKER_00: And they studied him with fair level of scrutiny because he's so well-loved.
• 44:04
  SPEAKER_00: And one of the things he said that I really liked,
• 44:06
  SPEAKER_00: he said,
• 44:07
  SPEAKER_00: people don't care how much you know unless they know how much you care.
• 44:13
  SPEAKER_00: People don't care about how much you know unless they know how much you care.
• 44:16
  SPEAKER_00: And people felt that from him.
• 44:18
  SPEAKER_00: People felt that from him.
• 44:19
  SPEAKER_00: So let me preface with that.
• 44:21
  SPEAKER_00: But what they found when they examined the way he coached was that 75% of the time when he was training,
• 44:30
  SPEAKER_00: The place was spent not so much as information,
• 44:35
  SPEAKER_00: but he was providing discreet information,
• 44:39
  SPEAKER_00: what to do,
• 44:40
  SPEAKER_00: what not to do,
• 44:41
  SPEAKER_00: how to bring it down,
• 44:42
  SPEAKER_00: how to bring it up on certain things.
• 44:45
  SPEAKER_00: In contrast, 7% of the time was spent dispensing compliments or disapproval.
• 44:56
  SPEAKER_00: I mean, just think about that for a second.
• 44:59
  SPEAKER_00: I think sometimes it might render us a bit more speechless if we can't say,
• 45:03
  SPEAKER_00: oh,
• 45:03
  SPEAKER_00: that's good,
• 45:04
  SPEAKER_00: that's great,
• 45:05
  SPEAKER_00: perfect,
• 45:06
  SPEAKER_00: wonderful,
• 45:06
  SPEAKER_00: right?
• 45:07
  SPEAKER_00: Whereas he's very specific on the way where he dispenses feedback.
• 45:13
  SPEAKER_00: Finally,
• 45:16
  SPEAKER_00: I left the last two curly ones here,
• 45:17
  SPEAKER_00: but the last one is I don't think deliberate practice should be mandated.
• 45:26
  SPEAKER_00: When I was preparing for this,
• 45:28
  SPEAKER_00: somebody sent me this little document,
• 45:33
  SPEAKER_00: professional competency for psychologists from APRA.
• 45:35
  SPEAKER_00: Anybody seen this, an advanced copy of this?
• 45:39
  SPEAKER_00: It's a new one that just came out.
• 45:41
  SPEAKER_00: Maybe I should show it to everybody, but it looks something like that.
• 45:46
  SPEAKER_00: And one of the things, competency-free, it says, exercises, professional reflexivity,
• 45:56
  SPEAKER_00: Big word, reflexivity.
• 45:59
  SPEAKER_00: Purposeful and deliberate practice.
• 46:03
  SPEAKER_00: And self-care, don't forget about yourself.
• 46:07
  SPEAKER_00: Yeah, competency three, especially on 3.6.
• 46:11
  SPEAKER_00: So I'm not against the idea, but DP is not competency.
• 46:19
  SPEAKER_00: DP is excellence.
• 46:22
  SPEAKER_00: You're pushing, you're pushing even beyond what is required of you.
• 46:26
  SPEAKER_00: So I'm not sure if we should go down there to say that that's where we need to go.
• 46:32
  SPEAKER_00: But in summary,
• 46:35
  SPEAKER_00: DP is not clinical practice.
• 46:36
  SPEAKER_00: It's not model-specific.
• 46:37
  SPEAKER_00: It's not reflective practice, though reflections are necessary.
• 46:40
  SPEAKER_00: It's not purposeful practice, though purposeful practice has its place.
• 46:44
  SPEAKER_00: It's not about you.
• 46:46
  SPEAKER_00: DP needs guidance and should not be mandated.
• 46:49
  SPEAKER_00: So let me sum it up in a way of thinking about this as my three wishes for you on
• 46:55
  SPEAKER_00: what we could go with this conversation.
• 46:58
  SPEAKER_00: There is a difference between evidence-based practice versus practice-based evidence.
• 47:03
  SPEAKER_00: It's not a play of words,
• 47:05
  SPEAKER_00: but evidence-based practice is based on what the clinical research is showing us.
• 47:09
  SPEAKER_00: I think that's important, but I would argue that it would be great if you could build your own evidence.
• 47:15
  SPEAKER_00: Show of hands if you're already using some kind of systematic client outcomes in your clinical practice.
• 47:22
  SPEAKER_00: Yep.
• 47:23
  SPEAKER_00: So it would be great for more of you to do that,
• 47:25
  SPEAKER_00: and not just do that,
• 47:27
  SPEAKER_00: but develop your own baseline,
• 47:28
  SPEAKER_00: develop your own little small data.
• 47:31
  SPEAKER_00: The small data is way more powerful than big data, which is detached, impersonal.
• 47:37
  SPEAKER_00: This is more localized, because what's best may not be best for you.
• 47:45
  SPEAKER_00: So if you could have that information, it'd be really useful.
• 47:48
  SPEAKER_00: Then you can combine your intuition with the data for you to make better decisions as you go.
• 47:52
  SPEAKER_00: And you are able to tweak because the best form of standardization is kind of customization.
• 47:58
  SPEAKER_00: Number two, my wish for you is not just focus on doing things right.
• 48:03
  SPEAKER_00: but placing your attention on doing the right things,
• 48:06
  SPEAKER_00: doing things that actually has leverage on your outcomes,
• 48:09
  SPEAKER_00: because outcomes,
• 48:10
  SPEAKER_00: it's a hard thing to think about how we can actually influence that.
• 48:13
  SPEAKER_00: We need to do things that's predictive and influencible, things that can actually...
• 48:19
  SPEAKER_00: have to leverage.
• 48:20
  SPEAKER_00: So one of the documents that we created is called the taxonomy of deliberate practice activities.
• 48:24
  SPEAKER_00: It helps you break down with your supervisor in consultation of what you can work through.
• 48:30
  SPEAKER_00: I think we're on version 6.1 now.
• 48:34
  SPEAKER_00: There's many iterations.
• 48:35
  SPEAKER_00: Later on, you get a link.
• 48:37
  SPEAKER_00: You could download this for you.
• 48:38
  SPEAKER_00: And then my wish for you on this is to be able to focus on learning.
• 48:45
  SPEAKER_00: You know, my mom then sort of chuckles.
• 48:47
  SPEAKER_00: We're back in the principal's office with the boys' sweat and talcum powder.
• 48:51
  SPEAKER_00: We're in there.
• 48:53
  SPEAKER_00: My mom says something to the principal or to me.
• 48:56
  SPEAKER_00: I don't know.
• 48:57
  SPEAKER_00: Maybe she's just commenting.
• 48:58
  SPEAKER_00: She said something that didn't make sense to me.
• 49:01
  SPEAKER_00: It only started to strike me more recently in my 40s.
• 49:04
  SPEAKER_00: And she laughed when the principal said about donating the money.
• 49:09
  SPEAKER_00: And she laughed even more when I said, no, we're not going to do that.
• 49:12
  SPEAKER_00: We're not going to donate.
• 49:14
  SPEAKER_00: But she said, oh, it's OK.
• 49:16
  SPEAKER_00: We keep it as that.
• 49:17
  SPEAKER_00: He will stay for five years.
• 49:20
  SPEAKER_00: Maybe Daryl is just a late bloomer.
• 49:24
  SPEAKER_00: And I thought, what does that mean?
• 49:25
  SPEAKER_00: Is that an insult or what?
• 49:28
  SPEAKER_00: But I think it's really important because if we take time to be able to do what we
• 49:33
  SPEAKER_00: need to do in our own time,
• 49:35
  SPEAKER_00: we can then be able to grow.
• 49:38
  SPEAKER_00: Because the things that we want to do when we're learning is not
• 49:41
  SPEAKER_00: to be a dabbler,
• 49:43
  SPEAKER_00: somebody who's just,
• 49:44
  SPEAKER_00: you know,
• 49:45
  SPEAKER_00: try something really hard,
• 49:46
  SPEAKER_00: and then after efforts decline,
• 49:49
  SPEAKER_00: nor are we trying to be kind of a hacker,
• 49:51
  SPEAKER_00: where like,
• 49:52
  SPEAKER_00: yeah,
• 49:52
  SPEAKER_00: if I learn this one specific model,
• 49:55
  SPEAKER_00: schema therapy for borderline personality disorder,
• 49:57
  SPEAKER_00: if I get this right,
• 49:58
  SPEAKER_00: and then,
• 49:58
  SPEAKER_00: you know,
• 49:59
  SPEAKER_00: it's not really gonna go in the long run,
• 50:00
  SPEAKER_00: or you're a bit more obsessive,
• 50:02
  SPEAKER_00: I'm a bit more obsessive,
• 50:03
  SPEAKER_00: you know,
• 50:04
  SPEAKER_00: you wanna,
• 50:04
  SPEAKER_00: yeah,
• 50:05
  SPEAKER_00: go down that rabbit hole and learn as much as you can,
• 50:07
  SPEAKER_00: but it's not sustainable.
• 50:09
  SPEAKER_00: It's not sustainable to do that because you burn out and fade away, as they say.
• 50:13
  SPEAKER_00: Instead, you want to be able to have time to understand that we perhaps are like oak trees.
• 50:20
  SPEAKER_00: It takes some time.
• 50:21
  SPEAKER_00: It takes some time.
• 50:23
  SPEAKER_00: It takes some time for us to evolve and to grow.
• 50:27
  SPEAKER_00: Now,
• 50:28
  SPEAKER_00: if you want the taxonomy,
• 50:29
  SPEAKER_00: if you want to learn more about all these stuff on the things that we spoke of,
• 50:34
  SPEAKER_00: there's no catch.
• 50:35
  SPEAKER_00: There's no upsell or anything.
• 50:38
  SPEAKER_00: Just go in there, and the email will be sent to you.
• 50:42
  SPEAKER_00: If you like reading, for me, honestly, writing books is a way to make friends for a painful introvert.
• 50:52
  SPEAKER_00: So...
• 50:53
  SPEAKER_00: We've got other books from my colleagues and all,
• 50:54
  SPEAKER_00: and Duane mentioned the one that's supposed to come out probably in a month or two.
• 51:00
  SPEAKER_00: In general,
• 51:01
  SPEAKER_00: it's more about helping people who are making transitions in their lives,
• 51:04
  SPEAKER_00: got crossed in between worlds.
• 51:06
  SPEAKER_00: Fingers crossed that might be out soon.
• 51:07
  SPEAKER_00: And if you want to keep abreast, Frontiers of Psychotherapist Development releases every Friday.
• 51:13
  SPEAKER_00: We talk about concept creep the last round.
• 51:15
  SPEAKER_00: We just celebrated our 10-year anniversary.
• 51:17
  SPEAKER_00: There's all this back catalog, all accessible for free to you.
• 51:23
  SPEAKER_00: I must say it's a real treat to be speaking in a place I call home and it's nice to
• 51:30
  SPEAKER_00: have good company and familiar faces and friends all around.
• 51:34
  SPEAKER_00: Thanks for having me.