Reigniting Therapy, An Interview with Daryl Chow, MA, PhD (Psych)
An interview with Dr. Daryl Chow regarding how to do effective therapy. Curt and Katie talk with Dr. Chow about the ways in which therapists can improve clinically – looking at the relationship, the expectations of clients, and what we each uniquely bring to the room. We also discuss deliberate practice, lifelong learning, and the difference between confidence and competence.
It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.
Click here to scroll to the podcast transcript.Transcript
Interview with Daryl Chow, MA, PhD (Psych)
Daryl Chow, MA, PhD (Psych) is a practicing psychologist and trainer. He is a senior associate of the International Center for Clinical Excellence (ICCE). He devotes his time to workshops, consultations and researches the development of expertise and highly effective psychotherapists, helping practitioners to achieve better results.
Daryl is the author of The First Kiss: Undoing the Intake Model and Igniting First Sessions in Psychotherapy. His work has also appeared in edited books, peer-reviewed journal articles, and he is a co-editor of The Write to Recovery: Personal Stories & Lessons about Recovery from Mental Health Concerns.
Daryl’s blog, Frontiers of Psychotherapist Development is aimed at inspiring and sustaining practitioners’ individualized professional development. His highly personalized in-depth online course for supervisors, Reigniting Clinical Supervision, serves as a leading light to help raise the bar of effectiveness in psychotherapy.
Currently, Daryl maintains a private practice with a vibrant team at Henry Street Centre, Fremantle, and continues to serve as a senior psychologist at the Institute of Mental Health, Singapore.
In this episode we talk about:
“Slow progress is real progress.” – Dr. Daryl Chow
- Chow describing himself as a slow learner
- The value of deep learning
- The problems with therapist education
- Banking versus kindling model of education
- Learning conversation versus theory
- The importance of practical learning
- How we get in the way as therapists
- How to manage first sessions (what you are gifting, versus what you are taking)
- Undoing the intake perspective
- We are not in the business of fast food
- Trajectory of change, continuity of services
- 20-30% of people come only for one session
- “Sufficing” our information rather than deep probing
“Information is not transformation” – Dr. Daryl Chow
- First principles and the hero’s journey
- Evidence-based therapy versus developing good therapists
- Deliberate practice as a verb
- “It is so much easier to buy tools than to get good”
- What is NOT deliberate practice
“Confidence is not competence.” – Dr. Daryl Chow
- We get worse as therapists over time if we don’t practice deliberately
- The importance of lifelong learning
- The systemic challenges to maintaining skills and getting better
- What to work on that has leverage for you – finding your own growth edges
- Measuring growth versus measuring performance
- Re-moralizing clinicians through improving efficacy
- The role of burnout and overwhelm in becoming complacent
- The importance of feedback and “feeding forward” and making tweaks
- Continuous calibration approach
“Instead of the pill model approach, we need the kind of continuous calibration approach so that we can figure out how we are doing.” – Dr. Daryl Chow
Resources mentioned:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
The First Kiss: Undoing the Intake Model by Dr. Daryl Chow
Daryl’s website for therapists: Frontiers in Psychotherapist Development
Reigniting Clinical Supervision
Relevant Episodes:
Meet the Hosts: Curt Widhalm & Katie Vernoy
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, the CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Join the Modern Therapist Community:
Podcast Homepage | Therapy Reimagined Homepage
Facebook | Facebook Group | Instagram | YouTube
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Our Facebook Group – The Modern Therapists Group
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:12
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy. And Katie and I have always had this long desire to change just about everything about therapy education and the way that therapists practice. And occasionally, we find time in our hero schedules to make it onto our show. And this time, we are so fortunate to have Dr. Daryl Chow joining us for this episode. Dr. Chow is going to be one of our keynote speakers at the Therapy Reimagined 2020 conference. But I’m always excited when we have people who actually do the research to back up the things that we talk about, as far as where some of the pitfalls are, where some of the changes need to be in our field, and just so excited to have Dr. Chow. So thank you so much for joining us, Dary.,
Dr. Daryl Chow 1:08
Well, I’ve been such a big fan of your show, so to be on this, it is a treat. Thanks for having me, guys.
Katie Vernoy 1:16
We’re so glad to have you. And like we ask everyone at the beginning of our episodes, who are you and what are you putting out into the world?
Dr. Daryl Chow 1:24
And that’s the one single question that has been on my mind. You know, you send me a list of stuff to think about, on what might be useful for your listeners. This is the one I know you asked this of your interviewees, and, you know, got me thinking quite a bit. So I I am a slow learner. You know, I am, you know, when I think about my history, you know, I’m 42 I come from Singapore. I’m a Asian, Chinese. I got out of there about 2010 and I’m now living in Western Australia. And recent visit, this is like pre covid time back home. I was walking down one of the shopping malls and I saw a kindergarten, preschool girl, and she was wearing her school uniform, and on the uniform, it says, pride in performance. And if you know anything about Singapore, performance is everything, right? I mean, we want to be the number one in everything, like number one, airports and number one city. You know, even though we were not the number one in Formula One, we just created a new category, night race, number one. You know, we’re the first to have that. And I say, I’m a slow learner with some level of seriousness about that, because when I think about what my history, I really felt badly in that kind of system where there was a lot of push for performance. And thinking about that and how I evolved through that, I realized only in the last several years, that when we emphasize on performance, it can actually impede learning. You know, when we are over emphasizing about hitting the right results and the mark, we can actually impede a sense of openness, willingness to take risks and to learn. And I guess that’s why I think I’m truly a slow learner. When I do stuff I do take a lot more time to process. I need some time to think about things. And you know, it will be like much later that I get it. And I think that also relates to your question about what I’m trying to put out in the world. I’m hoping that we appreciate what, what’s her name, Susan Rogers, who was a producer for Prince, doing the Purple Rain album, working with Prince for about four or five years, and she said this in an interview that I love, maybe because it’s a confirmation bias, but I love the fact that she said that slow progress is real progress. And I just love that, you know, and I think what I’m trying to put out the world is that I think we can afford the time to become deep learners, each and every one of us, to take the time to to metabolize, to learn and to titrate to how intense we need to learn, what we need to learn, what we need to discover and probably uncover about ourselves as well.
Curt Widhalm 4:24
There you have it, folks, Prince is the basis for everything that we should be doing. So, I am always a fan of tearing down the institutions of psychotherapy around everything from the beginning around education to the way that the systems are built and the ways that we practice and manage care. And through so many of your writings, you talk about the ways that don’t work for everybody. Even, you know, you’re describing yourself as a slow learner, you’re not fitting into this one size fits all therapist model. And as of starting from the beginning. What do you see is wrong with the way that therapists are educated?
Dr. Daryl Chow 5:12
Well, I think we I think the poof, this is the big one. I think we are trying really hard, right? I mean, not that people or academics or people in higher education are doing a bad job. I think we all trying to do a good job. We’re all trying to change and to help therapists in training, especially to develop. But we must understand what is really required is not a downstream effort. It’s not something that we need to do just to problem solve and to help people get through the system and pass and get the licensing and all the registration and whatnot. I think the endeavor is a lot of upstream work, and that is difficult. You really need to be intentional, deliberate about this approach. But I, you know, if I drill down to some specifics, which I talk a lot about in our blog in Frontiers, which is how to reimagine education psychotherapy, I think one of the key difference is what we would consider in the education system, the banking model versus a kindling model. A banking model is basically just, you know, where we give people the theory practice, and then, you know, the theory research, and then the practice, where we try to give people the cognitive information that they need, all the theoretical stuff, and then get them out to practice, much, much, much later, right? Maybe when they are in post grad on the master’s program. To do that. I suspect that one way that we need to rethink this is to flip this around, to get people as close as possible to the to to the work the directedness the work, which is the conversational nature of reality, where we create new experiences for people, and we need to get as close as possible to that, to kindle that piece and then deconstruct with the theories, philosophies and all the principles that govern how we work. Because then things get ignited. Things get lit up. Things get more interesting in that spirit.
Katie Vernoy 7:20
And it seems like it would really allow folks to have something, to hang the theories on, rather than trying to understand something that they don’t yet, they haven’t yet embodied.
Dr. Daryl Chow 7:34
I love that. I love that to hang on to something. It’s what Charles Charlie Munger that the right hand man of Warren Buffett, saying that, you know, we need a latticework, a coat hanger to be able to put all our different ideas ,right and to be able to sort of chunk them, because knowledge is multi level. Knowledge is not just a single piece. It’s hierarchical. It’s a full network of different ideas. But if we could learn to kind of hang them and to see how this interlink and how all these connects to you as a person, not just some kind of remote ideas in a book, but with your lived history, with your experiences, is what you bring to the fore into therapy, I think that would be probably worth thinking about. You know, I remember in my undergrad days, I was in this course of counseling module, right? And what Dr. Robert Claus did for me, you know, probably changed my view, you know, the first lesson he gave, and we all came with this textbook. Was it a Gerald Corey textbook, maybe? And it was all these different schools of thought, right, that we had to go through. So you kind of know that we’d be covering the landscape of psychotherapy, the field in and of itself. And he said to us, after the first hour of introduction, he says, Okay, guys, pack your bags. Come. We’re gonna go to the other room,you know, and other room, okay? And we went there. It looks like an FBI interrogation room, right? Because it’s got this one corner where you go in, it’s all like soundproof and all that. And then he says that, all right, majority of you will be seated here. And then, as you can see, the reflection of yourself. This is what we call a one way mirror, and you’re gonna go to the other side. Two of you are gonna go to the other side, and we’re gonna watch you talk, and then we’re like, whoa, wow. Okay, and you know, for the first time in my life, not just being a slow learner, right? I was also an anxious kid. So by the time this is, like, after two and a half years in the Army, because all males and say, Well, do that willingly or unwillingly. I was an unwilling one. And I think I was about 21 I told myself, right, screw it, right, you know. Stop, stop getting in the way. Just raise your hands to everything and say yes, yes, yes, you know. And before I could think about just say yes, and I say, what did I sign up for? And Candy a beautiful lady, she’s got really colorful hair. She said, Oh yeah, I’ll do it. And she was really cool about it. And I was like, not so sure. So I followed Candy’s lead, and I went to the other room. And then Dr. Clause chimes in. Okay, you guys now, just talk.
Katie Vernoy 10:23
Just talk.
Dr. Daryl Chow 10:24
Just talk. And then we’re like, Hello testing? We can hear you. And Candy took the lead. I followed her lead, and my one question to her was I like the color of your hair? Why did you do that? And then, and we talked, and she told me, but, and then she asked me, and we talked, and then after that, She flicked the light on to the other side, and he got the team to reflect. I mean, as we know, for some people who are trained in family therapy or system thinking, this is a quite a norm. But later, did I learn that being in an undergrad psych program, this is not the norm, to do this at the undergrad level. I had no idea, and it really sparked off for me something. It really just opened my eyes to how important to have conversations that we can create safe spaces for truth telling.
Katie Vernoy 11:29
Safe spaces for truth telling. I love that.
… 11:32
(Advertisement Break)
Curt Widhalm 11:32
And I’ve been a fanatic of your blog, of your books over the last couple of years. This just so wonderfully segues into a lot of what you’d written about in your book, The First Kiss, about even the way that we structure going into those first sessions with clients, and about how we turn people off in those first sessions. You know, people walk in and it’s this, you know, sterile room, sometimes, if you’re working in an agency, it’s this mountain of paperwork that we have to check through a bunch of boxes. And, you know, hanging that hat on something else, especially if you’re early in your career. Sum up this whole book in like, the next, like, minute or two, just as far as kind of moving to the next, the next piece of like, how do we just keep getting in our own way when it comes to that transition to actually seeing clients?
Dr. Daryl Chow 12:30
That’s a good point. How we get in the way. How we get in the way? First off, The First Kiss is not a romance novel.
Curt Widhalm 12:41
Don’t be kissing your clients.
Katie Vernoy 12:44
Yeah, and yeah, professional therapy does not include sex, so no kissing.
Dr. Daryl Chow 12:48
But I you know, I think the, I think we get in the way due to in part what we are told to do, what we are told is the right thing to do in our field, as counselors, family therapists, psychologists and whatnot, because we are told that we need to take a thorough clinical assessment or an intake, and with that is a whole barrage, you know, you and your listeners and myself, we know all the kinds of questions we need to ask, to check, to make sure that we are doing the right thing, you know, to make sure that we don’t miss out on risk, we don’t miss out on trauma or salient things that you know, maybe because we didn’t have the time or whatnot, we make sure that we need to cover our grounds. And on top of that, you got to make sure you write your case notes down. You cover those things, cover your ass, make sure that if there’s any litigation, you don’t get into trouble, right? But I think we need to to loosen that up a little bit to undo the intake perspective and think less about what we are taking and kind of just focus about what we are giving or gifting to people. Because think about it, right. I mean, if you have gone into therapy for the first time, moving and taking the journey and planning and getting there and sitting there with a perfect stranger to talk about yourself, not only talk about yourself, but talk about the thing that pains you, things that are difficult, maybe even shame involved. And then when you leave that. you know, where do you want. what do you want to leave the person with? You know, when I was writing the book, I used to go to this particular cafe, and I would sit down. And on that particular day, there was a guy, you know, was about my age, and he was also sitting with his father in law, and they were having coffee. And the father in law, after a while, just asked him, so, so how did it go? How’d it go? And then the guy said, What do you mean? Yeah, you saw some psychologists or some shit, right? Like, how did that go? And they said, Yeah, you know, I don’t understand this business, he said, I spent one hours this person for and I paid 180 bucks just for this person to ask me questions. I don’t get it. So I think we need to figure out a way to undo that intake perspective, open up the horizon a little bit so that we can kind of go back to the spirit and heart of it to think about what we are giving to people, even from the get go.
Katie Vernoy 15:45
I like that perspective. And I think the thing that, for me, kind of ties it into business, because if, if clients feel like they’ve just been probed and not actually given anything, I think they’re not going to be as likely to come back. I think that there’s enough, enough folks that have been involved in the medical model. They want to have some probing and some questions. But I think if we don’t actually take care of the clients and give them something in that first session, I don’t believe that we’re going to have the the customer service that maybe they would want, or the we’re not starting on a good foot. So to me, I really like this idea of what we’re gifting. And I know from myself, the way I look at is I want them to have something tangible to take with them, some whether it’s a tool or some sort of something that allows them to feel just a little bit better, feel more hopeful. But I still ask a ton of questions. So I guess my question to you is, how do you, how do you kind of get the information that you need to create a formulation that kind of stuff like, what does that, what does that trajectory look like if you’re not asking a ton of questions on the first appointment?
Dr. Daryl Chow 16:59
Yeah, good point. Let me answer to that. But I also want to say that there has got critical implication. Because we are not serving fast food, right? We’re not just trying to go, you know, one session miracle kind of thing, if sometimes, in some settings, that may be the expectation, but in most situations, it’s about continuity of care, a way to follow through. And I think the reason I got, I got sort of compelled to, compelled to write this book, was consulting with individuals and agencies, and, you know, looking at the data sets as we look at the outcomes to help them to, you know, move the needle just that little bit better. And we see that on average across all countries, right? And all different kinds of settings, the average number of sessions that people typically come for, it’s about four to six. Four to six is a typical range. Now, even if you’re doing long term therapy, there are, of course, outliers that people come longer than that, but on average, it comes about four to six. So the next question is, when we look at that, you know, we look at the trajectory of change, when this change typically, typically happens. And I stumbled upon one piece of other statistical information looking at that was, was that, even though that’s the average, think about what is the most common number of sessions that people come for? And in statistical terms, we call that mode. And the modal number of session turns out to be one, one that about 20 to 30% of people come only for one session, and then they stop. And I mean, we could argue that maybe they got what they want, but if the plan was from some kind of continuation, then that’s unplanned termination. That’s not part of the gig, not not part of how you set up. And I think when I when I started to look at that, I was thought, I thought was an outlier. So I asked some clinicians, and I work with other agencies, and I saw the same thing. Then when I turned back and look at the literature, well, it’s a common thing. It’s common. And I’m like, why are we accepting this as common as, okay, right? I mean, so I then I went into clinicians to ask, and hey, you know, instead of just kind of vague numbers, tell me these guys, this guy’s on your list, who came for only one visit. What happened? Do you remember? And they said, Who are these guys? Then it struck me that…
Katie Vernoy 19:32
They didn’t even know who they were?
Dr. Daryl Chow 19:34
That’s right, because then I look at my own data set, and I will say this with with some level of embarrassment. I don’t remember some of them as well, because I only saw them one time. We have no eyes on an aggregated level, on an individual, personal level, because we’re so busy, we are inundated with so many different cases to attend to, other side projects. You know. Yeah, and to me, that’s worrisome, and that’s how I got started. But let me come back to your point, if I may. Katie, I think the thing about how then do we gather the information to be able to formulate or conceptualize, you know, what we how we’re going to intervene and help this person? Herbert Simon has this term. Herbert Simon is a renowned decision maker. He calls this satisficing, that instead of getting maximal level of information, or on the flip side, getting minimal amount of information, there may be a sweet spot in between, like an inverted U that we may just get sufficient that would suffice for the moment, because information is not transformation. If we gather more information, what happens is our confidence increase, because we actually have more knowledge, know more, knows more information about the person. But it doesn’t necessarily translate to better decision making. It just means that you feel more confident, because now you have ticked the boxes of what you need to do to get a thorough assessment. But it may not necessarily help you to have a satisfactory level of information that can be helpful for the person, because after all, as we say, if you work long enough in the field, assessment is always ongoing.
Curt Widhalm 21:21
This builds into this idea of first principles that you’ve written about before. And there’s, you know, the different kinds of knowledge that you’ve described, the conditional, the content, the process knowledge, and kind of this over reliance on just gathering data, but not necessarily being able to apply it or do anything with it, that ends up just kind of turning some people off, especially in that first session, when they’re maybe looking at their most vulnerable times for some sort of transformative process, or at least the hope of some sort of transformative process.
Dr. Daryl Chow 21:56
That’s right.
Katie Vernoy 21:57
I’d like to know what are the first principles? Because I’ve not read your books. I will now start reading them voraciously, but I tell me what the first principles are.
Dr. Daryl Chow 22:06
Yeah, you know, that was the other question that was worried of being asked. Because, you know, we talked a little bit about that in the book, in a recent book together with two of my heroes, really, Mark Hubble and Scott Miller, and we address this thing about principle based learning. But in brief, principles are really about the fundamentals, about what Aristotle would call the first basis from which a thing is known. You know, drilling down to that, in fact, Emerson has a quote about, you know, you know methods that are many, you know, and you can have many methods, but if you have methods and no principles, you’re not in a good way. So principles, to me about fundamentals. Fundamentals, fundamental way of us understanding stuff. So if I could use an analogy here, if you think about music, right, you could think about wanting to create songs. If you are songwriter, you’d be thinking about some fundamentals, some principles that govern what creates an impactful song, like the format, about verse, chorus, verse, bridge, chorus, chorus, right? That create, creates a scaffold. If you’re writing a story, you know, stories go through a narrative arc. They have three acts. They go through a sort of journey, or maybe sometimes what we call, in Joseph Campbell’s language, the hero’s journey. You see this all the time, playing out from Star Wars to Lord of the Rings and all kinds of movies can be interweaved into this principle of the hero’s journey. So I think if you, if you can imagine this, if you could picture that methods right at the top, and then theories on the second layer, and then right at the bottom are principles, I think we need to focus on that, rather on on the third piece, which is the principles. Instead of just figuring out approaches and methods. Does that make sense?
Dr. Daryl Chow 24:04
It does. Thank you.
Curt Widhalm 24:06
Which seems to be the part that’s missing in developing good therapists in so much of developing research, or the magical model, or the magical theory that we end up spending so much time teaching, you know, evidence based therapy, that we don’t focus so much on building good therapists. And really, you know, there’s so much of this difficulty in getting educational institutions, getting post graduate education to really adopt these ideas. And you know you’re talking about working with Scott Miller and Mark Hubble and all these ideas around deliberate practice that really gets people to look at why, why they’re doing what it’s doing that’s successful.
Dr. Daryl Chow 24:06
MmHm.
Curt Widhalm 24:21
What has been the slow adoption of deliberate practice into the psychotherapy world? Because this, you know, it seems to be something that has, you know, especially Scott has been working on since the 90s, that just seems to have so much reluctance around it.
Dr. Daryl Chow 24:51
Yeah, again, going from the analogy about music. I, you know, another world that I am obsessed with, besides therapy, is music. And one thing that I noticed for myself in the domain of music is this: it’s so much easier to buy tools than to get good. So I, I spend a lot of time thinking about therapy, about music, spend a lot of time working on that. And in music, you know, I spend a lot of time looking at gears, or what we call gas syndrome, which is a gear acquisition syndrome, where, oh, you know, this mixer, oh this keyboard, oh this pedal. Maybe if I get that, I would then be able to write this song that I’m trying to do. I think that’s similar with therapy. You know, if you look at all the feeds and advertisements that’s coming up, it’s all about this, right? And it speaks to the immediacy. It speaks to some level about our fear of like, oh, not knowing, what’s the latest evidence of stuff? But, you know, I don’t know about you, but the musicians that I really end up enjoying is because you can tell you have a hint that this is their insight coming out onto the outside, that this is them. This is uniquely this person, even if they’ve even though their voice may sound like not so good, like Bob Dylan, but you know that there’s something soulful coming out, and you’re moved by that. So I think, you know, Curt, your assessment about focusing, about therapies, since your therapists, is similar with music, you know you don’t want to get caught up in whether Are you doing the technically most proficient stuff, or you’re just making a song with three chords? Because at the end of the day, you want to figure out how to let to kind of leave yourself behind, paradoxically, and let yourself come through to speak with another person who’s also letting themselves come through in the therapy room. So I think it’s, it’s, it’s a, it’s a phenomena that’s not unexpected, that it’s slow to of slow for uptake. But you know, of recent years, we see more and more people talking about this whole deliberate practice piece. My worry is this. I’m worried that deliberate practice becomes capital D and capital P, that we are so concerned of this more as a noun than to do the verb. Because if you really start to think about this, there’s a level of dedication involved. There’s a level of sweat, and there is no secret formula. There’s nothing magical. There’s nothing kind of like if you do this one thing you know, and then you get better overnight, and your clients will come back and thank you. You know this, there’s no magic formula to this. It’s hard work, and yet, there is a scaffold. There is a structure that we can offer you to think traditionally in education system, if you can come back to the theme of higher education, is that education tells you what to think, but when you come out in real life, you soon you get a kick in the butt that you need to figure out what to think, what to learn. And I think that’s where the rubber meets the road.
Katie Vernoy 28:53
Well, it sounds like what you’re talking about is that deliberate practice is not even what to think and what to learn. You know kind of what you should be thinking. It’s how to think, right? It’s, How do I approach this? How do I understand this? How do I assess this in this moment? And it’s more really being able to assess and rate your own skills. I know that that you have a new book out, and you know better results, that there’s a section where you and your co authors designate a chapter about what is not deliberate practice. So we’ve talked a little bit in past episodes, and we’ll link to them in the show notes about what deliberate practice is, or at least our understanding of it. But what is not deliberate practice?
Dr. Daryl Chow 29:38
Well, the first conflation that we make is that we conflate clinical practice with deliberate practice, because experience does not get us better. You know, I say this with some trepidation, because it has lots of implication. We get more confident as the years go by, but as we all know, confidence is not competence, and when we look at the data, Simon Goldberg and colleagues have released a paper a few years ago looking at just this, when clinicians have been collecting outcome data, systematically, routinely, using that as a way to guide their work and composite that across time. And we look at the data to see what happens to each individual clinicians, whether do they actually get better. And if you look at studies from David Olinsky and Michael Ronstadt that that’s true, most clinicians do feel this from the beginning all the way to become a highly experienced, seasoned practitioner, our confidence to be more healingly involved goes up. But Simon Goldberg’s work shows that in spite of that, our confidence plateaus, our competence, our outcomes does not improve. In fact, on average, there’s actually a slight regression downwards. So it’s almost like saying, if someone has 20 years of experience, it probably means one year of experience repeated 19 more times.
… 31:13
(Advertisement Break)
Curt Widhalm 31:16
Once we get to this point in our careers where we feel like we we know enough that we lose some of that hunger to continue to build on that that fire, that kindling that you talk about, that we reach a place of complacency, that it feels like so many of us just kind of lose out on that ambition once we reach a place of comfort within our own lives and our own practice. That really, as I’m hearing you, is the challenge of continuing to be lifelong learners, because we have this pitfall, because we have this blind spot.
Dr. Daryl Chow 31:54
Yeah, I think that’s a challenge. I think you know, if you, if you, if you speak to therapists of all ages as well as all nationality. One consistent thing you hear is that we all want to grow. We all want to get better. We all want to do better for our clients, but faced with a lot of upstream efforts, a lot of difficulties in organizations and systemic challenges. I mean, this is hard work. This is hard even just to make the time to do that. So, you know, I think most people do want to get better. Now, remind me again. Say your question one more time. I want to make sure I hear you correctly.
Curt Widhalm 32:36
It wasn’t so much of a question as there’s this observation of therapists reach this place of complacency when they they feel confident enough.
Dr. Daryl Chow 32:48
Yeah, and, you know, that’s tricky. That’s where we need to counteract that. Because when, I remember that, you know, I heard one, one of my colleagues, saying that, you know, I spent all these years doing this, you know, and now I get to this point, and I should reap the rewards, and then I’m thinking, but isn’t this meant to be lifelong, like, isn’t this meant to be something that we, we do all the way through our careers. But majority of us, you know, we are devoted to that. We We feel that there’s some need to push that growth edge, that threshold. But the difficulty is figuring out what to work on that actually has leverage for you, because it’s not like a blanket thing that everybody should now do this, do A, do B, do C, because for what you need to work on and what I need to work on will be different. That has implication based on where you are at. Because you know, before the days of Google Maps and whatnot, if a friend was to come to your house, right and he or she rings you before you can give the instruction, you need to figure out where the person’s coming from. And we argue in the book that we need to figure out where you’re at before where you need to go. And that means that we need to have a systematic way that we can collate your outcomes, one client at a time, session by session, pull all that together with with a composite level of closed cases, and then examine all right, how effective you are. Now, remember that we talked about performance at the beginning piece? This can strike terror for some therapists like to…
Katie Vernoy 34:38
Yeah.
Dr. Daryl Chow 34:40
Like, okay, am I really effective? What if I suck? What if I’m in the wrong profession? What if, you know, and that is where performance can impede learning, because we need to shift. We need to create spaces to explore each person’s growth edge. And one thing, you know, I’ve been consulting with some masters programs, and even though there may be a slow uptake, but there are people, there are people who are putting their heads down, trying to undo the old ways now. And I think we need to to acknowledge that. And one thing that’s striking is that instead of measuring performance, we really need to figure out a way of measuring growth, a way to kind of track, to see how people are willing to figure out, first, wherever you are at, to figure that out, and then let’s kind of help you, inch by inch by inch, move towards Vygotsky calls this the zone of proximal development, to get towards your growth edge. And I think that’s where it’s re-moralizing. Because if you could do that, and I’ve seen the payoff for clinicians when they do that, something within just kind of glows and figure out, you know, a way to do this. Because if you could see that what you’re where your efforts, where you’re banking in it’s paying dividends. You feel moralized. You feel uplifted to carry on. And that can spread to the other people that you meet as well.
Katie Vernoy 36:10
That was one thing I was thinking about when, when both of you were talking about kind of the complacency that can happen is, I think that there can be a burnout, a lack of desire to learn, a giving up, and so this idea of of re-moralizing people is exciting to me, to actually get to a place where there’s more efficacy. And I think those are the types of things that we theoretically are helping our clients with, right? We’re helping them to find their areas of confidence, to find those things and to help therapists in that same way just seems really rewarding. Because I think when, when I feel most ineffective with clients is when I’m I find myself finding excuses, not wanting to do anything, hoping the client cancels. Like I’m not saying, like, Ooh, how do I take this on? And this is, fortunately, a gross over generalization. This was more when I was in agencies and super burned out, but like when I’m struggling, it seems like that’s the point at which I want to back down, not at which, it’s not the point at which I want to take on new learning and understand where I’m faltering.
Dr. Daryl Chow 37:15
That’s right. That’s right. I akin this to a couple of years ago. This is pre kid time, like before we had kids. You know, my wife and I used to go to the bowling alley and, you know, we just loved, you know, spending time to throw the ball and chit chat and all that. And to me, in many ways, I’ll feel, is a bit like going to the bowling alley armed with everything, you know. You got all your gears, and you got all the whatever arm bands, and you got your nice, smoothed out bowling ball with your cool white shoes, and you’re getting ready to bowl. And then you throw that ball time and time again to see if you could hit that strike or that spare, except that that your only feedback that you’re getting is the sound of the pin, because you’re blowing through a veil. You don’t know how what happens to the pin, and you’re asked to repeat. You’re asked to keep going and keep trying to All right, you did well, you heard that sound. Yep, I think that went down and keep going and keep you know, I think we’re bowling through a veil, and I think we need to figure out a way to get closer, more proximal, towards feedback so that we can feed forward. So, you know, Curt raised the point about what, how we are taught about various evidence based models. I think that’s nothing wrong. I mean, that’s a thing to learn, but I think to go beyond that just means, instead of taking the pill model approach, which is, do this thing, adhere to this, make sure you’re doing this right, right? Because one side effect of doing that is you have no flexibility to tweak, to calibrate, continuous tweaking. The only way to tweak that is to quickly take the feedback and feed it forward to go all right, that worked, that hit the pin, good. Repeat that. That didn’t hit the pin? Oh, adjust your arm a little bit. Maybe stand more to this side, you know, and tweak. I think, instead of the pill model approach, we need the kind of continuous calibration approach so that we can figure out how we are doing, not just outsourcing to, you know, because I’m doing some kind of evidence based model. So that’s fine. I mean, we cannot continue to throw the pin over a veil.
Curt Widhalm 39:43
I could talk with Dr. Chow for hours about so many things, but we’re gonna be respectful of his time and thank you so much for spending your time with us. Where can people find more of you and your information and all of the wonderful writings and books that you’re putting out?
Dr. Daryl Chow 40:06
Well, it’s a treat to be here, so thanks for all the great questions. If you want to find out more, you could go to my website, at darylchow.com and specifically for therapists, you could go to darylchow.com/frontiers. And I have a blog site called Frontiers of Psychotherapist Development. And there’s stuff out there for free. You know, I try put out stuff consistently about this topic, and what we are discovering to help you to be at your frontier and books links and all are there. We have got two online workshops that are going on as well if you’re interested. One is about deep learner maybe I kind of created that course for myself, but I was really, you know, it was only recently launched, and, you know, it was two years in the making, and so happened that the launch hit right at the smack of the covid time, and it’s so interesting just hearing people’s perspective about wanting to join, not just collect dots, but to connect dots of what they’re learning and how this has implications of their client outcomes, whether are they moving the needle, and how to synthesize all that they’re doing, how to protect time for play and learning. So that’s that you could find that on my website. And also another online web based workshop called Reigniting Clinical Supervision. This is specifically for clinical supervisors who want to change the way that we are approaching this to actually reap better results. That’s all there. And finally, if you are into social media, we have a close group for frontiers to psychotherapist development, too, you can look that up and join in the conversation.
Curt Widhalm 41:51
And we will include links to all of those things in our show notes. You can find those at mtsgpodcast.com. And while you’re over there, you can check out the now totally live new Therapy Reimagined website, and that’s going to all of our Reimagined Conference information. We’re reimagining our 2020 conference due to covid. So all of the latest updates you can find out over there. Dr. Chow is one of our keynote speakers this year. We are so grateful to be able to put together such a wide range of phenomenal speakers. Check all of that out over on the website, and we’re able to put that on with the help of our generous sponsor, SimplePractice, SimplePractice Learning and all the CE information you can find out on the website too. So until next time, I’m Curt Widhalm with Katie Vernoy and Dr. Daryl Chow.
… 42:50
(Advertisement Break)
Announcer 42:50
Thank you for listening to the modern Therapist’s Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter, and please don’t forget to subscribe so you don’t miss any of our episodes.
SPEAK YOUR MIND