Practical Exercises for Mental Health Professionals

By Jordan Bawks, Shelley Mcmain, Anne Sonley and 2 more

While  there are many successful books describing the theories and research of clinical psychology, there is a gap in content, providing structured and simulations to rehearse critical skills, mental health professionals need in the field.  Advanced Therapeutics, Clinical and Interpersonal Skills series aims to fill that gap. Authored and edited by leading experts, each volume in the series focuses on one subfield within mental health, providing concise and practical exercises for professionals. Each volume is based on an empirically based pedagogy that is structured, incremental, and tightly focused on the essential skills mental health professionals must acquire to obtain licensure/registration and enter the workforce. 

Practical  Exercises for Clinical Psychology, volume one in the series, focuses, on providing concise and practical exercises. These exercises include repairing alliance ruptures, motivating patients to address barriers to change, suicidal behavior strategies and establishing boundaries/ limits. Each of these exercises has been tested by leading experts and clinics in the field. This book is based on an empirically based pedagogy that is structured, incremental, and tightly focused on the essential skills clinicians must acquire to enter the workforce and successfully treat patients.

• Uses Deliberate Practice methodology to enhance clinical skill acquisition, which can be adapted for use by individuals, in supervision pairings, small peer learning groups, and/or in large group settings.
• Focuses on evidence based "common-factor" clinical communication skills that are proven to be related to improved therapeutic relationships and superior patient outcomes.
• Each skill exercise comes with multiple levels of difficulty to allow individuals to train at their unique growth edge based on their level of training and experience.

• Language: English
• Publisher: Academic Press
• Release date: Aug 8, 2023
• ISBN: 9780323997669

Jordan Bawks

Jordan Bawks, MD, is a recent graduate of the University of Toronto Psychiatry Residency program, and now works as a general adult psychiatrist at Joseph Brant Hospital in Burlington, Ontario. He is an Assistant Clinical Professor (Adjunct) at McMaster University in the department of Psychiatry and Behavioural Sciences, with a special interest in psychotherapy education and therapeutic communication. He is a post-academic Candidate at the Toronto Institute for Contemporary Psychoanalysis. During his psychiatric residency he was a core member of the PsychEd Podcast (psychedpodcast.org) and received several teaching awards, including the Resident Psychiatric Educator Award with the Association for Academic Psychiatry.

Book preview

Part 1

Overview and instructions

Outline

Chapter 1. Overview of this book

Chapter 2. Instructions for the deliberate practice exercises

Chapter 1: Overview of this book

Abstract

The goal of this book is to help mental health trainees and professionals achieve competency in core clinical skills through the evidence-based methods of Deliberate Practice. This book is designed for all career stages, from beginning trainees who have never worked with real patients to seasoned professionals.

Keywords

Clinical training; Deliberate practice; Exercises; Goal setting; Healthcare; Mentoring; Professional expertise; Simulation Training; Simulation-based behavioral rehearsal; Skill Development; Supervision

The goal of this book is to help mental health trainees and professionals achieve competency in core clinical skills through the evidence-based methods of Deliberate Practice (DP). This book is designed for all career stages, from beginning trainees who have never worked with real patients to seasoned professionals. The book is organized into three parts:

Part I contains this chapter, which explains the concept of DP, its importance for the training of mental health professionals, and the specific clinical skills that will be focused on in this book, and Chapter 2, providing instructions on how to perform the skill-building exercises. We have designed the instructions to be as brief and simple as possible to help trainees and trainers get started.

Part II contains the 12 clinical skill-building exercises that are the core of this book. Each exercise contains a brief description of the skill being practiced and why it is relevant for mental health professionals. We advise that these skills be practiced repeatedly, sequentially, and, when possible, in the presence of a mental health trainer or supervisor. An additional Exercise 13 (mock sessions) is also included to help bring the practice of individual skills together.

Part III contains Chapter 3 (Sample Syllabus) and 4 (Taking the Next Step: Resources for Further Study). Chapter 3 provides a sample one-semester course syllabus, appropriate for junior trainees but scalable for more advanced learners, integrating didactic lectures with the skill-building exercises provided in this book.

Deliberate practice and professional expertise in mental health

This book uses the DP method to improve the skills of healthcare professionals. The learning principles of DP are designed to help professionals develop their abilities across many fields, such as sports, medicine, and music (Ericsson & Pool, 2016). According to K. Anders Ericsson, a pioneer expertise researcher, engaging in this method can help improve a person's performance and develop their expertise over time. Ericsson summarized the research on expertise and its achievement through the use of DP:

Analyzing a review of laboratory studies of learning and skill acquisition during the last century, we found that improvement of performance was uniformly observed when people were given tasks with well-defined goals, were provided with feedback, and had ample opportunities for repetition. These deliberate efforts to increase one's performance beyond its current level involve problem solving and finding better methods to perform the tasks. When a person engages in a practice activity (typically designed by teachers) with the primary goal of improving some aspect of performance, we called that activity deliberate practice. (Ericsson, 2003, p. 67)

Vaz and Rousmaniere (2021) summarized major findings from DP research:

• Top professionals from different fields maintain a regular training routine that is focused on improving their skills. This routine usually involves an assessment of their current performance and developing personalized learning goals. It also includes a tailored plan that focuses on incremental skill development.

• The training regime should be supervised and codesigned by a supervisor or trainer. They should also provide expert feedback and monitoring on the progress of the training program.

• DP involves a type of training that is not performed in one's comfort zone. In other words, it involves performing tasks that are beyond one's current abilities. It is also deliberate, as it requires one's full attention and conscious actions. It is a demanding and effort-intensive activity that is usually difficult to sustain.

DP is an alternative to traditional training methods that focuses on the procedural aspects of training, thereby promoting state-dependent learning (Vaz & Rousmaniere, 2021). It differs from the passive methods commonly used in traditional conceptual learning, such as attending lectures. Instead, DP focuses on tailored behavioral rehearsal designed to improve one's performance, the systematic observation, and monitoring of one's work performance, and provides opportunities for ongoing feedback from a supervisor (Goodyear & Rousmaniere, 2017).

Several studies suggest that procedural or active learning techniques are more effective at changing the professional's behavior than passive methods (Rousmaniere et al., 2017). Prominent mental health authors have also suggested that training should include a component that involves hands-on practice (e.g., Hill & Knox, 2013). For example, clinical researchers Safran and Muran (2000) wrote:

Training needs to go beyond the didactic presentation of declarative knowledge if therapists are going to develop the combination of procedural knowledge, self-awareness, and reflection-in-action skill necessary to respond to patients in a flexible and creative way. It is important for therapist training to include a substantial experiential component and to emphasize the process of personal growth. (pp. 206)

Interestingly, research also shows that trainees report that hands-on skills training is the most effective method for improving their skills (Hill & Knox, 2013).

One of the main features of DP is its use of simulation-based mastery learning (SBML; Ericsson & Pool, 2016; McGaghie et al., 2014). Defined as contrived social situations that mimic problems, events, or conditions that arise in professional encounters, simulation-based mastery learning has been used in medical education since at least the 18th century (McGaghie et al., 2014, p. 375). This type of training involves using simulations that replicate the conditions and problems that commonly occur in professional situations, helping individuals improve their skills by allowing them to practice in contexts that highly resemble real-world settings. For example, the would-be airplane pilot may use virtual airplane technology to simulate the environment where specialized piloting skills will be of the essence. These types of training methods allow individuals to improve their skills by allowing them to practice repeatedly and refine their skill incrementally (McGaghie, 2017). Research on SBML in medicine has demonstrated reduced ICU infection rates, lower childbirth complications, faster surgical recovery, reduced hospital length of stay and fewer blood transfusions and ICU admissions (McGaghie & Kristopaitis, 2015, p. 226). Anders Ericsson explained the importance of SBML for effective DP:

Unlike surgery with actual patients, practice in the simulator can be stopped at any time, allowing trainees an immediate chance to correct mistakes and even repeatedly perform challenging parts of procedures … simulators offer the possibility of presenting rare problems and emergencies that would better prepare performers to deal with such situations. A recent study of military pilots showed that those pilots who had trained for a specific emergency situation in a simulator were more effective at responding to the same situation when it occurred during an actual flight mission. Similarly, surgeons who can experience rare emergency procedures when they are mentally ready in the simulator will be able to make necessary adjustments through additional training. These learning experiences are likely to better prepare surgeons for rare and challenging situations that occur unexpectedly. (Ericsson, 2004, p.