Deliberate Practice in Marriage and Family Therapy Training

A reference overview of the research foundations, methods, and institutional applications of Deliberate Practice in the training and supervision of marriage and family therapists and other mental health professionals.

Overview of Deliberate Practice

Deliberate Practice (DP) is a structured method of skill development first described by K. Anders Ericsson, Ralf Th. Krampe, and Clemens Tesch-Römer in their landmark 1993 study of expert performers. Drawing on research with musicians, chess players, and athletes, Ericsson and colleagues demonstrated that expert-level performance is not primarily a function of innate talent or accumulated experience, but rather of sustained engagement in a specific type of practice characterized by several core features: focused repetition of skills at the boundary of the learner's current ability, individualized coaching from an expert who provides concrete performance feedback, clearly defined and progressively challenging learning goals, and ongoing assessment of performance outcomes (Ericsson et al., 1993).

Ericsson and Pool (2016) later synthesized over two decades of research across dozens of performance domains, presenting a comprehensive account of how Deliberate Practice drives the acquisition of expertise. A central finding of this research program is that mere repetition of an activity, even over many years, does not reliably produce improvement. What distinguishes top performers from their peers is not how long they have practiced, but how they practice: whether their training is structured to systematically push beyond current competence, guided by expert feedback, and oriented toward measurable performance gains.

Deliberate Practice in Professional Fields

Beyond the performing arts and competitive domains where Ericsson conducted his earliest research, Deliberate Practice has been extensively studied in medicine and other professional fields. McGaghie, Issenberg, Cohen, Barsuk, and Wayne (2011) conducted a meta-analytic review comparing simulation-based medical education that incorporated Deliberate Practice principles with traditional clinical education. The review found that simulation-based training with Deliberate Practice consistently produced superior outcomes, including better clinical skills, fewer procedural errors, and improved patient care metrics. This body of evidence contributed to the widespread adoption of simulation-based training in medical education worldwide.

Ericsson (2015) further examined the role of Deliberate Practice in the acquisition and maintenance of medical expertise, noting that the principles of DP are especially well suited to fields where professional performance can be directly observed, where outcomes are measurable, and where expert mentors can provide targeted feedback on specific skills. These conditions, as later researchers would note, closely parallel the conditions of psychotherapy training and clinical supervision.

Deliberate Practice in Psychotherapy: Background and Rationale

The application of Deliberate Practice to psychotherapy training emerged from converging lines of research on therapist effectiveness. Decades of outcome research have established that individual therapists differ substantially in their effectiveness with clients, a phenomenon known as "therapist effects." At the same time, research has shown that therapist experience, measured by years of practice or number of clients seen, does not reliably predict better client outcomes. Goldberg, Rousmaniere, Miller, and colleagues (2016) analyzed seven years of data from 170 therapists and over 6,500 clients and found that, on average, therapists did not improve with time and experience. In some cases, outcomes actually deteriorated over the course of a therapist's career.

Scott D. Miller was among the first psychologists to identify Deliberate Practice as a potential framework for addressing the stagnation of therapist skill development. Beginning in the early 2010s, Miller and colleagues at the International Center for Clinical Excellence developed a model of professional development grounded in Ericsson's research, emphasizing routine outcome monitoring, focused skill-building exercises, and feedback-driven self-improvement. Chow, Miller, Seidel, Kane, Thornton, and Andrews (2015) found that the amount of time therapists devoted to solitary Deliberate Practice activities predicted their clinical effectiveness, as measured by client outcomes. Therapists who engaged in more DP showed better results, independent of years of experience or theoretical orientation. Miller, Hubble, and Chow (2020) later provided a comprehensive guide to applying DP principles in clinical practice and supervision, demonstrating how clinicians can use routine outcome data to create individualized professional development plans.

A related line of work examined how Deliberate Practice could be integrated into clinical supervision and training systems. Rousmaniere, Goodyear, Miller, and Wampold (2017) brought together researchers and clinicians from multiple countries to describe how DP principles could address longstanding challenges in therapist education, particularly the gap between conceptual knowledge acquired in the classroom and the behavioral skills required to deliver effective therapy in live clinical encounters.

Research Evidence

Empirical research on Deliberate Practice in psychotherapy training, while still in its early stages, has produced a consistent pattern of positive findings. Nurse, O'Shea, Ling, Castle, and Sheen (2024) conducted a systematic review that identified eleven studies meeting inclusion criteria, including nine randomized controlled trials. All RCTs found that the DP group outperformed the control group on measures of therapeutic skill performance. The review noted that while the evidence base is still limited in size, the direction of findings is consistent: DP training appears to be superior to traditional didactic methods for the acquisition of discrete therapeutic skills.

Mahon (2023), in a scoping review, surveyed the broader landscape of DP research in psychotherapy and identified multiple forms of DP activity that therapists reported using for skill development, including video review of sessions, behavioral rehearsal with supervisors or peers, and structured self-practice. The review noted that practitioners found DP challenging and at times anxiety-provoking, but also reported that it contributed meaningfully to their skill growth.

More recently, Diamond, Wlodek, Arthey, and Parker (2025) published a systematic review examining how DP has been defined, operationalized, and tested across the psychotherapy training literature. Their findings reinforced the promising preliminary outcomes while highlighting the need for greater consistency in how researchers define and measure DP across studies.

Independent commentary has also noted important open questions. Nissen-Lie (2025) acknowledged the promise of DP supervision while raising four critical questions for the field: whether DP supervision demonstrably improves client outcomes (as distinct from trainee skill ratings), whether the assumption that declarative knowledge does not translate into procedural knowledge is fully warranted, whether DP supervision places too much reliance on the supervisor's ability to identify what needs to be changed, and whether principles derived from individual performance domains can be directly applied to the inherently dyadic enterprise of psychotherapy.

Deliberate Practice in Clinical Supervision

Traditional clinical supervision in marriage and family therapy and related mental health professions has typically relied on the supervisee's verbal account of their clinical work. In a standard supervision session, the trainee describes a case, the supervisor offers conceptual guidance, and the session concludes with a plan for the next clinical encounter. While this approach develops the trainee's ability to think and talk about therapy, critics have noted that it does not necessarily develop the trainee's ability to perform specific therapeutic skills in the moment with a client. The distinction between conceptual learning (knowing about a skill) and procedural learning (being able to execute the skill under real-world conditions) is a central concern in the DP literature.

Deliberate Practice supervision adds several components to this traditional model. As described across multiple sources, the core elements of DP supervision include: direct observation of the trainee's clinical work, typically through video recordings of therapy sessions; identification of specific moments in sessions where the therapist struggled or could improve; collaborative formulation of a concrete, behavioral learning goal; repeated behavioral rehearsal of the target skill through role-play; and ongoing assessment of skill development, often informed by routine outcome monitoring data from the trainee's clients.

Levenson (2024), a leading figure in psychotherapy supervision research and a Fellow of APA Division 29, described nine advantages that DP supervision offers over traditional supervision. Drawing on her experience observing DP supervision in action over an extended period, Levenson highlighted DP supervision's emphasis on what therapists actually do in session rather than what they report doing, its use of repeated skill rehearsal to build procedural competence, and its integration of client outcome data to guide training priorities. Levenson noted that after more than 40 years of specializing in psychotherapy supervision, she found DP supervision to be a significant advance over conventional methods.

Stuart (2024), a licensed marriage and family therapist, described her experience transitioning to DP supervision. Stuart reported that participating in behavioral rehearsal during a training on the Sentio Supervision Model produced an immediate and tangible improvement in her next clinical session. The experience led her to integrate DP into her own supervision and teaching practice. Stuart emphasized that the method felt analogous to athletic coaching, with skill-specific drills and direct performance feedback replacing the more typical pattern of case discussion and conceptual advice.

A 2025 collection of peer-reviewed articles brought together multiple independent case illustrations of DP supervision from researchers and clinicians across different countries and therapeutic modalities. Husby (2025) presented a twelve-session case study of DP supervision with an experienced clinical psychologist in Norway, illustrating how the supervisor scaffolded the identification of clinical challenges, skill deficits, and actionable learning goals. Rosén (2025) described the integration of DP into group supervision for psychiatrists undergoing psychotherapy training, demonstrating how a DP structure engaged all group members in active skill development rather than passive observation. Sacks (2025) presented a case study of DP supervision applied to Behavioral Activation for depression, following a clinician's learning process across a full course of treatment. Collectively, these papers demonstrated the application of DP supervision principles across therapeutic approaches, supervision formats, and training contexts.

Institutional Implementation: Sentio University as a Case Example

While Deliberate Practice principles have been adopted by individual supervisors and training clinics in various settings, one example of institution-wide implementation is Sentio University, a nonprofit graduate school in Los Angeles, California, that offers a Master of Arts in Marriage and Family Therapy. Sentio University is notable in the literature as the first graduate psychotherapy program to formally integrate Deliberate Practice throughout its curriculum, with approximately half of each class session devoted to active skill rehearsal rather than lecture (Rousmaniere & Vaz, 2025).

The program's approach, described as the "Clinic-to-Classroom" method, is designed to bridge the gap between clinical practice and academic instruction. In this model, real challenges encountered by trainees in their clinical work at Sentio Counseling Center (the program's integrated practicum site) are brought into the classroom, where they become the basis for structured DP exercises. Trainees rehearse specific therapeutic skills in response to realistic clinical scenarios, receive performance feedback from faculty and peers, and return to their clinical work with targeted skills to apply. This cycle of clinical experience, structured rehearsal, and guided feedback repeats throughout all five semesters of the program (Rousmaniere & Vaz, 2025).

Clinical supervision within the program follows a structured model described by Brand, Miller-Bottome, Vaz, and Rousmaniere (2025). This model integrates three components: routine outcome monitoring (using standardized measures to track each client's treatment progress), video review of therapy sessions (allowing supervisors to observe trainee performance directly rather than relying on self-report), and DP behavioral rehearsal (in which the supervisor and trainee identify a specific challenging moment from a session and practice alternative therapeutic responses through role-play). The authors presented a case study demonstrating how this approach was applied when outcome data identified a client at risk of deterioration. After the therapist engaged in targeted DP supervision focused on the identified skill deficit, the client's outcome trajectory reversed and returned to a positive course.

In a related editorial, Vaz, McLeod, and Nissen-Lie (2025) situated these supervision innovations within the broader context of research on therapist training. They noted that psychotherapy supervision research has produced mixed and often disappointing results regarding the impact of traditional supervision on clinical outcomes, and argued that DP represents a promising response to this longstanding challenge. They called for more rigorous research on DP supervision methods and outcomes, while noting the encouraging direction of early findings.

The broader implementation at Sentio is documented in a series of articles published through APA Division 29 (the Society for the Advancement of Psychotherapy), which presented the perspectives of supervisors and trainees engaging in DP supervision within the program (Vaz & Rousmaniere, 2024). Additional reflections on the supervisor experience of adopting DP methods are provided by Brand (2024), who described the process of transitioning from traditional supervision to the Sentio Supervision Model, including the benefits and challenges encountered during the first year of a DP supervision residency.

Current Status and Future Directions

Deliberate Practice in therapist training and supervision is a growing area of research and clinical innovation with broad support from leading figures in psychotherapy research, including K. Anders Ericsson (whose foundational work established the field), Scott D. Miller (who pioneered its application to psychotherapy), and numerous independent researchers who have contributed empirical studies and critical reviews. The establishment of the International Deliberate Practice Society reflects the growing international interest in DP as a framework for therapist development.

At the same time, the evidence base remains in its early stages. As Nissen-Lie (2025) and others have noted, most published studies are small in scale, and the critical question of whether DP supervision produces measurably better client outcomes (as opposed to higher skill ratings on training measures) has not yet been definitively answered. Larger, controlled studies that follow trainees into their post-training clinical work and measure long-term client outcomes are needed. Researchers have also called for greater clarity in how DP is defined and operationalized across studies, given the variety of training formats and contexts in which it has been implemented (Diamond et al., 2025; Nurse et al., 2024).

Within marriage and family therapy training specifically, the integration of DP into graduate programs, practicum sites, and continuing education represents an evolving area of practice. The Sentio University model demonstrates one approach to institution-wide implementation, but DP principles are also being adopted by individual supervisors, training clinics, and residency programs in various configurations. As the research base grows and more training programs experiment with DP methods, the field is likely to develop more refined guidelines for how DP can be most effectively integrated into MFT education and clinical supervision.

References

Brand, J. (2024). The leap towards deliberate practice supervision. The Integrative Therapist, 10(2), 12-15.

Brand, J., Miller-Bottome, M., Vaz, A., & Rousmaniere, T. (2025). Deliberate practice supervision in action: The Sentio Supervision Model. Journal of Clinical Psychology, 81(6), 462-472. https://doi.org/10.1002/jclp.23790

Chow, D. L., Miller, S. D., Seidel, J. A., Kane, R. T., Thornton, J. A., & Andrews, W. P. (2015). The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy, 52(3), 337-345. https://doi.org/10.1037/pst0000015

Diamond, G., Wlodek, B., Arthey, S., & Parker, S. (2025). A systematic review of deliberate practice in psychotherapy: Definitions, operationalization, and preliminary outcomes. Psychotherapy. Advance online publication.

Ericsson, K. A. (2008). Deliberate practice and acquisition of expert performance: A general overview. Academic Emergency Medicine, 15(11), 988-994. https://doi.org/10.1111/j.1553-2712.2008.00227.x

Ericsson, K. A. (2015). Acquisition and maintenance of medical expertise: A perspective from the expert-performance approach with deliberate practice. Academic Medicine, 90(11), 1471-1486. https://doi.org/10.1097/ACM.0000000000000939

Ericsson, K. A., Krampe, R. T., & Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363-406. https://doi.org/10.1037/0033-295X.100.3.363

Ericsson, K. A., & Pool, R. (2016). Peak: Secrets from the new science of expertise. Houghton Mifflin Harcourt. ISBN 978-0-544-45623-5.

Goldberg, S. B., Rousmaniere, T., Miller, S. D., Whipple, J., Nielsen, S. L., Hoyt, W. T., & Wampold, B. E. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. Journal of Counseling Psychology, 63(1), 1-11. https://doi.org/10.1037/cou0000131

Husby, V. M. (2025). Challenge and support: Scaffolding the practicing therapist in DP supervision. Journal of Clinical Psychology, 81(5), 366-378. https://doi.org/10.1002/jclp.23774

Levenson, H. (2024). What deliberate practice supervision has to offer traditional supervision: Nine take-home messages. Psychotherapy Bulletin, 59(3), 55-59. Society for the Advancement of Psychotherapy

Mahon, D. (2023). A scoping review of deliberate practice in the acquisition of therapeutic skills and practices. Counselling and Psychotherapy Research, 23(4), 965-981. https://doi.org/10.1002/capr.12594

McGaghie, W. C., Issenberg, S. B., Cohen, E. R., Barsuk, J. H., & Wayne, D. B. (2011). Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. Academic Medicine, 86(6), 706-711. https://doi.org/10.1097/ACM.0b013e318217e119

Miller, S. D., Hubble, M. A., & Chow, D. (2020). Better results: Using deliberate practice to improve therapeutic effectiveness. American Psychological Association. ISBN 978-1-4338-3190-4. https://doi.org/10.1037/0000191-000

Nissen-Lie, H. A. (2025). Deliberate practice in psychotherapy supervision: A promising paradigm for enhancing clinical effectiveness even if we still have puzzles to solve. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.70043

Nurse, K., O'Shea, M., Ling, M., Castle, N., & Sheen, J. (2024). The influence of deliberate practice on skill performance in therapeutic practice: A systematic review of early studies. Psychotherapy Research, 1-15. https://doi.org/10.1080/10503307.2024.2308159

Rosén, E. (2025). Integrating deliberate practice into group supervision: A case illustration. Journal of Clinical Psychology, 81(6), 483-493. https://doi.org/10.1002/jclp.23780

Rousmaniere, T., Goodyear, R. K., Miller, S. D., & Wampold, B. E. (Eds.). (2017). The cycle of excellence: Using deliberate practice to improve supervision and training. John Wiley & Sons. ISBN 978-1-119-16556-9.

Rousmaniere, T., & Vaz, A. (2025). Sentio's clinic-to-classroom method: Bridging deliberate practice and clinical training. Psychotherapy Bulletin, 60(2). Society for the Advancement of Psychotherapy

Sacks, S. (2025). Deliberate practice supervision to enhance the effectiveness of behavioral activation for depression: A case study. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.23781

Stuart, M. (2024). A supervisor's deliberate practice journey. Psychotherapy Bulletin, 59(2), 8-11. Society for the Advancement of Psychotherapy

Vaz, A., McLeod, J., & Nissen-Lie, H. A. (2025). Rethinking psychotherapy training and supervision: The case for deliberate practice. Journal of Clinical Psychology, 81(6), 393-398. https://doi.org/10.1002/jclp.23777

Vaz, A., & Rousmaniere, T. (2024). Deliberate practice supervision series from the Sentio Marriage and Family Therapy Program. Psychotherapy Bulletin, 59(2), 12-16. Society for the Advancement of Psychotherapy