Does practice make perfect? The effects of an eight-week manualized deliberate practice course with peer feedback on patient-rated working alliance in adults: A pilot randomized controlled trial

Background: Deliberate Practice (DP), which underscores the importance of expert mentorship, personalized learning objectives, feedback, and repetition, has been suggested as a method to enhance the effectiveness of therapists. Method: The study tested the efficacy of an eight-week, structured, group-based online course, enriched with peer feedback, for 37 Cognitive Behavioral Therapists. The goal was to assess whether this intervention could boost the quality of therapist-patient alliances, as compared to a control group. To measure this, therapists had their patients anonymously fill out the Session Alliance Inventory both before and after the course. The trial encompassed 120 patient alliance ratings at baseline and 64 at the post-course measurement. The DP course was comprised of a 75-minute remote video workshop each week for eight weeks, supplemented by related study materials. Each workshop focused on a specific skill, such as responding to client resistance, and included 55 minutes of concentrated role-play activities, providing ample opportunities for repetition and feedback. Results: Using a linear mixed model we did not find an effect on patient alliance ratings. However, we observed a trend (p = .054) indicating that the DP group decreased their alliance ratings (Cohen’s d = -0.40), while the control group demonstrated an increase in their scores (d = 0.49). Conclusion: This pilot study did not find support for DP leading to better patient-rated alliance compared to a waitlist control. However, the study had several methodological limitations. Further and more rigorous investigation of the effects of DP on patient outcomes is recommended.