A systematic review of deliberate practice in psychotherapy: Definitions, operationalization, and preliminary outcomes.

Abstract

Deliberate practice has been introduced to psychotherapy training to improve therapist performance. The emerging empirical evidence supporting the positive impacts of deliberate practice is complicated by confusion regarding how deliberate practice should be operationalized and applied in the psychotherapy context and wider debate about its role in developing expertise. This systematic literature review aimed to appraise and synthesize the preliminary evidence available regarding the role of deliberate practice in improving psychotherapy outcomes. We searched MEDLINE, EMBASE, APA PsycInfo, CINAHL, Web of Science, reference lists of articles, and other sources (last checked June 2023). Quantitative English language studies that examined deliberate practice interventions in psychotherapy contexts were included. Two authors independently extracted study data and assessed quality using the relevant Joanna Briggs Institute critical appraisal checklist. Randomized controlled trials were further appraised using the Cochrane risk of bias tool. Discrepancies were resolved through discussion with a third author (Stephen Arthey). Twenty studies were included. There was wide variability in how deliberate practice had been operationalized, and only three studies met the contemporary definition that experts in the field have clarified. Significant methodological limitations impacted the reliability of studies, and the evidence was too preliminary to support or refute its use. Further research is required to establish whether deliberate practice is an effective means of improving psychotherapy outcomes. This should include increased fidelity to contemporary operationalizations, more robust methodology, and more reliable measures of long-term client outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).