Improve Your Therapy Skills and Treatment Outcomes With Deliberate Practice

Improve Your Therapy Skills and Treatment Outcomes With Deliberate Practice

IN THIS VIDEO:

Maor Katz: Be here and wonderful to wonderful to introduce you. Just be very brief. Mike is a director of professional development at Feeling Good Institute and also manages the Canada Clinic. I've had the pleasure of working with Mike shoulder to shoulder in the past maybe a year and a half creating a book to train people with TEAM-CBT or using deliberate practicing TEAM-CBT and without further ado here's Mike.

Mike Christensen: Awesome. Thanks so much Maor. It has been truly a pleasure working together and I'm excited to be here today to give people a little bit of a taste of one of the ways that we work at FGI. You know as we dive in, I love being part of the Feeling Good Institute and this may seem like a bit of a shameless plug but that's okay. I'm a bit shameless at times because I have real passion for what we do and that is our mission is to improve lives through effective therapy. There's nothing that fires my engine more than seeing people develop and grow and become really effective and good at what they do and that's our whole passion and our goal at the Feeling Good Institute. We have therapists on staff who provide effective therapy and we're constantly improving. We have consultation groups once a week and we do training to get better and learn how we can deliver really effective approaches to help our clients get better. When I first started learning about TEAM, one of my goals was to see it grow and develop in Canada and now we have centers in New York and Silicon Valley in Canada in Israel and online throughout Canada, the US and that's just super exciting to me to see TEAM-CBT spreading around in a variety of forms including outpatient, intensive and lower fee options. So today we're going to get a little bit of a snapshot of one of the key aspects of what we've been working with over the past well really actually a foundational aspect of TEAM-CBT but one that we've been really intentionally targeting in the last last year and so my hope for today is that you will at the end of our webinar be able to do a couple of things. One, identify what are some of the barriers that might get in the way of your excellence in therapy skills and secondly to be able to implement what we would call the deliberate practice approach or process of obtaining mastery with therapy skill and you can apply this in a variety of different modalities. It's not just for TEAM-CBT but today we'll hone in on one aspect of that. You know in my career both as a therapist and as a trainer and teacher, I've yet to meet a therapist who wanted to be kind of below average, who was you know hoping to see poor outcomes with their patients. They all want to get better. We all want to see our patients improve. We have this desire to be skilled and effective. It's rewarding to see people get relief from their symptoms and it also feels good to know that we've done good work. We want to feel confident in ourselves and we not only want to see our patients get better but I like to see them get better more efficiently, more quickly to be able to get relief sooner rather than later. But what can we do to make that happen? How do we learn how to do that? How can we improve and become excellent in our therapy skills? So I want to start with a bit of a thought exercise and give you a poll. This isn't a comprehensive poll by any stretch but I want to ask you the question what are key ingredients to becoming an effective therapist and think about you know a couple of areas just to stimulate our thinking. So if you could go ahead and fill that out then we'll see where our results land here. Just give you a minute.

Awesome. Yeah and I'll be honest when I put this poll together, I really was not sure what the outcomes would be. I was curious to know. I had no kind of prediction one way or the other. We've got most of you have have answered. I think we've got about 80 percent and we really have four areas there. One is personal confidence, understanding of an approach or years of experience or a high level of confidence and the data is showing it's kind of all over the board here. We've got a number of you that have suggested 82 at this point that's having a solid understanding and foundation of knowledge in a particular approach is key. Being confident 50 over 50 thought that years of experience 36 percent and then having a high level of confidence in your skills as a therapist. I'm just going to end the poll now and give show you the results that have come forward and when I looked at these different areas it's interesting because actually none of them is a guarantee that you'll have good outcomes and I suspect some of you were on to that already with the poll. You see you can have a lot of personal confidence you can feel really great about yourself but not be very skilled and your results won't be there right? I think we can all agree with that. Additionally you can have actually a pretty great understanding of a therapeutic approach, have a lot of knowledge of the theory but not actually be that effective in delivering it. Now the third one having years of experience. I know when I started I thought to myself well once I've got more experience then I'll be better that that's the key and seeing your response is only 36 percent you guys have some insight because you're absolutely right. Sadly experience is not actually a guarantee of having better outcomes. In fact in a research study in 2016 they discovered that in the aggregate therapist did not improve with more experience either over the over time or with cases. In fact they became slightly less effective and that's sobering on the one hand but also kind of exciting because if we can find out why that happens then we can turn that around. You know if you think of any skill if you get complacent will you continue to improve and grow not likely and what will your results be? They will taper. The fourth one having a high level of confidence in my skills 50 percent of you thought that was a key ingredient and sadly actually therapists are poor judges of their effectiveness in a research study I just did a research brief that went out many of you may have seen it that suggested love yourself as a therapist, doubt yourself love yourself as a person doubt yourself as a therapist actually having a measure of self-doubt leads to increased effectiveness in your outcomes and in this study from 2012 they they pulled therapists to find out who thought they were better better than average and 100 of them thought they were better than average on the whole in Psychotherapy. Well if you I'm not a statistics guy but I know if 100 of people feel they're above average then 50 percent of them are either lying or deceived. Like even if we did a poll today here we've got 300 people here if we said in this group how many of you think you're above average a little over 150, you would be below average on the aggregate in this group and that is a bit humbling even though most of you would likely report that you're above average and so we're not actually the best judges of our our skill. So how do we get better?

What are they what are the traditional ways that we once we've done our education get better? Well we lean on supervision and I love supervision and I do a lot of it. I think it's fantastic. I think it's really key to improving and growing. Sadly my experience historically not so much recently as I've learned these new approaches but historically supervision is often you know a few people sitting around theorizing about a case and then sadly there's not as much actual kind of improvement that goes on in your skill set and so your outcomes don't actually change with supervision. Continuing education is another way. Today you're here. Many of you are going to get CE credit for attending this course and if I look over the kind of history of the times when I've done different CE courses a lot of them they provide you with a lot of great knowledge, information you know here's the knowledge you need to know but are you actually improving in your skill set by taking a CE credit course? Unfortunately a lot of them no you're not and that's a bit sad. You become more knowledgeable but not necessarily any more more skilled or effective. The third one is learning and implementation of an evidence-based treatment. So choosing a specific modality or approach and really diving into it you know learning about DBT or CBT or ACT or or whatever the approach is and historically that was similar to you know what we've learned in grad school. You learn about all these approaches and you you get some knowledge about them but then you come out of grad school and I hear this from people who are you know wanting to start internships or practicums they feel terrified about seeing their first clients because they feel like I have all this knowledge but I don't actually know what to do. I don't know how to do it. I I can describe to you what to do but can I actually do it myself and I think there's a shift that's happening in our industry. I'm I'm hoping and I'm excited about the fact that we are beginning to learn how to actually become more skilled. I know for David Burns his approach with his you know Stanford group and TEAM-CBT was to learn a different way actually how people become skilled and then the final one is how to get better. We actually need to know what our results are. Are we actually are our clients our patients improving? Are we improving? Is there some system that's in place to give us feedback to inform us of what we're we're doing and we're going to do a little bit of a modeling of what I would say is a bit of a traditional approach to learning a skill and then we'll model again the what I call deliberate practice and I've asked LJ Davis who's one of our trainers at FGI to assist me and and Brad Dolan who is actually one of our interns. He's been working through this approach and it's going to be a little bit simulated for the purposes of learning. Brad's going to demonstrate something that he's actually far more skilled that than he's going to model in this first set but the way we initially started is by saying okay what is the skill to learn and I think we can all agree that all forms are modalities of therapy concur that having a strong therapeutic alliance. Having a strong connection with our clients, an empathic understanding is foundational to our work together and yet how many times do we actually practice empathy training and so the the basics that we're going to focus on today is three components of what are called David Burns, Five Secrets Effective Communication. We're taking three of what I would say the most common ones. If you look at a variety of other empathy training strategies they'll almost all include these aspects that is reflective listening repeating back what a patient says so they know we got it. Then we call that thought empathy in TEAM-CBT. The second is naming the emotions that the patient stated or emotions they may be feeling helping them to elicit or connect with their emotional state and then finally the classical open-ended question inviting the patient to share more. So based on these criteria I'm going to have LJ and Brad do a demonstration for us of how we traditionally learned or worked with learning a particular skill particularly empathy skill and so I want you to pay attention to what they're doing because we'll do a little bit of evaluation as a group of what they're doing.

LJ Davis: All right well I'm going to be in the role of the supervisor and so Brad just to practice this how about we do a little role play and I'll pretend to be your client and then you can give me some empathy using those criteria.

Brad Dolin: That sounds good.

LJ Davis: All right so you know work has just been so stressful lately. I can never seem to get caught up and my boss just keeps expecting more. It's so frustrating and I just don't see a way out of it.

Brad Dolin: LJ yeah it's challenging so what I hear you saying is that work has been really overwhelming lately and you're struggling to keep up.

Mike Christensen: We're going to pause right there and I'm going to launch a poll and I want you to evaluate how Brad did on these criteria. Was he masterful or very good? It's a good start we're getting the basics and Brad's used to getting grades so you can be totally brutally honest with him. How did he do in his use of the empathy skills since we're seeing eight percent of you are suggesting he was masterful 35 very good 40 45 saying it was a good start to build on there's an opportunity for learning and 11 12 suggesting that Brad he's getting the basics but there's lots of room for improvement. I'm just going to share the results there and now I'm going to have LJ jump back in and and work with Brad to see if we can help him with his empathy.

LJ Davis: Okay Brad I thought that was was glad to see you you know you picked up on my feeling overwhelmed and I'm struggling to keep up. I think those were really important and I really felt understood and I think that's just a key thing for you to be learning when you're thinking about this is that when you can really say things back to the clients it helps them to really feel like you're getting it and understanding it and one thing that you missed though you got the one feeling of overwhelmed but like the sort of the frustration and the anger maybe that I might be feeling or or difficulties with the boss you didn't really go into that at all and I think that would really make things a lot stronger if you would go into that because then I would sense not just that you're hearing the words I'm saying but you're really like getting my experience and that would be so huge for your clients to to hear that and get to experience that feeling that that you're really there with them and really getting it. That makes sense.

Brad Dolin: Yeah thanks for that input LJ.

Mike Christensen: Now I'm going to launch another poll here and ask you after this demonstration how much improvement in Brad skill level did you observe during that demonstration. We're getting a variety of responses here. 33 percenters saying 0 25 23 are suggesting it was a 25 Improvement 27 of you suggest it was a 50 Improvement 14 suggested 75 Improvement and three percent suggested 95. So I'm just gonna end the poll now and share the results and the actual uh correct answer for this poll is zero percent. It's not possible to actually see whether Brad improved because he didn't. We have nothing to compare it to. He only did one version and so there was zero percent Improvement at this point. Now he might have learned something but he's actually become more skilled in it. No he hasn't because he hasn't had a chance to do it again and so when we ask ourselves what are the key ingredient ingredients to improvement how is it the deliberate practice enhances are our skill set there are three foundational components and in the areas of sports and music and science these three components are all there but in the areas of therapy historically they've been missing. You see if you if you wanted to learn how to play basketball, if you're teaching somebody how to play basketball you you start by learning out what they know how to do right now if you take some you know grade schoolers then then we start by you know do they know how to dribble the ball, do they know how to how to pass, do they know how to shoot, we get sort of a baseline of where they're at right. Most therapists actually don't know where they're at. They won't do testing as far as the outcomes with their patients and part of that is because we don't want to know because I think it would be very sobering for us and so it's key that we actually know where we're at. The second is actually getting regular systematic feedback. This is where supervision as well is getting feedback from our clients and our patients on a consistent basis will give us the indication are we actually improving in our skill set. At FGI we do testing before and after every session with every client so we know whether we're effective or not. We can actually tell you whether our clients are improving or whether they're static or whether they're regressing and the third component is taking part in deliberate practice where we actually practice the skills and so when we think about deliberate practice in the fields of you know kind of music or or sport we practice in what we call the zone of proximal development. We want to aim for an area that's challenging but not overwhelming. You don't take a grade schooler who's just learning to play basketball and take them to an NBA practice and say I want you to cover LeBron James that seems kind of ridiculous. We don't take a five-year-old learning to play the piano and put them you know on stage in an orchestra and say I want you to kind of practice with the orchestra that would be far too challenging for them. So we start where they're at. On the same front we don't take a concert pianist and have them play twinkle twinkle little star you know with the three or four notes from a beginner's manual they'd need something a little bit more challenging so there's a sweet spot that we're aiming for keeping in mind that even your concert pianist still practices the basics over and over again. Even your professional level athlete your professional basketball players still practices shooting free throws and passing the ball to teammates and dribbling and so as therapists we want to find out where we're at with a particular skill then practice at the basics until it becomes almost like second nature we become very skilled at it and then work towards more challenging but not overwhelming aspects of it. I know when I was learning it was you know I got to the point where I thought oh I've got this empathy skill down. I had a client who said oh you get me completely and then my next five clients actually gave me poor empathy skills ratings and it was humbling and yet refreshing and so we want to keep in mind that this is lifelong learning it's we never fully arrived.

Every patient every client that we work with will need a different language of empathy and so we can constantly learn by getting getting that feedback. How do we provide feedback when we're doing the practice? Well there are two kinds of important feedback. First is negative or corrective feedback and you'll notice LJ did a little bit of that and then positive or reinforcing feedback. As a basketball player when you shoot for the hoop the negative corrective feedback is when you miss it hits the rim and bounces off and the positive is when it goes through. When it goes through you keep doing the same thing over again. We need both the same with short clear and and actionable. It has to be in that moment. The basketball coach says to the player just lift your elbow a little when you when you shoot now try it again. So it's very brief very short and then practice again. The key principle is heavy rehearsal light feedback. We're aiming for a four to one rehearsal to feedback ratio. So if you're practicing for one minute that's 15 seconds of feedback. You see this you know in in coaching in sports and in music as well. You know the coach will say okay here's the drill now go and practice say practice for 10 minutes and then he'll bring them together and give him two minutes of tips and then they'll back in practice for 10 minutes. In therapy training we often do it backwards. We like to theorize and we really want to be nudging towards more more rehearsal. One thing I failed to mention early on is if you have specific questions please send them to Maor and we'll have a Q A at the end so we can in the in the chat box send them directly to Maor and and he and I will answer them at the end. And you will also want to make sure you have the the printout of the handouts for when we get to our practice section. This is a picture of Fausto Coppi I think it's Coppi for those that are Italian you can correct my pronunciation. Also Coppi was considered the greatest cyclist of all time in the 60s. He won the Tour de France multiple times the Giroud Italia the tour of Italy in in multiple what we call Classics or one day races and in my sport I was a national level cyclist at one time so um I knew a lot about Fausto and one of the things that happened was he had just completed a dominant race where he destroyed the competition and after the race one of the young reporters came up and made their way to the front through all the rest of the reporters and asked him this question. He said Fausto what is the secret to your greatness? Also paused for a moment because he hadn't seen this reporting before and he was young and he wanted to kind of help him out and he said there are three things you must do and everybody got really quiet. The rest of the reporters got out there you know notepads because they were going to capture you know the greatest of all time the Tom Brady of cycling, the LeBron James, the Wayne Gretzky when he speaks you really want to listen and he said there are three things you absolutely must do in order to become great. The first is ride a bike said. Now the second is more important and so pay attention and write this down and that is ride a bike and the third is the most critical piece of information that you'll have and he said ride a bike. Now in one hand he was being humorous but he also was capturing what is profound and critical. No matter what you're wanting to become great at. If you want to become a great musician you have to practice, if you want to become a great athlete, if you want to become a masterful therapist you absolutely have to practice. The challenge is there are barriers that get in the way of effective practice. We have this gravitational pull away from practice. You know there's a kind of a sense that oh we should just be good at this. People said to me when I was moving into the field of therapy they said oh Mike you're going to be so good at that you're such a sensitive caring person and I was but I wasn't actually very skilled so it's not enough to be caring sensitivity. We we do care about our clients and patients we want to be there for them.

So here are four four barriers that can get in the way of effective practice. The first is the challenge is too difficult right? Like our illustration with the musician we don't put a five-year-old learning to play scales in with you know the orchestra. We don't you know put you know a grade schooler in with an NBA to practice you know guarding Stephen Curry and so what we want to do is break it down into what are the basic skills and start with where you're at. You know with this empathy training you may not be able to get all three of the skills the first time. Let's focus on getting the one. Let's get the thought empathy then add the emotion, the feeling empathy and then add the inquiry. So we break it down into components that are digestible and remembering that when we do the feedback one thing we did well one thing to improve on now let's practice. Second is anxiety. If I suggested that right now I'm going to randomly select one of you and open your mic up and have you demonstrate a skill that you have never done before in front of a group of 339 colleagues I suspect that the vast majority would feel a little bit anxious. You might even be feeling anxious now that I've said that out loud. I know I would be because it would be a bit intimidating because we want to do well, we want to show that we're skilled. The key when you get into practice with a diet or a triad is to jump right into the practice face that fear. It's like learning to ride a bike. The first time you try you fall off and it's a bit scary so then you get back on and you do it again and that's how we we learn. For some, there may be some personal work required. It may be so overwhelming to jump into this that it can be hard and so then you may want to do some personal work and it's one of the things we do at FGI. We do a lot of deliberate practice in our consultation groups but we always have the door open for personal work because sometimes there's things that are going in our lives that are challenging and can be overwhelming. The third is it feels good to theorize. We love to theorize. We paid thousands of dollars for our degrees and we have this wonderful piece of paper on the wall that says we're pretty smart and it seems almost wrong not to share our wisdom and our knowledge and so when we get into practicing and training together it's like here's the best opportunity to share how smart I am how much I know.

It's like this almost addictive thing that we we have. It feels feels good. So the key is to keep your feedback really concise and focused on the particular skill rather than this broad kind of teaching thing that we do and then the fourth one which really goes hand in hand with the second and third is we can fall into the trap of excessive feedback. Remember that a four-to-one to feedback ratio is key and excessive feedback is just a subtle form of avoidance. We're sort of avoiding facing the music in a sense and so I'm going to have Brad and LJ now demonstrate what I we would consider a very effective approach and just so you're aware this is the first time Brad has heard this client statement. He hasn't heard it before so it's fresh to him and LJ's going to walk him through a deliberate practice approach to developing his skill and then we'll do the same polls again here. Go ahead LJ.

LJ Davis: So excuse me so Brad will do the same role play again and you know work has just been incredibly stressful lately and I never seem like I can get caught up. My boss just seems to be expecting more and more and it is so frustrating. I just I can't see any way to get out of this trap.

Brad Dolin: Yeah so I'm hearing that work has been really stressful lately and it's a huge struggle just to try to keep up.

LJ Davis: Okay that was great Brad you saw some emotions and you didn't have had like my struggle of trying to keep up. What's let's give it another shot and see if you can also bring in the element of what's going on with my boss like a little more thought empathy there. I'll give you the the prompt again and work has just been so stressful lately. I can never seem to get caught up and my boss just keeps expecting more it's so frustrating I just don't see any way out of it.

Brad Dolin: LJ yeah so work has been so stressful lately and there's this huge struggle just to try to keep up and on top of that even given how much you're doing your boss is demanding more and more.

LJ Davis: Oh I love that Brad. I loved how you got my boss in there this time and let's see now if we can add some more emotions that I might be feeling. You accurately reflected the stressful that I told you see if you can maybe bring in some others. I'll give you the more Brad just work has been so stressful lately. I can never seem to get caught up and my boss just expects moron it is so frustrating and I don't see any way out of it.

Brad Dolin: LJ yeah so the work has been just so stressful lately and it's just been this tremendous struggle just just keeping up and on top of this your boss is expecting so much and you mentioned you're feeling frustrated. I wonder if you're understandably feeling a bit angry at your boss as well.

LJ Davis: All right that's really great Brad. You want to give it one more? Let's give it one more go and you know there's you you brought in anger there. I wonder if there might be some other tender feelings that we could add maybe check and see if there's some other maybe softer feelings in there as well. Let's try and add that in and see how that looks in inquiry and it'd be great too if you could then ask me a question at the end maybe bring in some inquiry to try to deepen where I go with that. So hi work has just been so stressful and I could never seem to get caught up and my boss just is expecting more and more and it's so frustrating and I can't see any way out of it.

Brad Dolin: LJ yeah I'm hearing that work has just been so stressful for you lately. It's a huge struggle just trying to get stuff done and on top of this your boss is just demanding more and more and you're feeling frustrated and I'd imagine maybe even a bit understandably angry, overwhelmed I don't know you know maybe even feeling inadequate and I'm wondering if I'm starting to get this right and if you could tell me a bit more about how you're thinking and feeling.

Mike Christensen: All right let's pause right there. I'm just going to launch the poll. What's your estimation of Brad's delivery of empathy in that last round? We can see in the results here 37 of you thought it was masterful. You can't even think of any way to improve it and 51 thought well that was pretty solid. Maybe a couple of tweaks here here and there and and 12 there could be some other areas of improvement and so let me ask you this question again now when you think back to the first time Brad did the demo with LJ compared to the the last round how much improvement did you see in Brad's skill level and as the results are coming in see the vast majority you view thought that there was at least a 50 Improvement, most of you thought it was 75 percent in a number, 95 percent Improvement and a couple would love to see more from your Brad before the show just the zero percent either they thought you were so good at the beginning they couldn't tell the difference and Brad is an incredibly skilled therapist one of the things that Maor and I noticed is when Maor and I started doing our training in TEAM-CBT it took us we would agree you know one to two to three years in some ways to develop some of the skill that Brad's been able to develop in six months to a year he he's so much more skilled in such a shorter period of time because he's been working through deliberate practice and he's set his ego at the door he's humble enough to go no oh yeah I still have areas to improve and I can work with this and so now it would seem almost wrong for me not to give you an opportunity to experience this yourself you know in many one hour CE credit situations they wouldn't actually have you practice but we're going to have you go to breakout groups and Daniel I just want to check in with you I realized I didn't make you host of a very good song where you but as I'm talking you have a chance to get that that set up. What I'm going to do is have you go into breakout groups of three ideally I'd love for you to be in great breakout groups of two so you can get more practice um but with a number of 327 we know that sometimes technical things can get in the way and and there also be maybe some that would feel too overwhelmed to jump into practice that would be a bit a bit sad and I know some of you may also you know feel tempted to go to the bathroom or get a drink, log out anything to avoid practice but remember practice is the only way to get better and so choosing not to practice is kind of like choosing not to improve as a therapist and so the breakout instructions are first off take one minute to introduce yourself we're going to be in the breakout group for 10 minutes and then the person whose first name comes first in the alphabet you get to play the patient first you don't actually have to start with practice um but then of the other two in your group one of you will decide to to play the therapist and please make that decision fairly quickly jump right In and you're going to practice until what we call Mastery so you'll notice LJ and Brad did four to five rounds with the statement and I've given you two client statements one's a little simpler and then one's a little bit more challenging. Then after five minutes switch roles now if you're in a group of three it will only be time for two of you to do practice and I feel a little sad and guilty that one of you will miss out on that opportunity but you're going to observe what's taking place and then after we're in the breakout groups I will give you an opportunity to just evaluate a couple of things and then we're gonna have a bit more instructions about CE credits, a bit of follow-up and then some some Q A, Daniel can you open up your mic how are we doing it yeah no we're all set to go what what's the timetable that we're heading out to the room score 11 minutes okay in there and maybe what I'll do is right now I'm just going to make sure that everybody has oops now let me put this to everyone everyone in the meeting I'm going to make sure that everyone has the so can I do that no I can't you know. Oh yeah I'm just gonna attach the the file from the desktop here you know here we go so if for some reason you weren't able to download it is in the chat box right right now and you should be able to get a hold of that right away all right well let's head to our breakout groups and then we look forward to getting a bit of feedback from you.

Well as the last few are rejoining here we want to just do a little bit of processing or processing depending on where you're you're from and so I'm going to ask you a couple of questions and you could free even if you wanted to provide a little bit more input you could send in the chat box to Maor any comments or thoughts that you have. I'm gonna ask you this question, first off were you able to spend the majority of the time practicing and if not what got in the way of the practice was it theorizing or avoidance or anxiety might have been technical too for some I know you know got cut off but if you weren't able to practice you know to that four to one ratio what got in the way think about that question and if you have a response you can just type it into the the chat appreciate the hands hence going up for the sake of time we want to forge ahead. The second is did you notice the challenge to keep the feedback brief? It's arguably my toughest challenge is it's hard to keep the feedback brief. I want to comment on a whole bunch of things and was that a challenge for you as well? And then sec in the last question for you just to think about as a practice debrief is for those that did practice for those that had the opportunity to practice did you notice your skill level improve? Did you notice a change? You feel more confident in doing those three empathy skills? And Maor is going to have a look at some of those and may share some of those as well before we dive into the the Q a um just a couple of things that we need to cover. The one is just a reminder that um you know Feeling Good Institute and this might be a little bit of a shameless pug as well but almost everything that we're doing at the Feeling Good Institute now is trying to incorporate deliberate practice into it. I teach a course 13-week course in September and we're incorporating more and more practice opportunities because we're seeing the change in the development. We also have you know consultation groups and in a certification and therapist community where you can get support in in that training and then of course the free webinars for those that are are looking to refer you know clients or or patients or you know if you're wanting to do that Feeling Good Institute we have you know a number of therapists all over Canada and the U.S doing video therapy and you can go to our website and just click on the book a free consult have them go there and then they can can get matched. We do a 15-minute consultation. I did one this morning with a lovely woman who wants to work on anxiety and it's exciting to have that opportunity to connect with her and so there's some opportunity there to have options for for referrals. In order to get your CE credits you need to complete the mandatory survey immediately after the presentation, complete it today if you want the the CES and then you'll receive a certificate certificate um by email. If you have questions you can contact certification at feelinggoodinstitute.com. She does get a lot of emails so if you don't get an immediate response just be patient. Maor if I could draw you in I know we just have a couple of minutes here if there's key questions that have come up or comments that you think would be really valuable for us we want to end a couple of minutes before to give people a chance to do this survey.

Q & A Session