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Examination of use of role playing in a professional practice educative context; application to clinical psychology example
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Clinical Psychology Supervision Observation Report Dianne Allen p.1
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
ROLE PLAY IN TRAINING FOR CLINICAL PSYCHOLOGY
PRACTICE: INVESTING TO INCREASE EDUCATIVE
OUTCOMES
Dianne Allen, 2006
Contents ROLE PLAY IN TRAINING FOR CLINICAL PSYCHOLOGY PRACTICE: INVESTING TO INCREASE
EDUCATIVE OUTCOMES ................................................................................................................................... 1 Abstract: ................................................................................................................................................................. 2 INTRODUCTION .................................................................................................................................................. 2 CONTEXT OF DISCUSSION TO FOLLOW (Methodology) ................................................................................. 2 OBSERVATION AND EVALUATION OF ROLE PLAY USE IN A CLINICAL SUPERVISION PRACTICE .... 5
General Overview: .............................................................................................................................................. 5 Example 1 – first exposure to role play ................................................................................................................ 5 Example 2 – first opportunity to play therapist role ............................................................................................. 6 Examples 3-5 – demonstration, practice and gradual handover to trainees ........................................................... 7 Example 6 – role play work developed from observation of a trainee‟s video of a case session ............................ 7 Example 7 and 8 – what is involved in cognitive restructuring to bring change .................................................... 8 Evaluation ........................................................................................................................................................... 9
CONSIDERING THE NATURE OF THE ROLE PLAY AS AN EDUCATIVE OPPORTUNITY ....................... 10 Table 1: Roles and Responses and Potentials for Learning available in the Role Play as a part of a Group
Supervision Session ....................................................................................................................................... 11 Stopping and immediate debriefing ................................................................................................................... 13 Fluidity in practice ............................................................................................................................................ 13
WHERE IS CURRENT RESEARCH ON USE OF ROLE PLAY IN PROFESSIONAL TRAINING UP TO? ..... 13 Other Professional Training Literature............................................................................................................... 14 Clinical Training Literature ............................................................................................................................... 14 Clinical Psychology Training Literature ............................................................................................................ 14
RECOMMENDATIONS ...................................................................................................................................... 15 Acknowledgements: .......................................................................................................................................... 17
BIBLIOGRAPHY ................................................................................................................................................. 18
Clinical Psychology Supervision Observation Report Dianne Allen p.2
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
Abstract: A qualitative study of the use of role play work, in a year’s clinical group supervision
sessions as part of clinical practice education, is evaluated for recommendations about
how to make more of this time-intensive learning/teaching strategy.
Keywords: Role play, Clinical Psychology, reflective work
INTRODUCTION
Enacting a skill is a significant part of learning a practice skill. But learning-by-doing,
and learning-from-experience, a different but related process, to be more effective, need some
educative tool supports. Using role play, engaging in an as-if therapy session, operating as-if
therapist or client, as a part of clinical training, and for the clinical psychologist, is one such
experiential learning support. Working with the experience, using some structuring to guide
observation and to extend the reflective work to capture the participants‟ and observers‟ learning
is another support to the experiential learning that is happening. The following examination
draws on (1) observations of the use of as-if activity in group supervision sessions undertaken as
part of a clinical psychology post-graduate course, (2) post-session evaluation and (3) ongoing
scholarship around the more effective use of role play and reflective work, to suggest ways of
increasing the learning outcomes from this time-intensive method.
CONTEXT OF DISCUSSION TO FOLLOW (Methodology)
One strand of the field of qualitative research of practice seeks to open up a conversation
between practitioners – the writers and the readers – with a view to enunciating and developing
valid practice understanding. Such an approach recognises (1) the particulars of practice
(Toulmin, 1996); (2) the necessity of building a consistent and reasonable fit between the nature
of the phenomenon being investigated (ontology of clinical psychology practice), how it is
known (epistemology), how what can be known of its nature is found (methodology) in a way
that is consistent with its purpose (axiology) (Heron & Reason, 1997) and where the practice
investigation involves inquiry to learn, by evaluating practice with a view to improving that
practice for the individual practitioner (Allen, 2005). Such an approach uses story telling to tap
abductive connections between practitioners, to build a broader, evidence-based, coherent
understanding of the practice being examined (Bateson, 1979; Mezirow, 1991; Schon, 1991).
Clinical Psychology Supervision Observation Report Dianne Allen p.3
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
To engage in this kind of inquiry about practice involves then: (1) specific practice description
and evaluation, (2) talking about the practice and explicating aspects of the practice, (3)
exploring areas for possible improvements, (4) sharing such work with others to draw in the
benefits of their experience and evaluative assessments in order to engage in the kind of
collaborative inquiry that allows them to build better evidence-based models of practice.
In the case of clinical psychology practice, practice-focused scholars recognise (1) the
universe of one between client and therapist (Schon, 1983), (2) the systemic nature of their
interactions (Bateson, 1972), and (3) a need to learn to work with a variety of models to help the
client (who also works with a variety of models, learnt in a variety of ways) to form the effective
and experienced practitioner (Norcross & Goldfried, 2005 and also Argyris‟s (1993, p.260) idea
of the „overdetermining causality‟ of the manager seeking effectiveness, being „precisely
sloppy‟). Furthermore, for clinical psychology, an additional layer of reflexivity arises: clinical
psychology is a practice steeped in conversation, with its communication modes and as a
dialogic enterprise. The person of the practitioner, and how they express attitudes, to the person
of the client, the nature of the client‟s current dilemmas, and the context of the client‟s lived
imperatives and then how they develop a collaborative investigative relationship to facilitate
actionable problem solving for the client, is part and parcel of the clinical psychologist‟s
practice expertise. Knowledge of psychological conditions and technique in diagnosis, skill in
case conceptualisation and therapeutic interventions without appropriate attitudinal and
relational inputs results in ineffective practice (APA, 2006; Nelson & Neufeldt, 1998; Whiston
& Coker, 2000).
The argument, then, for supporting role play work as a potent component of clinical
psychology training is built as follows. Firstly, clinical psychology practice involves a
significant proportion of learning by doing, and of a complex professional practice. Such
learning-by-doing can be enhanced by intentional use of reflective processes (Kressel, 1997;
Boud et al, 1985). Secondly, clinical psychology practice includes the use of the person as part
of the practice, especially individual skills in interpersonal interactions. Consequently, good
clinical psychology practice is associated with developed self-awareness, so to improve clinical
psychology practice involves self-reflective work (APA, 2006; Graham, 2003; Gonsalvez et al,
2002; Milne, 2002; Nelson & Neufeldt, 1998; Neufeldt, 1999; Rose et al, 2005). Thirdly, the
practice of clinical psychology is based in communication skills and interpersonal skills,
developed since birth, and for language, conversation and meaning making, its origins lie in
Clinical Psychology Supervision Observation Report Dianne Allen p.4
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
early-life learning and may include learning coloured by emotional content. To improve such
learning, by undertaking change, may involve engaging with that well-established, learned
response, and contesting original learning and its emotional content. Fourthly, the „action‟ of
clinical psychology practice is a combination of conversing, and inquiring by conversing, and
using conversing dialogue to challenge thinking patterns to generate change. Since it is a
„communicative‟ endeavour, it will need to be investigated using techniques capable of dealing
faithfully with that kind of phenomenon. Role play, by engaging the participants in interactive
conversation, related to how they interact when endeavouring to deal with a particular issue, in a
specific context, provides an opportunity to try applying knowledge, and learn the skill or
technique, while also potentially raising sensitivity to any attitude change that might need to be
involved, and then, to practise modifying responses (Bell, 2001; van Ments, 1999). With
appropriate awareness of the potential of role play to deliver on these four, and interactive,
dimensions, a trainer can develop supportive structures to assist the trainee utilize experience by
attending to this knowledge-skill-relational-attitudinal complex in a more self-aware and
intentional way.
Role playing, where the trainee clinical psychologist is acting as-if therapist or client, or
able to observe another acting as-if therapist or client, and which draws on the trainee‟s
observations of the responses of their clients in actual therapy sessions, provides the experience
of trying out how they understand the conduct of therapy. Demonstration of the same/relevant
processes by an experienced practitioner, including explication of the steps and practitioner
reasoning in diagnostic questioning, case conceptualisation and testing, then design and
application of therapeutic intervention, followed by opportunities to practice, and supported by
relatively immediate feedback, allows the trainer and trainee to work more intentionally with
modeling and learning-by-doing. Structuring reflective work to tap such learning, and
including identifying the affective as well as the cognitive and the behavioural components,
begins the process of making much more of this learning experience, increasing its efficiency as
a learning vehicle.
Clinical Psychology Supervision Observation Report Dianne Allen p.5
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
OBSERVATION AND EVALUATION OF ROLE PLAY USE IN A CLINICAL SUPERVISION PRACTICE
General Overview:
A recent collaboration between a clinical psychology supervisor working within the
Cognitive Behaviour Therapy arena (P-Supervisor) and a specialist educator who was looking to
develop reflective practice in professional formation education, resulted in observations of, and
discussion around, role play and other experiential learning that was available in a post-graduate
coursework group supervision session, and how present practices might be improved. The
observations and post-course trainee evaluations highlighted that when video review or case
discussions indicated a trainee‟s need to work on the skill element of the practice, the recourse
the supervisor used, to mount a role play, was appreciated by the trainees. Over two semesters,
involving 20 sessions observed, role plays were the primary vehicle for skill learning on 13
occasions, representing approximately 20% of the total group supervision time. In three role
plays the trainees played the role of therapist while the trainee with the case difficulty played the
role of the client. In one role play the supervisor took the role of client, while the trainees
shared the role of therapist. In nine role plays the supervisor took the role of therapist, while
the trainee with the case difficulty, or a volunteer, took the role of client (always playing
another‟s part, not playing themselves, with one exception: when the issue was the trainee
therapist‟s experience of resistance to a client‟s proposed solution.)
Example 1 – first exposure to role play
At the first observed session of the first semester, the „fresher‟ group of trainees
(students with limited or no practice experience, and/or just beginning formal postgraduate
studies) developed objectives for the semester that included „knowledge‟ and „skills‟. The P-
Supervisor indicated that to focus on skills would involve working with case material,
undertaking role plays, observing and providing feedback to video records of the trainees
operating as therapists. Arrangements were made for one of the trainees to bring a video of
their therapy practice to the next session. By way of example, in the second half of that session,
one of the trainee‟s case concerns was used as an opportunity for a role play. The P-Supervisor
undertook the role of therapist, the trainee with the case concern played the role of the client, the
remainder of the class observed. The role play was broken into two parts, the first stage some
diagnostic work, and the second stage some therapeutic work. In the break in the middle, the P-
Clinical Psychology Supervision Observation Report Dianne Allen p.6
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
Supervisor dismissed the „client‟ from the room and engaged with the observers about
diagnosis, and about possible therapy. The P-Supervisor also indicated some of his own
practice thinking – what was the possible diagnosis and why, and what would be his next steps:
in testing the diagnosis and in the development of an appropriate therapy activity. At the end of
the role play there was debriefing, at a number of levels. The observers were asked for their
responses to what they had observed. The trainee in the client role was asked for their response
to the experience and invited to make comments of their experience of the therapeutic processes
from the „client‟ perspective. The P-Supervisor reiterated for the observers, and disclosed for
the client role player, what he was doing before the break and after the break, and linked it back
to the material of the course: lectures on techniques, on theory; the prospective practice work
with clients and video records for learning about practice, from the clinical psychologist‟s point
of view; discussions associated with case conferences, etc.
Example 2 – first opportunity to play therapist role
In the second observed session in the first semester the P-Supervisor tapped material and
issues raised in the faculty-wide Case Conference held just before the group supervision session.
The P-Supervisor offered to play the client while the trainees undertook the therapist role, in
turns, around the group. Each trainee was involved in asking questions, either the questions
that were in their mind, or in some cases apparently building on the material developed from
previous trainee questions. At the end, the P-Supervisor debriefed with some feedback about
his observations of their process, including the diagnosis (stated as such) that the trainees were
watching themselves and being too hard on themselves, remarking that psychotherapy is like a
magnifying glass with a capacity to enlarge their awareness of their own practice and behaviour,
and indicating that general questioning skills were appropriate, and that what he considered was
lacking was „consolidation‟, a skill to be learned. The P-Supervisor then explored the cognitive
behaviour therapy approach of what is the message?, what is the belief?, that has come through
to them as therapists, from their questions and his answers as client. One of the trainees queried
whether the role play was a time-efficient way of learning this material.
Clinical Psychology Supervision Observation Report Dianne Allen p.7
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
Examples 3-5 – demonstration, practice and gradual handover to trainees
Again, in the first semester, at the seventh observed session, a trainee role played their
case concern client with general anxiety disorder, while the P-Supervisor undertook the therapist
role in an extended demonstration of fluid conduct of his therapeutic approach.
At the eighth observed session, the other trainees role played the therapist with a trainee
role playing their client, where the trainee was wanting help with how to help the client change
behaviour, while the P-Supervisor observed, and used strategic interventions to clarify what
stage of the process the trainees were up to (exploring the BASIC-P to clarify what change was
wanted), to review where the trainees had progressed to, and help them to shift focus on to
exploring affect, examining and then clarifying the antecedents. When the P-Supervisor judged
that the trainees had exhausted these he suggested a shift of models and demonstrated the
method of using questions to challenge the barrier.
In the ninth session where the trainee had a case involving panic attacks and was wanting
to know more about how to use Socratic questioning to challenge intermediate beliefs, the P-
Supervisor demonstrated, froze the action to explain the process to that point, then offered the
role of therapist to any takers (there were none), continued the process, including using role play
as a therapeutic device with the „client‟ (trainee with the case concern). Discussion elicited that
the P-Supervisor‟s fluid execution represented 25 years experience with this kind of area, and
his observation that with the trainee‟s present training and two years experience they would be
much further along in their practice than he was at the same time, and exhibiting much of this
fluidity.
Example 6 – role play work developed from observation of a trainee’s video of a case session
In the first observed session of the second semester (with a different group of trainees,
but including two trainees who had been with the supervisor in semester one), the P-Supervisor
used the material presented in a trainee‟s therapy session video to work some more with one of
the general trainee learning objectives – how to use Socratic questioning to progress the matter.
The trainees were given time to think about the kinds of Socratic questioning they would use.
Then the P-Supervisor took the therapist role while the trainee played their case client role. The
Clinical Psychology Supervision Observation Report Dianne Allen p.8
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
P-Supervisor was called away from the session. One of the trainees shared her awareness of the
P-Supervisor‟s process: focusing on one Socratic question and going at it by a variety of ways.
Other trainees took up the therapist role, each one exploring what was on their agenda, with the
role played client. In the wrapping debrief the P-Supervisor suggested that the trainees go back
to their own videos of therapy sessions, and use the “I Spy” method to identify, in the session,
when they could have asked a Socratic question to move the session on. The P-Supervisor
indicated that the therapist may well have to ask many questions, many times, to help people
change.
Example 7 and 8 – what is involved in cognitive restructuring to bring change
In the seventh observed session of the second semester the trainees took turns in
operating as-if the therapist to identify and test intermediate beliefs for a trainee working as-if
her client who was presenting for stress management. The P-Supervisor set the scene by
examining where the case presenter was experiencing difficulty and setting the role playing
therapists the task of working with self esteem while trying to test intermediate beliefs. When
each trainee had contributed, the P-Supervisor took a turn in the therapist role to test another
trainee‟s summarising metaphor, and to examine how important the responsibility causing the
stress was to self-identity. The P-Supervisor then invoked a time-out from the role play to give
evaluative feedback on the contributions of the role playing therapists, positively affirming the
quality of the questions asked, the different tacks taken to examine the client‟s cognitions and
then to ask the trainees for an enunciation of their perception of the intermediate beliefs. Each
trainee, including the one playing the client role who had brought the case concern to the group
examination, was asked to enunciate what they saw as the intermediate belief. When that
information was gathered the P-Supervisor asked whether they found it helpful to write it down,
and followed through with some commentary on Judith Beck‟s case conceptualisation approach.
The effective work in the role play was then identified and reaffirmed, together with the
evaluation that what was not happening, or not happening efficiently, was what the P-Supervisor
called „consolidation‟: the process of having an enunciated, hypothesised intermediate belief and
to be testing it „using sticks of dynamite and blasting away at it‟. A trainee then sought
additional enunciation of what was meant by „consolidation‟, relating it to her enunciated head
knowledge of four stages of Socratic questioning. The P-Supervisor elaborated, and applied the
material back to the instance they had been working with, stating out the kinds of intermediate
beliefs that they might focus such Socratic questioning on to help the client change those
Clinical Psychology Supervision Observation Report Dianne Allen p.9
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
intermediate beliefs, and re-iterating that one question, alone, is most frequently not enough to
shift the ground on such a belief. The P-Supervisor then summarised the learning to date and
suggested the next steps in therapy for the case presenting trainee. The case presenting trainee
then asked explicitly „how would you go about that?‟ for the issue of helping the client to
change (cognitive restructuring). The P-Supervisor now took the role of therapist and played
out the kind of summarising, questioning and revisiting a suite of metaphors related to the
intermediate belief („I am a failure if I don‟t get the board to change‟) with more testing
questions that brought the client role playing trainee to the point where they recognised their
guilty thoughts, and from the early case information had indicated the client was learning how to
have some success with dealing with guilty thoughts. At the wrap, the trainee trying to clarify
what was happening and how it fitted the „four stages‟ model that was queried earlier, asked
about that again and was informed that the whole discussion was „consolidation‟, and that the
next session would involve much the same process of attempting to dismantle that belief until
the change came and the stress coming from that intermediate belief was relieved, when the
therapist could then start work on other beliefs.
Evaluation
The above examples and description indicate some of the „flavour‟ of the use of role play
in these group supervision sessions. Doing a role play in the first session helped set the
expectations for „doing role plays‟ as part of the group supervision process. Using the case
conference contextual briefing, and the P-Supervisor playing the client, forcing the trainees to
role play the therapist in the second session, ensured the engagement of the trainees, equitably,
in the therapist role, and by the second session. Later sessions provided graduated
demonstrations of expertise in different parts of the therapeutic approach, and after
demonstration, and explanation in some cases, allowed for trainee trial of observed learning, but
not necessarily immediately. Time pressures mean that the trialling that followed needed to be
staggered over a number of group supervision sessions. Sometimes the observation of such
modelled learning occurred during the review of videotapes of clinical practice. When, during
the second semester, the P-Supervisor was unexpectedly called away from a role play, the
trainees demonstrated a capacity to recognise and articulate process, and to continue the role
play, thereby testing their facility with the process.
As mentioned earlier, the trainees appreciated the practitioner‟s recourse to the role play
as the skill modelling approach. At the beginning one trainee queried the use of role play as a
Clinical Psychology Supervision Observation Report Dianne Allen p.10
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
time-efficient way of learning this material. The P-Supervisor was surprised to be shown how
much time was spent in his group supervision sessions on this aspect, and like this trainee, had
an overarching concern that he make the whole experience an efficient learning process, and
was uncertain about the level of participation of all trainees, and was aware, at times, of
inadequate emphasis on identifying learning, or the level of learning possible from the session.
One level of debriefing between the educator and the supervisor used an analysis of the
observed scripts of the supervisor when engaged in each of the intentional learning elements of
the sessions. Comparing the role play instances with videotaped trainee clinical sessions and
discussions of trainees‟ case issues, showed that, by comparison with the framing of the learning
from the videotaped trainee clinical sessions, there was much less intentional learning structure
given to the trainees to help them draw out some of the learning possible from the role play.
Discussion of this observation, and questioning some more about what was informing the P-
Supervisor‟s practice with the role play work, elicited further sharing about the nature and
experience of fluid practice.
CONSIDERING THE NATURE OF THE ROLE PLAY AS AN EDUCATIVE OPPORTUNITY
The role play, in the group supervision session context described above, allowed for a number of
different combinations of experience and opportunities for observation as conveyed in Table 1.
The trainee can play a role – either therapist or client
The trainee can observe a role played – either therapist or client
The trainee can observe a peer playing the role of either therapist or client
The trainee can observe the supervisor playing the role of either therapist or client
The supervisor can play a role – either therapist (showing particular practice strategies)
or client (showing particular psychological profiles, both straightforward and more
complex)
The supervisor can observe the trainees playing in a role – either therapist or client
Clinical Psychology Supervision Observation Report Dianne Allen p.11
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
Table 1: Roles and Responses and Potentials for Learning available in the Role Play as a part of a Group Supervision Session
Roles
Played:
Participant Observer
Client Therapist
Trainee Clinician
(Client from Case) Responses drawn from client, and so observed by trainee
during case session
Beginning development of
„pattern‟ of condition (May request a stop to process
to allow for querying of
understanding of what „seeing‟,
for checking of naming steps and stages)
Experienced Clinician Demonstrates experienced
moves
Can enunciate moves if
requested
Demonstrates constellation of moves in fluid process
May choose to stop process for
intentional direction of
attention, for naming steps and stages
Other Trainee Clinicians Observation of client responses –
building understanding of „pattern‟ of
response in case condition
Observation of therapist moves –
building understanding of process: assessment, therapeutical interventions,
fluidity of process with experience
(May request a stop to process to allow
for querying of understanding of what „seeing‟, for checking of naming steps
and stages)
Trainee Clinician
(Client from Case) As above
Trainee Clinician Demonstrates novice moves Demonstrates intentional
moves to achieve practice
goals – assessment and/or
therapeutic intervention
Experienced Clinician Observation of trainee awareness and capabilities demonstrated in role of
client or of therapist
Focus of observation for training role:
affirming sound practice; questioning practice for learning goals
May choose to stop process for
intentional direction of attention, for
naming steps and stages, for asking for trainee therapist practice thinking or
„client‟ response to therapeutic step
enacted
Other Trainee Clinicians As above
Experienced Clinician
(Composite Client
responses from practice
knowledge) Responses drawn from many
clients, and typical response pattern available for trainee
observation of pattern of
response
Trainee Clinician As above
Other Trainee Clinicians As above
In such role plays a variety of aspects of clinical psychology practice are enacted. At a
diagnostic level, the role play can expose the typical exchanges of a client with a particular
condition, and more and less effective techniques for gathering relevant diagnostic information
about that condition. Where the trainee plays the client role, and of their own case concern, the
trainee is mobilising their observations of the client in the case, though they may not always
recognise the significance of such information, and how to develop it into an appropriate case
conceptualisation. At the therapeutic level, the role play can highlight more and less effective
interchanges for different stages of the therapeutic process, as well as client strategies for
frustrating such therapeutic moves. For the trainee operating as the therapist, the role play
presents an opportunity to test moves in basic skill learning, or in developing a different
Clinical Psychology Supervision Observation Report Dianne Allen p.12
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
approach needed to build additional flexibility in practice. When the trainee operates as the
client, there is an opportunity for the trainee to experience the process „from the other side‟,
another important experience. Indeed, in one instance the supervisor taking the therapist role
invoked „role play‟ as a therapeutic strategy with the client. The trainee playing the client role
then experienced how valuable „role playing‟ can be, in either developing insight of the „other
party‟s point of view‟, and/or how a client might be moved out of a stuck position, to see their
problem differently.
As an educational vehicle, the role play can operate with any one of the various stages of the
development of a fully effective practice, especially when such a practice is inherently complex
and hedged about with the uncertainties and ambiguities of interpersonal interchange:
The demonstration of the first steps
The demonstration of the whole
The learning of the parts of the whole
The learning of the whole
Demonstrating the difference between novice, competence and expertise
Working on developing a practitioner‟s comfort in the whole and with a developing
routinisation of approach
Undertaking first steps in flexibility of approach
Learning to be self-critical about a point in practice and its theoretical underpinnings
One of the difficulties of endeavouring to make the most of an experiential learning instance
is just how much is available for observation and for learning, and where to focus attention, as
the above analysis shows. When a role play is conducted in the group context, the group can be
mobilised to assist with the task of observation of what is quite complex.
Another part of learning how to learn from experience is realising that other kinds of
formal learning usually involve pre-structured material (theorising is one mechanism of
structuring evidence into some sort of coherent story); and that the task of a learner working
with their own experience is the task of developing a coherent story of such experience –
looking for the patterns amidst a host of data, some of which is „noise‟ – not significant to the
task at hand (Kressel, 1997).
Clinical Psychology Supervision Observation Report Dianne Allen p.13
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
Stopping and immediate debriefing
Since the role play is an educative tool, in an educational context, it is within the
province of the supervisor, or the trainee, whether playing a role, or observing, to halt the
activity, and engage in questioning and/or debriefing about the material presented to that point.
Such liberty is used when a supervisor is demonstrating, and seeking to consciously identify
parts of the process, naming them, perhaps describing them, and/or talking about their own
thinking during the process. Such liberty may be used by the trainee, if willing to engage in this
way, and offered permission to do so, to question what is happening, to confirm their
observations, to clarify any confusion, to test their recognition of elements, to ask for an
explanation of the process and the practitioner thinking informing such process.
Fluidity in practice
Again, in debriefing with the supervisor, the educator asked about the nature of stopping
and starting, and for practitioner reasoning about that. The supervisor expressed discomfort
with too much stopping and starting, since that can risk the effectiveness of the process.
Stopping to unpack process, especially with the „client‟ role player present, can alert the „client‟
to the expected next response. In clinical practice, the therapist is a bit like a person working at
night, with only a torch for light, in an unknown house of many rooms, looking for something
that is there. It is not known where the something is, and it might be found at any time. The
process is one of persistent and systematic exploration, room by room, and recognition of the
significant that leads up to the discovery of the something. There is no knowing which
particular set of questions is to yield that find. Furthermore, part of the discovery process is in
the fluidity of practice itself, and this needs to be demonstrated. Fluidity cannot happen while
deliberate stoppages are invoked.
WHERE IS CURRENT RESEARCH ON USE OF ROLE PLAY IN PROFESSIONAL TRAINING UP TO?
In general terms there is very little recent research into the use of role play in
professional training. As Yardley-Matwiejczuk (1997) tracks the history of earlier exploration
of role play, she reports the early (1970‟s to 1980‟s) flush of activity drying up when critiques
relating to „ecological validity‟ coincided with the epistemological shifts and critiques that have
reinvigorated qualitative research methods. In the absence of research, there are a few useful
Clinical Psychology Supervision Observation Report Dianne Allen p.14
Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
guidebooks on how, why, and when to use role play as an educative tool, and as part of the
experiential learning repertoire (see Bolton & Heathcote, 1999; Errington, 1997; van Ments,
1999; Yardley-Matwiejczuk, 1997).
Other Professional Training Literature
Role play, as an educative tool in training in activities related to other professions,
appears mostly for management, marketing, language learning, conflict resolution, negotiation,
cross-cultural activities, interpersonal and communications aspects of any professional practice
and as an aspect of simulations in business and engineering where the complex interactions and
responsiveness of the professional to a changing dynamic is the capability being addressed
(Errington, 1997; van Ments, 1999). Here recent research includes that of where the use of role
play in the simulation that has moved to the online platform, using computer capabilities for
multiplayer gaming, over time, as a significant resource for such learning (Bell, 2001).
Clinical Training Literature
Compared with the clinical psychology application, evaluation of the use of role play in
clinical training for nursing, medicine, and social work has a slightly larger reported corpus.
Themes that are addressed in this literature include the building of practice-relevant
communication skills in the service of diagnostic and therapeutic activity, especially in building
an effective therapeutic/professional relationship with the patient/client, both of which are
significant to the practice of clinical psychology, and so have lessons for clinical psychology
practitioners and trainers. Like van Ments and Errington, recent publications are focused on
better use of the role play as a training strategy (see, for example Joyner & Young, 2006).
Clinical Psychology Training Literature
A basic scan of the current journal literature on the use of role play in working at skill
development for clinical psychologists, shows a fairly thin engagement of the field with this
process. The material falls into two main categories: dealing with issues that might be related
to using this experiential tool in the context of clinical psychology training [Pomerantz, 2003,
and see literature cited there]; and reporting on the use of the role play in providing a
standardised context for skill assessment. Within the first of these categories, a recent theme
relates to who might play the client, pointing to risks where the clinical psychology students are
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Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
called on to play the client and what alternatives might allow an instructor, and a class, to work
through and around such a problem (Osborn et al, 2004; Pomerantz, 2003; Shepard, 2002).
In summary, the efficacy of the use of role play in professional and clinical training
tends to be taken for granted. In reporting „best practice‟, most educators focus on the
debriefing or post-activity reflective work required to enunciate and consolidate the learning.
Van Ments and Errington speak of the time required for this, and indicate ratios of 1:1:1 or 1:2:3
as appropriate commitments of time for preparation: role play: debriefing.
More practitioner discussion, working with rich practice descriptions and engaging in
evaluations against educative criteria, focused on the practitioner capabilities sought to be
developed in clinical psychology trainees, is needed.
RECOMMENDATIONS
Given the above observations, evaluation and analysis, and inputs from the literature, the
following are areas where more intentional educative inputs would enhance the learning
available in using role play in clinical practice training (ie emphasis is on the debriefing to
enhance the learning experience van Ments, Errington):
1. Provide time for more emphasis on reflective work:
end of session formal time and structured approach;
beginning of session formal time and structured approach;
session minuting and minuter‟s reflections on the learning outcomes structured towards
the learning objectives negotiated (or theorised), and rotated through the group; [so peer
practice and peer review, contributing towards learning from and with peers]
encouragement to engage in written personal reflective work on session experience
between sessions – pro-formas for such reflective work issued;
occasions provided for sharing from or about that reflective work during the semester.
2. Provide opportunities in the session for more emphasis on reflective work in the group form:
recognising that many peer inputs in the group sessions represents outcomes of
„reflective work‟ („Reflection is a cognitive process with a number of phases, focused on
coming to a conclusion for the purpose of action, with various activities designed to
survey and test premises and argument, and where judgment is exercised and
understanding developed by the interaction of „facts‟ and „meaning‟ for the inquirer
(Dewey, 1933, pp.102-118, p.4, p.12, p.77, p.165)‟);
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Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
capturing reflective work in the session minuting (important insights shared by peers)
3. Provide exercises for helping the student work with their case material at the two levels:
the formal case reporting of practice records;
the unreported documentation of the self-study of practice (possible development for
clinical practice assessment?)
4. Provide resources for developing an individual‟s reflective work:
time and practice in the sessional time, including preparation for peer review (the
rotational, shared minuting and post session learning objectives reflection work)
pro-formas for different approaches for use at different stages of the semester
o basic pro-forma for first four sessions (eg personal: Reaction/ Elaboration/
Contemplation)
o pro-forma for diagnostic work on own practice (eg Affect, Behaviour, Cognitions
= practice actions)
o pro-forma for reviewing reflections gathered over the first four weeks, second
four weeks, and third four weeks, using the basic, or self-directed pro-forma, and
shifting the focus, and deepening the reflective potential (eg identifying recurrent
themes; identifying negative surprises; identifying departures from routine or
recommended process (Kressel, 1997); or Smyth‟s critical structure for
confronting culture-based assumptions (Smyth, 1996))
discussion, and trials, about other ways of reflecting and processing information, and
self-awareness on preferred processing approach and implications for differences in style
of practice
5. Use additional resources for developing the group reflective work:
deBono‟s six hats (deBono, 1985)
handing over „time-out decision making‟ (when to stop and explain or discuss action;
when to take the action steps more slowly, with explanatory asides) to the students
capturing the student-expressed insights into practice in the minuting process
6. Use the individuals in the group to share the observational load: each observer focus on a
different aspect; all look for „getting warm‟; each observer then formally contributes to the
debrief about their particular focus; use this a couple of times, changing the particular focus
amongst the group so that observers gradually learn to „see‟ more of the whole complex
An instance – In Cognitive Behaviour Therapy there is a mnemonic for practice: “ABC”. It
refers to Affect, Behaviour, Cognitions. In working with a role play situation, a debrief could
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Role Play in Training for Clinical Psychology Practice: Investing to Increase Educative Outcomes
be developed around the use of Affect, Behaviour and Cognitions to explore the application and
relevance of these to the therapeutic stance displayed in the as-if therapist‟s practice (analysis at
the practical/technical level). A separate and relevant approach could be taken to address the
self in the practice: what is the practitioner‟s Affect, Behaviour, Cognitions, and how are these
impacting in the practice situation? (There are now at least three „cuts‟ of reporting: (1) the as-if
therapist can report their contemporary self-awareness; (2) observers can report their
observations of practitioner Affect, Behaviour, Cognitions [observation of another practitioner
for signs and testing inferences with contemporary self-awareness reported]; (3) observers can
report on their own experience of similar therapeutic instances to reflectively abduce and
develop personal self-awareness in these three categories, and work some more on the personal
efficacy implications for their professional practice effectiveness).
Acknowledgements: I wish to acknowledge and thank Dr Craig Gonsalvez, and the students of his Group Supervision for Clinical
Psychology practice classes in 2006, at University of Wollongong masters classes, for access to the sessions
observed, for sharing in thinking about reflective practice, in practice, and for post-session professional discussions
and analysis review.
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