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 trainees 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

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Abstract:
A qualitative study of the use of role play work, in a years 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).

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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 Argyriss (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 clients current dilemmas, and the context of the clients 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 psychologists 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

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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 trainees 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.

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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 trainees 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 anothers part, not playing themselves, with one exception: when the issue was the trainee therapists experience of resistance to a clients 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 PSupervisor 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 trainees 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-

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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 psychologists 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.

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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 PSupervisor 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-Supervisors fluid execution represented 25 years experience with this kind of area, and his observation that with the trainees 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 trainees 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 trainees 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

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P-Supervisor was called away from the session. One of the trainees shared her awareness of the P-Supervisors 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 trainees 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 clients 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 Becks 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

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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 dont 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 practitioners recourse to the role play as the skill modelling approach. At the beginning one trainee queried the use of role play as a

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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 PSupervisors 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

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Table 1: Roles and Responses and Potentials for Learning available in the Role Play as a part of a Group Supervision Session
Participant Client 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)

Observer 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)

Therapist 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

Roles Played:

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

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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 partys 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 practitioners 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).

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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 (1970s to 1980s) 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

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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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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 minuters 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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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 individuals 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 Smyths 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: deBonos 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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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 therapists 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 practitioners 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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