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The use of data in the twenty-first century to improve expert decision-making has radically transformed what it means to be an expert in multiple fields, including behavioural healthcare. This chapter summarises the impact on information technology on the field, including use of digital platforms to enable video therapy and online cognitive behavioural therapy programmes. The chapter is intended for practitioners seeking information on how to be a twenty-first century expert, where years of education and experience matter less compared to evidence of performance in the form of solid outcome data. Key to the use of outcome data is expertise in how to use questionnaires in therapy and how to interpret results, both at the individual client level as well as overall results across multiple clients. A twenty-first century expert measures are not simply to measure outcomes but to improve results over time. Failure to incorporate the use of data into routine practice ignores an evidence based practice with decades of evidence as to its effectiveness, potentially resulting in suboptimal care.

Supervision is considered the signature pedagogy and after direct client practice it is rated as the number one learning and development method by practitioners. However, as we set out in this chapter, the relationship between supervision and client outcomes is not a strong one. Drawing on the use of routine outcome data, we demonstrate how clinical supervision can be improved when both practitioner and supervisor demonstrate an attitude of humility and a willingness to learn from the data they collect. Using these data to enhance supervision by improving client outcomes and to inform deliberate practice (DP) is the hall mark of the effective twenty-first century practitioner and supervisor.

In the previous chapter, the reader will have become familiar with the idea of screening for traumatic experiences within organisations as a way to identify those who may benefit most from interventions and support. In this chapter, I present an overview of the trauma therapy literature in the first instance and then explore some of the debates regarding specific trauma-informed treatments versus general therapeutic approaches. The multicultural competency literature is discussed, and the multicultural orientation approach of cultural humility, cultural opportunity and cultural comfort is highlighted in a practice context. This chapter concludes with a case study vignette that brings it all together with a clinical example of what trauma-informed therapy through a multicultural lens might look like. As such I operationalise choice, collaboration , trust and transparency, and cultural principles from the trauma-informed care literature. Although applied here to specific trauma-informed organisations, some of the methods and processes that I unpack can be used in non-specific organisations where social/case managers are employed and wish to operationalise choice and collaboration in a structured way.

In the previous chapter, I introduced the reader to the ideas and research of the common factors. The common factors are varied and have demonstrated to have small to large effect sizes depending on what variable is being examined. In this chapter, I categorise four more evidence based relationship variables which tend to be more task orientated and aligned to the therapeutic alliance. Indeed, the therapeutic alliance, goals and collaboration, alliance rupture–repair, and feedback-informed care are four trans-theoretical factors that can contribute greatly to outcomes. At the same time, when poorly established they can and do impact negatively on client outcomes. This is not an exhaustive overview of the literature, rather each variable is briefly discussed, the evidence supporting the effectiveness is highlighted, and Top Tips are provided to assist the development of the practitioner.

Deliberate practice (DP) is an innovative training method for improving psychotherapy skills acquisition and expertise in the twenty-first century. I introduce the reader to the principles and processes of DP and the rationale for its use. The concept of DP is not new, indeed it is used to support the improvement of performance in diverse areas, from sport to music. However, its application to psychotherapy is still in its infancy. Firstly, I provide the rationale for including DP as a method of therapist training based on research that illustrates that many of the current criteria that we use to identify expertise have little to no added impact on client outcomes. Additionally, some of the limitations of current traditional training regimes are outlined, along with the emerging evidence base for DP as a training method that can help improve the acquisition of therapeutic skills and expertise.

In the previous chapters, we have explored some of the key debates around empirically supported treatments, and I have introduced the reader to the concept of evidence based practice as a tripartite model that speaks to a much wider understanding of therapy research and practice. In this chapter, I introduce the concept of the common factors and some of the research that supports the idea that in general all therapy approaches tend to be as effective as each other, indeed, a summary of this research going back as far as 1936 is highlighted. The common factor proposition rests on the premise that there are far more commonalities across diverse therapy methods, than differences, and that it is these trans-theoretical constructs that are responsible for the lion’s share of outcomes. After briefly reviewing some of the literature, several common factor models are presented for the reader to consider.

In this chapter, an overview of the trauma-informed approach is described. The background and context to trauma, its impact on the person, and organisational responses are considered. More specifically, I distinguish between trauma specific and non-specific organisations by defining the characteristic of each. This chapter sets the tone for the remainder of the book by introducing a conceptual model for both specific and non-specific trauma organisations. In order to do this, I outline the differential components that are deemed necessary for organisations to be trauma-responsive; in doing so, I introduce the Trauma Ecology Model to the literature, outlining its various components.

In this chapter, Ravind Jeawon and I discuss the ideas around being responsive to diversity in an evidence based manner. Although this chapter belongs within the evidence based responsiveness section discussed in the previous chapter, we both considered it essential to provide a whole chapter on its theory and application, as it is an integral area often overlooked in clinical training and provided a curtesy overview during ongoing professional development and clinical supervision. The multicultural literature uses different terminology to refer to the practice of responsiveness, we discuss these ideas and the evidence base for them, while introducing the reader to other processes and theories which will help developing practitioners make sense of what can be a vastly complex area of clinical work. Several adapted, real life case examples are drawn from Ravind’s clinical experience to encourage reflection and provide insight into these processes.

The application of therapeutic theory to routine psychotherapy practice is a complex area, and needs to be done by a competent and well-trained practitioner. The case study is recognised as a valid method to illustrate the processes of therapy and how theoretical knowledge can be applied to practice scenarios to bring about change. This simulated case study illustrates the application of therapeutic variables based on evidence based relationships and responsiveness. A therapist and client-simulated case illustrate these applications, and an accompanying narrative elucidates the role these play in the therapeutic encounter. Finally, the chapter describes how some of the issues identified in the case study as practitioner deficiencies can be used to inform a deliberate practice (DP) training regime supported by supervision and the use of data. In doing so, this chapter builds on the previous chapters in this book and provides a picture of how the twenty-first century practitioner and supervisor can use data to better inform their individual, and collective work, with the ultimate aim of improving expertise in order to increase client outcomes.