APPENDIX

Difficulty Assessments
and Adjustments A
Deliberate practice works best if the exercises are performed at a good challenge
level that is neither too hard nor too easy. To ensure that trainees are practicing at the
correct difficulty, they should do a difficulty assessment and adjustment after each level of
client statement is completed (beginner, intermediate, and advanced). To do this, use
the following instructions and the Deliberate Practice Reaction Form (Figure A.1), which is
also available at [Link]
behavioral-therapy (refer to Clinician and Practitioner Resources). Do not skip this process!

How to Assess Difficulty

The therapist completes the Deliberate Practice Reaction Form (Figure A.1). If they

• answer either Question 1 or 2 on the Reaction Form as “too hard,” follow the instruc-
tions to make the exercise easier;

• answer both Questions 1 and 2 as “too easy” and “no,” proceed to the next level of
harder client statements or follow the instructions to make the exercise harder; or

• answer both Questions 1 and 2 as “good challenge” and “no,” do not proceed to the
harder client statements but rather repeat the same level.

Making Client Statements Easier

If the therapist ever answers either Question 1 or 2 on the Reaction Form as “too hard,”
use the next-level easier client statements (e.g., if you were using Advanced client
statements, switch to Intermediate). But if you already were using Beginner client
statements, use the following methods to make the client statements even easier:

• The person playing the client can use the same Beginner client statements but this
time in a softer, calmer voice and with a smile. This softens the emotional tone.

• The client can improvise with topics that are less evocative or make the therapist
more comfortable, such as talking about topics without expressing feelings, the
future/past (avoiding here and now), or any topic outside therapy (see Figure A.2).

175
176 Appendix A

FIGURE A.1. Deliberate Practice Reaction Form

Question 1: How challenging was it to fulfill the skill criteria for this exercise?

Question 2: Did you have any reactions in “good challenge” or “too hard” categories? (yes/no)
Good Challenge Too Hard
Emotions and Thoughts Body Reactions Urges Emotions and Thoughts Body Reactions Urges

Severe or Migraines, dizziness,

Manageable shame, Body tension, sighs,
Looking away, overwhelming foggy thinking, diarrhea, Shutting
self-judgment, shallow breathing,
withdrawing, shame, self- disassociation, down,
irritation, anger, increased heart rate,
changing focus judgment, rage, numbness, blanking out, giving up
sadness, etc. warmth, dry mouth
grief, guilt, etc. nausea, etc.

Too Easy Good Challenge Too Hard

Proceed to next Repeat the same Go back to previous

difficulty level difficulty level difficulty level
Note. Reprinted from Deliberate Practice in Emotion-Focused Therapy (p. 180), by R. N. Goldman, A. Vaz, and T. Rousmaniere, 2021, American Psycho-
logical Association ([Link] Copyright 2021 by the American Psychological Association.

FIGURE A.2. How to Make Client Statements Easier or Harder in Role-Plays

Talking about
events in the
future/past, or
LEAST
outside therapy
EVOCATIVE
(EASIER)

Talking about Expressing

anything without strong feelings
expressing feelings while talking
(content) (affect)

MOST
Talking about
EVOCATIVE
here and now,
(HARDER)
therapy, or
therapist

Note. Figure created by Jason Whipple, PhD.

Appendix A 177

• The therapist can take a short break (5–10 minutes) between questions.

• The trainer can expand the “feedback phase” by discussing cognitive behavioral
therapy or psychotherapy theory and research. This should shift the trainees’ focus
toward more detached or intellectual topics and reduce the emotional intensity.

Making Client Statements Harder

If the therapist answers both Questions 1 and 2 on the Reaction Form as “too easy,”
proceed to next-level harder client statements. If you were already using the Advanced
client statements, the client should make the exercise even harder, using the following
guidelines:

• The person playing the client can use the Advanced client statements again with a
more distressed voice (e.g., very angry, sad, sarcastic) or unpleasant facial expres-
sion. This should increase the emotional tone.

• The client can improvise new client statements with topics that are more evocative
or make the therapist uncomfortable, such as expressing strong feelings or talking
about the here and now, therapy, or the therapist (see Figure A.2).

Note. The purpose of a deliberate practice session is not to get through all the
client statements and therapist responses but to spend as much time as possible
practicing at the correct difficulty level. This may mean that trainees repeat the
same statements or responses many times, which is okay as long as the difficulty
remains in the “good challenge” level.