Thanks for letting me contribute! Here's a friendly response to your response :-)
First, I actually share your bias against certifications. I hold no certifications. I suspect we've both seen them lead to things we don't want. So, why did I write a post about certification if I'm not a fan? Because other people are.
The fact is that the default way for many (most?) in our field is to grow their skills by certification. The research is pretty clear, for the average therapist, certification has no impact on clinical outcomes. That doesn't change the fact that "advanced" trainings and certifications are our field's default way to grow.
It strikes me that this is because certifications are inherently motivating. Since this is the default way our field does continuing education, and because it's engaging to people, I think we should use it.
Second, your comments on intrinsic versus extrinsic motivation identify a very common barrier to good gamification. This is called the "points, badges, and leaderboards" problem. People often think adding points, badges, and leaderboards to their boring and/or extrinsically motivated activities will make them more engaging.
That always backfires.
The way to fix extrinsic motivation is to use less points and more creativity, empowerment, and social relationships, so that the experience is more intrinsically motivating. That's why I talked a lot about empowering therapists and fostering relationships. This is also why I did NOT talk about leaderboards or publicly tracking outcomes.
My thinking is that if therapists are already intrinsically motivated to go through a certification process, let's point that energy in a productive direction - deliberate practice.
I think this is important because the alternative is to follow what some have called "big boy rules," leaving the responsibility of doing practice completely on the shoulders of the individual. It doesn't work. Or rather, it works with a small group of highly motivated, super intrinsically motivated clinicians. But if we want to scale, if we want to change the profession and create a tribe of expert therapists who can work with compassion and kindness to relieve the mountains of human suffering all around us, well then most of us need a little more structure.
Thanks for letting me collaborate with you. I hope we can do it again in the future.
Jordan, this is brilliant. Really appreciate you sharpening further the dialogue.
You hit an important note about "why I did NOT talk about leaderboards or publicly tracking outcomes."
I'm concerned that this is what some are going to do. This is exactly about the extrinsic/intrinsic paradox that might backfire.
I'm not thinking about a story about a cardiac unit at one hospital who was told that they were going to make the medical outcomes of heart surgeries public. This was to motivate them for better performance.
The result? More heart surgeons not taking on complicated cases.
At this point in time, I'm prepared to change my mind about the value of certification process...
Thoughts from others?
p/s: This is where I feel asynchronous dialogue is useful. I get time to think before I respond. PLUS, it allows allows to chew on it and chime in.
Daryl, are you referring to Atul Gawande's initial attempts to make check lists standard practice in surgery? At first there was a lot of resistance. But when the data showed a drop in complications from surgery & that when nurses could encourage surgeons to follow protocol, general morale & plus outcomes were better, check lists became standard practice. Maybe we're at the forefront of that sort of change in our field?
Hi Vivian, the story of the backfire effect in the cardiac unit trying to track outcomes wasn't from Atul Gawande.
As far as I know, and as you said, Gawande's efforts to help surgical teams to adapt a checklist has had positive outcomes (see his book Checklist Manifesto).
I've been thinking a lot about this and I think this distinction between internal and external motivation is crucial.
I don't know what's going to happen, but I can see insurance companies latching on to your research (and others) about tracking outcomes and forcing clinicians to do it, much like standardized testing in schools.
Hi Jordan, what appealed to me about your ideas, as it did for Daryl, was this "... to really leverage the social aspects of your activity and allow veteran users to apply their own creativity to what they've learned." This is what would engender more enjoyment in our work as well as bring more play & creativity into deliberate practice. DP is a mainly solitary journey, even though it's supported by a coach.
You made a good point below that "... if we want to scale, if we want to change the profession and create a tribe of expert therapists who can work with compassion and kindness to relieve the mountains of human suffering all around us, well then most of us need a little more structure." To do that, we need the data which FIT provides as a first step, combined with DP so we can fine tune our own, our trainees' & our supervisees' work to keep us at our growing edge – in a fun/exciting way. How to make that appealing to those who aren't intrinsically motivated seems to be the challenge here, let alone how to scale this to make it routine in therapist training, practice & certification processes.
Thanks for your kind words Vivian. I agree. I would mark a subtle nuance which is we want to foster and grow internal motivation, not create external motivation.
You might be familiar with Dan Pinks book on human motivation- Drive. That's what were wanting.
And yes we must use feedback measures and deliberate practice.
Hey Daryl,
Thanks for letting me contribute! Here's a friendly response to your response :-)
First, I actually share your bias against certifications. I hold no certifications. I suspect we've both seen them lead to things we don't want. So, why did I write a post about certification if I'm not a fan? Because other people are.
The fact is that the default way for many (most?) in our field is to grow their skills by certification. The research is pretty clear, for the average therapist, certification has no impact on clinical outcomes. That doesn't change the fact that "advanced" trainings and certifications are our field's default way to grow.
It strikes me that this is because certifications are inherently motivating. Since this is the default way our field does continuing education, and because it's engaging to people, I think we should use it.
Second, your comments on intrinsic versus extrinsic motivation identify a very common barrier to good gamification. This is called the "points, badges, and leaderboards" problem. People often think adding points, badges, and leaderboards to their boring and/or extrinsically motivated activities will make them more engaging.
That always backfires.
The way to fix extrinsic motivation is to use less points and more creativity, empowerment, and social relationships, so that the experience is more intrinsically motivating. That's why I talked a lot about empowering therapists and fostering relationships. This is also why I did NOT talk about leaderboards or publicly tracking outcomes.
My thinking is that if therapists are already intrinsically motivated to go through a certification process, let's point that energy in a productive direction - deliberate practice.
I think this is important because the alternative is to follow what some have called "big boy rules," leaving the responsibility of doing practice completely on the shoulders of the individual. It doesn't work. Or rather, it works with a small group of highly motivated, super intrinsically motivated clinicians. But if we want to scale, if we want to change the profession and create a tribe of expert therapists who can work with compassion and kindness to relieve the mountains of human suffering all around us, well then most of us need a little more structure.
Thanks for letting me collaborate with you. I hope we can do it again in the future.
Jordan, this is brilliant. Really appreciate you sharpening further the dialogue.
You hit an important note about "why I did NOT talk about leaderboards or publicly tracking outcomes."
I'm concerned that this is what some are going to do. This is exactly about the extrinsic/intrinsic paradox that might backfire.
I'm not thinking about a story about a cardiac unit at one hospital who was told that they were going to make the medical outcomes of heart surgeries public. This was to motivate them for better performance.
The result? More heart surgeons not taking on complicated cases.
At this point in time, I'm prepared to change my mind about the value of certification process...
Thoughts from others?
p/s: This is where I feel asynchronous dialogue is useful. I get time to think before I respond. PLUS, it allows allows to chew on it and chime in.
Daryl, are you referring to Atul Gawande's initial attempts to make check lists standard practice in surgery? At first there was a lot of resistance. But when the data showed a drop in complications from surgery & that when nurses could encourage surgeons to follow protocol, general morale & plus outcomes were better, check lists became standard practice. Maybe we're at the forefront of that sort of change in our field?
Hi Vivian, the story of the backfire effect in the cardiac unit trying to track outcomes wasn't from Atul Gawande.
As far as I know, and as you said, Gawande's efforts to help surgical teams to adapt a checklist has had positive outcomes (see his book Checklist Manifesto).
Totally agree Daryl.
I've been thinking a lot about this and I think this distinction between internal and external motivation is crucial.
I don't know what's going to happen, but I can see insurance companies latching on to your research (and others) about tracking outcomes and forcing clinicians to do it, much like standardized testing in schools.
I think that would be catastrophic.
Hi Jordan, what appealed to me about your ideas, as it did for Daryl, was this "... to really leverage the social aspects of your activity and allow veteran users to apply their own creativity to what they've learned." This is what would engender more enjoyment in our work as well as bring more play & creativity into deliberate practice. DP is a mainly solitary journey, even though it's supported by a coach.
You made a good point below that "... if we want to scale, if we want to change the profession and create a tribe of expert therapists who can work with compassion and kindness to relieve the mountains of human suffering all around us, well then most of us need a little more structure." To do that, we need the data which FIT provides as a first step, combined with DP so we can fine tune our own, our trainees' & our supervisees' work to keep us at our growing edge – in a fun/exciting way. How to make that appealing to those who aren't intrinsically motivated seems to be the challenge here, let alone how to scale this to make it routine in therapist training, practice & certification processes.
Thanks for your kind words Vivian. I agree. I would mark a subtle nuance which is we want to foster and grow internal motivation, not create external motivation.
You might be familiar with Dan Pinks book on human motivation- Drive. That's what were wanting.
And yes we must use feedback measures and deliberate practice.
Hi Jordan, thanks for pointing to Dan Pinks work "Drive". I haven't heard of it & will check it out. All the very best.