The Science of Interpersonal Skill Development.
Interpersonal skill improves through focused practice, feedback, reflection, and repeated refinement, not experience alone.
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Why experience is not the same as practice.
Interpersonal skill is often assumed to improve with time: more client conversations, more field experience, more years in practice. But experience and improvement are not the same thing.
One large longitudinal study followed:
170
therapists
6,591
patients
Therapist outcomes did not reliably improve with experience. In some cases, performance declined slightly.
Experience contributes to professional development, but it does not reliably improve interpersonal skill on its own. Improvement is better supported by structured practice focused on specific behaviours, an appropriate level of challenge, timely feedback, reflection, and repeated refinement.
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The conditions that make practice effective.
Across fields such as music, sport, medicine, and aviation, expert performance research points to the value of deliberate practice: focused work on specific skills, paired with feedback and repeated refinement.
Deliberate practice is practice designed for improvement. Five conditions are especially important:
Specific skill focus.
Practice a precise behaviour, not a vague competency.
Right level of challenge.
Work just beyond current ability.
Timely feedback.
Understand what worked, what fell short, and what to adjust.
Repetition with refinement.
Try again with a clearer target.
Guided reflection.
Build awareness so learning can be applied in new situations.
Making interpersonal skill observable.
Deliberate practice explains how skills improve. Common-factors research helps clarify which interpersonal behaviours matter.
Dr. Bruce Wampold, Skillsetter's Chief Scientist, is one of the field's leading psychotherapy researchers. His work has helped synthesize decades of research into what contributes to effective therapeutic relationships and client outcomes.
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That research helps make interpersonal effectiveness more observable. It can be seen in both what a practitioner says and how they say it.
These are professional behaviours that can be observed, practiced, and refined. They are also behaviours that traditional teaching methods often struggle to isolate and assess.
What they say
The words they choose, the questions they ask, and how accurately they respond to another person's experience.
How they say it
The tone, pacing, warmth, timing, and emotional responsiveness they bring to the interaction.
How Skillsetter applies the science.
Specific skill focus.
Right-sized challenge.
Feedback and reflection.
Repetition with refinement.
Evidence of performance.
Skillsetter focuses practice on the moments where interpersonal skill is most visible: the missed cue, the difficult disclosure, the defensive response, the rupture in trust, or the question that needs particular care.
Learners are not just completing a simulation. They are practicing behaviors that shape real conversations and, in therapeutic settings, are linked to stronger client outcomes.⁴
research & citations
Independent research using Skillsetter.
Over the past decade, Skillsetter has been used in independent research across psychotherapy and counselling, school psychology, medicine, nursing, social work, and paramedicine in at least 10 countries. These studies used Skillsetter to deliver deliberate-practice training, evaluate the platform, or collect data, with some finding stronger learning experiences, learner satisfaction, and skill development than conventional approaches.
Research Using the Skillsetter Platform
Barata, M., Santos, J. M., Sousa, D., Silva, C., Alface, C., & Coelho, P. (2025). We are on the road to somewhere: How deliberate practice can enhance the path of continuing education in mental health. Practice Innovations, 10(2), 132–143. https://doi.org/10.1037/pri0000273
Barata, M., Sousa, D., & Vaz, A. (2024). The effect of deliberate practice training on psychology students’ empathic skills. Journal of Expertise, 6(4).
Catalino, D., Sousa, D., Santos, J. M., Soares, A., & de Fabiana, P. (2026). Pre-post differences in facilitative interpersonal skills and self-assessment following deliberate-practice training. Journal of Clinical Psychology. Advance online publication. https://doi.org/10.1002/jclp.70182
Chen, S-Y., Coker, K., Walthen, C., & Sheperis, D. (2021). Effects of clinical skills training: Technology and pedagogy for the quality virtual classroom. Journal of Technology in Counselor Education and Supervision, 1(1), 49–52. https://doi.org/10.22371/tces/009
Córdoba Salgado, O. A. (2023). Feasibility of a deliberate practice training program for therapists: Supporting the development of empathy, consensus, and collaboration competences. [Doctoral dissertation, Universidad de los Andes]. Repositorio Institucional Séneca. https://repositorio.uniandes.edu.co/server/api/core/bitstreams/0e8dd408-dc8a-436a-b8d8-b9a64f636ffd/content
Flynn, A. W. P. (2024). A construct validity analysis of the facilitative interpersonal skills performance task. [Unpublished doctoral dissertation]. University of Wisconsin–Madison. https://asset.library.wisc.edu/1711.dl/U4WR6A7OERGW68Y/R/file-1a6b6.pdf
Goldberg, S. B., Baldwin, S. A., Flynn, A. W., Babins-Wagner, R., Caperton, D. D., Williams, C. Y., et al. (2026). Multimodal assessments of therapist characteristics are largely unrelated to patient outcomes: A preregistered analysis. Clinical Psychological Science, 21677026261424222. https://doi.org/10.1177/21677026261424222
Kauffmann, J. R. (2022). Are you my nurse? The effects of patient-delivered gender microaggressions on women trainees’ clinical work in integrated primary care. [Doctoral dissertation, University of Denver]. Electronic Theses and Dissertations. https://digitalcommons.du.edu/cgi/viewcontent.cgi?article=3120&context=etd
Larsson, J., Werthén, D., Carlsson, J., Salim, O., Davidsson, E., Vaz, A., Sousa, D., & Norberg, J. (2025). Does deliberate practice surpass didactic training in learning empathy skills? A randomized controlled study. Nordic Psychology, 77(1), 39–52. https://doi.org/10.1080/19012276.2023.2247572
Magill, M., Mastroleo, N. R., & Martino, S. (2022). Technology-based methods for training counseling skills in behavioral health: A scoping review. Journal of Technology in Behavioral Science, 7(3), 325–336. https://doi.org/10.1007/s41347-022-00252-8
Mae-yang, H., Bible, Y., In-Sook, J., & Ju-hee, Y. (2023). Exploration of the application of technology in counselor training. Korean Journal of Counseling, 24(3), 1–29. http://dx.doi.org/10.5703/kjc.24.3.202306.1
Newman, D. S., Villarreal, J. N., Gerrard, M. K., McIntire, H., Barrett, C. A., & Kaiser, L. T. (2022). Deliberate practice of consultation communication skills: A randomized controlled trial. School Psychology, 37(3), 225. http://doi.org/10.1037/spq0000494
Nurse, K., O’Shea, M., & Sheen, J. (2024). Qualitative accounts from deliberate practice training for empathic communication among psychotherapy trainees. Counselling and Psychotherapy Research, 24(4), 1368–1379. https://doi.org/10.1002/capr.12761
Østergård, O. K., Nielsen, J., Hjorthøj, C., Nilsson, K. K., & Poulsen, S. B. (2022). Effect of deliberate practice training of graduate students in general psychotherapeutic skills compared with theoretical teaching: Protocol for the randomised controlled TRIPS trial. BMJ Open, 12(9), e062506. https://doi.org/10.1136/bmjopen-2022-062506
Schall, M. K. (2024). The relationship between clinician-perceived competency and expert-rated competency in REBT using anxiety-focused simulated-based practice. [Doctoral dissertation, St. John’s University]. Theses and Dissertations. https://scholar.stjohns.edu/cgi/viewcontent.cgi?article=1790&context=theses_dissertations
Stewart, S. H., Drinane, J. M., Owen, J., & Dumas, D. (2024). Psychotherapy training via a task-based assessment of the multicultural orientation framework: A pilot study. Counselling and Psychotherapy Research, 24(1), 190–198. https://doi.org/10.1002/capr.12629
Tomás, M., Sousa, D., Barata, M., Amaro, I., & Coelho, P. (2025). The effect of a deliberate practice training on the delivery of empathetic interventions in clinical psychology master students. Journal of Expertise, 8(1). https://www.journalofexpertise.org/articles/volume8_issue1/JoE_8_1_Tomas_etal.pdf
Waltrich, N. J., Sheen, J., Ling, M., & O’Shea, M. (2025). Developing empathy in paramedic students using didactic and deliberate practice education programs: A mixed-methods study. Internet Journal of Allied Health Sciences and Practices, 23(4). https://nsuworks.nova.edu/cgi/viewcontent.cgi?article=2707&context=ijahsp
Winkeljohn Black, S., Shrivastava, S., Awlia, D., & Crede, M. (2025). Psychotherapy trainees’ perspectives on the impact, usability, and feasibility of an online program to increase multicultural orientation toward religious and spiritual clients. Psychotherapy, 63(2), 152–162. https://doi.org/10.1037/pst0000589
Yamin, J. B., Cannoy, C. N., Gibbins, K. M., Krohner, S., Rapport, L. J., Trentacosta, C. J., Zeman, L. L., & Lumley, M. A. (2023). Experiential training of mental health graduate students in emotional processing skills: A randomized, controlled trial. Psychotherapy, 60(4), 512. https://psycnet.apa.org/doi/10.1037/pst0000495
Foundational research cited on this page
These sources support the scientific principles behind Skillsetter and are distinct from studies that used the platform.
1. Goldberg, S. B., et al. (2016). Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. Journal of Counseling Psychology, 63(1), 1–11.
2. Ericsson, K. A., et al. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363–406.
3. Wampold, B. E., & Imel, Z. E. (2015). The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work (2nd ed.). Routledge.
4. Anderson, T., et al. (2009). Therapist effects: Facilitative interpersonal skills as a predictor of therapist success. Journal of Clinical Psychology, 65(7), 755–768.
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