Is training effective? A study of counseling psychology doctoral trainees in a psychodynamic/interpersonal training clinic

The influence of deliberate practice on skill performance in therapeutic practice: A systematic review of early studies

OBJECTIVE

Deliberate practice (DP) is recommended as a new approach to facilitate the acquisition of discrete therapeutic skills, however, its implementation and effectiveness in psychotherapy remains unclear.

METHOD

A systematic search on DP for therapeutic skills among psychotherapy trainees and psychotherapists yielded eleven studies for inclusion. Nine were randomized controlled studies (RCTs), including seven unique RCTs, and two were within-group studies.

RESULTS

Risk of bias was assessed as "high" for one RCT, "some concerns" for the remaining RCTs, and "serious" for within-group studies. All RCTs found the DP group performed better than the control group. All studies involved efforts to improve performance based on learning objectives and iterative practice but varied in the source of expert guidance and feedback. The included studies provide limited insight into best practice for delivering DP.

CONCLUSION

The results highlight the paucity of research in this field; however they offer insight into current applications of DP and provide preliminary empirical support DP for as a model for promoting the development of discrete therapeutic skills. Given the rapid dissemination of DP publications and manuals in psychotherapy, future research is strongly encouraged.

Predicting resistance management skill from psychotherapy experience, intellectual humility and emotion regulation

OBJECTIVE

Resistance management in psychotherapy remains a foundational skill that is associated with positive client outcomes (Westra, H. A., & Norouzian, N. (2018). Using motivational interviewing to manage process markers of ambivalence and resistance in cognitive behavioral therapy. Cognitive Therapy and Research, 42(2), 193-203). However, little is known about which therapist characteristics contribute to successful management of resistance. Research has suggested that psychotherapy performance does not improve with experience (Goldberg, S. B., Rousmaniere, T., Miller, S. D., Whipple, J., Nielsen, S. L., Hoyt, W. T., & Wampold, B. E. (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), that psychotherapists lack humility (Macdonald, J., & Mellor-Clark, J. (2015). Correcting psychotherapists' blindsidedness: Formal feedback as a means of overcoming the natural limitations of therapists. Clinical Psychology & Psychotherapy, 22(3), 249-257), and that difficult therapeutic moments may dysregulate therapist emotions (Muran, J. C., & Eubanks, C. F. (2020). Therapist performance under pressure: Negotiating emotion, difference, and rupture. American Psychological Association). This study aimed to 1) identify whether psychotherapy experience (i.e., training versus no training and number of years of psychotherapy experience) was associated with resistance management skill, and 2) identify whether humility and difficulties regulating emotions among trained individuals were each associated with resistance management.

METHOD

A sample of 76 trained and 98 untrained participants were recruited for the present study. All participants completed the Comprehensive Intellectual Humility Scale (CIHS, Krumrei-Mancuso, E. J., & Rouse, S. V. (2016). The development and validation of the comprehensive intellectual humility scale. Journal of Personality Assessment, 98(2), 209-221), the Difficulties in Emotion Regulation Scale (DERS; Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54), and the Resistance Vignette Task (RVT; Westra, H. A., Nourazian, N., Poulin, L., Hara, K., Coyne, A., Constantino, M. J., Olson, D., & Antony, M. M. (2021). Testing a deliberate practice workshop for developing appropriate responsivity to resistance markers: A randomized clinical trial. Psychotherapy, 58, 175-185 ) which was used to assess resistance management skill.

RESULTS

Trained individuals performed significantly better on resistance management than untrained individuals; however, years of experience within the trained sample were not associated with resistance management. Conversely, lower humility and greater difficulties regulating emotions were each associated with significantly poorer resistance management in trained individuals.

CONCLUSION

These findings suggest the possibility of improving training to focus on key skills, like resistance management, through supporting humility and emotion regulation in training, as opposed to simply acquiring more experience.

Definition and Criteria for the Assessment of Expertise in Psychotherapy: Development of the Psychotherapy Expertise Questionnaire (PEQ)

Therapist expertise is a complex, multifaceted, and continually evolving concept. Defining this construct and its constituent components can yield a substantial contribution to the field of psychotherapy, consequently enhancing the comprehension of the fundamental factors that underlie its effectiveness. Within this framework, the present research aimed at developing and assessing the psychometric properties of the Psychotherapy Expertise Questionnaire (PEQ), a self-report measure to assess therapist expertise. A sample of 260 psychotherapists of various theoretical orientations were involved in this research. They completed a survey that included the PEQ as well as other self-reported measures aimed at evaluating personality traits, self-efficacy, self-esteem, and insight orientation. The analysis provided evidence of a good fit for both a correlational model with eight factors and a higher-order model, where the eight subdimensions were grouped into subjective (performance; cognitive functioning; personal and relational qualities of the therapist; therapist self-assessment) and objective (experience; reputation with clients and colleagues; training and professional updating; deontological ethics and setting rules) factors. The eight dimensions, two higher-order factors, and total score all showed excellent levels of internal consistency. Furthermore, significant associations were found between PEQ scores and insight orientation, general self-efficacy, self-esteem, personality traits, and time exercising clinical practice. To conclude, the Psychotherapy Expertise Questionnaire (PEQ) is a valuable, theoretically guided, and psychometrically robust self-report measure designed to assess therapist expertise and its constitutive dimensions. This measure can have practical applications in guiding tailored training and customised supervision.

An apprenticeship model in the training of psychotherapy students. Study protocol for a randomized controlled trial and qualitative investigation

Background

One approach towards advancing the quality of mental health care is to improve psychotherapists’ skills through education and training. Recently, psychotherapy training has benefitted from adapting training methods from other professions (e.g., deliberate practice). The apprenticeship model has a long history in skill trades and medicine, but has yet to be adopted in training mental health professionals. This study aims to investigate the impact of apprenticeship training on clinical psychology students’ skills.

Methods

In a pragmatic mixed-methods trial, 120 first year students in a Master’s degree clinical psychology program will be randomized to either training-as-usual or training-as-usual plus psychotherapy apprenticeship. In the intervention group, students will participate, over a period of 10 weeks, in weekly treatment sessions together with licensed therapists at outpatient mental health and substance use treatment clinics. Outcomes are assessed post-intervention and at two-year follow-up. The main outcome measure is the Facilitative Interpersonal Skills (FIS) performance test. Additional self-report measures tap self-efficacy, self-compassion, worry, rumination, and stress. Weekly reflection log entries written by the students will be qualitatively analyzed in order to gain an in-depth understanding of the learning process. Students’ and therapists’ experiences with the intervention will be explored in focus group interviews.

Discussion

To the best of our knowledge, this is the first controlled study to investigate the impact of apprenticeship as an isolated training component in the education of clinical psychologists. The study is designed so as to yield a comprehensive understanding of an approach which could prove to be a valuable supplement to the existing educational methods in this field and ultimately, contribute to improve the quality of mental health care.

Learning Processes and Acquisition of Knowledge and Skills in Training and Supervision of Psychotherapy and Counselling: A Study Protocol for a Scoping Review

Background: Increased awareness of the individual therapist’s vital contribution to treatment processes and outcome, and the potential role of training and supervision in this respect, warrants a close look at the empirical and theoretical literature on teaching and learning of therapists and counselors.

Methods: A scoping review of the literature will be conducted based on an overarching research question: when authors have reported on learning processes and acquisition of knowledge and skills in psychotherapy/counseling and supervision/training literature over the past 30 years (since 1990), what evidence, concepts, theories, and models have they reported? A comprehensive search strategy is carried out to identify publications indexed in Scopus, PsycINFO, and Cochrane Central Register of Controlled Trials. Publications will be sorted according to four categories: (1) conceptual/theoretical; (2) empirical (quantitative, qualitative, mixed methods); (3) review, meta-synthesis or -analysis; (4) training program/model description. Procedures for the upcoming scoping review of conceptual/theoretical, empirical, and training program/model description publications will be outlined.

Conclusion: Besides clarifying existing perspectives, practices, and evidence, and documenting the shifting trends of the field during the past three decades, this scoping review identifies knowledge gaps that point to vital future directions for research and theory development. Moreover, the comprehensive scoping lays the foundation for subsequent, more focused systematic reviews that address identified key research topics more specifically.

How to become a responsive therapist: A study of experiences of developing therapists

OBJECTIVE

: A growing body of empirical evidence suggests that psychotherapy is more effective when therapists tailor interventions to fit their specific clients' needs, a concept referred to as therapist responsiveness in the psychotherapy literature. However, the question of how therapists learn to become responsive rarely has been examined.

METHOD

: The central question of this study, put to eleven graduate student therapist trainees, was, "How did you learn to be responsive to clients as a novice therapist, and in what ways have you become responsive?" A critical-constructivist grounded theory method was employed to generate themes from trainees' replies.

RESULTS

: The analysis showed that trainees learned to improve their responsiveness to clients by: (1) becoming more aware of cues that signaled the need to adapt interventions (as related to psychotherapy change processes, client-therapist relational dynamics, clients' identities and cultural contexts, and the maximizing of clients' agency); (2) developing attunement to their own emotions and engaging in self-care; and (3) adopting mindsets that facilitated their trying new relational or therapy approaches while also maintaining professionalism.

CONCLUSION

Based upon these findings, preliminary suggestions for responsiveness training are presented to guide programs that wish to train responsive psychotherapists .

The Synergistic but Troubled Relationship Between Psychotherapy Science and Practice: Moving Forward

How to foster the integration of science (especially empirical research) and practice has been a vexing problem since the beginnings of counseling psychology and other applied fields. We propose that the basis for this problem is the very different, even contradictory, demands of empirical research and practice, and the resulting ways of being research scientists and practitioners. Focusing on psychotherapy, we posit seven such demands/pulls and ways of being and seven tactics for strengthening integration. Clinically relevant research on the therapeutic relationship and therapist skills/interventions conducted at the Maryland Psychotherapy Clinic and Research Lab is summarized. We emphasize that for science and practice to be mutually facilitative, the field will need to pay close and ongoing attention to ways of strengthening integration.

The competence development of German psychotherapy trainees: A naturalistic, longitudinal and multidimensional outcome study

Objectives:This study investigated the development of German psychotherapy trainees in professional, relational, and personal competence. Methods: The study followed a naturalistic pre-post design over 3 years and included a control group of non-trainee psychologists. The sample consisted of 219 participants, including 64 cognitive-behavioral trainees, 120 psychodynamic trainees and 35 control participants. Outcomes were knowledge (multiple choice exam), case-formulation competence (Case Formulation Content Coding Method), healing and stressful involvement (Therapist Work Involvement Scales), attributional complexity (Attributional Complexity Scale), introject affiliation, and affiliation in patient treatments (Intrex questionnaire). Multilevel Modeling was used to investigate change over time and group by time interactions. Comparisons to the control group were limited to knowledge, case-formulation competence, and attributional complexity. Results: Trainees improved in knowledge, case-formulation competence, healing involvement, and affiliation in treatments with small to medium effects. There was no change in stressful involvement, attributional complexity or introject affiliation. According to reliable change indices, the majority of trainees did not change reliably. Over time, trainees outperformed the control group only in case-formulation competence. There were several main and group by time effects regarding trainee orientation. Conclusions: Results imply benefits of training on professional and relational competence but only limited effects on personal competence.

On what do therapists agree? Assessing therapist evaluations of emotion regulation strategy effectiveness

OBJECTIVE

To develop more unified, process-based, and disseminable psychotherapy treatments, it is important to determine whether there is consensus among therapists regarding intervention strategies.

DESIGN

Because emotion regulation is a cornerstone of modern treatments and a thriving area of clinical research, we assessed therapists' ratings of the effectiveness of commonly studied emotion regulation strategies.

METHODS

Therapists (n = 582) read eleven vignettes describing stressful scenarios and rated the effectiveness of ten emotion regulation strategies in each scenario.

RESULTS

Across therapists, we found general consensus regarding the most (i.e., problem-solving) and least (i.e., concealing emotions) effective strategies. Cognitive/behavioural/third-wave therapists rated acceptance and distraction as more effective, and emotional expression and gathering information as less effective, than other therapists, Fs> 4.20, ps < .05, whereas hours of clinical experience were generally unrelated to strategy effectiveness ratings.

CONCLUSIONS

We discuss what these points of agreement and relative disagreement among therapists reveal about a more unified, process-based treatment approach and how these results can guide emotion regulation research.

PRACTITIONER POINTS

There is general consensus among practising therapists that problem-solving is the most effective emotion regulation strategy and expressive suppression is the least effective. However, CBT-oriented therapists rated acceptance and distraction as more effective than non-CBT-oriented therapists. Non-CBT-oriented therapists rated emotional expression and gathering information as more effective than CBT-oriented therapists. Years of experience were unrelated to ratings of emotion regulation strategy effectiveness.

Psychotherapy Expertise Should Mean Superior Outcomes and Demonstrable Improvement Over Time

How the field understands psychotherapy expertise is important. It affects how we practice and how we prepare others for practice. As in our other work, we argue that the most meaningful definition of expertise must involve steady improvement over time to achieve superior performance on some meaningful measure, which typically is client outcome. We also argue that the best means by which a therapist can achieve this is through ongoing deliberate practice. We contrast our position with not only Hill, Spiegel, Hoffman, Kivlighan, and Gelso’s preferred definition, in which they anchor expertise in therapist performance, but also with the various other possible definitions of expertise (e.g., therapist experience, therapist self-assessment of expertise) that they proffer as options.

Therapist Expertise in Psychotherapy Revisited

The thesis of this article is that the lack of evidence related to the identification and development of therapist expertise is due to the inadequate definition and operationalization of the concept. We propose a definition of expertise that is restricted to performance in the conduct of psychotherapy: the manifestation of the highest levels of ability, skill, professional competence, and effectiveness. In addition, we offer several criteria that may be used to assess expertise: performance (including relational and technical expertise), cognitive processing, client outcomes, experience, personal and relational qualities, credentials, reputation, and self-assessment. We then review research related to the development of expertise, highlighting the role of experience with clients, personal therapy, supervision, deliberate practice, and feedback. Finally, we conclude with recommendations for conducting research on therapist expertise.