Knowledge Of Psychotherapy Research Articles

Psychiatry training in Hungary, difficulties and advantages

Introduction While in theory our training program is quite satisfactory, in practise it often falls short. The first two years give a more general knowledge, including spending time at internal, ICU and neurological wards as well as attending a month-long course about communication, palliative care and basic legal principals important in healthcare. The second three years provide the opportunity to engage in profession-related rotations, like psychotherapy, psychiatric rehabilitation and addictology.Objectives The design in itself is clear, but the supervision for its enactment is insufficient. This leads to regional differences between the four faculties of our country, not everyone is able to partake in the supposedly mandatory rotations (mostly because of shortcomings in staff ) and the organization of our theoretical education varies greatly in each region to the point of non-existence in one area, since the COVID-19 pandemic started. The personal supervision of each psychiatry trainee also leaves much to be desired both on professional and – in psychiatry very important – mental levels. Competence and responsibility limits are often vague, and, especially in country hospitals, to much is expected of the resident (i.e. doing a nightshift alone, without direct supervision).MethodsIt is a positive thing that in theory there are standards in place, the problem is that they are more viewed as guidelines, than demands to be met. Nevertheless, some of the faculties provide well-organized education (even subdivided per year of training) and/or take rotations outside of the ‘home ward’ seriously. The opportunity to gain a basic knowledge in psychotherapy is also beneficial and a good aspect of our training. Easily accessible or even obligatory participation in psychotherapy for ourselves during our training however, is lacking.Results The decreasing number of psychiatry trainees sadly is a worldwide trend and Hungary is no exception. This poses more difficulties, i.e. making it harder to let a resident go on ‘outside’ rotations, especially from wards already struggling with staff shortages. Because of the latter, there is also little time to teach the trainees appropriately and pay them the attention they need.ConclusionsAll in all, there is much potential in our training program and its standards, also leaving room for substantial improvement in realizing the practical aspects. The decline in numbers of psychiatry trainees is worrisome and calls for more general intervention on a European or even global level.Disclosure of InterestNone Declared

Core knowledge in psychotherapy—Transconceptual approaches and results

Core knowledge in psychotherapy—Transconceptual approaches and results

Implicit attitudes toward psychotherapy and explicit barriers to accessing psychotherapy in youths and parent–youth dyads

Few studies have investigated implicit and explicit attitudes toward psychotherapy in youths (Study 1), although information about attitudes would improve interventions that aim to decrease barriers to accessing psychotherapy including parents (Study 2), who facilitate the help-seeking process of youths. The Study 1 sample comprised 96 youths (14-21 years) and the Study 2 sample 38 parent-youth dyads. Differences in implicit attitudes regarding psychotherapy and a medical treatment were measured with the Implicit Association Test, and psychotherapy knowledge and self-reported barriers to psychotherapy were assessed with questionnaires. The actor-partner interdependence model was used to test the dyadic effects of implicit attitudes on explicit attitudes in parents and youths. We did not find evidence for an implicit bias toward psychotherapy compared to a medical treatment, neither in youths, nor in parents. Self-reported barriers were a predictor for lower help-seeking intentions. Deficits in psychotherapy knowledge were more relevant in younger participants. Having a prior or current experience with psychotherapy and having a friend or family member with a prior or current experience with psychotherapy were predictors for better psychotherapy knowledge, but was not for lower barriers to accessing psychotherapy. Partner effects (degree to which the individual's implicit attitudes are associated with explicit attitudes of the other dyad's member) were not found. Specific deficits in psychotherapy knowledge should be addressed in interventions to lower barriers accessing psychotherapy. Parents should be included in interventions as a valuable resource to support youths in seeking psychotherapy for mental disorders.

The Establishment of a Clinic for Personality Modulation in Iran: A Novel Approach in Personality Psychiatry with a Dimensional Approach

The Establishment of a Clinic for Personality Modulation in Iran: A Novel Approach in Personality Psychiatry with a Dimensional Approach

Regional survey into trainee experience of core psychotherapy training

AimsThis project aims to assess the experience of psychiatry core trainees who have undertaken core psychotherapy training (CPT), to identify what is experienced positively and potential areas of improvement.BackgroundPsychotherapy is an necessary part of core psychiatry training, requiring one short and one long case to complete core training.MethodAn anonymous online survey was drafted, containing both qualitative and quantitative questions, to assess trainees experiences of CPT. It was circulated via Trust email (locally) and Twitter (nationally).ResultA total of 35 responses were received: 21 core trainees, 12 higher trainees, 1 consultant, and 1 staff grade doctor. 6 respondents had completed a short case only; 2 a long case only; 25 both; and 2 neither.Confidence in psychotherapy knowledge was rated on a 1–5 scale (1: significantly below average to 5: significantly above average). Theoretical knowledge improved from a 2.57 average before CPT to 3.63 following, and clinical application improved from 2.43 before to 3.66 following.Knowledge prior to delivering CPT was most commonly obtained from Balint group (71.4% of respondents) and MRCPsych courses (65.7%).The main barriers to obtaining psychotherapy experience were: accessing supervision (60.0% of respondents); not enough patients (53.3%); and a lack of guidelines on accessing supervision and patients (43.3%). Additionally, getting time away from day jobs was identified as a concern, particularly among LTFT trainees.Important learning points from CPT identified by trainees were: knowledge of psychoanalytic concepts, such as transference and counter-transference; differences between the theoretical models; an alternative approach to formulation; and how these skills can be useful in all clinical encounters, such as maintaining rapport, boundaries, and time-keeping. The useful role of supervision was also highlighted.ConclusionThis project serves as an introductory look into how trainees view their experience of CPT, and potential areas for improvement.Themes for improvement, arising from qualitative responses, are: clear reading list, including introductory materials; clear guidelines at induction, including supervisor contact details; improved access to supervision; patients to be allocated; protected time for psychotherapy, with extra support for LTFTs; shadowing; increased choice of modality; and more formal teaching on psychotherapy. These are key areas to be targeted to improve the trainee experience, particularly for those who risk delays in their training.

Lien entre empathie et personnalité chez le médecin de famille

ObjectivesEmpathy promotes positive physician-patient communication and is associated with improved patient satisfaction and treatment adherence. Personality influences the physician's empathy. This study attempted to study various factors that may influence the doctor's empathy, especially her/his personality. MethodA cross-sectional study was conducted among public health physicians practicing in Sfax. Self-reported questionnaires including the Jefferson Scale of Empathy (JSE) and the Big Five Inventory (BFI). Hierarchical regression analysis was performed to explore the effects of big five personality traits on empathy. ResultsThe average age of physicians was 45.35 years old. The average score of empathy was 96.24. We found that leisure activity was the most predictive factor of clinical empathy (P=0.03, β=−0.254, R2=24.1%), and that leisure activity, childcare, and time spent with family members were associated with empathic concern (P=0.005, β=−0.328, P=0.042, β=−0.324 and P=0.015, β=−0.287). Having knowledge of psychotherapy was significantly associated with perspective-taking (P=0.012, β=−0.298, R2=30.4%). The number of hours of work had an association with personal distress (P=0.029, β=−0.323, R2=9.4%). DiscussionDespite the limitations of our survey, the results highlighted the link between empathy, professional well-being, and personality traits relating to extraversion and agreeableness in family physicians. This is consistent with some studies. ConclusionOur work has highlighted the determinants of empathy. The doctor's well-being allows her/him better communication and heightened empathy. The different methods that can improve empathy according to the personality of the doctor remain to be developed later.

The Role of Learning Support and Chat-Sessions in Guided Internet-Based Cognitive Behavioral Therapy for Adolescents With Anxiety: A Factorial Design Study.

BackgroundIncreased awareness of anxiety in adolescents emphasises the need for effective interventions. Internet-based cognitive behavioural therapy (ICBT) could be a resource-effective and evidence-based treatment option, but little is known about how to optimize ICBT or which factors boost outcomes. Recently, the role of knowledge in psychotherapy has received increased focus. Further, chat-sessions are of interest when trying to optimize ICBT for youths. This study aimed to evaluate the role of learning support and chat-sessions during ICBT for adolescent anxiety, using a factorial design.MethodA total of 120 adolescents were randomised to one of four treatment groups, in a 2x2 design with two factors: with or without learning support and/or chat-sessions.ResultsAnxiety and depressive symptoms were reduced (Beck Anxiety Inventory- BAI; Cohen’s d =0.72; Beck Depression Inventory- BDI; d =0.97). There was a main effect of learning support on BAI (d =0.38), and learning support increased knowledge gain (d =0.42). There were no main effects or interactions related to the chat-sessions. Treatment effects were maintained at 6-months, but the added effect of learning support had by then vanished.ConclusionICBT can be an effective alternative when treating adolescents with anxiety. Learning support could be of importance to enhance short-term treatment effects, and should be investigated further.

Annotated Bibliography for Supervising Psychiatry Residents in Psychodynamic Psychotherapy.

This paper sought to compile an annotated bibliography for the outpatient year of adult psychiatry residents, providing resources for a foundation in psychodynamic theory which can be utilized in supervision to aid in ongoing psychotherapeutic work. In selecting the readings, the ACGME Milestones sub-competencies considered were (i) empathy and process, (ii) boundaries, (iii) alliance and provision of psychotherapies, (iv) seeking and providing supervision, and (v) knowledge of psychotherapy (theories, practice, and evidence base). Once the readings were selected, two authors independently reviewed the articles to determine which key sub-competencies each article addressed. Chance corrected agreement between the reviewers was assessed using the Cohen kappa statistic. The kappa for interrater agreement was 0.83. A list of 32 readings was compiled sequentially, allowing for theoretical concepts to be progressively built upon. The content of the papers aligned well with multiple sub-competencies in the medical knowledge (MK) and patient care (PC) domains. The bibliography allows for close examination of therapeutic frame; active listening and reflecting on the meaning of the therapist's interventions; transference and the use of countertransference as a diagnostic/therapeutic tool; defense mechanisms; patient pressures towards reenactment; theoretical viewpoints on therapeutic action (e.g., ego psychology, self-psychology, relational therapy, object relations, classical/modern Kleinian); and meaning of lateness, treatment breaks, and termination. This list serves as an ancillary resource which can augment discussions in therapy supervision, while also aiding in standardizing the minimal knowledge base achieved in psychodynamic theory.

“It has taken me a long time to get to this point of quiet confidence”: What contributes to therapeutic confidence for clinical psychologists?

BackgroundWithin clinical psychology, there is a broad training and range of practice. However, most clinical psychologists practice psychotherapy and this study explored what relates to confidence in therapeutic practice.MethodAn online survey was distributed to Irish psychologists. Three‐quarters of the survey participants constituted 46% of the total population of Irish health service psychologists, the remainder working in various non‐health service settings. Clinical psychologists practising psychotherapy were the focus of this study (N = 170).ResultsPsychotherapy practice was a dominant activity for nearly all clinical psychologists but only 13% believed that their psychology training fully equipped them to practice psychotherapy and nearly one‐half felt limited confidence for therapeutic work. More confident clinical psychologists were more satisfied with the psychotherapy knowledge and skills gained during clinical psychology training, more satisfied with their supervisory support, had spent longer in personal therapy, and had more years of experience.ConclusionsPerceived quality of psychotherapy training during clinical psychology training provides an essential foundation for therapeutic confidence. Ongoing access to satisfying supervision in post‐qualification practice also supports confident therapeutic work. In addition, the significance of substantial experience of personal therapy for confidence points to its inclusion as a valuable part of clinical psychology training.

The problem of knowledge in psychotherapy with an adolescent girl: reflections on a patient’s difficulty in thinking and issues of therapeutic technique

This paper reflects on the technical challenges posed to the therapist by an adolescent who finds it hard to engage in the therapeutic process. This is done through the description of a year of three times weekly psychotherapy with a 14-year-old girl who struggled immensely to begin to ‘think’ about her anxieties about sexuality and separation in her sessions. Despite seeking therapy of her own volition, and being reflective about the links between her state of mind and her family history in the assessment sessions, she remained silent for much of the time after she started therapy, only talking sporadically and mainly expressing her conflict through self-harm. The paper describes the therapist’s difficulties in delivering interpretations when confronted with the patient’s defences against having her internal experience understood. Development in the adjustment of the technique and working through the countertransference are described to show how small steps could be taken towards feeling and thinking together with the patient in the session.

Eysenck, Strupp, and 50 years of psychotherapy research: A personal perspective.

In this article, we review the status of psychotherapy research at the time of the founding of the journal Psychotherapy, and trace its history over the past 50 years, spanning the career of the first author. We trace this history in the context of the development of treatments for panic disorder and agoraphobia emanating from our research program. In so doing, we discuss the early visions of Strupp and Eysenck and the realization of many of their own goals for psychotherapy research. We conclude with a view toward the future based on cumulative knowledge of psychotherapy and psychopathology and, in the context of that knowledge, the type of ideal research programs that will be required.

Preparing International Medical Graduates for Psychiatry Residency: A Multi-Site Needs Assessment

Despite the growing number of international medical graduates (IMGs) training in medicine in Canada and the United States, IMG-specific challenges early in psychiatry residency have not been fully explored. Therefore, the authors conducted a needs-assessment survey to determine the needs of IMGs transitioning into psychiatry residency. Using a 15-item online questionnaire, authors conducted a needs-assessment of IMG residents in five Canadian psychiatry residency programs. The survey examined IMGs' perceived difficulties with the transition into psychiatry residency, educational needs, and demographic data. Data were analyzed with descriptive statistics and Mann-Whitney tests. IMGs identified the following difficulties with their transition into residency: understanding the healthcare system, medical documentation, and evidence-based medicine/mental health. Language barriers and social isolation were significant factors affecting the transition into residency for residents who did not speak English as their first language. Residents who lived in Canada 12 months or less had greater perceived difficulties in psychotherapy knowledge and adapting to the Canadian healthcare system; 88% of IMGs reported having little-or-no IMG-specific preparation for psychiatry residency from their psychiatry program; however, 69% reported that they would use IMG resources if offered; 63% felt that faculty in their program should undergo training to assist with IMG transition. Several perceived challenges, needs, and gaps in training were reported by IMGs in Canadian psychiatry residency programs. The results of this survey will be used to inform future curriculum development to facilitate IMG transition into psychiatry postgraduate training programs.

Reconciling technical and practical knowledge in psychotherapy through Polanyi’s tacit knowing

Content and FocusPsychotherapy is a field which is informed by several philosophical traditions especially positivism, contextualism, and more recently critical realism (Alvesson & Sköldberg, 2010; Pilgrim & Bentall, 1999). These separate paradigms are grounded in different ontologies and epistemologies and as a result adherents rely on different assumptions about the nature of knowledge. While these various philosophical traditions have enriched psychotherapy theory and practice, they have also produced conflict over which knowledge paradigm best represents the field. This paper examines the ontological and epistemological foundations of the debate and seeks to provide a pathway towards integration. To highlight the different philosophical assumptions the division between traditional research-based knowledge and practice-based knowledge will be explored. The philosophical scheme of noted scientist and philosopher Michael Polanyi will be promoted as the grounds for re-orienting and unifying our philosophical foundations.

Reconciling technical and practical knowledge in psychotherapy through Polanyi’s tacit knowing

Content and FocusPsychotherapy is a field which is informed by several philosophical traditions especially positivism, contextualism, and more recently critical realism (Alvesson & Sköldberg, 2010; Pilgrim & Bentall, 1999). These separate paradigms are grounded in different ontologies and epistemologies and as a result adherents rely on different assumptions about the nature of knowledge. While these various philosophical traditions have enriched psychotherapy theory and practice, they have also produced conflict over which knowledge paradigm best represents the field. This paper examines the ontological and epistemological foundations of the debate and seeks to provide a pathway towards integration. To highlight the different philosophical assumptions the division between traditional research-based knowledge and practice-based knowledge will be explored. The philosophical scheme of noted scientist and philosopher Michael Polanyi will be promoted as the grounds for re-orienting and unifying our philosophical foundations.

S30-01 Clinical Linguistics as the Basic Element of Methodological Knowledge in Psychotherapy

S30-01 Clinical Linguistics as the Basic Element of Methodological Knowledge in Psychotherapy

Journal Digest

Journal Digest

Therapy 101: A Psychotherapy Curriculum for Medical Students

This pilot project, designed and taught by a resident, created a curriculum to introduce medical students to the practice of psychotherapy. Medical students who are knowledgeable about psychotherapy can become physicians who are able to refer patients to psychotherapeutic treatments. A search of the literature did not identify a curriculum that introduced psychotherapy, its applications, and evidence for its use. The authors worked closely with a faculty mentor to create a course that fulfilled a perceived need for more psychotherapy teaching of medical students. "Therapy 101: An Introduction to Psychotherapy" is a 6-hour curriculum that employs creative teaching techniques such as video clips from TV shows, role play, and recordings of therapy sessions. The series was evaluated using a multiple-choice pre/postcourse test with questions on psychotherapy, written feedback, and perceived knowledge of psychotherapy. The scores from the pre/postcourse test measuring the students' knowledge of psychotherapy did not change significantly. However, students' self-rating of knowledge greatly increased after the series. Written feedback showed substantial enthusiasm for the course. Students can benefit from a short and engaging curriculum on psychotherapy. "Therapy 101" was very well accepted by students and has been integrated into the curriculum for students in the mental health pathway. Medical students may benefit from more exposure to psychotherapy as taught by a resident.

Resenha do livro Psicoterapia interpessoal: guia prático do terapeuta

O livro é direcionado aos diversos profi ssionais que atuam na assistência em saúde mental e, segundo seu prefácio, a obra é resultado de 3 décadas de desenvolvimento de um método de tratamento psicoterapêutico, inicialmente para depressão maior, denominado psicoterapia interpessoal (TIP); posteriormente, passou a ser aplicado em outros transtornos psiquiátricos complexos, como o transtorno de personalidade borderline. A obra tem o objetivo de ser um guia de fácil leitura e consulta, descrevendo os métodos de abordagem e condução dos casos clínicos, mas já partindo do pressuposto de que os profi ssionais (leitores) possuem conhecimento e habilidade nos fundamentos da psicoterapia e no manejo de pessoas com diagnósticos como transtornos do humor ou ansiedade, por exemplo. Cabe aqui frisar que embora não haja referência a nenhuma obra de Carl Rogers, considerado o precursor do relacionamento interpessoal como recurso pedagógico e psicoterapêutico, esta obra apresenta enorme semelhança com a teoria desse autor, mas não em relação às indicações a determinados transtornos como os do humor, as quais são feitas de forma completa, também especifi cando em cada contexto a abordagem a ser usada. O livro é muito bem elaborado, tanto do ponto de vista didático como científi co, ou seja, é um livro de fácil leitura e compreensão e com referências a artigos de periódicos de grande relevância no meio acadêmico e científico.

Factors Associated With Primary Care Clinicians' Choice of a Watchful Waiting Approach to Managing Depression

Watchful waiting to manage depression in primary care may be an appropriate management approach for some patients who present with less severe depression. This study examined factors associated with primary care clinicians' choice of a watchful waiting approach to care management for depression. Secondary data were analyzed from Partners in Care, which examined dissemination of best practices for depression in primary care. Primary care clinicians' decisions regarding watchful waiting were examined by using the baseline survey data from Partners in Care completed by clinicians and patients from February 1996 to March 1997. Participants were 167 primary care clinicians from 46 practices of seven managed care organizations across the United States and their 1,187 patients with depression. Primary care clinicians' proclivity for watchful waiting was examined by using a brief scenario describing a patient with major depressive disorder. Thirty-four clinicians (20 percent) reported a strong proclivity to use watchful waiting for the patient in the scenario. The proclivity was significantly associated with clinicians' reports of the proportion of their actual patients with whom they used this approach. Clinicians were significantly more likely to choose watchful waiting for their actual patients if they had more psychotherapy knowledge (p=.035) or perceived that the need to treat the patient's medical illness was more important than the need to treat his or her mental illness (p=.046) and were less likely to choose a watchful waiting approach if they perceived the lack of availability of mental health professionals as a barrier (p=.050). Primary care clinicians' knowledge of treatment and perception of barriers influence their proclivity for watchful waiting. Clinician education to promote appropriate use of watchful waiting on the basis of clinical need is recommended.

Factors Associated With Primary Care Clinicians' Choice of a Watchful Waiting Approach to Managing Depression

Factors Associated With Primary Care Clinicians' Choice of a Watchful Waiting Approach to Managing Depression