Psychotherapy Skills Research Articles

New Caucus to Promote Value of Psychotherapy Treatment

Among the possible activities of the caucus is to provide mentoring to young psychiatrists interested in increasing their psychotherapy skills.

Repurposing process measures to train psychotherapists: Training outcomes using a new approach

AbstractAims: First, this paper presents the rationale for a novel approach to training counsellors in which measures for psychotherapy process research are taught to students before moving on to teaching basic empathic reflections and interventions. The rationale for this is that client process measures can be re‐purposed to help orient and sensitise trainees to key in‐session moments. Second, we present a training outcome study that assesses the effectiveness of this approach. Method: Using an experiential‐integrative therapy approach, a 13‐week training program was used to teach psychotherapy skills and process research measures to22 clinical graduate students taken from two cohorts. As part of the course, trainees conducted several single sessions with volunteer clients on four separate occasions. Training outcomes were measured using both trainee and client reports. Results: Compared to baseline, therapists reported significant and steady gains (all p's<.05) in session management, reducing their anxious self‐awareness, and in improved sense of self‐efficacy, with the latter having the largest effect (partial Eta Sq.=.381). Discussion: While the findings provide some support for a new training strategy, a dismantling design is needed next to more closely examine the process‐measure approach to training.

A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for Posttraumatic stress disorder

BackgroundPosttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Among military veterans, the lifetime prevalence of PTSD has been estimated to be as high as 20%. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Transferring this research knowledge into clinical settings remains one of the largest hurdles to improving the health of veterans with PTSD. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies.MethodsThe current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity (i.e., psychotherapy adherence and competence) and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians’ adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. The study results will inform how best to implement and transfer evidence-based psychotherapy (e.g., CPT) to clinical settings to attain comparable outcomes to those observed in research settings.DiscussionFindings will deepen our understanding of how much and what type of support is needed following a workshop to help clinicians become proficient in delivering a new protocol. Several influences on clinician learning and patient outcomes will be discussed. An evidence-based model of clinical consultation will be developed, with the ultimate goal of informing policy and influencing best practice in clinical consultation.Trial registrationClinicalTrials.gov: NCT01861769

Advanced Psychotherapy Training: Psychotherapy Scholars’ Track, and the Apprenticeship Model

Guided by ACGME's requirements, psychiatric residency training in psychotherapy currently focuses on teaching school-specific forms of psychotherapy (i.e., cognitive-behavioral, supportive, and psychodynamic psychotherapy). On the basis of a literature review of common factors affecting psychotherapy outcomes and experience with empirically supported and traditional psychotherapies, the authors aimed to develop an advanced contemporary and pragmatic approach to psychotherapy training for eight residents (two per PGY year) enrolled in a specialized Psychotherapy Scholars' Track within an adult general-residency program. The authors developed core principles and clinical practices, and drafted year-by-year educational goals and objectives to teach the psychotherapy scholars. Based on experiential learning principles, we also developed an individualized form of psychotherapy training, which we call "The Apprenticeship Model." The Psychotherapy Scholars' Track, and "Apprenticeship Model" of training are now in their third year. To date, authors report that scholars are highly satisfied with the structure and curriculum in the track. Trainees appreciate the protected time for self-directed study, mentored scholarship, and psychotherapy rotations. Patients and the Psychotherapy Scholars experience the "Apprenticeship Model" of psychotherapy training as authentic and compatible with their needs and resources. The Psychotherapy Scholars' Track developed and piloted in our general psychiatry residency is based on common factors, empirically-supported treatments, and use of experiential learning principles. Whether the Psychotherapy Scholars' Track and "Apprenticeship Model" will ultimately increase residents' psychotherapy skills and positively affect their ability to sustain postgraduate psychotherapy practice in varied settings requires long-term evaluation. The developers welcome empirical testing of the comparative effectiveness of this psychotherapy teaching approach relative to others.

Innovations in simulated and technology-aided learning for core psychiatric trainees in psychotherapy

A training need to help core trainees prepare for the psychotherapy long case was identified. We prepared and showed a training DVD to all core psychiatric trainees at South West London and St Georges Mental Health NHS trust. A questionnaire was designed to receive feedback from trainees. A total of 26 trainees participated. All trainees found the DVD informative. Most trainees found the DVD helpful in reducing their anxieties prior to taking on a long case. All trainees found the DVD accurately reflected their experience of psychotherapy and supervision. Using simulated and technology-aided learning material is a useful and economical way of introducing psychotherapy skills to core psychiatry trainees before the clinical supervised experience of a long case.

Casebook of Interpersonal Psychotherapyedited by MarkowitzJohn C. and WeissmanMyrna M.. New York, Oxford University Press, 2012, 504 pp., $55.00 (paper).

Casebook of Interpersonal Psychotherapyedited by MarkowitzJohn C. and WeissmanMyrna M.. New York, Oxford University Press, 2012, 504 pp., $55.00 (paper).

Using Motivational Interviewing to Meet Core Competencies in Psychiatric Resident Training

the authors propose that motivational interviewing (MI), a brief intervention designed to manage ambivalence regarding complex behavior change, is well suited for integration into psychiatric residency training programs. the authors provide a brief description of MI. In addition, based on a review of the literature the authors explore which core competencies the empirically validated, client-centered, and directive method of MI would address. the authors argue that psychiatric residency programs can effectively address several core competencies through the addition of MI training in their curricula, including Brief Psychotherapy, Patient Care, and Interpersonal and Communication Skills. the implementation of MI training offers psychiatric residency programs potential benefits in several key areas. However, the authors provide guidance for important research questions to more confidently ascertain whether MI training for psychiatric residents is worthwhile.

Mental Health across Cultures – A Practical Guide for Health Professionals

This guide for all health professionals provides a model for working in mental health across cultures, and outlines practical ways of using psychotherapy skills across cultures.

Insights about Psychotherapy Training and Curricular Sequencing: Portal of Discovery

The authors discuss the curricular implications of a research project originally designed to evaluate the instructional strategy of using standardized patients in a psychotherapy training seminar. The original project included second-year residents enrolled in an introductory psychotherapy seminar that employed sequential meetings with standardized patients. Residents were videotaped at baseline and at 6 week intervals; these sessions were rated by outside raters, standardized patients, and the residents themselves using two rating scales designed to assess psychotherapy skill. Results of the ratings were used to assess whether the instructional strategy was effective in teaching psychotherapy. Data were analyzed for group and individual effects. Results of unpaired t tests revealed that as a group resident performance did not improve. Individual effects were examined using regression analysis of individual learning plots. This analysis revealed that residents differed widely in their individual responses to this instructional technique. These results precipitated a realization about the curriculum. Despite initial disappointment about the apparent limitations of the technique, thoughtful analysis prompted a reinterpretation that led to residency curriculum modification.

Understanding, respecting and integrating difference in therapeutic practice

The purpose of this paper is to promote thought and discussion around how and why we treat patients in chosen ways. In the present climate practitioners are required to treat patients following NICE guidelines in which cognitive behavioural therapy (CBT) is the treatment of choice in the majority of diagnoses. This paper raises concerns that this may lead to an homogenization of treatment, loss of invaluable skills and understanding from other treatment approaches, and loss to the patient who may be best cared for by a combination of treatments and approaches, most notably patients presenting with complex pathology. This paper aims to present this as a general principle, and by way of example, will focus on coupling two specific treatment orientations, cognitive behavioural therapy with psychodynamic psychotherapy, with the specific diagnosis of obsessive compulsive disorder (OCD). Methods: Clinical material is drawn from case studies from practice in secondary adult mental health care services within the NHS. All patients were referred to the psychological services for treatment for OCD and provided with 1:1 therapy with UKCP‐registered therapists. Details have been anonymized by describing fictitious cases re‐constructed from clinical material. A theoretical understanding is included which provides both an overview for integrating treatment for the specific example of OCD and is intended by extension to other diagnoses. Results: Working with the commonalities of therapeutic approaches, and integrating specific skills of CBT and psychodynamic psychotherapy, appears to offer a viable mode of treatment for cases resistant to single‐orientation therapies. Conclusions: Coupling the skills of different therapies can be effective in treating complex patients that are referred to the secondary mental health services. Conversely, restricting practice to single orientation therapies can lead to an impoverished care for patients and diminution of invaluable therapeutic skills which may become underused, undervalued and lost in the practice of mental health care within the NHS. Acknowledgement of the skills of others, valuing these and learning from each other can help to avoid the defensive reactions of practitioners, where each may defensively retreat to their corners of specialism. Respecting and sharing skills from different orientations, and acknowledging this in the NICE guidelines, is good for both mental health services and patient care and addresses the concerns raised by practitioners exemplified by Bateman (2000, p. 147) that ‘psychotherapy continues to be bedeviled by ideological schisms with practitioners apparently ignoring alternative conceptualizations and potentially superior interventions’.

Keeping the Psyche in Psychiatry: Eight Years Later

My first column as editor of this journal’s psychotherapy columns declared my prime objective in taking on the task: “Keeping the Psyche in Psychiatry.” 1,2 I am concerned about the practice by psychiatrists of well founded forms of psychotherapy in all psychiatric settings. I am a senior psychiatrist and psychoanalyst in private practice with a longstanding involvement in medical education and in professional organizations. To counterbalance my own perspective, I have often tried to write in more general terms than my own psychodynamic orientation. Invited guest columnists have written from the perspective of other schools of psychotherapy as well as other professional environments. Of course, I have not been alone in this quest. Numerous psychiatrists in leadership positions—from widely varying practice settings and all parts of the country, as well as academic psychiatrists and even some leaders in managed care—have expressed their concern about the fading role of psychotherapy and the decreasing interest in the patient’s personal narrative 3 in psychiatric practice. They lament the decline of the psychotherapy skill set in many recentlytrained psychiatrists. In my initial column, I highlighted the American Psychiatric Association’s Commission on Psychotherapy by Psychiatrists (COPP), of which I had been chair. COPP is now a committee of the same name reporting to the Council on Quality Care. It comments frequently on psychotherapy issues, writes or revises position statements, reviews practice guidelines, contributes to the design of psychiatric practice surveys, makes presentations at scientific meetings of the American Psychiatric Association, and has completed a paper differentiating the common, often supportive denominators of psychotherapies and their divergence into distinctively psychodynamic and cognitive-behavioral methodologies. COPP continues to be a respected voice for psychotherapy by psychiatrists in the American Psychiatric Association. However, it is only one of many forces at work to advance the cause. Now, almost 8 years later, what has been accomplished? In the past year, several major, longstanding efforts have come to fruition with beneficial implications for psychotherapy by psychiatrists. On the down side, a recent study shows that the trend continues for psychiatrists to provide psychotherapy for a smaller proportion of their patients, with more psychiatrists doing no psychotherapy at all. The well-rounded psychiatrist skilled in the full armamentarium of treatments is still an endangered species. Like the proverbial three-legged stool, the viability of psychotherapy by psychiatrists rests on the complex interaction of three bases—scientific support, availability of training, and financial reimbursement. However, in the new healthcare environment, a fourth leg is equally essential—privacy.

The Benefits of Using Psychotherapy Skills Following Treatment for Depression: An Examination of “Afterwork” and a Test of the Skills Hypothesis in Older Adults

It has long been assumed that one of the reasons clients maintain improvement after psychotherapy is that they learn skills during the course of therapy and continue to apply them once therapy has ended. While research on homework completion and psychotherapy outcome provides support for this assumption, there has been no direct examination of “afterwork,” the use of skills learned in therapy after therapy has ended, or how those posttherapy skills differ across different theoretical approaches. The purpose of this study is to test a skills hypothesis of long-term psychotherapeutic benefit in a sample of 90 older adults who have completed psychotherapy for depression. Helpfulness of the techniques learned in therapy was negatively associated with depressive symptoms up to 2 years after treatment. The number of techniques used was positively correlated with depressive symptoms within 6 months of treatment once helpfulness was controlled, indicating that skills learned in therapy are used when symptoms return. There were also between-group differences in which skills were reported to be covered and used by patients after therapy ended. These findings support the expectation that the benefits of therapy are extended by continuing to use helpful skills learned in therapy.

Counseling and psychotherapy skills training for family physicians.

In many healthcare systems, family physicians are the primary source of direct care for patients with mental health problems in the community, yet family physicians are not often routinely or adequately trained to conduct counseling or psychotherapy. The current study conducted a 5-weekend yearlong, hands-on, interactive, intensive training of family physicians in the skills of officebased counseling/psychotherapy. Fifty-five family physicians took the course over 4 different years. Outcomes were analyzed with 3 major measures and collected at baseline, the end of the course, and 6 months later. Based on an ability to answer a skill-testing questionnaire called the Carkhuff Discrimination Skills Index, all the family physician participants significantly improved their counseling skills by the end of the course and about half continued to improve 6 months later. Participants showed significant improvement in their confidence counseling individuals, couples, and families. Participants also indicated they significantly increased the time they spent in counseling individual patients as a result of the course. Implications for future research on primary care training programs in psychological therapy are discussed.

Building the Foundation

The teaching alliance, defined as the “explicit contract between teacher and learner,” is a fundamental dimension of all education and of particular importance in psychiatric and psychotherapy education. However, it is an often neglected concept in medical education and even, somewhat surprisingly so, in the psychiatric educational literature. The fine article by Ursano, Kartheiser, and Ursano in this volume of Psychiatry calls attention to this fundamental component of the relationship between learner and teacher in an important and useful way. The authors draw an analogy between the teaching alliance and the therapeutic alliance. The latter is an enduring concept which continues to be addressed as an important and “measurable psychotherapy skill” (Summers & Barber, 2003) of fundamental clinical importance for psychiatrists to acquire. Analogously, developing and maintaining the teaching alliance is a pedagogic skill that psychiatric educators must attain. In this commentary, I will call attention to how the teaching alliance in educational activities can be influenced by not only “transference issues” familiar to psychiatrists, but also the “Hidden Curriculum” of educational relationships (Haidet & Stein, 2006) which is an implicit, but powerfully important factor in educational settings. Haidet and others describing the hidden curriculum contend that the totality of what educators “do” in the learning environment creates an educational atmosphere that influences educational relationships like the teaching alliance in a manner analogous to how the therapeutic alliance can be influenced (for better and worse) by transference phenomena (Lazaratou et al., 2006).

Teaching Clinical Competence

This Commentary is written from my experience as a teacher of Emily Liu in a graduate clinical psychology course focusing on the training of psychotherapy skills. Liu took the class simultaneous to seeing the case of TC, and she utilized the class to develop her approach to the case, including conceptualization and formulation; the processing of her emotional, "countertransferential" reactions to the client; the devising of intervention strategies with the client; reflection upon the process; and writing about the case. These processes are reviewed in the context of the course and issues raised by the nature of the case material itself. A synergistic overlap is reviewed among (a) the skills taught in the course, (b) an emerging national consensus on core clinical skills developed at the 2002 Scottsdale "competency conference," and (c) the competencies required to function in Peterson's "disciplined inquiry" paradigm, which is the model underlying the structure of the case studies in this PCSP journal. It is this overlap which provided to Liu very targeted and effective preparation in graduate school for the development of her impressive case study in this journal.

Drop-In Supervisor Critical in Psychotherapy Training

Back to table of contents Previous article Next article Education & TrainingFull AccessDrop-In Supervisor Critical in Psychotherapy TrainingMark MoranMark MoranSearch for more papers by this authorPublished Online:20 Apr 2007https://doi.org/10.1176/pn.42.8.0018aA system for assessing residents' competency in psychotherapy that includes direct supervision of psychotherapy sessions by faculty appears to be promising, according to psychiatry faculty at the University of Wisconsin School of Medicine and Public Health.At a poster session at last month's meeting of the American Association of Directors of Psychiatric Residency Training in San Juan, Puerto Rico, psychiatry training director Art Walaszek, M.D., presented preliminary results of a comprehensive system for assessing psychotherapy competence.That system includes direct faculty observation of resident performance, measurement of patient outcomes using rating scales and satisfaction surveys, and a “capstone” experience that tests the ability of residents to develop and present a comprehensive psychotherapy formulation and outcome.In an interview with Psychiatric News, Walaszek said faculty observation involves a “drop-in” visit by supervising faculty typically in the middle of a 50-minute session and usually for about 10 minutes.“The resident can use that as a time to consult with the faculty supervisor right there in the session, with the patient included as a partner,” Walaszek said. “The supervisor can directly observe and provide feedback on the resident's psychotherapy skills.”He said the practice of drop-in supervision has been in place at the University of Wisconsin for at least five years— though the formal assessment system was not instituted until 2005—and that he believes patients, residents, and faculty are now acculturated to the idea. “We train people early on that this is part of what we do here,” he said.Walaszek said that a survey of patients and residents conducted by colleague Pauline Thome, Ph.D., indicated that the practice of drop-in supervision is not only tolerated but also appreciated.“Patients were the most open to it and the least likely to see it as detrimental” among those surveyed, he told Psychiatric News.“ My speculation is that patients appreciate the fact that there is a team involved in their care and that the team is available.”Walaszek acknowledged the practice is controversial in some quarters, but said he believes it may come to be more widely practiced as training programs struggle with how to assess psychotherapy competence.After a period of orientation of faculty and residents, the Psychotherapy Competency Assessment Plan was instituted in July 2005 for PGY-2 residents. The second iteration began in July 2006 for PGY-2 and PGY-3 residents.As part of building a portfolio of psychotherapy cases, residents were asked to administer rating scales to patients at the start and end of therapy and at several interim points. The rating scales include at least one measure of symptoms (depending on each patient's diagnosis) and a global measure (typically the Global Assessment of Functioning). At the end of therapy, patients complete a patient satisfaction survey, developed internally.Finally, residents are required to develop and present a comprehensive“ capstone” formulation of one psychotherapy case and a description of the course of therapy. A faculty member evaluates each presentation using a locally designed assessment tool.Outcome data from the patient rating scales were not available at the time of the poster session presentation, but Walaszek said the quality of first-year “capstone” case formulations surpassed faculty expectations and that residents seemed to find the sessions enjoyable and informative as well.“We are seeing the residents more rapidly getting an understanding of what we expect from them, and that in turn is resulting in more rapid mastery and confidence on the part of residents,” Walaszek said. “I am looking forward to expanding this further and being able to say with some reliability that residents have seen a certain number of patients and can perform the necessary skills.“Residents are also using patient outcome measures in a way that puts us in line with what the rest of medicine is doing and with what is going to be expected from psychiatrists in the future,” he continued. “I think it helps us know that we are delivering services that help people in a measurable way.” ▪ ISSUES NewArchived

My Life in Testing

This autobiographical essay describes my career as a psychodiagnostician, which began at the City College of New York in 1941 and ended in the late 1970s when I became a full-time psychoanalyst in Manhattan. As a green, 20-year-old psychology undergraduate, I was picked by Gardner Murphy to assist David Rapaport at the Menninger Clinic in Topeka, Kansas, who was developing new methods for using psychological tests to diagnose and treat soldiers during World War II. Our findings were presented in the classic, two volume work, Diagnostic Psychological Testing, published in 1945–1946 (Rapaport, Gill, & Schafer, 1945–1946; 1968), to which I added two clinically enriched monographs: The Clinical Application of Psychological Tests, published in 1948 (Schafer, 1948/1995), and Psychoanalytic Interpretation in Rorschach Testing (Schafer, 1954), published in 1954. After the Menninger Clinic, I continued to hone my assessment expertise at the Austen Riggs Center and Yale University, but I also sought opportunities to develop psychotherapy skills. I completed psychoanalytic training in 1960 at the Western New England Institute for Psychoanalysis and thereafter sought positions that would offer more time for treating patients. A notable highpoint in my testing career was assessing Jack Ruby, killer of Lee Harvey Oswald. I look back fondly at my years as an assessment psychologist, which produced nearly 4 decades of great memories.

Janet Tolan: Skills in Person-Centred Counselling and Psychotherapy.

Janet Tolan: Skills in Person-Centred Counselling and Psychotherapy.

Psychotherapy skills in the real world⇓

Basic psychotherapy skills can be extremely useful in a doctor9s everyday practice, says <b>Julie Sladden</b>. Here she outlines some of the different types and explains how you can put them to use

Skills in Gestalt Counselling and Psychotherapy

Skills in Gestalt Counselling and Psychotherapy