Psychotherapy Training Program Research Articles

Vitalizing the Group—And Me

Emotional liveliness in a psychotherapy group can take various forms. Maintaining this liveliness can be a challenging task in a group, particularly when both the patients and the therapist face deeply rooted inhibitions, including fears about competition, being judged, and being destructive. The author of this paper, a candidate and group member in a postdoctoral group psychotherapy training program, recounts some of her experiences as the leader of a newly formed and developing group, particularly as they relate to her efforts to become and remain a “libidinal” (i.e., life or vital force) leader, despite the impact of the group members’ and her own anxieties. Clinical anecdotes and insights about the author’s own growth, both personally and professionally, as they relate to establishing and maintaining vitality are presented.

The experience of therapeutic change for psychologists preparing to become psychotherapists

The present study aims to reveal the experience of therapeutical change and importance of emotional, experiential learning for a future psychotherapist. There are two research questions: how do psychologists preparing to become psychotherapists experience and make sense of therapeutical change, and how do they experience and make sense of the group experience. The study is of qualitative nature using Interpretative Phenomenological Analysis (IPA) as a research method and Psychodrama group therapy as an intervention method. Findings show a clear progress towards a more authentic and stronger self. Personal therapy is recommended as an essential component of a psychotherapy training program.

Training Issues in Yoga Therapy and Mental Health Treatment

The field of yoga therapy is in the midst of a paradigm shift that will affect our education and clinical practice. Some yoga therapists are seeking additional professional training to work with special populations, while others prefer to conduct treatment in much the same way they have for decades. Some yoga therapists have chosen to align with IAYT's move toward accreditation, and perhaps to explore third-party reimbursement and licensure,while others elect to solidify their identity as "renegade"practitioners or educators. The fields of psychotherapy and psychiatry have also entered a period of transition. Many clinicians now acknowledge the body's integral role in transformation. Some have begun to study yoga or incorporate yogic interventions into treatment, while others choose to practice psychotherapy and support yoga therapy as a valuable adjunct treatment. Yoga has also made its way into psychotherapy training programs, and has become a hot topic at psychology conferences. IAYT's membership reflects this significant trend toward the integration of yoga and psychology. Of its nearly 3,000 members, 40%hold a medical license, and almost half those licenses are in mental health. The great wall between yoga therapy and mental health treatment is crumbling.

Integrating Neurobiological Findings Into Psychodynamic Psychotherapy Training and Practice

New knowledge regarding the neurobiology of human development has enormous implications for the field of psychotherapy. Recent discoveries confirm the existence of mirror neurons, explain the intersubjective neurobiology of affect regulation, highlight the role of implicit/procedural memory in attachment processes, and document the fact that gene-environment interactions structurally change the brain throughout life. Addressing the fact that psychotherapeutic techniques have lagged behind in incorporating these findings, this paper describes one method of integrating these neuroscience findings and their implications for treatment into a graduate psychotherapy training course. Basic principles of attachment theory and psychodynamic psychotherapy are evaluated in light of these new neuroscience data. In addition, interpersonal dynamics in the classroom can trigger instinctive neurological processes, especially when the subject matter is the impact of trauma in human lives. The students' potential for neurobiologically co-constructed learning experiences inform the lecturers' presentations of content and clinical material. For example, when employing photographic, auditory or video training materials involving trauma, the authors discuss techniques designed to help students maintain a self-regulatory state that keeps their prefrontal lobes and self-reflective capacities active despite the potential of traumatic material to trigger nonconscious, affective responses that can block thought. The authors' interactions with the students and with each other in the context of the course, contribute to students' nonconscious procedural knowledge, hopefully enriching the conscious, verbal, left hemisphere-dominant learning that is also taking place. In today's psychotherapy training program, the content and the context and the intersubjective experience are the message.

Creating coherence in real-life decision processes: Reasons, differentiation and consolidation

Differentiation and Consolidation Theory describes human decision making as a process in which attractiveness values are restructured in order to reach a decision and support the decision made. Here, the theory was developed to include reasons pro and con alternatives and tested on students making decisions between two university psychotherapy training programs (cognitive-behavioral and psychodynamic therapy). Before and also after the decision, the attractiveness of the chosen alternative was upgraded and the non-chosen alternative downgraded. Different measures of evaluations of an alternative, such as "best" or "worse" converged over time until shortly after the decision. The number of reasons pro and con alternatives give a more complete picture than attractiveness and increased from the first to the last session. The reasons supporting the chosen alternative increased in strength, but reasons against the non-chosen alternative decreased. In informal comments participants reported that the study also served as a decision aid.

So Where Do We Go from Here?

Binik and Meana’s (2009) article criticizes sex therapy as an institution and as a psychotherapy specialty, but these criticisms are not new. Many of us in the field have lamented about these problems (as well as few others that they did not mention) for years. There are serious problems with the field of sex therapy, including poor insurance reimbursement, essentially no money for research, difficulty with standardization, lack of an agreed-upon knowledge base, ‘‘media stars’’ diagnosing a ‘‘caller’’ after a few minutes on the air for the amusement of the audience, plus all the other problems that Binik and Meana identified. So far, the field and its practitioners do not have a remedial plan or even the collective will to create such a plan, which is quite unfortunate. I am going to let other sex therapists valiantly defend their turf and I will make a different point. What response did the authors expect? Did they think sex therapists would agree that sex therapy is a fraud, voluntarily disband their organizations, meekly offer abject apologies for misleading the public, or some other mea culpa? Is it possible they had another purpose? Why would Binik and Meana preach to sex therapists? Sex therapists really cannot change the situation; it is up to the general psychotherapists to take up Binik and Meana’s challenge. Sex therapists will continue to sit in their offices until those who need (or think they need) sex therapy stop making appointments. If general psychotherapists would just assume the care of these sexually troubled souls, sex therapy would wither and die. Why publish this article in a sexology journal and speak at sex therapy conferences? Binik and Meana should publish in general psychotherapy journals and speak at general psychotherapy conferences. A few papers in mainstream psychotherapy journals explaining how easily cognitivebehavior therapy, psychodynamic, or other therapeutic approaches can treat sexual concerns will set the stage. The authors can demystify sex therapy, expose all our tricks (maybe even the secret handshake), and nip those referrals in the bud. If there is nothing special about sex therapy, all the well-trained psychotherapist needs to do is read a couple of articles or attend a lecture or two. Once the sex therapist is unmasked as a fake, the general therapist will have a new source of clients and the sex therapy institutions will crumble as all unused relics do. Those papers and presentations will give Binik and Meana the needed platform to urge the professors at psychotherapy training programs to demand all basic psychotherapy textbooks cover sex therapy. The faculties of these programs decide which textbooks to use and the publishers want to please them; if they demanded that the textbooks cover sex therapy, they would. Binik and Meana are excellent writers and respected scholars; they can even write the needed chapters. I hope they have more success than the rest of us who have tried to interest these editors in sex therapy chapters previously. It has been the editors—not the sex therapists— who have refused to consider these chapters in the past. Binik and Meana should not bemoan the lack of a Sex Therapy Division at the American Psychological Association—they should start one. I am sure that many sex therapists, some of whom are also card-carrying psychologists, would be interested. It also would generate increased interest among general psychologists about sex therapy and its practice. Or could it be that the psychologists just have not been interested? C. Moser (&) Department of Sexual Medicine, Institute for Advanced Study of Human Sexuality, 45 Castro Street, #125, San Francisco, CA 94114, USA e-mail: Docx2@ix.netcom.com

A University Psychotherapy Training Program in a Psychiatric Hospital: 25 Years of the Conversational Model in the Treatment of Patients with Borderline Personality Disorder

The aim of this paper is to describe the development, delivery and experience of a university psychotherapy training program for psychiatry trainees in a public psychiatric hospital, demonstrating that patients with severe borderline personality disorder can be treated successfully with psychodynamic psychotherapy and stressing the need for structured psychodynamic psychotherapy training in psychiatry. Two of the authors (JH and JS) were part of the first group of eight trainees supervised by Professor Russell Meares and several other experienced psychiatrists. Ninety trainees have successfully completed the course. Two hundred and forty patients have been treated by trainees in this program to date; 49 patients have dropped out. The training program provided a sound psychodynamic base and an improved capacity to relate with our patients, not only in the program but also in our routine work as psychiatrists. An important public health issue and community need was addressed, which also proved to make sound economic sense as the number of patients who were treated might not have otherwise received long-term psychotherapy. An integrated process model of psychoanalytic psychotherapy--the conversational model--has evolved and continues to be offered as a 3-year part-time clinically oriented course leading to a Masters in Medicine, Psychotherapy at the University of Sydney. Several outcome studies and papers have been published and workshops have been presented both in Australia and overseas. The patients improved considerably--their self harming behaviour stopped within 6 months and they were no longer clinically depressed at the end of 1 year.

Ethics in Psychotherapy and Counseling

Ethics is a critical issue in every helping profession, in which the clients—patients—are in trouble and seeking help. This is especially the case in psychotherapy, for which the focus of intervention is targeting the most internal, sometimes hidden and intimate world of an individual. Since its first edition (1991),1 Ethics in Psychotherapy and Counseling: A Practical Guide has served as one of the most comprehensive texts providing practical guidance regarding ethical behavior for therapists and counselors. The book insightfully highlights the ethical values of respect, responsibility, integrity, confidentiality, competence, and concern in detail. It helps clinicians to be thoughtful about ethical principles, potential challenges, and dilemmas as well as about getting appropriate training and supervision that can help them better navigate these challenging waters. The strength of the current edition is that it deeply discusses the competence of a human therapist as well as the critical thinking on how to create strategies for self-care and—in general—how to help without hurting. It puts the codes and complaints into historical and empirical context and guides clinicians in how to respond to ethics, licensing, and malpractice complaints. The issues of beginnings and endings in therapy, absences and accessibility, and the use of informed consent are also explored in detail. One of the most important parts is the guidance on how to respond to suicidal risk and how to recognize the early warning signs when a supervisory consultation is required. Boundary issues and sexual relationships with clients are also very important aspects of ethical behavior discussed in the text. Although it is striking that the majority of disciplinary actions taken against practitioners by licensing boards are due to sexual misconduct, and civil suits against a therapist for incompetence account for only a minority of all claims, I have the impression that the issue of sexual misconduct is overwhelmingly discussed here and that the disproportionately large amount of discussion of the topic rather reflects the authors' research interest. Sexual abuse of clients is just the tip of the iceberg, but the vast majority of the ethical issues related to incompetence and other hurts usually and probably do not reach the threshold of legal claims. Although ethical principles and guidelines are common in all forms of psychotherapy, some fine tuning, distinction, and focus on special features would have been useful; e.g., detailed discussion of individual versus group therapy and of behavioral versus dynamic approaches could have highlighted the important aspects of ethical behavior related to the applied psychotherapy approach per se. Case vignettes or case reports also could have been helpful to illustrate the practical issues of some complex situations, especially since this is a “practical guide.” For those who would like to read extensive case studies that provide illustrative guidance on a wide variety of topics in ethics, I would recommend Gerald Koocher and Patricia Keith-Spiegel's Ethics in Psychology: Professional Standards and Cases.2 The appendices of Ethics of Psychotherapy and Counseling contain useful codes of conduct and ethical principles for psychologists as well as guidelines for ethical counseling in a managed care environment, all prepared by the American Psychological Association and Canadian Psychological Association. Although this book was probably intended to be used globally, and the ethical principles are general in every culture, comparisons of the different cultural environments and the codes and guidelines of ethics created by many respective associations in the field are slightly lacking. The text is easily readable, engaging the attention even for outsiders. I definitely recommended it for every practicing clinician, psychotherapy training program, primary care physician, residency program, and psychology course, and it is even worth reading by patients to increase their awareness of what they can expect if they meet a professional, ethical therapist.

Intensive Psychotherapy Training in Korean Psychiatric Residency Programs

ObjectiveThe authors investigated the current practice of intensive psychotherapy by residents in the department of psychiatry.MethodsWe mailed a questionnaire to 126 fourth-year psychiatry residents in order to obtain data on their clients' sociodemographic characteristics, the settings in which psychotherapy is being conducted, the effects of psychotherapy, the difficulties associated with psychotherapy, the state of supervision and the level of clients' satisfaction.ResultsApproximately 51.5% of the residents completed the questionnaires. The average number of clients was 4.9±3.8, the average number of psychotherapy sessions was 26.2±20.1, and 69.4% of the residents had performed insight-oriented psychotherapy. Approximately 69.8% of the fourth-year residents had received some form of supervision, and 58.7% agreed to increase the frequency of supervision. Approximately 74.2% of the cases were supervised. The average number of supervisions per case was 9.2±10.5.ConclusionThe setting in which psychotherapy is conducted, number of clients, and type of supervision varied greatly among the training institutes surveyed. Based on these findings, we expect to create better psychotherapy training programs for psychiatric residents.

Teaching Psychotherapy Mindfully

Teaching Psychotherapy MindfullyJon FredericksonJon FredericksonCo-Chair of the Intensive Short-Term Psychotherapy Training Program at the Washington School of Psychiatry.Search for more papers by this authorPublished Online:October 2007https://doi.org/10.1521/psyc.2007.70.3.242PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Volume 70Issue 3Oct 2007 Information© Guilford Publications Inc.PDF download

Empathic relational bonds and personal agency in psychotherapy: Implications for psychotherapy supervision, practice, and research.

Although psychotherapy researchers have become increasingly interested in identifying common factors that contribute to effective therapeutic practices, across psycho-diagnostic categories and treatment approaches, relatively little attention to date has been focused on the impact of these research findings for psychotherapy supervision and training programs. To address this gap, in this article we describe key components of an integrative psychotherapy supervision and training program that focuses on the development of a strong therapeutic alliance as an empirically supported, common principle of change in psychotherapy. We review empirical research evidence that addresses the contributions of therapist empathic engagement for the development of secure, relational bonds, heightened client agency, and the development of strong therapeutic alliances, and we discuss the implications of these findings for therapy practice and supervision training. We conclude with specific recommendations for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Assessing and predicting supervisors' evaluations of psychotherapists – an empirical study

Objective: The aim of this study was to analyze the dimensions used by supervisors to evaluate trainee therapists and to detect how supervisors' assessments are influenced by features of the case and of the therapist. Method: Data from 226 patients with diverse mental and social disorders who had been treated by 22 trainee therapists under the supervision of 12 supervisors were analyzed by factor- and regression analyses. Supervision was implemented as part of a psychotherapy training program. After treatment, each supervisor was asked to evaluate the trainee by using a list of 38 items proposed by Kanfer, Reinecker and Schmelzer (1996). Case characteristics and therapists' features were assessed by questionnaires and checklists and related to the supervisors' evaluations. Results: The statistical analyses indicated that supervisors could not easily integrate the multitude of relevant aspects into a differentiated schema of evaluation. A two-factor model best fitted the data. The two factors focus on specific aspects of therapeutic behavior. The evaluations were mainly related to the experience of the trainee therapist and to therapy outcome. For trainee therapists with more experience, the standards of comparison were set higher resulting in less positive evaluations. Discussion: The results are discussed with reference to a process-oriented view of supervision and therapist evaluation. It was concluded that supervisors of behavior therapy seem to weight therapist-related and case-related information differently. However, the way supervisors integrate these types of information into evaluations of trainee therapists still remains rather vague.

Residency Provides Antidote to Decline In Psychotherapy Training

Back to table of contents Previous article Next article Education & TrainingFull AccessResidency Provides Antidote to Decline In Psychotherapy TrainingEve BenderEve BenderSearch for more papers by this authorPublished Online:7 May 2004https://doi.org/10.1176/pn.39.9.0034aPriyanthy Weerasekera, M.D., developed a psychotherapy training program in which all psychiatry residents must learn how to conduct seven types of evidence-based psychotherapy.For years, psychiatry residency programs have been “behind the times” in teaching residents how to conduct a variety of evidence-based psychotherapies, according to Priyanthy Weerasekera, M.D., M.Ed., an assistant professor of psychiatry and behavioural neurosciences and coordinator of the postgraduate psychotherapy training program at McMaster University in Ontario, Canada.Weerasekera spoke about the importance of psychotherapy training for residents at the seminar “Scholarly Activity in Psychotherapy Training,” held in conjunction with the annual meeting of the American Association of Directors of Psychiatric Residency Training in New Orleans in March (Original article: see story above).“Until the last couple of years, residency training guidelines were not based on what the evidence was telling us,” she noted. Many psychiatrists, including herself, were trained to conduct just one type of psychotherapy, such as psychodynamic psychotherapy.In January 2001, the Residency Review Committee in Psychiatry (RRC) of the Accreditation Council for Graduate Medical Education began requiring residents to demonstrate competency in brief psychotherapy, cognitive-behavioral therapy, combined psychotherapy and psychopharmacology, psychodynamic therapy, and supportive psychotherapy.But some Canadian residents were already ahead of the game. In 1995, six years before the RRC issued those requirements in the United States, Weerasekera developed McMaster’s postgraduate psychotherapy training program “to instill in residents the skills they need to make the best treatment decisions for their patients” by enabling them to conduct different types of evidence-based psychotherapies with a variety of patients.The program includes seven mandatory psychotherapy modules, which residents complete by the end of the four-year program: client centered, cognitive-behavioral therapy (CBT) for depression, CBT for anxiety, interpersonal therapy for depression, long-term dynamic psychotherapy for interpersonal problems, couples and family therapy, and group therapy.Residents also learn the importance of establishing a therapeutic alliance with patients, regardless of what type of therapy they are conducting, and how to integrate pharmacotherapy with psychotherapy, Weerasekera said. Many of the specific therapeutic skills are taught by manuals, which “operationalize treatment and enhance patient outcomes,” she added.As they learn the skills necessary to conduct the different psychotherapies, residents “are assessed in a standardized, objective manner,” she noted. For instance, most of the residents’ individual therapy sessions are audiotaped, and family and couples therapy is videotaped.The tapes are then reviewed by a faculty member, who uses a rating scale to evaluate the resident’s performance and gauge the level and quality of the patient’s improvement between the first and last few sessions of psychotherapy, Weerasekera said.In their fourth year of training, residents learn what Weerasekera calls the “multiperspective formulation model,” which teaches residents how to integrate the different types of psychotherapy they’ve learned and perhaps use several different approaches with one particular patient.“For me,” Weerasekera said, “the most rewarding thing has been to see that residents can learn these interventions and offer them to patients as part of their treatment.”Information about McMaster University’s postgraduate psychotherapy training program is posted online at www.fhs.mcmaster.ca. ▪ ISSUES NewArchived

Learning Psychotherapy

Article AbstractFrom our regular book review column. Learning Psychotherapy, along with its companion volume, Learning Psychotherapy: Seminar Leader's Manual, is the text/workbook for the psychotherapy training program commonly known as the "Missouri Modules." Dr. Beitman is Professor and Chairman of the Department of Psychiatry and Neurology at the University of Missouri-Columbia. Dr. Yue, of China Medical University in Shenyang, China, collaborated for the purpose of developing a psychotherapy training program for China. She is currently a resident in psychiatry at the University of Missouri-Columbia. The Modules have received rapid acceptance by a number of training programs in the United States and abroad, including Vanderbilt, where I am residency training director and course leader. This review is therefore written by one who has attended a "Train the Trainers" seminar, taught the course in its entirety once, and is about to begin a second year of teaching the course to psychiatric residents.

A new psychotherapy training program : description and preliminary results.

Psychotherapy training programs require a uniform introduction to psychotherapy that presents the basic, generic concepts common to the major schools in a time-efficient manner. The program described in this article fits these criteria. The program has been initiated at seven residency training programs in the United States. The authors describe the six modules comprising the program-verbal response modes and intentions, working alliance, inducing patterns, change, resistance, and transference and countertransference. The authors also report preliminary results of the program evaluation (N = 15) from the University of Missouri-Columbia. By using a well-researched measure of trainee self-confidence as psychotherapist (The Counselor Self-Estimate Inventory), the authors report a statistically significant increase in trainee self-confidence beginning and maintained after Module 4. The authors conclude that this training shows promise as a standard introduction to psychotherapy for psychiatric residents.

Clinical training: challenges for a new millennium.

It is a challenging and intimidating task to comment on the thoughts of several prominent leaders in the field of psychotherapy research and training. For many years I have turned to their scholarly writings for guidance, insight, and understanding. I have also urged my students to read their articles and books, to attend their presentations, and to listen carefully to the reports of these experts about the state of psychotherapy. In the present context Drs. Watkins and Guarnaccia have invited this impressive group of experts to offer their views on the direction in which psychotherapy training is moving and the particular implications of these trends for psychotherapy educators and training programs. To paraphrase the once popular television commercials about an American investment company, "When Levenson, Strupp, Mahrer, Boulet, and Beutler talk, people listen." When thinkers of this stature share their wisdom, I listen carefully, and I urge my colleagues who are involved in psychotherapy training to do the same. In my brief comments, I will discuss some of the challenges that we educators face and attempt to offer some recommendations that are based, in part, on the views of these contributors.

Group Supervision Meets Technology: A Model for Computer-Mediated Group Training at a Distance

ABSTRACTTechnological advances make the application of computer-mediated communication a supervision tool for group psychotherapy training when students and faculty are at a distance. A brief review of the literature on computer-mediated group dynamics provides the context for training applications. A model group psychotherapy training program that combines face-to-face and computer-mediated group supervision is described and clinical training examples are presented. Recommendations and guidelines for using computer-mediated supervision are proposed.

How to Practice Brief Dynamic Psychotherapy: The Core Conflictual Relationship Theme Method

HOWARD E. BOOK, M.D., D.PSYCH.: How to Practice Brief Dynamic Psychotherapy: Conflictual Relationship Method. American Psychological Association, Washington, DC, 1997, 181 pp., $39.95, ISBN 1-55798-46-54. Dr. Book is psychoanalytically oriented. Seeing the increasing demands for psychotherapy from clients and for cost containment from third-party payers, he turned to investigating the brief psychodynamic psychotherapies and adopted the wellknown time-limited approach developed by Luborsky, identified as The Conflictual Relationship Method, that seems to bring not only symptom relief but some significant characterological change as well. This work by Book serves as fine introduction to this mode of doing brief psychotherapy, as Luborsky himself recognizes in the Foreword. Book helped establish Brief Psychodynamic Psychotherapy Training Program at the University of Toronto. He is Coordinator of Brief Psychotherapy Training for psychiatry residents and Director of the Post-Graduate Training Program in brief psychodynamic psychotherapy at the Clarke Institute of Psychiatry in Toronto. He has private practice where he does brief and long-term psychotherapy and supervises therapists. His dedication and skill as teacher are evident in his structuring of this book, which he correctly describes as a user-friendly, readable, clinically focused presentation of this method. In an Introduction and Part I, he uses clinical vignettes to sketch out the strengths and weaknesses of brief approaches, the inclusion and exclusion criteria for the selection of suitable patients, the particular countertransference issues that emerge, and the use of supportive and expressive techniques derived from all dynamic therapies that are applied in particular blend tailored to this mode of treatment. Following Luborsky, he demonstrates techniques that help guide patients into portraying their symptoms and distress within the context of specific interactions or relationship they have had with others. He demonstrates how therapists can scan for overarching within these episodes and then bundle them together, while using an experience near attentiveness rather than psychodynamic oriented one, to discover that the themes often share fundamental Core Conflictual Relationship Theme that defines precisely the circumscribed area of maladaptive interpersonal functioning that is most problematic for each patient and on which then the time-limited therapy can most fruitfully focus. Part II is detailed case study of Book's evaluation, 16 treatment visits, and follow-up interview of woman client who had severe problems by being excessively compliant. He provides essential details of the client's and of his own communications. He comments on why he said what he said and how he concludes that what he said was successful or not. Laying himself out quite openly, he demonstrates his confidence and enthusiasm for this method and in the success of this particular treatment course. And indeed the patient felt she had been helped. psychoanalytic ear of some readers may find that things are overall bit too pat and wrapped up so neatly that the full range of complex processes embedded within the interactions between him and his client are not fully captured. Shortcuts can be treacherous. Yet, this material is instructive just because of this. For the work demands of each reader to probe on his or her own for what is really going on between these two. For example Book proposed the time-limited therapy contract in dialogue that went as follows (pp. …

Supervision in Psychotherapy: An Educational Experiment in Integrative Metalearning

This article describes the background, setting, and realization of an educational experiment in a professional three-year psychotherapy training program. It suggests a model for psychotherapy supervision using integrative metalearning. The high degree of involvement and activity, the equality in the supervision situation, and the focus on contact-making and self-reflection were perceived as being transferred from the supervision to the psychotherapy situation with clients. These factors were also acknowledged as crucial to the effectiveness of the metalearning situation. The positive outcome of this experiment serves as a basis for continuing with supervision from an integrative metalearning perspective.

The impact of Managed Care on the Therapeutic Identity of Psychotherapists

Abstract Managed care has had a iremendous impact on the practice and profession of psychotherapy. However, the policies and procedures of managed care often conflict with the fundamental principles of psychotherapy. This, of course, causes dilemmas for psychotherapists at the level of practice, but it also creates internal psychological conflict in psychotherapists. The source of this conflict is the disparity between the demands of contemporary practice and the internalized value system of the psychotherapist (i.e., therapeutic identity). Typical ways in which psychotherapists resolve this dilemma arc considered. Furthermore, implications for psychotherapy training programs are discussed.