Psychotherapy Training Program Research Articles

Living the Language of Psychotherapy: How Therapists Use Their Experiences from Being Patients

Personal therapy is a requirement in several psychotherapy-training programs, and more than 80% of therapists have been psychotherapy patients. No quantitative evidence of the effects on their patients’ outcomes has been presented. However, qualitative studies and expert experiences highlight the value of therapists having been patients themselves. To investigate this further, we used in-depth qualitative methods to explore the experiences of eight early career psychologists. For our data collection, the participants wrote reflexive notes on two occasions, and met for a full day of focus groups. The notes and transcriptions of the focus groups were analyzed from the perspective of reflexive hermeneutic phenomenology. In all, the therapists had been patients in 19 courses of various psychotherapies. The core experiential themes were: (1) their own suffering had been for real; (2) ambivalence of sharing vulnerability; (3) the significance of experiencing theoretical concepts – the language of psychotherapy – in real life; (4) dealing with shame; (5) the need to know that therapists may become so important that the patient can easily be hurt; and (6) the therapist became an inner model that the patient could use. The therapists seemed to use their psychotherapy experiences in their personal development and professional lives. Therapists may have a unique opportunity to benefit from psychotherapy due to the language they have acquired for sharing experiences with their therapists.

Meaning-centered psychotherapy training program for cancer care clinicians: Efficacy and impact of the first 5 years.

Meaning-Centered Psychotherapy (MCP) is a manualized, evidence-based intervention designed to help cancer patients to find meaning and alleviate distress. Meaning-Centered Psychotherapy Training (MCPT) is a multicomponent program for cancer care clinicians that consists of didactics, group experiential learning, and role-plays with simulated patients to learn MCP and acquire skills to deliver it in real-world oncology settings. The efficacy and impact of MCPT for multidisciplinary cancer care clinicians to learn and disseminate MCP is described and evaluated. A multilevel evaluation based on the RE-AIM framework was utilized to assess the efficacy of the MCPT program over the initial 5 years of the program. The outcomes of the evaluation supported MCPT goals. Three hundred forty-two participants attended MCPT. Overall satisfaction measured in the post-training assessment was high. Significant increases in MCP skills were demonstrated by participants over the course of the role-play sessions, and participants showed significant improvements in pre/post-training MCP knowledge assessment scores, as well as significant increases in self-reported overall MCP skills and core competencies. Follow-up survey responses indicate that MCP trainees were utilizing MCP, had made changes to their clinical practice, and progressed on individual implementation goals. During the first 5 years, the MCPT program was successfully developed, established, implemented, and shown to be effective in the dissemination of MCP across the RE-AIM domains. Future directions for training and implementation research include increasing diversity of providers and investigating the impact of the program on patient outcomes.

A 21st Century Principle-Based Training Approach to Psychotherapy: A Contribution to the Momentum of Transtheoretical Work.

Despite the finding that the majority of psychotherapists adopt a rather process-oriented and integrative stance, it is uncommon that psychotherapy trainings are transtheoretical and transdiagnostic. Considering principles of change that cut across different schools of therapy holds promise for developing truly research-informed psychotherapy trainings. Common principles of change may answer the question what should be trained. Another important question is how to train. In current psychotherapy training programs, transfer of theory into practice relies mainly on role-playing exercises and supervised practice, both of which have their limitations. A fantasy for the future would be the development, implementation, and evaluation of a complementary 21st century online principle-based and marker-led psychotherapy training: incorporating the concepts of deliberate practice as well as expert training, the huge potential of technologies, and considering the importance of (context) responsiveness. To illustrate this idea, we present a training that we are currently developing, an online Alliance-Focused Training.

Engaging Minds: Toward Developing Psychoanalytic Candidates

ABSTRACT The future and vibrancy of psychoanalysis rests on increasing the accessibility to training for early career clinicians. By recognizing and addressing the numerous barriers to the immersive experience of psychoanalytic training, we can foster strong candidate groups. This paper recounts one institute’s process of creating multiple points of access and substantive mentorship for new clinicians, aiming to nurture involvement over time with institute members and its professional offerings. Valuing both individual developmental trajectories and attracting diverse applicants across disciplines while attending to the significant obstacles many potential trainees face, generated increased interest and matriculation in both psychotherapy and psychoanalytic training programs.

Learning Outcomes of e-Learning in Psychotherapy Training and Comparison With Conventional Training Methods: Systematic Review.

Mental disorders pose a major public health problem in most western countries. The demand for services for common mental health disorders has been on the rise despite the widespread accessibility of medication. Especially, the supply and demand for evidence-based psychotherapy do not align. Large-scale increase of modern psychotherapy is difficult with current methods of training which are often expensive, time consuming, and dependent on a small number of top-level professionals as trainers. E-learning has been proposed to enhance psychotherapy training accessibility, quality, and scalability. This systematic review aims to provide an overview of the current evidence regarding e-learning in psychotherapy training. In particular, the review examines the usability, acceptability, and learning outcomes associated with e-learning. Learning outcomes are assessed in different modalities including trainee experiences, knowledge acquisition, skill acquisition, and application of trained content in daily practice. Furthermore, the equivalence of web-based training and conventional training methods is evaluated. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search from Ovid, MEDLINE, PsycINFO, and Scopus databases between 2008 and June 2022 was conducted. Inclusion criteria required studies to describe e-learning systems for psychotherapy training and assess acceptability, feasibility, or learning outcomes. The risk of bias was evaluated for both randomized and nonrandomized studies. Learning outcomes were categorized using the Kirkpatrick model. Effect sizes comparing e-learning and traditional methods were calculated. The search yielded 3380 publications, of which 34 fulfilled the inclusion criteria. Positive learning outcomes are generally associated with various e-learning programs in psychotherapy training including trainee satisfaction, knowledge, and skill acquisition, and in application of trained content in clinical practice. Learning outcomes generally show equivalence between e-learning and conventional training methods. The overall effect size, indicating this disparity, was 0.01, suggesting no significant difference. This literature displays a high level of heterogeneity in e-learning solutions and assessment methods. e-Learning seems to have good potential to enhance psychotherapy training by increasing access, scalability, and cost-effectiveness while maintaining quality in terms of learning outcomes. Results are congruent with findings related to e-learning in health education in general where e-learning as a pedagogy is linked to an opportunity to carry out learner-centric practices. Recommendations for conducting psychotherapy training programs in blended settings supported by activating learning methods are presented. However, due to the heterogeneity and limitations in the existing literature, further research is necessary to replicate these findings and to establish global standards for e-learning, as well as for the assessment of training outcomes in psychotherapy education. Research is especially needed on the effects of training on patient outcomes and optimal ways to combine e-learning and conventional training methods in blended learning settings.

Who are the skilled therapists? Associations between personal characteristics and interpersonal skills of future psychotherapists

ABSTRACT Objective Facilitative interpersonal skills (FIS) are a promising variable to explain the so-called therapist effect. We aimed to investigate associations between observer-rated interpersonal skills and self-reported personal characteristics of future therapists. Method In this cross-sectional observational study, psychology students and trainee therapists completed self-report personality and sociodemographic questionnaires as well as the FIS Performance Task (German version, observer-rated). Mixed multilevel model analysis was conducted with FIS total mean score (mean value of 312 individual ratings [13 video-clips, 8 FIS-items, 3 raters]) as dependent variable, therapist ID and FIS clip ID as random effects and 15 therapist variables as fixed effects. Results In the present sample consisting of 177 participants (age: M = 29.8 years (SD = 7.3), [18,59]; 79.1% female, 20.9% male) greater therapists’ experience level, male gender and lower levels of alexithymia were predictive for higher FIS score when statistically controlling for other therapist variables in the model. Age, self-reported childhood maltreatment, attachment style, emotion regulation and self-concept variables turned out to be unrelated. Conclusion The results can inform psychotherapy training programs. They specifically support the importance of addressing therapists’ potential difficulties in recognizing and verbalizing emotions. This is in line with theoretical literature on alliance ruptures and premises of the Alliance-focused training.

CHOOSING SUPERVISORS IN PSYCHOTHERAPY TRAINING

This study started from the observation that after completing training in a therapeutic orientation, some trainees turn to other supervisors, with a background in other therapeutic orientation and registered with other training providers. The supervisee has the right to choose the supervisor, and the supervisor has the right to accept or not to sign the supervision contract, but without discrimination based on gender, race, religion, etc. However, on the market of psychotherapy training programs, one can observe situations when future supervisees look for a supervisor from another training school/ institutions, not wanting to continue supervision within the same institution, where they trained to become psychotherapists. Thus, the interest turns towards finding out what are the reasons standing at the basis of these situations in Romania. Another interest turns towards identifying what possibilities has training provider at hand to increase the quality of its training programs.

Intimate and sexual feelings in psychotherapy: educational topic or still taboo?

Background Intimate and sexual feelings are common within psychotherapy, with negative outcomes when not managed adequately. Aims This study aims to investigate the understudied topic of these intimate and sexual feelings in basic education and psychotherapy training programs. Method In this convergent mixed method study, both a survey (N = 786) and 8 focus groups (N = 36) were conducted among psychotherapists in Flanders, Belgium (November 2016 – June 2018), using inferential and thematic analyses respectively. Results The majority indicates that dealing with intimate and sexual feelings towards clients was hardly part of either their basic education or psychotherapy training. Talking about such feelings with peers or supervisors remained difficult because of concerns about being judged. Therapists indicating this topic was addressed in some way in their training indicated more often that they did not perceive it as a taboo topic. Therapists advocated a more open discussion and reflection on this topic. Education and training, as well as support from renowned key figures in their field, were regarded as important incentives to initiate change. Conclusion Psychotherapy training should focus on how to deal with intimate and sexual feelings, referring to introspection and exploration of these feelings in a more integrated way during training.

Transformative Moments in an Online China Child Therapy Teaching Journey

ABSTRACT Over the past 25 years, the International Psychotherapy Institute (IPI) faculty has been honing its technique for distance learning by listening for unconscious themes emerging in the classroom that resonate with learning resistances or teaching concepts. This coauthored paper describes an online, child and adolescent psychoanalytic psychotherapy training program coordinated by IPI and Jiandanxinli, offered by Western faculty to Chinese psychotherapists-in-training. An IPI child analytic faculty member collaborated with two Chinese course participants to study the cross-cultural meanings of teaching, presenting, and consulting. This independent research project unearthed new understandings about the challenges, strengths, and limitations of online, translation-dependent learning. Additionally, the article underscores the importance of embracing an ethical stance and cultural humility when teaching child therapy to students from different cultures.

Perceived professional development of Chinese psychotherapy trainees: a pilot study

For more than 30 years counselling and psychotherapy services in China have progressed rapidly. Currently, various Chinese universities, hospitals, official mental health centres, and private mental health service organizations provide psychotherapy training programs. However, little is known about Chinese psychotherapy trainees and their development. This pilot study investigated the characteristics and perceived professional development of 20 Chinese trainees during and after an advanced training program for psychosomatic medicine and psychotherapy, which is a collaboration project between Peking Union Medical College Hospital and the Department of Psychosomatic Medicine and Psychotherapy from the University Medical Center Freiburg in Germany. Trainees completed questionnaires from the SPRISTAD (Society for Psychotherapy Research Interest Section on Therapist Training and Development) study at the beginning (T1), at the end (T2), and one year after finishing the program (T3). Seventeen of the twenty participants were clinicians. Trainees reported a prominent rise of Currently Experienced Growth throughout the training period, which nearly dropped to the baseline level after the training, although Retrospective Career Development showed a trend of an overall increase. Both ‘experience in therapy with patients’ and ‘participation in courses or seminars’ were the most important positively perceived sources of influence on trainees’ development. This implies the importance of continuous psychotherapy training for the development of therapists during their career. Future research with a larger sample size should also assess trainees’ development from the viewpoint of trainers, supervisors, and patients.

Changes in reflexivity during existential supervision

ABSTRACT The goal of the current study was to uncover and describe the phenomenon of changes in reflexivity during existential supervision. We analyzed interviews with four female existential psychotherapy trainees utilizing Interpretative Phenomenological Analysis. The data yielded three themes: (1) The supervisory relationship: a basis for changes in reflexivity, (2) The influence of the nature of the supervisor’s presence and interventions used for expression of reflexivity, and (3) Changes in reflexivity: a subjective experience of internal transformations. Findings suggest supervision educators should be cognizant of the nature of the supervisory relationship and the supervisor’s presence and specific interventions used in supervision to enhance supervisee reflexivity. These findings add to an in-depth understanding of the supervision process and inform psychotherapy and supervision training programs aimed at improving trainee reflexivity.

Utilisation of a Collaborative Research Methodology for a Critical Realist Inquiry Into the Feasibility of Knowledge Evolution in the Academy and the Production of Interdisciplinary Practical Knowledge

An inquiry into the feasibility of practical knowledge evolution in the academy, was conducted in collaboration by a Gynecologist-Obstetrician and two experienced psychotherapists. For thirteen years, the latter were Ed.D candidates at Derby University, UK, and due to impediments imposed by the institution, they were compelled to undertake many bureaucratic procedures. Working in collaboration, the team developed strategy, composed texts, and constructed a comprehensive chronological timeline of events, documented in correspondence between the doctoral candidates, University staff and supervisory authorities. The physician enrolled on the candidates’ psychotherapy training program, and being interested in the practical, theoretical and methodological considerations of their research, reviewed the candidates’ academic texts. Through dialog, the team produced practical knowledge in the interdisciplinary field of Psycho-Gynecology, and workshops on physician-patient communication, presented at three formal proceedings. The research demonstrated the practical importance of interdisciplinary research, and work in this ‘trialogic’ framework, facilitated elucidation of methodological understandings related to the evolution of practical knowledge. However, introducing innovative practical knowledge into the British academy remains a challenge.

Observing infants together: long-term experiences of observers and families

ABSTRACT Infant observation is a key component of many psychotherapy and psychoanalysis training programs. Observers and families have described the intensity of this unique experience. However, there has been limited investigation of the subsequent experiences of infant observation on observers and on families who had taken part. In the present study, the experiences of observers and families several years following the infant observation period were investigated. We recruited a total of 10 participants, consisting of 7 observers (mean age 53.7 years) and 3 parents (mean age 51.7 years). The length of time since the infant observation was an average of 10.0 years (range 2–16 years). Semi-structured interviews were conducted, and the overarching themes and subthemes were explored using thematic analysis. Both observers and families were able to vividly reflect on the infant observation period. All participants reported developing their observation and reflective skills, which observers who work as psychotherapists described as being crucial to their current practices. Participants keenly felt the loss during the observation period, with some parents feeling a more unresolved loss. In summary, the experience remains present and impactful for both observers and parents for years following the infant observation period.

Provider perspectives of implementation of an evidence-based insomnia treatment in Veterans Affairs (VA) primary care: barriers, existing strategies, and future directions

BackgroundCognitive behavioral therapy for insomnia (CBT-I) is a highly effective nonpharmacological intervention that is widely considered the gold standard for insomnia treatment. Insomnia is a prevalent and debilitating public health concern. Up to one third of the general population struggles with chronic insomnia, greatly increasing the risk for chronic pain and inflammation, depression and suicide, and cognitive decline. Over the last 10 years, the Veterans Health Administration (VHA) evidence-based psychotherapy training program has trained nearly 1000 providers to deliver CBT-I in hospitals and clinics nationwide. Despite increased access, most patients with insomnia receive sleeping medications instead of CBT-I. This is particularly concerning for vulnerable populations, like older adults, who may be at increased risk of harms from medications. The goal of this study was to obtain a broad range of perspectives on CBT-I implementation from providers who commonly utilize and deliver CBT-I. This work identifies barriers and successful strategies used to overcome these barriers to guide future implementation efforts promoting evidence-based sleep care.MethodsSemi-structured interviews, using the Consolidated Framework for Implementation Research (CFIR) as a guide, were conducted with 17 providers from five Veterans Affairs (VA) facilities (8 primary care physicians, 4 primary care psychologists, and 5 CBT-I coordinators). We used a thematic analysis approach in which common ideas were identified across interviews and then grouped into larger conceptual themes. Data were concurrently collected and analyzed with rapid assessment process (RAP) techniques.ResultsFindings suggested implementation barriers and facilitators related to the CFIR constructs of intervention characteristic (e.g., providers unfamiliar with primary evidence of CBT-I effectiveness), inner setting (e.g., sleep as a low relative priority in primary care), and outer setting (e.g., lack of external incentives for increasing CBT-I use), as well as several successful strategies, including use of local champions and supportive opinion leaders.ConclusionsThese findings suggest promising opportunities to improve implementation of CBT-I, especially at facilities with less well-established CBT-I programs. Formal implementation trials are needed to systematically determine the real-world impact of strategies such as enlisting CBT-I champions, informing opinion leaders about CBT-I services, and promoting network weaving among primary care, mental health, and sleep clinics.

Descriptions and Reflections on the Cognitive Apprenticeship Model of Psychotherapy Training & Supervision.

This paper offers a detailed description of a Cognitive Apprenticeship Model for psychotherapy training and supervision. This form of training has been utilized in a novel psychotherapy training program developed for psychiatric trainees, enrolled in a specialized psychotherapy scholars track, embedded in an adult psychiatric residency training program. The paper offers new elaborations of the model, reflections on the apprenticeship supervision and implementation, and clinical lessons learned. The four dimensions of this model include: (1) acquisition of psychotherapy content knowledge; (2) an application of the Cognitive Apprenticeship Model of Supervision, utilizing modeling, coaching, scaffolding, articulation, reflection and exploration as essential aids in structuring a live, real-time supervisory experience; (3) sequencing of clinical psychotherapy training activities; and (4) use of situated learning and communities of practice, as important components of psychotherapy training. The article also discusses an apprentice method of psychotherapy supervision including the intake, working through, and termination phases, Barriers impeding apprenticeship supervision and implementation, and reflections on participant experiences are discussed. This approach may be valuable to others considering the development or evolution of psychotherapy training programs for psychiatrists, psychologists, social workers, or other mental health professionals.

Psychotherapy training for psychiatrists in European countries

Psychotherapy training is a crucial component of psychiatric education across European countries. We present an overview of the training programs offered to psychiatrists in European countries. The focus is on the different approaches, duration, and requirements for psychotherapy training across Europe. The training programs range from shorter, more focused courses to longer, in-depth programs that encompass a range of therapeutic modalities. The requirements for entry into these programs, as well as the standards of assessment, vary from country to country. In addition, there are differences in the types of therapy that are emphasized, with some countries prioritizing psychodynamic approaches and others emphasizing cognitive-behavioral therapies. This review also explores the challenges facing psychotherapy training programs in Europe, including the need to adapt to new technologies and changing healthcare systems. Overall, this review aims to provide an insight into the current state of psychotherapy training for psychiatrists in European countries.

“The remainder of your practicum training has been terminated”: a unique challenge faced by trainees during the COVID-19 pandemic

ABSTRACT The Coronavirus (COVID-19) pandemic has posed many unprecedented challenges to psychotherapists, as many clinics swiftly moved to providing services remotely or needed to close temporarily. While some practica were able to offer trainees the option to provide telehealth, some made the difficult decision to terminate psychotherapy training programs for the remainder of the academic year, or longer. This decision has had numerous implications for and impacts on students, such as concern over development of clinical and counseling skills, intervention and assessment hours, and uncertain effects on clients. These concerns are discussed from the perspective of a trainee, and several therapy-relevant resources and ways of managing are also highlighted.

Psychotherapy at a public hospital in the time of COVID-19: telehealth and implications for practice

ABSTRACT As the crisis of global pandemic continues to unfold and alter the everyday workings of public life, early trends in the impact on mental healthcare treatment at a safety-net hospital illuminate implications for clinical work in the public sector under unprecedented conditions and beyond. While there are many important areas to consider and research to come, the current paper will explore the impact of the COVID-19 crisis on attendance of psychotherapy sessions. The authors point to early evidence from their caseloads in an outpatient psychodynamic psychotherapy training program showing a statistically significant decrease in missed appointments upon switching, in crisis, to a telehealth model. In this paper we explore possible reasons for this decrease in missed appointments, including psychological reasons (such as increased need for connection) and logistical reasons (such as eliminating barriers to attendance). Finally, we point to considerations and implications for practice during and after the crisis of the pandemic has subsided, and consider ways in which the changing approach may, in effect, increase access and remove barriers to care that pre-date our current crisis.

The Psychoanalytic Education of CAPA Graduates

ABSTRACTThe CAPA Psychodynamic Psychotherapy Training Program and the evolution of Internet videoconferencing applications have inspired and enabled graduates of its advanced program to seek distance psychoanalytic training, mainly in approved institutes of the American Psychoanalytic Association. Two forms of training, Formal Distance Programs and Distance Accommodation, are described. Distance analytic training presents technical and pedagogical challenges to institutes and to their faculty. Some of the objections to distance education that hamper participation by essential faculty are presented. These issues are discussed and remedies are suggested. With experience, these challenges can be addressed and the training experience becomes satisfying for faculty as well as students. The candidates themselves, in two letters, describe their positive experiences in simultaneous training. A sample of clinical work brought to supervision by a distance candidate in the early years of training is presented to give some sense of the aptitude for psychoanalytic work that exists among distance candidates. Some preliminary thoughts about the variations in the psychoanalytic processes are raised and will need to be supplemented by further experience.

Key factors in psychotherapy training: an analysis of trainers', trainees' and psychotherapists' points of view.

The literature on clinical training lacks identifications of the factors that are most relevant in training programs; accordingly, the main aim of this work is to fill this research gap by assessing which factors that trainers, trainees and psychotherapists consider most relevant in psychotherapy training programs. A secondary aim is to identify whether these factors differ among trainers, trainees and psychotherapists. An ad hoc questionnaire was created and administered at 24 psychotherapy schools from 14 institutions; the sample included 641 trainees, 172 trainers and 218 psychotherapists of various theoretical orientations. The questionnaire included 63 items and used a 5-point Likert scale. An exploratory factor analysis was completed to identify the latent structure. The reliability of the dimensions was then checked. Finally, an analysis of variance and a multivariate analysis of variance were completed to achieve the study’s aims. Four factors emerged from the study’s results: trainers’ relational characteristics, supervision, transmission of clinical know-how, and theoretical background and technical support. All these factors displayed acceptable reliability and internal consistency. Moreover, their relative rankings varied based on the participants’ roles and theoretical backgrounds. This study’s results indicate that the new instrument’s psychometric qualities are acceptable. It thus could be used to develop a new approach to psychotherapy training, as this study’s results regarding trainees’ needs underline the differences between trainees’ perceptions of those needs, as compared to trainers’ and psychotherapists’ perceptions.