Psychotherapy Training Research Articles

Effects of deliberate practice and structured feedback in psychotherapy training (DeeP): a study protocol of a randomized-control-trial

BackgroundPsychotherapeutic competencies encompass a variety of skills that influence the work and therapeutic success of psychotherapists. In particular, interpersonal skills and the associated ability to react appropriately in complex therapy situations have already shown significant correlations with later therapeutic success. Strengthening interpersonal skills should therefore be a central aim of psychotherapy training. However, previous studies have shown that not only content learning is decisive for later learning success and skill development, but also the didactic method has a significant effect. Deliberate Practice and Structured Feedback have shown to be promising didactic tools. The primary objective of this study is to investigate the efficacy of Deliberate Practice and Structured Feedback as well as their combination in the context of psychotherapy training in comparison to classic didactic training. The trainees’ learning progress of interpersonal skills and its influence on subsequent outpatient therapies will be examined. Secondary, the study aims to identify further determinants of trainees’ therapeutic skills and to investigate the effects of ruptures on the course of therapy.MethodsThe underlying study, a randomized-control-trial with three intervention groups (Deliberate Practice, Structured Feedback, combination of both) and an active control group, will be conducted on a sample of N = 240 trainees and their patients (N = 1000). All trainees will each attend three consecutive workshops on “Strengthening therapeutic skills in challenging therapy situations”, which will be carried out using the corresponding didactic tool. Scientific assessments will take place online for the trainees (pre, in-between, post, follow-up) and for the patients (after each therapy session for 24 weeks, follow-up). Primary outcomes will be constituted by the trainees’ Facilitative Interpersonal Skills and the patients’ symptoms. Multilevel as well as structural equation modelling will be used to analyze the data.DiscussionThe study investigates the efficacy of different didactic tools regarding the strengthening of trainee’s interpersonal competencies as well as their effects on subsequent therapies. Results of this study address a research gap concerning the improvement of psychotherapy training as well as the quality assurance of future therapies.Trial registrationGerman Clinical Trial Register (DRKS) – DRKS00034279; retrospectively registered.

Clinical supervision based on video vs. verbal report: a randomized controlled trial

ABSTRACT Clinical supervision is considered important in psychotherapy training, but little is known about the efficacy of specific supervision methods. We investigate two such methods (video-based vs. verbal report-based supervision) in a randomized controlled trial. Seventy-three supervisees were trained in common cognitive-behavioral therapy methods (i.e. behavioral activation and cognitive restructuring) by means of written information and a modelling video demonstrating the techniques. Supervisees had to apply the techniques in role plays with standardized patients (presenting depressive patients). Subsequently, supervisees were randomized to supervision, based on the video, or supervision based on the verbal report of the supervisees. Subsequently and after a three-month follow-up period, supervisees had to demonstrate the therapeutic techniques again. Therapist competence, therapeutic alliance, empathy, and anxiety were assessed through various different perspectives (i.e. independent raters, standardized patients, and supervisees’ self-evaluation). Both supervision conditions lead to a significant improvement of therapeutic competences, therapeutic alliance, and empathy. No significant differences were found between the two supervision conditions. At three-month follow-up, training effects decreased on all perspectives except standardized patients. A training condition without supervision would be necessary to demonstrate that improvements are specific effects of the supervision conditions. Moreover, further supervision seems necessary to maintain training effects over time.

From Agency to Responsibility: Gestalt Therapy Trainees’ Experience of Engaging in Personal Therapy

Personal therapy is a common mandatory element of counseling and psychotherapy training in the United Kingdom. Previous research has established that this practice provides trainees with a unique learning space but also is associated with financial and emotional costs. Furthermore, some argue that the practice of personal therapy is ethically questionable. At the heart of many relational modalities, such as Gestalt psychotherapy, lies the relationship between client and therapist and more research is needed to explore how trainees perceive established training methods. The current study recruited 11 trainee Gestalt practitioners and conducted one-to-one semi-structured interviews to explore their experiences of engaging in personal therapy. A number of themes emerged in reflexive thematic analysis: trainees perceived personal therapy to be associated with professional and personal gains as well as financial and emotional costs; they also viewed personal therapy to be an essential component of their training but would like to be involved in discussions around how it is shaped. We recommend that training providers and professional bodies offer such a dialogic space, and that future research and practice further considers the barriers of minority clients and trainees in particular.

Explaining Transtheoretical Therapist Training using Alliance-Focused Training as an Example

Although most psychotherapists adopt an integrative and process-oriented approach, transtheoretical approaches to psychotherapy training are rare. To better prepare future therapists for the complexities of clinical practice, such an approach is needed. A promising way forward is to consider principles of change that cut across different schools of therapy. The principle of the therapeutic alliance is where different therapy schools agree most. Therefore, an alliance-focused training is presented below, where therapists learn to recognize ruptures in the therapeutic alliance and respond to them with resolution strategies. Current teaching methods like role-playing and supervision have their limitations, as they can only be applied post hoc and to a small number of cases. A new approach could be an online training that integrates principles of change, such as the alliance and markers for interventions, utilizes proven methods of deliberate practice and expert training, and makes use of the potential of technology.

Effects of cognitive training and group psychotherapy on cognitive performance of post COVID-19 patients: an exploratory and non-randomized clinical trial

Cognitive complaints are common signs of the Post COVID-19 (PC) condition, but the extent and type of cognitive impairment may be heterogeneous. Little is known about neuropsychological treatment options. Preliminary evidence suggests cognitive symptoms may improve with cognitive training and naturally over time. In this clinical trial, we examined whether participation in a weekly group consisting of cognitive training and group psychotherapy is feasible and would exert beneficial effects on cognitive performance in PC and whether improvements were associated with intervention group participation or represented a temporal improvement effect during syndrome progression. 15 PC patients underwent an 8-week intervention. Cognitive performance was assessed before and after each intervention group participation. A control group of 15 PC patients with subjective neurocognitive or psychiatric complaints underwent two cognitive assessments with comparable time intervals without group participation. To attribute changes to the intervention group participation, interaction effects of group participation and time were checked for significance. This is an exploratory, non-randomized, non-blinded controlled clinical trial. Within the intervention group, significant improvements were found for most cognitive measures. However, significant time x group interactions were only detected in some dimensions of verbal memory and visuo-spatial construction skills. Significant time effects were observed for attention, concentration, memory, executive functions, and processing speed. The intervention setting was feasible and rated as helpful and relevant by the patients. Our results suggest that cognitive symptoms of PC patients may improve over time. Patients affected by both neurocognitive impairments and mental disorders benefit from group psychotherapy and neurocognitive training. The present study provides evidence for a better understanding of the dynamic symptomatology of PC and might help to develop further studies addressing possible therapy designs. The main limitations of this exploratory feasibility trial are the small sample size as well as the non-randomized design due to the clinical setting.

The Role of Safety in Change-Promoting Therapeutic Relationships: An Integrative Relational Approach.

The significance of the psychotherapeutic relationship in promoting psychotherapeutic change is widely recognized. In this paper, we contribute to the relational orientation of psychotherapy through a transtheoretical exploration of safety. We aimed to identify and integrate those relational and change-promoting principles and aspects of safety that are school-independent. We conducted an overview and synthesis of the clinical-theoretical and empirical literature that we believe has significantly addressed the role of safety in regulating change-promoting therapeutic relationships. The relational and change-promoting aspects of safety form a dynamic system involving the therapist, the client, and the relationship. These interact, influence each other, and perform multiple homeostatic functions: they allow to resist change, assimilate small changes that do not disrupt the client's way of functioning, regulate major changes that disrupt and alter the client's way of functioning, and regulate adjustments in the way the therapist and client work together. From an integrative-relational perspective, a safe therapist is a precondition for co-creating a safe environment. This establishes trust and fosters an affective bond that provides additional sources of safety for the therapeutic relationship and the client. To promote change, however, the relational aspects of safety need to be fine-tuned (calibrated and personalized) for each therapy in terms of intensity, duration, timing, scope, and sources, accommodating developmental, individual, and situational differences. Crucially, the safety of the therapist, the client, and the relationship must be neither perfect, steady, or static, but rather safe enough, adaptive, and dynamic, leaving space not only for self-discovery and self-awareness but also for the co-regulation of tolerable frustrations, disappointments, and insecurities that facilitate the client's resilience and adaptation. Focusing on school-independent, safety-based relational principles and understanding how they evolve and adapt over time and across circumstances can make a significant contribution to the current relational orientation in psychotherapy. This has important implications for psychotherapy practice, training, and research.

Therapy in turmoil: Russian psychotherapists navigate war and ethics

This ethnographic study explores how Russian psychotherapists are navigating professional ethics and politics after Russia's invasion of Ukraine in 2022. Analysing a conversation between an instructor and students at a psychotherapy training centre in Russia, the study examines how therapists negotiate neutrality, values and therapeutic approaches in a shifting sociopolitical landscape. The author identifies four approaches to delineating the boundaries between professional practice and political engagement and explores how the boundaries between therapeutic and political realms are constantly negotiated through social interaction. These processes highlight tensions within Russian therapeutic culture and offer insights into professional subjectivity formation amid political turmoil, revealing the complex interplay between individual subjectivity, professional identity and sociopolitical structures in contemporary societies. The research contributes to anthropological understandings of professional communities as mediators between individuals and states. The study also shows how cultural norms adapt to political pressures and illuminates the role of therapeutic practices in shaping societal responses to political events in authoritarian settings.

Something has sort of opened up for me: psychology students' reflections after participating in an apprenticeship training model.

Typically, psychotherapy training comprises of didactic approaches and clinical practice under supervision, with students rarely having the opportunity to observe other therapists' work in real time. Many trades and professions employ apprenticeship to teach new skills. However, it is rarely employed in psychotherapist training. This qualitative study was part of a pilot study that developed and tested the feasibility of an apprenticeship model to be used in psychotherapy training, and investigated how students experienced such training. Ten first-year clinical psychology students joined experienced therapists as observers and/or co-therapists. Each student attended up to 8 therapy sessions with different therapists/patients. The students wrote reflective log entries after each session. In sum, 66 log entries were collected and analyzed with reflective thematic analysis. Five themes were generated, reflecting how the students changed their perspectives from an internal focus to an increasingly external focus: Being informed by emotions, What sort of therapist will I become? Shifting focus from me to the other, The unpredictable nature of therapy, and Growing confidence in therapeutic change. The students gained insights into the dynamic nature of therapy, therapists' responsiveness, and how internal and external foci of attention inform the therapeutic work. Such tacit knowledge is difficult to convey via didactic methods and might receive limited attention in clinical programs. Apprenticeship training is a promising supplement to traditional training.

Shaping psychotherapy trainees' potential: insights from training program directors.

The role of the therapist has received growing attention in psychotherapy research, suggesting that training effectiveness may also depend on the person of the trainees, with relevant implications in terms of candidate selection or tailoring training to the person. In the present study, we focused on how and how much psychotherapy training can be effective in fostering trainees' characteristics associated with successful therapists and contrast trainees' characteristics that could represent limitations as therapists. The aim was to explore training program directors' perspectives on individual trainees' limitations and strengths, and on the effectiveness of training in shaping successful therapists. To this aim, we interviewed 14 training program directors with different psychotherapy approaches. Audio recordings of these semi-structured interviews were transcribed verbatim and analysed using NVivo software. According to our findings, transversally to different psychotherapy approaches, trainees' self-awareness and the ability to embrace uncertainty were recognized as the main characteristics of good trainees. Four training elements were fre- quently mentioned by directors as effective in shaping trainees' development: experiential learning, the use of paradigm that pri- oritizes self-awareness (instead of technique-focused approaches), the centrality of supervision and inter-vision, the trainer-trainee relationship. These insights highlight the importance of trainees' self-awareness and the ability to embrace uncertainty as potential personal variables that may influence the effectiveness of future psychotherapists and suggest giving attention to experiential learning and training relationships as crucial elements of psychotherapists' development during the training.

Measuring psychotherapist functioning with the Therapist Work Involvement Scales (TWIS): reliability, factor structure, and measurement invariance

Objectives The Therapist Work Involvement Scales (TWIS) is a self-report research instrument that enables a multilayered description of psychotherapists’ experiences when treating clients. The TWIS was created in a comprehensive study of close to 5,000 psychotherapists, and has been used in multiple studies. The aim of the current paper is to clarify the organization and statistical characteristics of the TWIS, and to present an updated version for longitudinal and cross-sectional research. Methods Collection of a large sample of psychotherapy trainees made possible the use of confirmatory factor analysis (CFA) to evaluate the dimensions and structure of therapists’ process experiences, assessing reliabilities, measurement invariance over gender, item statistics, and correlations with other measures to show concurrent and predictive validity. Results The CFAs largely confirmed the factor structure of four of the five facets, and of the global super-factors. The global factors of Healing Involvement and Stressful Involvement each showed substantial correlations with therapists’ attachment style and professional growth, and were used to describe four practice patterns that typify the experiences of therapists. Conclusion The results have shown the TWIS to be a statistically sound, multidimensional research instrument enabling therapists to describe their experience in current therapeutic work.

Advancing a cultural–historical activity perspective in a psychodynamic-oriented psychotherapy training programme

South Africa cannot ignore the far-reaching influence of its colonial and apartheid history on the psychological functioning of its people. Psychotherapy as a fundamental psychological intervention approach cannot ignore its evolving history as the architect of the social psyche and of an individual’s psychological functioning. With regards to psychodynamic psychotherapy, the literature has lamented this therapeutic approach’s lack of consideration of the impact of the colonial and apartheid historical trauma on the prevailing sociocultural and mental health challenges. The crux of this article is to address this epistemological lacuna, by arguing for the integration of psychodynamic theory with cultural-historical activity theory (CHAT) for application in therapeutic processes. The article further posits that this integration needs to be introduced in training programmes for student psychotherapists who, as in the case of South Africa, are themselves the descendants of the generation that was exposed to historical trauma of colonialism and apartheid and are living with latent transgenerational trauma. To create a suitable foundation for the integration of psychodynamic theory and CHAT in psychotherapeutic practice, there is a need to apply critical pedagogical strategies in the training programmes of psychotherapists. Thus, this article further highlights the possibilities of employing critical pedagogical principles that incorporate ontological reflection, pedagogic discomfort, troubled knowledges, mutual vulnerability, strategic empathy, and compassion.

The ‘four selves’ framework for facilitating personal and professional development (PPD) in qualifying‐level systemic psychotherapy training

AbstractPersonal and Professional Development (PPD) has been long considered a central component of counselling and psychotherapy training. Key literature in respect of PPD approaches for psychotherapy training is reviewed, and the scant literature specifically relating to systemic psychotherapy noted. The ‘Four Selves’ PPD Framework, developed in Northern Ireland by the lead author as part of qualifying‐level Systemic Psychotherapy training, is presented, including its diagrammatic representation, constituent elements and an illustrative example. This is followed by guidance from the PPD tutor (lead author) based on her experience of utilising the Framework to facilitate tailored PPD sessions across the two‐year clinical Masters programme aimed at enhancing trainee self‐reflexivity, supplemented by feedback on the ‘model‐in‐practice’ from a recent cohort of students. The article concludes by encouraging readers to consider the applicability of The ‘Four Selves’ PPD Framework to their own psychotherapy training contexts.

Structurally informed psychodynamic theory case conceptualization: Expanding the conceptualization map.

There is a rich history of psychological movements that call upon the field to collaborate with clients to both acknowledge and resist oppression, as well as an increasing emphasis in professional guidelines on conceptualizing clients with attention to the role of the social and physical environment, to contemporary experience with power, privilege, and oppression, and to institutional barriers and related disparities. These calls indicate the need for psychological case conceptualization to move beyond preconceived assessments of which aspects of clients' identities are salient to them, to engage with clients' sociocultural identities as situated within systems of power and oppression, and to engage in advocacy to improve clients' socioenvironmental contexts and to challenge structural oppression. In this article, we attend to the foundational contributions of Black psychology, intersectionality, liberation psychology, Indigenous healing, and radical healing for using case conceptualization to guide structurally responsive and impactful treatment and advocacy. We then present a case example drawn from a composite of clinical encounters that captures client distress interwoven with structural forces such as addiction stigma, intersecting classism and sexism, White privilege, and caregiver leave policies. To demonstrate how to integrate structural forces with theory, we present how this case would be conceptualized utilizing psychodynamic frameworks infused with attention to the ways in which structural forces shape and perpetuate the client's distress. To move from naming to integrating structural competency in case conceptualization, psychotherapy training must address how structural forces shape how client distress develops and is maintained and necessitates advocacy outside of the session. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Mothers with a history of trauma and their children: a systematic review of treatment interventions.

Mothers with a history of trauma frequently face significant challenges in their relationships with their children. Therefore, it is crucial for trauma-exposed mothers and their young children to receive adequate trauma-informed treatment. This review aimed to examine the effects of trauma-informed interventions on improving the mother-child relationship among mothers with a history of trauma and their young children under 6 years old. The study analyzed 15 articles that met the eligibility criteria, encompassing a sample size of 1,321 mothers. The systematic GRADE approach was used to rate the certainty of evidence in this systematic review. The study found that while some interventions demonstrated small to large effects, the quality of evidence was only moderate. The most promising interventions were Parent-Child Interaction Therapy (PCIT), Child-Parent Psychotherapy (CPP), and Maternal Empowerment Program (MEP), which all included elements of psychotherapy, psychoeducation, and skills training. The study underscores the importance of understanding the needs of mother-child dyads affected by trauma and tailoring interventions to meet those needs. Overall, the literature suggests that interventions combining psychotherapeutic, psychoeducational, and skills-training components are most effective in improving mother and child-related outcomes for mothers with a history of trauma and their young children. The review provides recommendations for future research and emphasizes the importance of considering the mother-child relationship in trauma-informed interventions.

Pilot study of implementing Managing and Adapting Practice in a German psychotherapy master’s program

Despite a significant accumulation of research, there has been little systemic implementation of evidence-based practices (EBP) in youth mental health care. The fragmentation of the evidence base complicates implementation efforts. In light of this challenge, we sought to pilot a system that consolidates and coordinates the entire evidence base in a single direct service model (i.e., Managing and Adapting Practice; MAP) in the context of a legal reform of psychotherapy training in Germany. This pilot study aimed to evaluate the feasibility of the implementation of MAP into the curriculum of the reformed German master's program. Eligible participants were students in the master’s program at Philipps-University Marburg during the winter-term 2022/2023. Students first learned about MAP through introductions and role plays (seminar 1), followed by actively planning and conducting interventions using MAP resources for patients in a case seminar under supervision (seminar 2). A repeated-measures survey was conducted to investigate students’ knowledge gains, perception of MAP and changes in their self-rated confidence to use EBP. Results indicated that students perceive MAP to be manageable to learn. Positive progress was achieved with regard to their knowledge and self-reported confidence to use EBP, although interpretation and generalization of the results are limited by small and homogeneous samples, lack of statistical power and missing comparison groups. The feasibility of the implementation and suitability of measures are discussed. Important implications could be drawn with regard to future investigations.

BEST FOR CAN – bringing empirically supported treatments to children and adolescents after child abuse and neglect: update to the study protocol

ABSTRACT Background: The implementation trial BESTFORCAN aims to evaluate the dissemination of Trauma-Focused Behavioural Therapy (TF-CBT) for children and adolescents in Germany with posttraumatic stress symptoms (PTSS) after child abuse and neglect (CAN) with a focus on supervision. Objective: This update to the study protocol outlines changes made due to practical reasons in the course of the ongoing trial while maintaining methodological quality. Method: The amendments to the original study protocol comprise (1) a more refined operationalisation of the primary outcome sufficiently adherent TF-CBT therapy (SATT), (2) changes in the study sites and (3) additional inclusion of one post-gradual psychotherapy training institute. Discussion: The adaptions to the original study protocol ensured high methodological quality through the transparent presentation of protocol modification: ensuring the recruitment of participating psychotherapists in training by including a further post-gradual training institute as well as an adaption of the measurement of SATT with high external validity. The objectives, diagnostic set, and secondary outcomes remained unimpaired by the amendment. Therefore, we expect the trial to provide evidence for the effect of model-specific trauma-focused supervision on the implementation outcomes of TF-CBT as compared to supervision as usual. Trial registration: German Clinical Trials Register identifier: DRKS00020516..

Healing involvement and stressful involvement experienced by psychotherapy trainees: Patterns, correlates and perceived development

Healing involvement and stressful involvement experienced by psychotherapy trainees: Patterns, correlates and perceived development

Research‐informed counselling and psychotherapy: A training and accreditation agenda

AbstractTraining and accreditation standards play a critical role in the development of a research‐informed agenda. This commentary on Barkham et al. (Counselling and Psychotherapy Research, 2024) discusses obstacles to fully integrating research into the training and standard agendas, and the potential role that the British Association for Counselling and Psychotherapy (BACP) can play in helping to overcome such obstacles. Knowledge of research evidence is currently limited in training and accreditation standards for counselling and psychotherapy, and course tutors are often not familiar—or engaged—with research findings. In the development of professional standards (for instance, within SCoPEd), the BACP should work to ensure that research competencies are comprehensive, contemporary and explained in a granular manner. Further helpful developments might include an annual research‐oriented conference for trainers and clinical supervisors, a journal dedicated to disseminating research and good practice in training and clinical supervision and/or a training/clinical supervision research network to coordinate activities in these area. BACP events—across all elements of the profession—should strive to address issues of research awareness and participation, and the use of research to inform practice. Critically, across all of these possibilities, BACP's Research Department, alone, cannot be left to support moves to a research‐informed profession. Rather, an organisation‐wide initiative is needed in which appreciation of the research evidence is at the heart of all aspects of the Association's work.

Héctor Fernández-Álvarez (1944-2023).

This article memorializes Héctor Fernández-Álvarez (1944-2023). Héctor was an exceptional mentor, therapist, supervisor, professor, researcher, author, and leader, as well as a beloved brother, partner, father, and grandfather. The consummate renaissance person who embraced all manners of cultural expressions through an intentional wanderlust, he sought to understand all forms of human suffering and to alleviate senseless ones. Héctor's career spanned well over 5 decades. He received a licenciatura degree in 1967 from the University of Buenos Aires and a PhD in 1995 from the National University of San Luis, Argentina. Héctor held multiple academic appointments throughout Latin America and Spain. He authored over 100 journal articles or book chapters, and 16 books, including a novel, La Distancia (The Distance), and Fundamentals of an Integrated Model of Psychotherapy, one of the most respected psychotherapy books in Latin America and Spain. In 1977, Héctor challenged the constraints of a military dictatorship by founding Aiglé (the everlasting flame). Aiglé remains a nongovernmental organization that delivers clinical and community services and prepares mental health practitioners informed by an active research program that evaluates training and psychotherapeutic processes and outcomes. Over the years, Héctor advanced Aiglé as a practice-oriented research clinical setting to investigate psychotherapy as it unfolds in clinical practice. He developed an integrative model of care that resulted in Aiglé's cognitive-integrative model. Aiglé has grown to be a hallmark for research-based, leading-edge psychotherapy training in Latin America. Highlights of Héctor's career and professional contributions are noted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Addressing Challenges for Psychotherapy Supervision in Global Mental Health: Experiential Learnings From Rural Nepal.

As the field of global mental health grows, many psychotherapy trainees will work across cultures in low-resource settings in high-income countries or in low- and middle-income countries. Faculty members and mentors may face several challenges in providing supervision for psychologists in low-resource settings. As such, there is a need to develop best practices for psychotherapy supervision in global mental health. We describe the common challenges and potential strategies in psychotherapy supervision based on our research, clinical, and academic partnerships between academic institutions, a nonprofit organization, and the Nepali government. The strategies and considerations we have found helpful include focusing on therapies with strong behavioral and interpersonal (rather than emotional or cognitive) components and using locally validated therapies or standard manuals that have been endorsed by the WHO for low-resource settings. Other strategies include providing psychotherapy training for local psychiatrists who may be in supervisory roles and gaining competence in navigating different expectations of social structures and family dynamics. Supervisors face many challenges while supporting trainees and early psychologists in global mental health settings. While ensuring local adaptation, key considerations can be developed into best practices to support psychiatrists, supervisors, and trainees based in low- and middle-income countries.