Training Psychiatry Residents in Psychotherapy: The Role of Manualized Treatments

The Past, Present, and Future of Psychotherapy Manuals: Protocol for a Scoping Review

BACKGROUND

Psychotherapy manuals are critical to the dissemination of psychotherapy treatments. Psychotherapy manuals typically serve several purposes, including, but not limited to, establishing new psychotherapy treatments, training providers, disseminating treatments to those who deliver them, and providing guidelines to deliver treatments with fidelity. Yet, the proliferation of psychotherapy manuals has not been well-understood, and no work has aimed to assess or review the existing landscape of psychotherapy manuals. Little is known about the breadth, scope, and foci of extant psychotherapy manuals.

OBJECTIVE

This scoping review aims to identify and explore the landscape of existing book-based psychotherapy manuals. This review aims to specify the defining characteristics (ie, foci, clinical populations, clinical targets, treatment type, treatment modality, and adaptations) of existing book-based psychotherapy manuals. Further, this review will demonstrate how this information, and psychotherapy manuals more broadly, has changed over time. This project aims to make a novel contribution that will have critical implications for current methods of developing, aggregating, synthesizing, and translating knowledge about psychotherapeutic treatments.

METHODS

This scoping review will review book-based psychotherapy manuals published from 1950 to 2022.This scoping review will be informed by guidance from the Joanna Briggs Institute Scoping Review Methodology Group and prior scoping reviews. Traditional search and application programming interface-based search methods will be used with search terms defined a priori to identify relevant results using 3 large book databases: Google Books, WorldCat, and PsycINFO. This review will leverage machine learning methods to enhance and expedite the screening process. Primary screening of results will be conducted by at least 2 authors. Data will be extracted and double-coded by research assistants using an iteratively defined codebook.

RESULTS

The search process produced 78,600 results, which were then iteratively deduplicated. Following deduplication, 50,583 results remained. The scoping review is expected to identify common elements of psychotherapy manuals, establish how the foci and content of manuals have changed over time, and illustrate coverage and gaps in the landscape of psychotherapy manuals. Results from this scoping review will be critical for future work focused on developing, aggregating, synthesizing, and disseminating knowledge about psychotherapeutic treatments.

CONCLUSIONS

This review will provide knowledge about the vast landscape of psychotherapy manuals that exist. Findings from this study will inform future efforts to develop, aggregate, synthesize, and translate knowledge about psychotherapeutic treatments.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/47708.

Pilot Study of the MAP Curriculum for Psychotherapy Competencies in Child and Adolescent Psychiatry

OBJECTIVE

This pilot study aimed to evaluate the relevance, feasibility, acceptability, and instructional efficacy of the Managing and Adapting Practice (MAP) curriculum for enhancing the teaching of psychotherapy to child and adolescent psychiatry (CAP) fellows. MAP is a system of resources and decision models that supports practitioners in selecting and implementing psychotherapeutic interventions for children and adolescents. The MAP curriculum includes modules to guide education about psychotherapeutic procedures (e.g., behavioral activation) common in evidence-based treatments for an array of childhood problems and to support development of competencies in assessment, treatment planning, and reflective practice.

METHODS

Curriculum coding was used to examine the relevance of MAP's core components to the skills articulated in the Accreditation Council for Graduate Medical Education (ACGME) CAP milestones. Feasibility, acceptability, and learning outcomes were examined after delivery of the MAP curriculum to 12 CAP fellows at two sites, with instructional features tailored according to faculty preferences and training program structure.

RESULTS

Coding suggested that the MAP curriculum was relevant to 95% of the 21 ACGME CAP training subcompetencies. Feasibility was indicated by the successful delivery of 100% of the planned MAP curriculum across the two sites. Acceptability was supported by positive feedback from the CAP fellows, and psychotherapy knowledge increased significantly. Finally, case review scores (mean±SD=2.21±0.15) showed positive posttraining application of MAP to two patients and exceeded scores achieved by other samples of mental health professionals.

CONCLUSIONS

This pilot study demonstrated the potential for the MAP curriculum to support CAP education. MAP's versatility as a curriculum supports broader adoption, with continuing rigorous empirical evaluation.

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.

Skills-Based Psychotherapy Training for Inpatient Psychiatry Residents: a Needs Assessment and Evaluation of a Pilot Curriculum

OBJECTIVE

The study's objectives were to assess the psychotherapy interests and needs of psychiatry residents, to develop a psychotherapy didactic curriculum for psychiatry residents on the inpatient service, and to evaluate residents' self-reported understanding and confidence with skills-based interventions.

METHODS

Psychiatry residents within a major metro region in the Northeast were asked if they would voluntarily participate in a survey to assess their interest and skills. Based on the results of this survey, the authors devised an 8-week course for seventeen residents on the inpatient unit. Topics included general cognitive behavioral therapy (CBT), sleep hygiene, behavioral activation, dialectical behavioral therapy (DBT), mind-body skills, and motivational interviewing. Residents completed post-course questionnaires on comprehension and confidence in providing psychotherapy skills using 5-point Likert scales.

RESULTS

Participants (N = 39) reported a strong interest in learning psychotherapy and in education focused on inpatient skills-based interventions. At the end of the course, 12/17 (70.6%) participants provided feedback to indicate that 9/12 (75%) respondents experienced increased confidence in therapy skills, 10/12 (83.3%) reported a basic understanding of skills-based psychotherapy, and 10/12 (83.4%) believed they could teach at least one new technique.

CONCLUSION

Psychiatry residents in this study overwhelmingly requested additional training focused on skills relevant to inpatient service, and the curriculum the authors developed led to a subjective self-reported understanding of and confidence in providing these psychotherapy skills on the inpatient unit. These very preliminary results suggest that provision of increased skills-based psychotherapy training for inpatient psychiatry residents is important and beneficial within resident education.