The competence development of German psychotherapy trainees: A naturalistic, longitudinal and multidimensional outcome study

Objectives:This study investigated the development of German psychotherapy trainees in professional, relational, and personal competence. Methods: The study followed a naturalistic pre-post design over 3 years and included a control group of non-trainee psychologists. The sample consisted of 219 participants, including 64 cognitive-behavioral trainees, 120 psychodynamic trainees and 35 control participants. Outcomes were knowledge (multiple choice exam), case-formulation competence (Case Formulation Content Coding Method), healing and stressful involvement (Therapist Work Involvement Scales), attributional complexity (Attributional Complexity Scale), introject affiliation, and affiliation in patient treatments (Intrex questionnaire). Multilevel Modeling was used to investigate change over time and group by time interactions. Comparisons to the control group were limited to knowledge, case-formulation competence, and attributional complexity. Results: Trainees improved in knowledge, case-formulation competence, healing involvement, and affiliation in treatments with small to medium effects. There was no change in stressful involvement, attributional complexity or introject affiliation. According to reliable change indices, the majority of trainees did not change reliably. Over time, trainees outperformed the control group only in case-formulation competence. There were several main and group by time effects regarding trainee orientation. Conclusions: Results imply benefits of training on professional and relational competence but only limited effects on personal competence.

Experience-Based Competency Training in Child and Adolescent Psychotherapy

Abstract. Background: Compared to adult psychotherapy training, there is little knowledge about the use of standardized actor-patients (SPs) for the development of professional competencies for younger patient populations. Objective: We assessed the effectiveness of two university-based training programs for diagnostic as well as intervention skills in child and adolescent psychotherapy. Methods: Psychology students took part in two courses on the development of diagnostic competencies ( N = 59) and on intervention skills ( N = 51). We applied active and experience-based learning strategies, including exercises on self-awareness, mindfulness, peer role-play, and the use of SPs. Competence gain as well as a general evaluation of the seminars were assessed by self-report. Results: For both seminars, self-reported competence increased significantly with a large effect. The retrospective evaluation of learning success and acceptance ratings of the didactic formats were high. Conclusions: Experience-based trainings that include SPs are a feasible option for child and adolescent psychotherapy. The findings are discussed from a conceptual as well as a practical perspective.

Developing practice-based evidence: benefits, challenges, and tensions

Attempts to regulate service delivery in line with results from randomized trials have been vigorously debated. In this paper, results from practice-based studies using the CORE System illustrate the potential to enrich knowledge about the actual outcome of psychological therapy in routine care. These studies also provide data for important questions in psychotherapy research, like orientation differences, the importance of the therapist factor, number of sessions needed for clinical effect, and the alliance-outcome question. Obstacles and challenges in making such studies are illustrated. In conclusion, arguments are put forward for introducing a common measurement system that strikes a balance between clinicians' questions and the need for comparable data, and that encompasses the complexities of patients' reasons for seeking psychological help.

Treatment via videoconferencing: a pilot study of delivery by clinical psychology trainees

OBJECTIVE

This pilot study explored the outcomes of clinical psychology trainees delivering treatments via videoconferencing.

DESIGN

A noncurrent, multiple baseline across subjects and settings.

SETTING

University outpatient psychology clinic.

PARTICIPANTS

Six clients (two men and four women) with an anxiety or depressive disorder were randomly assigned to received six sessions of individual therapy (either via videoconferencing or face to face) from a male or female clinical psychology trainee.

MAIN OUTCOME MEASURES

Participants provided daily ratings (0-10) of subjective distress/well-being via text messaging, and at pre-, post-, and 1 month follow-up of treatment, completed the Depression Anxiety Stress Scales and the Outcome Questionnaire-45. Along with the trainees, participants also provided feedback on the therapy experience.

RESULTS

The subjective well-being of all participants improved, and all videoconferencing participants showed a statistically and clinically significant reduction in symptomology and gains in general life functioning. Feedback comments were positive.

CONCLUSIONS

This study suggests that there is value in clinical psychology trainees gaining experience in the delivery of treatments via videoconferencing. Further study is needed to demonstrate the potential for university clinics to deliver mental health services, via this modality, to rural and remote areas.

Short-term and long-term effects of training in emotionally focused couple therapy: professional and personal aspects

This study investigated the immediate and long-term personal and professional effects of a 4-day externship training in emotionally focused couple therapy (EFT). EFT externship training uses lecture, discussion, video vignettes, live demonstrations, and role-plays to convey an attachment-based approach to working with couples. The two samples included clinicians (N = 76) who completed surveys immediately before and after training, and a subset of these clinicians (N = 29) who completed measures an average of 8 months later. Results indicate that following training, participants increased in their EFT knowledge and competence, became more open to their feelings, were more self-compassionate, were less likely to use avoidant attachment behaviors, and improved their own personal relationships.

Therapeutic Change

In this rejoinder, the authors respond to the comments, feedback, and suggestions offered by Hatcher, Miville, and Nutt. The authors clarify a possible point of confusion, reaffirm their contention that the crux of sound psychology practice rests on therapists’ ability to facilitate change with their clients, and acknowledge both the progressive development that characterizes the process of becoming a competent counselor and the problem of assuming advanced training alone can compensate for the limitations inherent in the microskills-only approach to training. Next, the authors address the issue of complexity, including their intention to balance the need to provide a coherent, accessible model that does not fall prey to oversimplification. Finally, the authors note key similarities to and differences from the competency benchmarks and invite their colleagues to join them in the rigorous testing needed to validate their model of counseling competence.

Microskills Training

For more than four decades, the microskills approach has been the dominant paradigm for training entry-level counseling students. At its inception, the model met a critical need: instruction in discrete counseling behaviors, which at the time was conspicuously missing from training curricula. Although these behaviors have become essential components of training in counseling psychology and other mental health specialties, the authors’ reexamination of the literature leads them to question the overall adequacy of the model. After reviewing prominent textbooks in the field and evaluating the research on microskills training, the authors identify five serious limitations of the model. While respecting and retaining the positive features of the microskills approach, its limitations bespeak the need to develop training paradigms that embrace a broader model of counselor competence.

Training in Counseling Psychology

This Major Contribution, consisting of four articles, critically evaluates the status of training in counseling psychology, especially at the entry level, and offers a model for moving the field forward. In this first article, we provide a rationale for the contribution, laying the foundation for the subsequent three articles. Specifically, we ask the questions, Do training programs in counseling psychology produce the desired results? and Is the prevailing paradigm of training effective in developing counselor competence? Then we report on the research showing a disappointing relationship among training, experience, and expertise. We conclude by inviting the profession to engage in honest self-reflection about the status and future direction of training in counseling psychology.

A conceptual and empirical review of the meaning, measurement, development, and teaching of intervention competence in clinical psychology

Through the course of this paper we discuss several fundamental issues related to the intervention competence of psychologists. Following definitional clarification and proposals for more strictly distinguishing competence from adherence, we interpret Dreyfus and Dreyfus's [Dreyfus, H.L., & Dreyfus, S.E. (1986). Mind over machine: The power of human intuition and expertise in the age of the computer. New York: Free Press.] five stage theory of competence development (from novice to expert) within a strictly clinical framework. Existing methods of competence assessment are then evaluated, and we argue for the use of new and multiple assessment modalities. Next, we utilize the previous sections as a foundation to propose methods for training and evaluating competent psychologists. Lastly, we discuss several potential impediments to large scale competence assessment and education, such as the heterogeneity of therapeutic orientations and what could be termed a lack of transparency in clinical training.

Problemas enfrentados por terapeutas analítico-comportamentais em sua prática clínica

O artigo apresenta situações-problema encontradas na interação com o cliente, conforme o relato de cinco terapeutas analistas comportamentais e algumas soluções adotadas. Os relatos foram obtidos por meio de uma entrevista, cujas verbalizações foram registradas e transcritas. As categorizações das verbalizações foram estabelecidas e ajustadas com a ajuda da avaliação de quatro colaboradores. Os resultados sugerem que situações de difícil manejo tendem a surgir quando o cliente: (a) aproxima-se do terapeuta de modo indevido, (b) contesta o terapeuta após feedback, (c) coloca sua vida ou a de terceiros em risco ou (d) provoca choro no terapeuta. Discute-se a importância do preparo dos profissionais para manejarem situações na interação com o cliente que, entre outras coisas, ameacem a privacidade do terapeuta ou que apelem para a exposição de questões pessoais do profissional. São sugeridas utilizações dos resultados para fins didáticos na formação de terapeutas comportamentais e para elaboração de pesquisas futuras.