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A proposed makeover of psychotherapy training: Contents, methods, and outcomes
... Although therapist responsivity comes in diverse forms, we focus here on the CRPI framework that our team has advanced (Boswell et al., 2020;Constantino et al., 2020;Constantino, Goodwin, et al., 2021;Gaines & Goldfried, 2021). CRPI is perhaps best described as a "metaorientation" that can guide therapists of any theoretical orientation in their use of evidence-based and context-responsive clinical decision making. ...
... To this end, clinical trainers, in addition to the other methods they teach, should emphasize ways to both respond to patients' needs and perceptions when deciding on a therapy starting point and a willingness to do more than simply "stay the course" when emerging contexts call for it-what has been referred to as clinical departures Constantino, Goodwin, et al., 2021) or local adaptations (Shoham et al., 2014). This notion of ongoing responsiveness from the outset of and through therapy spans training contents, methods, and outcomes (Boswell et al., 2020). ...
... Answering this call, Constantino and colleagues present an "ifthen" responsive framework that proposes clinical training and practice be guided by a compendium of research-supported responses to clinically observed markers of key challenges in therapy (Boswell et al., 2020;Constantino et al., 2013;. Importantly, this is an approach to psychotherapy training and practice that is patient-centered, transdiagnostic and transtheoretical, clinically relevant and observable, and researchdriven, subsuming all relevant findings. ...
... To us, a shift toward a modular, responsive, and transtheoretical training paradigm-accompanied by research evidence, clinical guidelines, and video illustrations-would be revolutionary in its ability to unify divided camps, and it would be poised to inform, as well as benefit from, a movement toward consensus. We direct readers interested in helping the field to adopt transtheoretical, principle-based, and modular training practices to the works of Boswell, Constantino, Eubanks-Carter, and colleagues (e.g., Boswell et al., 2020;Constantino et al., 2013;Eubanks-Carter et al., 2015). ...
In any maturing discipline, consensus is generally viewed as a valuable pursuit. Yet, in psychotherapy, one could argue that little such maturation has occurred despite the field being over 100 years old. The current article first reviews one perspective on consensus introduced in 1980, which focuses on the middle level of theoretical abstraction. Next, we present this conceptualization as a sought-after outcome for psychotherapy practice and research; review progress that has been made toward consensus thus far; and offer potential future directions to further move the discipline toward clinically meaningful consensus. We then outline a way to accelerate consensus by leveraging technologies that can augment intradisciplinary and interdisciplinary professional communication. We conclude by discussing the resulting implications for psychotherapy training.
... implementation of psychological interventions. However, in contrast to psychotherapy, psychotherapy training methods are rarely the subject of empirical research (e. g., Boswell et al., 2020;Callahan & Watkins, 2018). Thus, empirical studies are needed that investigate the effect of training methods on therapist competence development. ...
Background: Feedback is considered one of the most important strategies in psychotherapy training. Objective: We investigated the effect of competence feedback on therapist self-perceived competence, professional self-confidence, and tendency to self-disclosure in supervision. Method: Master-level psychotherapy trainees ( N = 67) were randomly assigned to a competence feedback group (CFG) or a control group (CG). Trainees in CFG repeatedly received feedback regarding their therapeutic competencies during cognitive behavioral therapy for 114 patients with a major depressive disorder. Feedback was provided by licensed psychotherapists, based on video tapes of the treatments. Trainees’ therapeutic competencies, professional self-confidence, and tendency to self-disclosure in supervision were evaluated by self-report questionnaires. Results: Self-perceived competence improved significantly more in the CFG than in the CG. Professional self-confidence improved overall, but no differences between CFG and CG were found. Self-disclosure did not change significantly in general. Conclusion: We conclude that specific training strategies are necessary for achieving specific training aims.
... A focus on the therapeutic relationship as a mechanism of change is an evidence-based mechanism of change that needs to be added to the standard clinical psychology curriculum through courses and supervision. Boswell et al. (2020) argue that training in clinical psychology practice should be context-responsive and individualized to the client, leading to the need for therapists to be interpersonally skilled, attuned, and trained in multiple approaches to effectively treat their clients. ...
Objective:
There is a strong evidence-base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence-base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence-based approaches.
Methods:
We use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development-from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change.
Results/conclusions:
Based on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.
... The valuable progress that has been made in in-person psychotherapy should be applied to VCP. In this sense, it is important to avoid disseminating manualized treatments and instead train therapists in general principles of change (Castonguay and Beutler, 2006;Castonguay et al., 2019;Goldfried, 2019;Boswell et al., 2020). It is important to avoid incurring the infructuous dispute between specific therapeutic schools and focus the efforts on achieving therapeutic competence (Cooper et al., 2019). ...
With the advent of COVID-19, a sudden, unexpected, and forced shift has been produced in the field of psychotherapy. Worldwide, many therapists closed their offices and started to deliver psychotherapy online through a screen. Although different media started to be incorporated, videoconferencing is undoubtedly the most common way in which therapists are doing therapy these days. This is catalyzing a rapid change in the practice of psychotherapy with probable lasting effects and deserves to be carefully reflected upon. Therefore, in this paper our aim is to outline the main challenges for a medium that may have arrived to stay. In that sense, we review the literature to describe the state-of-the-art regarding the main aspects of videoconferencing psychotherapy as well as to suggest possible avenues for future research and practice.
Massive training of mental health providers is one of the proposed means of improving access to evidence-based treatment for a variety of common mental disorders. While communication and knowledge dissemination technologies (videoconferencing, web platforms) can help make training more accessible in time and space, their contribution to the development of skills among providers needs to be carefully evaluated. Objectives Establish how technologies are used to optimize the training of practitioners and what are the effects of online training on the acquisition of clinical knowledge and skills. Method A quick review of the literature was conducted. In order to be included, studies had to concern online training intended for providers in active clinical practice, deal with the treatment of a common mental disorder or addiction, and include an objective measure of clinical knowledge or skills. The studies were analyzed and compared in terms of learning methods and activities incorporating digital technologies. Results Twenty studies were identified. Passive learning methods, involving little or no interactivity, are predominant in asynchronous mode online training (AOT), while activities that allow a high level of interaction with the trainer, such as role-playing or supervision, are found in synchronous mode training. Knowledge acquisition: AOTs appear to be effective in improving the knowledge of the trainees for at least six months. Classroom training or the addition of supervision does not produce learning outcomes that are superior to the AOT. Skill acquisition: No conclusions can be drawn about the effects of online, asynchronous, synchronous or blended training, as the results are mixed or even contradictory. Conclusion Considering the low methodological quality of the studies analyzed, which limits the nature and scope of the conclusions of this review, the results of the studies suggest that AOTs that include basic interactive technologies, such as online quizzes, can be a simple and effective way to improve clinical knowledge of mental health practitioners.
La formation massive d’intervenants en santé mentale figure parmi les moyens proposés pour améliorer l’accès aux traitements fondés sur les données probantes pour divers troubles mentaux courants. Si les technologies de communication et de diffusion des connaissances (visioconférence, plateformes Web) peuvent aider à rendre la formation plus accessible dans le temps et dans l’espace, il est nécessaire de bien évaluer leur apport au développement des compétences chez les intervenants.
Objectifs Établir comment les technologies sont utilisées pour optimiser la formation des intervenants et quels sont les effets des formations en ligne sur l’acquisition des connaissances et habiletés cliniques.
Méthode Une revue rapide de la littérature a été réalisée. Pour être incluses, les études devaient concerner une formation en ligne destinée aux intervenants en pratique clinique active, porter sur le traitement d’un trouble mental courant ou d’une toxicomanie et comporter une mesure objective des connaissances ou des habiletés cliniques. Les études ont été analysées et comparées en fonction des méthodes et activités d’apprentissage intégrant les technologies numériques.
Résultats Vingt études ont été recensées. Les méthodes d’apprentissage passives, impliquant peu ou pas d’interactivité, prédominent dans les formations en ligne en mode asynchrone (FLA), alors que les activités permettant un niveau élevé d’interaction avec le formateur, comme les jeux de rôle ou la supervision, se retrouvent dans les formations en mode synchrone. Acquisition des connaissances : les FLA semblent efficaces pour améliorer les
connaissances des intervenants sur une période d’au moins 6 mois. La formation en salle ou l’ajout d’une activité de supervision ne produisent pas de résultats d’apprentissage supérieurs à la FLA. Acquisition des habiletés : aucune conclusion ne peut être tirée quant aux effets des formations en ligne, asynchrones, synchrones ou mixtes, car les résultats sont partagés, voire contradictoires.
Conclusion En considérant la faible qualité méthodologique des études analysées qui limite la nature et la portée des conclusions de la présente recension, les résultats des études permettent d’avancer que les FLA qui comportent des technologies interactives de base, telles que des quiz en ligne, peuvent constituer un moyen simple et efficace pour améliorer les connaissances des intervenants en santé mentale.
Although the field of psychotherapy has been in existence for well over a century, it nonetheless continues to be preparadigmatic, lacking a consensus or scientific core. Instead, it is characterized by a large and increasing number of different schools of thought. In addition to the varying ways in which psychotherapy has been conceptualized, there also exists a long-standing gap between psychotherapy research and how it is conducted in actual clinical practice. Finally, there also exists a tendency to place great emphasis on what is new, often rediscovering or reinventing past contributions. This article describes each of these impediments to obtaining consensus and offers some suggestions for what might be done to address them.
This book aims to create a new venue for evidence-based practice in psychotherapy—a venue that goes beyond the traditional and unidirectional dissemination of research, whereby clinicians are typically viewed as passive recipients of scientific findings. In contrast, this book is the result of an active, intense, and bidirectional collaboration of psychotherapy researchers and practitioners. Based on an extensive review of literature, it first offers a list of 38 empirically based principles of change that are clustered within five categories: client prognostic, treatment/provider moderating, client process, therapeutic relationship, and therapist interventions. It then illustrates the expertise of six therapists from diverse theoretical orientations who describe how they implement each of these principles with specific cases of depression and anxiety disorders (with or without substance abuse or personality disorder). The book also includes exchanges between researchers and clinicians on several issues regarding the current list of principles of change, such as how similarly and differently they are addressed or used across a variety of treatments, how helpful they can be in clinical routine (and/or under which situations they may not be clinically valid), how they may be combined for particular purposes (such as teaching and training), and how the list can be expanded to guide future research based on clinicians’ observations and reflections. This book is an attempt to advance psychotherapy by having researchers and clinicians share their unique and yet complementary knowledge. It also lays the foundations for further collaborations and partnerships between different stakeholders in mental health services.
Although a historically prominent model of evidence-based practice (EBP) privileges the faithful delivery of single empirically supported treatment (EST) packages, psychotherapy research demonstrates that therapist adherence to an EST is often unrelated to patient outcome. Additionally, perseverative adherence when facing disruptive clinical process can relate to worse outcomes. In contrast, unmanipulated within-case variability in adherence, or the natural incorporation of theoretically “off-brand” interventions into an EST, can associate with more improvement. Further supporting the value of therapist flexibility, treatments that intentionally integrate theory-informed departures (away from the foundational EST) vis-à-vis specific disruptive clinical processes can outperform the standard EST without such departures. Thus, responsively adjusting treatments, such as cognitive-behavioral therapy (CBT), to patients’ contextualized pathology, characteristics, and momentary interactions with the provider may represent a more empirically well-supported form of EBP. Consistent with these ideas, we present an overview of context-responsive psychotherapy integration (CRPI), an approach to EBP in an if-then key. CRPI frames common factors as typical and potentially disruptive clinical “if” situations that therapists will encounter and to which they “then” need to be responsive beyond strict adherence to any EST. Notably, such departures can be temporary, thereby supporting vs. replacing the primary EST interventions. To illustrate CRPI’s application to practice, we focus on one example of patient resistance to CBT as a contextual process marker and motivational interviewing as a theory- and evidence-informed departure response. We also discuss clinical, cultural, empirical, and training considerations from the CRPI perspective.
A lack of effective therapist training is a major barrier to evidence‐based intervention (EBI) delivery in the community. Systematic reviews published nearly a decade ago suggested that traditional EBI training leads to higher knowledge but not more EBI use, indicating that more work is needed to optimize EBI training and implementation. This systematic review synthesizes the training literature published since 2010 to evaluate how different training models (workshop, workshop with consultation, online training, train‐the‐trainer, and intensive training) affect therapists’ knowledge, beliefs, and behaviors. Results and limitations for each approach are discussed. Findings show that training has advanced beyond provision of manuals and brief workshops; more intensive training models show promise for changing therapist behavior. However, methodological issues persist, limiting conclusions and pointing to important areas for future research.
Objective:
To review the therapist effects literature since Baldwin and Imel's (2013) review.
Method:
Systematic literature review of three databases (PsycINFO, PubMed and Web of Science) replicating Baldwin and Imel (2013) search terms. Weighted averages of therapist effects (TEs) were calculated, and a critical narrative review of included studies conducted.
Results:
Twenty studies met inclusion criteria (3 RCTs; 17 practice-based) with 19 studies using multilevel modeling. TEs were found in 19 studies. The TE range for all studies was 0.2% to 29% (weighted average = 5%). For RCTs, 1%-29% (weighted average = 8.2%). For practice-based studies, 0.2-21% (weighted average = 5%). The university counseling subsample yielded a lower TE (2.4%) than in other groupings (i.e., primary care, mixed clinical settings, and specialist/focused settings). Therapist sample sizes remained lower than recommended, and few studies appeared to be designed specifically as TE studies, with too few examples of maximising the research potential of large routine patient datasets.
Conclusions:
Therapist effects are a robust phenomenon although considerable heterogeneity exists across studies. Patient severity appeared related to TE size. TEs from RCTs were highly variable. Using an overall therapist effects statistic may lack precision, and TEs might be better reported separately for specific clinical settings.
- Castonguay