No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Training beginning therapists to respond to basic ethical situations in therapy: Deliberate practice vs case discussion
ResearchGate has not been able to resolve any citations for this publication.
Therapists’ responses to challenging therapy situations on the Facilitative Interpersonal Skills (FIS) performance task are a significant predictor of therapists’ differences in treatment outcomes. The aim of this study was to assess whether the complexity of the therapy situation influenced the facilitative interpersonal skills of trainees. Trainee therapists (n=46) participated in an experiment in which they responded to a set of challenging and benign (i.e., non-challenging) video vignettes of therapy situations of the FIS performance task. Their responses were video recorded and coded by four independent raters. Results showed that trainees scored significantly higher on the FIS performance task responding to benign therapy situations than responding to challenging situations. This is the first study to investigate difficulty of therapy situations as a potential predictor or trainees interpersonal skills. Further research is needed to replicate these results in a larger sample.
Objective: We identified studies using the facilitative interpersonal skills (FIS) performance task method to determine its psychometric properties, impact on therapy outcomes, connection to therapy process, and effectiveness in training therapists. Method: All peer-reviewed papers and unpublished dissertations/theses were included if they were empirical articles utilizing FIS, anything outside of this criterion was excluded. A PsycInfo and Google Scholar search on December 9, 2022, identified the literature explored in this review (N = 24). Results were presented in a narrative format. Results: Findings indicated FIS is reliable (intraclass correlation coefficient = .80–.95) with good ecological and content validity. High FIS therapists had clients with superior outcomes and FIS had a positive link with therapeutic processes. FIS was also determined to be effective in training and assessing therapists. Discussion: The FIS rating method has significant potential for future studies concerning training helpers, measuring performance, and increasing psychotherapeutic outcomes. Additional research is needed to confirm the findings in this emerging area of study. Other: This study was supported by a grant from the Sorensen Center for Moral and Ethical Leadership at Brigham Young University.
The Structural Analysis of Social Behavior (SASB; Benjamin, 1974, 1982, 1984) system was used to study the interpersonal process between patient and therapist in the 3rd session of 14 therapeutic dyads. Dyads were grouped into good and poor outcomes cases (n = 7) on the basis of the amount of change in the patients’ introject as measured by the INTREX Introject Questionnaire (Benjamin, 1983). Strong support was found for the following hypotheses based on interpersonal theory, linking therapists’ introject state, interpersonal process in therapy, and outcome: (a) Poor outcome cases (no introject change) were typified by interpersonal behaviors by the therapist that confirmed a negative patient introject; (b) the number of therapists’ statements that were subtly hostile and controlling was highly correlated with the number of self-blaming statements by the patients; (c) therapists with disaffiliative introjects tended to engage in a much higher level of problematic interpersonal processes that have been associated with poor outcome. Implications for future research and therapist training are discussed.
A large body of research identifies therapist expressed empathy as one of the most important predictors of psychotherapy outcome. Deliberate practice (DP) is an effective method to improve skills in many fields. We asked if DP also can be used to enhance the skill of expressing empathy. Objective: The aim was to compare the efficacy of DP to didactical learning methods (DLM) in enhancing the skill of empathic expression in students. Method: A repeated measures randomized controlled group design was used. Novice students (N = 36) from psychologist-, medicine-, social work-, and nursing programs received two training sessions of either DP (n = 21) or DLM (n = 15). Participants’ skills in empathic expression were assessed with the Measure of Expressed Empathy (MEE) on three occasions: before the first, between, and after the last training session. Results: Participants in the DP-group showed improved empathic expression, whereas participants in the DLM-group did not. Conclusions: These findings suggest that DP is an effective training method for therapeutic skills such as empathic expression and holds implications for the future development of educational practices to incorporate active skill training methods.
We studied whether counseling self-efficacy increases after taking a helping skills course as well as whether trainer (instructor) effects are associated with postclass self-efficacy. We surveyed 551 undergraduate students and 27 trainers in helping skills courses across three semesters at one large mid-Atlantic U.S. public university. We found that students reported greater counseling self-efficacy after taking the course. In addition, trainers accounted for small but significant amount of the variance (7%) in changes in counseling self-efficacy. There was evidence that the instructors' authoritative teaching style but not their facilitative interpersonal skills were associated with increases in students' counseling self-efficacy. Implications for helping skills training are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Objective
The use of deliberate practice (DP) as an adjunct method of training practitioners in the acquisition of therapy skills is gaining increasing attention. However, to date, no evidence synthesis has been reported on.
Methods
A scoping review was conducted based on Arksey and O'Malley's five-stage method, which was compliant with the preferred method for reporting items for systematic reviews and meta-analysis extension for scoping reviews. Three databases (Scopus, Embase and PubMed) were searched for articles reporting on primary data, in English. The initial search yielded 1,087 articles, of which 14 are included in this review.
Results
Findings suggest that DP is still in its infancy and is being used to train practitioners in a host of therapeutic skills and practices in various training and educational contexts, including using technology as a platform. DP compares more favourably than usual didactic workshops for skill acquisition across variables such as techniques, communication skills and interpersonal and evidence-based relationship factors.
Conclusion
Further research needs to replicate and extend these initial findings, and recommendations for practice and research are considered. This is the first scoping review of this rapidly developing area of practice.
This introduces the Special Issue on Competency. We briefly trace the history of the Competency Initiative in the training of health service psychologists that began in 2002 and now has been integrated in the Standards of Accreditation. We provide an overview of the 10 articles in the special issue and provide our perspective on critical needs for future research.
Experience is often regarded as a prerequisite of high performance. In the field of psychotherapy, research has yielded inconsistent results regarding the association between experience and therapy outcome. However, this research was mostly conducted cross-sectionally. A longitudinal study from the U.S. recently indicated that psychotherapists' experience was not associated with therapy outcomes. The present study aimed at replicating Goldberg, Rousmaniere, et al. (2016) study in the German healthcare system. Using routine evaluation data of a large German university psychotherapy outpatient clinic, the effect of N = 241 therapists' experience on the outcomes of their patients (N = 3,432) was assessed longitudinally using linear and logistic multilevel modeling. Experience was operationalized using the number of days since the first patient of a therapist as well as using the number of patients treated beforehand. Outcome criteria were defined as change in general psychopathology as well as response, remission, and early termination. Several covariates (number of sessions per case, licensure, and main diagnosis) were also examined. Across all operationalizations of experience (time since first patient and number of cases treated) and therapy outcome (change in psychopathology, response, remission, and early termination), results largely suggest no association between therapists' experience and therapy outcome. Preliminary evidence suggests that therapists need fewer sessions to achieve the same outcomes when they gain more experience. Therapeutic experience seems to be unrelated to patients' change in psychopathology. This lack of findings is of importance for improving postgraduate training and the quality of psychotherapy in general. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Consultation is a pivotal competency area for psychologists, yet little is known about how graduate training supports psychologists in consultation competency development. This study reports on the application of a deliberate practice approach to consultation training for 13 school psychology trainees, with a focus on communication skill development and application. Over 4 weeks, trainees viewed a series of four brief videos of a teacher consultee describing actual school-based problems and applied explicitly defined communication skill responses (i.e., paraphrasing, clarifying, and reflecting feelings). Responses were recorded and uploaded by trainees weekly on the Flipgrid online platform, shared with the instructor, and supervisory feedback provided regarding the accuracy and quality of final responses. Pre and posttraining data indicated trainees’ increased communication self-efficacy and overall satisfaction with the training. Areas for training improvement were also noted, including the supervision feedback process. The promise of a deliberate practice approach in supporting psychological consultation competency development is discussed, as are the future directions for training and research.
Effectively using motivational interviewing (MI) in practice can be difficult. However, there are a number of studies that examine training students across helping professions, with the goal of promoting more effective use of MI. The purpose of this systematic review and meta-analysis was to quantify the effectiveness of teaching students MI. In total, 15 randomized and nonrandomized studies met inclusion criteria and were examined in the current review of 8 dependent variables. A large and significant overall Hedges’ g of 0.90 (95% CI [0.45, 1.35]) was found. When restricted to randomized controlled trials only, it decreased to moderate-in-size (g = 0.74, CI [0.41, 1.56]). Significant effects were observed with the knowledge, empathy, and change plan outcomes. Moderation analyses revealed training length was a significant moderator, with greater effects being associated with longer trainings. Limitations of the current meta-analysis included the small sample size and lack of consistency among training duration, measurement, and data collection, as well as the resulting heterogeneity. Future research appears warranted to further assess student MI training effectiveness, especially using more rigorous and standardized procedures and in determining enduring effects of the training.
The present study used a newly developed simplified coding system, the Therapist Demand and Support Code, to examine specific therapist behaviors in the context of a previously conducted training trial on Deliberate Practice (DP). The parent trial randomized trainees to a DP workshop or its Traditional, more didactic counterpart (Westra et al., 2020). In both groups, trainees were taught to use Support, rather than Demand, for managing ambivalence and resistance, with the DP group having more feedback and practice. In this study, 68 trainees interviewed both an ambivalent community volunteer and an ambivalent simulator 4 month post workshop. The DP group was found to exhibit significantly fewer Demand behaviors than the Traditional group, with the latter also being significantly quicker to use Demand in the interviews. Moreover, the simulator evoked significantly greater Demand from therapists, regardless of the Training group, suggesting the simulators were more resistant. Although therapist use of Support was equal for community volunteers across training groups, Traditional workshop trainees decreased Support when interviewing the more resistant simulators, whereas DP trainees increased their Support with this same group. This is consistent with findings that DP trainees were more appropriately responsive, making fewer Demands following interviewee counterchange talk and using more Support at these times. These results provide some initial validation of the simplified therapist behavior coding system and offer further evidence for the benefits of DP workshop training for managing resistance. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Deliberate practice (DP) is an emerging training method for improving individual performance that may be worth adapting and testing for applicability to groups, given the prevalence of group training for continuing education. This study compared an adapted DP workshop to the same traditional, non-DP workshop for managing ambivalence and resistance. The same presenter delivered the workshops to 88 randomly assigned community psychotherapists. The DP workshop involved repeated interaction with multiple recreations of resistance, with consistent group feedback especially on ideal expert performance. The control workshop was more didactic, with fewer opportunities for practice and feedback. We assessed video vignette performance and coded 20-min interviews with ambivalent interviewees from the community. Both workshops produced equivalent trainee satisfaction and significant increases in self-reported skills. However, the DP versus control group demonstrated better observer-rated skill on all performance measures postworkshop. Although skills declined to 4-month retest in both groups, the DP trainees retained their relative advantage over traditional workshop trainees. Moreover, at the 4-month follow-up, DP versus control trainees were rated as more empathic by community interviewees and self-reported practicing the skills at higher rates. These findings support the continued investigation of DP as a means for improving therapist skill in continuing education workshops. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
In their commentary, Macnamara and Hambrick (Psychol Res, 2017) accused my colleagues and me of systematically changing the definition of the concept of deliberate practice. Deliberate practice was the result of a search for characteristics of effective practice in the laboratory that was shown to improve expert professional performance in domains, such as music. In this reply, I will first describe five different criteria that defined the original concept of deliberate practice and each of them is presented with directly supporting quotes from Ericsson, Krampe, and Tesch-Römer (Psychol Rev 100:396–406, 10.1037/0033-295X.87.3.215, 1993) paper. Unfortunately, Macnamara, Hambrick, and Oswald (Psychol Sci 25:1608–1618, 10.1177/0956797614535810, 2014) misinterpreted our concept of deliberate practice, and defined it much more broadly: “as engagement in structured activities created specifically to improve performance in a domain” (p. 914). This definition led them to include activities, such as attending lectures, studying alone by students, and group activities led by a coach, where each activity does not meet one or more of our criteria for deliberate practice. In this commentary, I will argue that Macnamara and Hambrick (2020) became aware of some of the original criteria for deliberate practice, such as the role of individualized training by a teacher, and these discoveries misled them to assume that we had changed our definition. The intended meaning of sentences that Macnamara and Hambrick (2020) had carefully selected is shown to have an appropriate interpretation in Standard English that is consistent with our original definition of deliberate practice. In conclusion, I will give a proposal for how the different perspectives can be reconciled.
Considerable attention has been given to the benefits of applying deliberate practice to the field of psychotherapy. The philosophical underpinnings of the deliberate practice framework have the potential
to help improve psychotherapy training by encouraging lifelong learning. However, the deliberate practice model has been previously applied and studied in fields that differ from psychotherapy in important ways. These differences have significant implications for the application of deliberate practice to psychotherapy. This article aims to highlight the exciting possibilities and the current limitations of the deliberate practice model for psychotherapy. We offer potential ways to address some of these limitations via research and clinical practice. Giving more consideration to these limitations could increase the utility of deliberate practice for psychotherapists.
In a 5-year follow-up assessment, 33 students who had taken an undergraduate helping skills course indicated that they had continued to use the helping skills in both their professional lives and personal relationships. On average, there were no significant changes from pretraining to follow-up on empathy, natural helping ability, or facilitative interpersonal skills. Furthermore, although students had increased in self-efficacy for using the skills during training, on average they maintained their self-efficacy levels at the follow-up. The 15 participants who had further mental health education, however, scored higher at follow-up on empathy, natural helping ability, self-efficacy for using the skills, and facilitative interpersonal skills compared with the 18 participants who had no further mental health education (controlling for pretraining levels), suggesting that continued exposure to and practice using the skills helped them continue to improve their helping abilities. Qualitative data indicated that participants typically had positive experiences in the helping skills course. Implications for training and research are provided. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Objective: Therapist interpersonal skills are foundational to psychotherapy. However, assessment is labor intensive and infrequent. This study evaluated if machine learning (ML) tools can automatically assess therapist interpersonal skills.
Method: Data were drawn from a previous study in which 164 undergraduate students (i.e., not clinical trainees) completed the Facilitative Interpersonal Skills (FIS) task. This task involves responding to video vignettes depicting interpersonally challenging moments in psychotherapy. Trained raters scored the responses. We used an elastic net model on top of a term frequency-inverse document frequency representation to predict FIS scores.
Results: Models predicted FIS total and item-level scores above chance (rhos = .27–.53, ps < .001), achieving 31–60% of human reliability. Models explained 13–24% of the variance in FIS total and item-level scores on a held out set of data (R²), with the exception of the two items most reliant on vocal cues (verbal fluency, emotional expression), for which models explained ≤1% of variance.
Conclusion: ML may be a promising approach for automating assessment of constructs like interpersonal skill previously coded by humans. ML may perform best when the standardized stimuli limit the “space” of potential responses (vs. naturalistic psychotherapy) and when models have access to the same data available to raters (i.e., transcripts).
Clinical Impact Statement
Deliberate practice (DP) has been encouraged for helping therapists develop expertise, but empirical evidence about its effectiveness is lacking. Question: Can DP help therapy trainees develop self-efficacy for using immediacy and improve the working alliance? Findings: DP helped therapists develop self-efficacy for talking with clients about the therapy relationship. Identifying and learning to manage personal reactions to clients, being given specific ideas of how to handle situations differently, and practicing immediacy were cited as helpful components of DP training. Meaning: DP can be a helpful addition to regular supervision. Next Steps: More research is needed with other trainers, therapists, and interventions.
The current study explored trainee therapists' experiences in alliance-focused training (AFT), a form of group supervision focused on training therapists to recognize and negotiate alliance ruptures. We analyzed interviews with 36 former trainees who received AFT during their predoctoral psychology internships. Findings centered on trainees' views of the central AFT tasks of videotape analysis, awareness-oriented role-plays, and mindfulness training; the supervisor's stance, including the provision of support and validation and the extent to which the supervisor served as a positive role model; and the impact of AFT on trainees' clinical skills. Many trainees reported that AFT increased their awareness, acceptance, and comfort with navigating ruptures, but some trainees reported that AFT supervisory tasks were anxiety-provoking and that AFT made them less comfortable in session. The findings underscore the challenges that AFT presents for trainees, who are asked to take risks in supervision, and for supervisors, who need to create a safe space for trainees and model sensitivity to supervisory ruptures. The findings also point to the potential benefits for trainees who feel safe and supported enough to explore the most challenging therapeutic moments in the context of a group supervision.
This study is a longitudinal examination of the impact of therapist stage of training on client outcomes in psychotherapy. The study included 22 PhD-level psychologists who work in a university counseling center (8 female, 14 male) who had completed at least 2 training periods in the center where data were gathered. Therapists worked with 4,047 clients, and 40,271 sessions were included in our analyses. Clients were given the Outcome Questionnaire-45 (OQ-45) on a session-by-session basis, tracking treatment response. The effect of stage of training on both the magnitude and speed of OQ-45 change was examined through hierarchical linear modeling. Therapists were found to achieve the same amount of change or less change on average in their later stages of training. Therapists were also found, on average, to achieve the same rate of change or a slower rate of change in later stages of training. Findings suggest that as therapists progress through formal stages of training, they do not improve in their ability to effect change in their clients. Given these findings, a better understanding of expertise in psychotherapy practice and how to develop it may be an important area for future theory development, research, and training program development. We call for further work examining if and how an individual therapist can become more effective with time.
With the transformation of health service psychology training to a culture of competence (Roberts, Borden, Christiansen, & Lopez, 2005), comes the necessity for an associated culture of assessment to ensure competence. Although the Competency Benchmarks (Fouad et al., 2009) and the toolkit for assessment of competency (Kaslow et al., 2009) have been major advances, the question remains whether training programs are using a competency-based approach to education and training, including how they are assessing those competencies. The purpose of this study was to assess the state of the art in use of competencies and their assessment. Training programs were surveyed with respect to what competencies are viewed as important, and the relationship between what supervisors and faculty desire and value in training competencies versus what they assess and what trainees achieve was assessed. Also assessed was which competencies are most frequently not achieved and what form of remediation plan is used.
Objective:
Psychotherapy researchers have long questioned whether increased therapist experience is linked to improved outcomes. Despite numerous cross-sectional studies examining this question, no large-scale longitudinal study has assessed within-therapist changes in outcomes over time.
Method:
The present study examined changes in psychotherapists' outcomes over time using a large, longitudinal, naturalistic psychotherapy data set. The sample included 6,591 patients seen in individual psychotherapy by 170 therapists who had on average 4.73 years of data in the data set (range = 0.44 to 17.93 years). Patient-level outcomes were examined using the Outcome Questionnaire-45 and a standardized metric of change (prepost d). Two-level multilevel models (patients nested within therapist) were used to examine the relationship between therapist experience and patient prepost d and early termination. Experience was examined both as chronological time and cumulative patients seen.
Results:
Therapists achieved outcomes comparable with benchmarks from clinical trials. However, a very small but statistically significant change in outcome was detected indicating that on the whole, therapists' patient prepost d tended to diminish as experience (time or cases) increases. This small reduction remained when controlling for several patient-level, caseload-level, and therapist-level characteristics, as well as when excluding several types of outliers. Further, therapists were shown to vary significantly across time, with some therapists showing improvement despite the overall tendency for outcomes to decline. In contrast, therapists showed lower rates of early termination as experience increased.
Conclusions:
Implications of these findings for the development of expertise in psychotherapy are explored. (PsycINFO Database Record
The theoretical framework presented in this article explains expert performance as the end result of individuals' prolonged efforts to improve performance while negotiating motivational and external constraints. In most domains of expertise, individuals begin in their childhood a regimen of effortful activities (deliberate practice) designed to optimize improvement. Individual differences, even among elite performers, are closely related to assessed amounts of deliberate practice. Many characteristics once believed to reflect innate talent are actually the result of intense practice extended for a minimum of 10 years. Analysis of expert performance provides unique evidence on the potential and limits of extreme environmental adaptation and learning.
Objective:
This study examined whether therapists' facilitative interpersonal skills (FIS) would prospectively predict the outcomes client of therapies that occurred more than one year later.
Method:
Therapists were 44 clinical psychology trainees who completed the FIS performance task and a self-reported measure of social skills in the initial weeks of their training. In the FIS task, prospective therapists were presented with a standard set of videos portraying clients in therapy. Verbal responses to these therapeutic simulations were recorded and then rated by trained coders. More than one year later, the therapists began providing psychotherapy to clients in a psychology clinic. Clients completed a symptom measure before each therapy session.
Results:
Using multilevel modeling, it was found that therapist FIS significantly predicted client symptom change. That is, higher FIS therapists were more effective than lower FIS therapists. However, subsequent analyses showed that this FIS effect was not uniform across all therapy durations; specifically, higher FIS therapists were more effective than lower FIS therapists over shorter durations (e.g., ≤8 sessions) but did not differ from lower FIS therapists in effectiveness for the small percentage of therapies that were longer-term (e.g., >16 sessions).
Conclusions:
Therapists' interpersonal characteristics may influence client progress in therapy. (PsycINFO Database Record
We examined the effectiveness of the Hill model of helping skills training for 191 undergraduate students in six sections of a semester-long course. Students completed self-report, performance, and nonverbal measures at the beginning; they conducted one 20-min helping session at the beginning and another toward the end of the semester; and they completed self-efficacy measures at the end of the semester. Students’ helping skills improved over the course of the semester, as evidenced by higher helper- and volunteer client–rated session quality, reduced proportion of words spoken in sessions, increased proportion of exploration skills used in sessions, and increased self-efficacy for using helping skills. Self-reported empathy predicted four of the five helping skills criteria at the beginning-of-semester assessment. Facilitative interpersonal skills predicted end-of-semester self-efficacy in helping skills when controlling for retrospective prelevels and instructor effects. Implications for training and research are presented.
Objectives:
Therapist effects, independent of the treatment provided, have emerged as a contributor to psychotherapy outcomes. However, past research largely has not identified which therapist factors might be contributing to these effects, though research on psychotherapy implicates relational characteristics. The present Randomized Clinical Trial tested the efficacy of therapists who were selected by their facilitative interpersonal skills (FIS) and training status.
Method:
Sixty-five clients were selected from 2713 undergraduates using a screening and clinical interview procedure. Twenty-three therapists met with 2 clients for 7 sessions and 20 participants served in a no-treatment control group.
Results:
Outcome and alliance differences for Training Status were negligible. High FIS therapists had greater pre-post client outcome, and higher rates of change across sessions, than low FIS therapists. All clients treated by therapists improved more than the silent control, but effects were greater with high FIS than low FIS therapists. From the first session, high FIS therapists also had higher alliances than low FIS therapists as well as significant improvements on client-rated alliance.
Conclusions:
Results were consistent with the hypothesis that therapists' common relational skills are independent contributors to therapeutic alliance and outcome.
Little empirical research exists about highly effective psychotherapists, and none about the factors that mediate the acquisition and maintenance of superior performance skills (e.g., Ericsson, 1996, 2006; Ericsson, Krampe, & Tesch-Romer, 1993). In the full sample, a 3-level multilevel modeling (Level 1: clients; Level 2: therapists; Level 3: organization types) of practitioner outcomes was used to examine the contribution of the therapist to treatment effectiveness. Consistent with prior research, in the full sample (n = 69 therapists; n = 4,580 clients) it was found that therapist effects explained 5.1% of the variance in outcome, after adjusting for initial severity. Therapist gender, caseload, and age were not found to be significant predictors. In a subsample of therapists, the relationship between outcome and therapist demographic variables, professional development activities, and work practices was analyzed (n = 17 therapists, n = 1,632 clients). Therapist characteristics (e.g., years of experience, gender, age, profession, highest qualification, caseload, degree of theoretical integration) did not significantly predict client-reported outcomes. Consistent with the literature on expertise and expert performance, the amount of time spent targeted at improving therapeutic skills was a significant predictor of client outcomes. Further, highly effective therapists indicated requiring more effort in reviewing therapy recordings alone than did the rest of the cohort. Caveats and implications for clinical practice, continuing professional development, and training are discussed. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
Many undergraduate psychology students assume positions as mental health paraprofessionals during or after college. The present study was a quasi-experimental evaluation of the effectiveness of teaching motivational interviewing (MI), a counseling approach that applies to many paraprofessional occupations. Results from 83 undergraduates indicated that both intensive and extended MI courses resulted in greater increases in MI knowledge, confidence, and skill than a brief MI lecture but did not differ from one another. Post-course reflective listening, summarizing sills, and ability to develop discrepancy for these two groups neared or exceeded beginning proficiency thresholds. Findings of this study suggest that even without outside practicum experience, students can achieve meaningful improvements in MI skill through undergraduate courses, which may enhance their performance as paraprofessionals.
Responses from 55 of the 98 clinical psychology programs surveyed indicate that 67% offer formal courses in ethics, compared with 9% reported 22 yrs earlier in a similar survey. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Competency-based education (CBE) is a model that guides the educational process toward acquisition of the knowledge, skills, and attitudes needed for effective professional practice in service of the public. Increasingly adopted by medicine and other professions, the CBE model involves establishing competency goals, developing curricula and other experiences designed to help students reach these goals, integrating instruction in the full range of competencies throughout the educational sequence, guiding and evaluating student learning through ongoing assessment of competence, and revising courses and activities in light of student competence outcomes. Included in a full CBE model are attention to unintended learning outcomes (the “hidden curriculum”) and to areas not covered (the “null curriculum”), and efforts to promote education based on individual student learning trajectories as opposed to set courses or number of hours. Within professional psychology, we suggest that APA accreditation is aligned with a version of the CBE model; and significant progress has been made in identifying and measuring professional competencies. However, these are merely tools that can help training programs implement a broader CBE educational model that we contend has not been widely realized in professional psychology. This article reviews CBE and its application in medicine, discusses the benefits and criticisms of CBE, and considers what a fuller realization of CBE would look like in professional psychology training programs, including graduate programs, practicum, internships, and postdoctoral settings. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Professional psychologists are expected to know ethical standards and engage in proactive analysis of ethical considerations across professional roles (e.g., practice, research, teaching). Yet, little is known about the current state of doctoral ethics education in professional psychology, including the content covered and pedagogical strategies used to ensure developing this core component of professional competency (de las Fuentes, Willmuth, & Yarrow, 2005). A survey of ethics educators from APAaccredited programs across the United States and Canada resulted in 136 instructors reporting on their program's ethics training. The majority of questionnaires returned were from PhD programs (77.9%). A substantial number of programs were clinical (59.6%) and followed a scientist practitioner training model (69.9%). The response rate across specialties ranged from 34.5% to 41.4%. Nearly all (95.6%) reported having a required ethics course. Lectures (95.6%) were the most common teaching method reported. Fully 100% of ethics educators reported teaching about mandated reporting and informed consent to treatment. An overwhelming majority (90% and above) covered the same 11 other topics, showing notable convergence in content. The most commonly used document across programs (99.3%) was the Ethical Principles of Psychologists and Code of Conduct (APA, 2010). The most common type of assignment was reading (94.1%), and the most common teaching practice was "teaching by example" (90.4%). Finally the most endorsed teaching goal was advancement of critical thinking (94.9%). Implications for ethics education and future research directions are described.
The Competency Benchmarks document outlines core foundational and functional competencies in professional psychology across three levels of professional development: readiness for practicum, readiness for internship, and readiness for entry to practice. Within each level, the document lists the essential components that comprise the core competencies and behavioral indicators that provide operational descriptions of the essential elements. This document builds on previous initiatives within professional psychology related to defining and assessing competence. It is intended as a resource for those charged with training and assessing for competence. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In 2005, the authors (Handelsman, Gottlieb, & Knapp, 2005) proposed that ethics education be conducted based on a model of ethics acculturation. Here, the authors extend that work by offering some principles that support implementation of an ethics acculturation model (EAM) over the full course of professional preparation. The authors argue that ethics education should be life-long and provide students and trainees with positive, ongoing, experiential, and supportive educational environments and activities. After presenting and explaining each principle, the authors offer a detailed example showing how various exercises from the existing literature may be employed to facilitate students' ethical development. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors provide a recitation of events in recent years that document an increased focus on competency-based models of education, training, and assessment in professional psychology, particularly clinical, counseling, and school psychology, based on the work of the American Psychological Association's (APA's) Task Force on Assessment of Competence in Professional Psychology. The article begins with the inclusion of competencies as part of the "Ethical Principles of Psychologists and Code of Conduct" (APA, 2002). Next, accreditation practices in the United States and Canada are summarized. Competency-based education, training, and credentialing efforts in professional psychology are reviewed, including graduate, practicum, internship, and postdoctoral levels; licensure; postlicensure certifications; and board certification. General and specialty credentialing efforts both in North America and internationally follow. The Competencies Conference: Education and Credentialing in Professional Psychology and work on developing competencies for the profession are discussed. Then initiatives focused specifically on the assessment of competence are delineated. Implications for continued progress toward a culture of the assessment of competence are discussed in light of the historical origins within the profession of the competency-based movement. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The authors examined outcomes and predictors of outcomes for 85 undergraduates in 3 helping skills classes. After training, trainees used more exploration skills in helping sessions with classmates (as assessed by perceptions of helpees and helpers/trainees as well as behavioral counts of skills), were perceived by helpees as more empathic, talked less in sessions, conducted better sessions (from helpee and helper/trainee perspectives), and reported higher self-efficacy for using helping skills. In addition, trainees' confidence increased while learning exploration skills, dropped while learning insight skills, and then increased again while learning action skills. The authors were not able to predict outcome from the variables used (grade-point average, empathic concern and perspective taking, perfectionism). Suggestions for training and future research on training are included. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Continuing education workshops have been criticised for focusing on knowledge rather than skill acquisition by a focus on didactic teaching methods. A recent randomised controlled trial conducted by Westra et al. (in press) demonstrated that a deliberate practice (DP) training workshop for responding to ambivalence and resistance resulted in longer‐lasting skill acquisition than the same workshop in a traditional, more didactic format. The present study examined whether this same DP workshop was also efficacious at the level of client motivational language in 4‐month post‐testing interviews used to assess trainee skill in the Westra et al. parent study. Sixty therapists from the community (30 = DP and 30 = traditional) conducted an interview with either an ambivalent simulator or an ambivalent community volunteer. Interviews were coded for interviewee motivational language using the Motivational Interviewing Skills Code (MISC 1.1; Glynn & Moyers, 2009). Counterchange talk (CCT) was further classified into either Ambivalent‐CCT (uttered to disclose conflict about change) or Resistant‐CCT (statements against change uttered to oppose the therapist). Results revealed a significant difference between training groups, with the DP group eliciting less Resistant‐CCT than the traditional training group. This study provides further support for the use of DP training for potentially creating more productive conversations by minimising Resistant‐CCT; a form of speech that has been found to be negatively associated with client outcomes.
The Facilitative Interpersonal Skills (FIS) task is a performance test of therapists’ use of common relational skills (e.g. empathy, building expectations). The FIS method includes (a) materials that simulate difficult client moments on video, which are used to collect therapists’ responses to these situations; and (b) independent ratings of these responses. Many of the FIS items are informed by psychotherapy processes that have been linked to outcome and facilitative conditions that have been reframed as individual therapist skills (e.g. alliance bond capacity). Overall, the FIS has predicted psychotherapy outcome. A single study is described in which FIS predicted the therapist effect using multilevel modelling of a large sample of clients who were nested within therapists. We also summarise two additional outcome studies that used experimental designs. One future direction is to better understand how therapists form responses to these difficult moments. We conclude that forming an optimal therapeutic response during challenging, emergent in‐session situations involves responsiveness (Stiles et al., 1998), or finding a response that fits the clients’ needs within any moment.
The premise of this chapter is that the therapist’s inner experience matters considerably when providing psychotherapy. It has a major and far-reaching effect on what transpires in psychotherapy, how the work goes, and the extent to which the treatment is successful. Similarly, effective therapy of all persuasions is not simply a matter of the skilled application of techniques (e.g., reflection of the patient’s feelings, interpretations, systematic desensitization) but also the therapist’s inner experience, which impacts not only what techniques are chosen but also how they are applied. To use the technique of interpretation as an example, the tone, duration, content, depth, timing, and ultimately, the effectiveness of an interpretation will depend importantly on what the therapist is feeling and thinking about a patient and himself or herself at the moment of that interpretation, and probably at other moments, as well. Our focus in this chapter is twofold. First, we explore the inner experience of the good (i.e., effective) psychotherapist. The current wealth of multilevel modeling studies in which therapist and patient factors are partitioned into independent levels clearly underscores that some therapists are more effective than others on the whole, and also that a given therapist will be more effective with some of his or her patients than others. Our conceptualization of the effective therapist includes therapists who are more effective overall and effective with given patients. Do more effective therapists have different inner experiences than less effective therapists? Are inner experiences different when a therapist is being more effective than when that therapist is being less effective? Second, we focus on how the good therapist handles, uses, and manages his or her inner experience. This focal point is based on the premise that what a therapist does with his her inner experience is as important as what that therapist experiences.
A medical student's letter of recommendation for postgraduate training applications should provide a fair and accurate assessment of academic and clinical performance, as well as define character attributes pertinent to the practice of medicine. Since its inception in 1997, the emergency medicine (EM) standardized letter of evaluation (SLOE) has evolved into an instrument that provides just such an assessment. Concise, standardized, and discriminating in its assessment of performance relevant to the practice of EM, the SLOE is judged by program directors in EM as the most valuable component of a potential resident's application. Other specialties would benefit from such a specialty-specific perspective, which is currently lacking in most Electronic Residency Application Service application materials. Creation of specialty-specific SLOEs which define performance metrics or competencies and noncognitive personality traits critical to each unique specialty would add substantially to the holistic review of our graduating students. As a result, specialty-specific SLOEs would increase the likelihood that programs could effectively identify applicants who would not only be a "good fit" for their programs but also graduate to become successful physicians.
Objective:
Intraclass correlation coefficient (ICC) is a widely used reliability index in test-retest, intrarater, and interrater reliability analyses. This article introduces the basic concept of ICC in the content of reliability analysis.
Discussion for researchers:
There are 10 forms of ICCs. Because each form involves distinct assumptions in their calculation and will lead to different interpretations, researchers should explicitly specify the ICC form they used in their calculation. A thorough review of the research design is needed in selecting the appropriate form of ICC to evaluate reliability. The best practice of reporting ICC should include software information, "model," "type," and "definition" selections.
Discussion for readers:
When coming across an article that includes ICC, readers should first check whether information about the ICC form has been reported and if an appropriate ICC form was used. Based on the 95% confident interval of the ICC estimate, values less than 0.5, between 0.5 and 0.75, between 0.75 and 0.9, and greater than 0.90 are indicative of poor, moderate, good, and excellent reliability, respectively.
Conclusion:
This article provides a practical guideline for clinical researchers to choose the correct form of ICC and suggests the best practice of reporting ICC parameters in scientific publications. This article also gives readers an appreciation for what to look for when coming across ICC while reading an article.
Ethical practice has a complex and ambiguous relationship to notions of ‘competence’. Both, of course, seem vital elements of suitability to practise in professional roles across the settings of health and social care. But exactly how they relate is less self-evident. Is there such a thing as ‘ethical competence’? This article argues that there is, and that is it something which we might assess in the teaching of professional ethics. After comparing different versions of what a practitioner ‘competent’ at meeting ethical challenges in their work might look like, I argue (1) that ethical practice and wider professional competence (or, from the reverse angle, misconduct and incompetence) are integrated rather than distinct, and relatedly that (2) competence and ethical practice should be seen as achievable in tandem, rather than one being prior to the other. I then consider the model of skills acquisition utilised by Hubert and Stuart Dreyfus—and in nurse education by Patricia Benner—and argue that while illuminating, it does not provide an adequate framework for the development and assessment of ethical competence. Rather, we need a pluralistic approach incorporating different forms of propositional knowledge, practical reasoning and orientation-based skills.
Background
Competency-based training and assessment is considered the best practice internationally in postgraduate clinical psychology education. In Australia, there are still some ways to go as programmes begin to integrate competency-based pedagogical models into clinical training and assessment. Further understanding of the strengths and challenges of these models will be useful to educators interested in developing a competency-based approach.MethodsA structured literature review was carried out using the databases PsychInfo, PubMed, and PsychArticles. Keywords were: competency, and “training” or “assessment” or “model” or “clinical” or “psychology” or “medicine” or “allied health.” Articles had to be written in the English language and published in peer-reviewed journals. Relevant book chapters and web references from professional accreditation bodies were also assessed for inclusion. A total of 54 references were utilised in the review.ResultsThe review supports the relevance of competency-based learning and teaching. It draws on seminal benchmarking work from the international literature and considers the strengths and limitations of competency-based approaches to clinical health training and assessment. The review provides support for the ongoing progression towards competency-based training models in Australian postgraduate clinical psychology.Conclusions
Competency-based training and assessment methods offer educators sophisticated mechanisms for ensuring that clinical psychology graduates are prepared to meet the demands of professional practice and public accountability. Further efforts at integrating competency-based training models into Australian postgraduate curriculum, and associated research into the outcomes, are necessary to ensure a pedagogical culture of best practice in this country.
This article outlines the theory, research, and procedures of stress inoculation training (SIT). SIT consists of three overlapping phases. Their first phase, conceptualization, is an education phase that emphasizes the development of a warm, collaborative relationship through which a careful assessment and problem reconceptualization are completed. The second phase, skill acquisition and rehearsal, target and develop a repertoire of palliative and instrumental coping skills for anxiety reduction. A table of common cognitive coping skills is included to exemplify the range of coping skills employed. The third phase, application and follow-through, focuses upon activities that transfer coping skills to real life and prevent relapse. Finally, guidelines for the selection and design of individual and group application of stress inoculation training are provided.
This article describes results of a national questionnaire completed by counselor education program professors regarding their teaching of ethics. The questionnaire asked professors about 5 aspects of ethics education: materials used, instructional methods used, content taught, methods of evaluation used, and professors' goals for the ethics education of their students. Questionnaire results and demographic data about professors and programs are used to describe perceptions and practices of counselor educators who teach ethics.
The authors present the results of a survey investigating ethics education practices in counselor education programs accredited by the Council for Accreditation of Counseling and Related Educational Programs and counselor educators' beliefs regarding ethics education. Survey responses describe current curricular approaches to ethics education, content, and instructional methodologies used in counselor education. The survey also ascertained information regarding counselor educators' beliefs about ethics education and their abilities to teach ethics, implications for counselor education, professional development, and suggestions for further research are discussed.
Reflects the dissatisfaction of a growing number of mental health care professionals who question the lack of strong empirical foundations in the DSM and who are confounded by its patchwork of vaguely defined disorders, each defined by seemingly arbitrary time limits or poorly related symptoms. Expressing concern about whether the DSM truly provides a method for differentiating normal from pathological, clinicians and therapists alike wonder if the DSM should remain the diagnostic tool of choice. This book is divided into 3 main parts: (1) introduction and background, (2) methodological considerations, and (3) representational alternatives.
In this book, readers will find thought-provoking essays on alternative systems within several theoretical orientations, including psychodynamic, narrative, and cognitive/biological. This book challenges readers to move away from conventional thinking and engage in continued dialogue and discussion about specific modifications and alternatives to the DSM. Such work will eventually lay the groundwork for systems that may better serve the needs of mental health care clients. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Since the first clinical description of motivational interviewing (MI), research and applications have mushroomed. First applied to problem drinking, MI has subsequently been used with a variety of other problems, including drug abuse, gambling, eating disorders, anxiety disorders, chronic disease management, and health-related behaviors. In this chapter, we present an overview of MI, including ways it has been used in clinical practice, outcome research, how it may work, and how clinicians learn it. (PsycINFO Database Record (c) 2012 APA, all rights reserved)