Research and the supervisory process.

Reviews current research on the psychotherapy supervisory process that addresses the effects of supervision on therapist attitudes toward patients and various methods of training and acquiring specific intervention strategies. Emphasis is placed on the importance of relationship skills for psychotherapy outcome, and the methodological problems that are encountered in the study of the process of building these skills in the supervisory setting are noted. An important area for further research is the acquisition of intervention skills that lie outside the area of relationship enhancement. The continued growth in number of treatment manuals is mentioned as a positive current development in the training of experienced therapists and as a promising research tool for future psychotherapy outcome studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of manual-guided training in the conduct and efficacy of interpersonal psychotherapy for depression.

This article reviews findings from manual-guided training programs in short-term interpersonal psychotherapy (IPT) for depression, an exploratory treatment that focuses on symptom reduction and improvement of social functioning. The literature revealed (a) that experienced, dynamically trained therapists were able to achieve a high level of competence in IPT after comparatively brief training and were able to maintain adherence to the manual over a lengthy study; (b) that general dimensions of the psychotherapy process, including therapist warmth and patient difficulty, were highly correlated with ratings of therapist competence in the performance of IPT; and (c) that therapists judged as performing IPT more competently tended to be more effective. Although definitive evidence on the effectiveness of manual-guided training is lacking, the use of manuals and systematic therapist training appear to be useful for the conduct of psychotherapy efficacy research. Findings showing that manual adherence is related to therapist efficacy suggest a role for these procedures in clinical training and competency determination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special series.

Provides an introduction to the special series on research in utilizing competency-based criteria for training psychotherapeutic skills. The introduction of manuals for practicing psychotherapy reactivates an old debate about the value of competency-based education for the mental health disciplines. In a general way, this special series approaches and explores this debate. The articles included are of two types: (a) those that address general issues of criteria-based training and (b) those that explore standards for training in specific approaches. Altogether, the articles cover a variety of therapeutic approaches, including most of those that are applied by contemporary mental health practitioners. Moreover, the articles address the problems of negative effects, common versus specific variables, and the roles of cognitive and experiential learning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of treatment manuals to train psychotherapists: Observations and recommendations.

The author's experience using treatment manuals for various forms of psychotherapy in several situations provides the basis for this discussion of their value in graduate-level clinical training programs and psychiatric residencies. Use of manuals is recommended, particularly for novice psychotherapists. Commonly accepted goals of clinical training are enumerated. Based on the goals, features of manuals that distinguish those likely to be most useful for early training are identified. Limitations of available manuals for meeting the goals of training are outlined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Graduate training in psychotherapy: Are therapy outcomes enhanced?

Several sources of indirect evidence supporting the value of graduate training in psychotherapy are reviewed here. Training protocols that are known to enhance trainees' skills are briefly discussed, as are conclusions of meta-analytic reviews examining relationships between therapist experience and training, and therapy outcome. An updated meta-analysis of therapy outcome studies involving within-study comparisons of psychotherapists of different levels of training and experience is summarized. It is concluded that a variety of outcome sources are associated with modest effect sizes favoring more trained therapists. In many outpatient settings, therapists with more training tend to suffer fewer therapy dropouts than less trained therapists. Shortcomings of available research and speculations about possible variables influencing outcomes are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A national survey of practicing psychologists' attitudes toward psychotherapy treatment manuals.

There has been considerable debate and little empirical data on the role of psychotherapy treatment manuals in clinical practice. Attitudes toward treatment manuals are a potentially important determinant of how likely practitioners are to use manual-based treatments in clinical practice. A total of 891 practicing psychologists nationwide were surveyed about their attitudes toward treatment manuals and their ideas about the content of manuals. Practitioners held widely varying attitudes toward treatment manuals, and ideas about what constitutes a manual were associated with attitudes in a predictable way. Recommendations are made for how to gather more useful information about practitioners' attitudes toward the many changes affecting current models of clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An invitation to theoreticians and researchers from an applied experiential practitioner.

In order for applied experiential psychotherapy to progress, there are certain problems that must be solved, including the need for (a) a strategy of therapeutic procedures, (b) a library of significant live data on experiential psychotherapy, (c) a dream screen, (d) instruments to measure bodily feelings, (e) ways for therapists to disengage from their personalities and assimilate to the patient, and (f) methods by which the patient interacts with deeper personality processes. The solution of these problems would constitute breakthroughs for the development of applied experiential practice. Psychotherapeutic theoreticians and researchers are invited to use their resources, knowledge, and expertise to solve these practical problems. (55 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research, practice, and managed care.

Examines the relationship between practitioners, researchers, and managed care. Managed care systems' basic purpose is to conserve as much as possible the health care dollar, and to provide rationale for the equitable distribution of public funds. Despite evidence that psychotherapy is an effective treatment, this well-documented conclusion continues to be assailed. Research has been used as a tool for undergirding the rationing of therapeutic services. Similarly, the demand for treatment manuals has been met and treatment manuals have been shown to be of value, although the value is limited. In the same vein, time-limited forms of therapy can produce change, but such changes will in most cases be modest. The author notes that it is one thing to recognize that in the face of a shrinking health care economy professionals must accept more or less severe restrictions imposed on their activities. However, it is quite another to create the impression that brief or time-limited forms of psychotherapy are fully comparable or even superior to more intensive and extended forms. There is also reason to believe that well-trained experienced therapists are superior service providers. The need for greater tolerance and realism in accepting what psychotherapy can and cannot do is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of treatment manuals in cognitive therapy: Experience and issues.

This article traces some historical developments in the use of treatment manuals in psychotherapy research and reviews characteristics that have facilitated the development of cognitive therapy manuals. Arguments in favor of and opposed to the further development of treatment manuals are reviewed. Where cognitive therapy research exists that is relevant to these arguments, it is reviewed; where research does not exist, suggestions are provided for research and data that may address these arguments. The article concludes by suggesting three general areas for future treatment-manual research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of a Cognitive Adjunct Procedure Within a Microtraining Situation.

The present study examined the generalization effects of three methods of counselor training: cognitive-behavioral (CB), behavioral (B), and programmed learning (PL). Each of 45 low-scoring females, prescreened on empathic communication, was randomly assigned to one of these groups. The CB and B groups received training via manuals, videotapes, and individual supervision, whereas the PL group received programmed manuals only. The CB group was exposed to cognitive strategies in addition to the skill acquisition content of the B and PL groups. Each trainee completed an interview before, after, and 4 weeks after training. The effects of training on different communication skills were examined and assessed by interview, written, and self-report measures. Findings indicated that the CB group was more empathic at posttraining and demonstrated better communication skills than the PL group at follow-up. The B group generally fell in the intermediate position between the CB and PL groups. These findings are discussed in terms of different cognitive strategies and the benefits of programmed manuals within microtraining. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What are the benefits of mindfulness? A practice review of psychotherapy-related research.

Research suggests that mindfulness practices offer psychotherapists a way to positively affect aspects of therapy that account for successful treatment. This paper provides psychotherapists with a synthesis of the empirically supported advantages of mindfulness. Definitions of mindfulness and evidence-based interpersonal, affective, and intrapersonal benefits of mindfulness are presented. Research on therapists who meditate and client outcomes of therapists who meditate are reviewed. Implications for practice, research, and training are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of training in time-limited dynamic psychotherapy: Changes in therapist behavior.

16 therapists participated in a year-long manualized training program as part of the Vanderbilt II study of time-limited dynamic psychotherapy. Changes in therapist behavior were measured with the Vanderbilt Therapeutic Strategies Scale (an adherence measure), the Vanderbilt Psychotherapy Process Scale (VPPS), and interpersonal process codings using the Structural Analysis of Social Behavior (SASB). The training program successfully changed therapists' technical interventions in line with the manualized protocol. After training, there was increased emphasis on the expression of in-session affect, exploration of the therapeutic relationship, an improved participant–observer stance, and greater use of open-ended questions. There was also an indication of unexpected deterioration in certain interpersonal and interactional aspects of therapy as measured by the VPPS and SASB ratings. These results question the assumption that greater control of the therapy variable is straightforwardly achieved with manuals and adherence scales. Changing or dictating specific therapist behaviors to achieve technical adherence may alter other therapeutic variables in unexpected and even counterproductive ways. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Positive psychology and the humanistic tradition.

Positive emotions are discussed within the context of experiential, client-centered, and related psychotherapies. An attempt is made to discuss the idea that the effects of such psychotherapies could be enhanced if positive emotions were viewed as a cause of positive psychotherapy outcomes rather than a consequence of focusing on painful and disturbing emotions. It is concluded that therapists within the humanistic tradition have highly positive views of persons and their tendency to be forward moving. Prizing patients while they express "negative" emotions seems much more likely to lead to positive emotions than the reverse. Thus, the positive psychology movement with its emphasis on giving preference to positive emotions seems misguided in a clinical context. Despite these reservations about the value of focusing on positive emotions in psychotherapy, the authors call for research to test the consequences of such a focus in experiential psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supervision: Its contributions to treatment efficacy.

The efficacy of supervision in training of psychotherapists is discussed in relation to (a) trainees' attitudes, beliefs, and skills, (b) trainee's performance in the therapist role, (c) interactional process events in supervision and psychotherapy, and, (d) client change. Although investigations to date suggest the potential of supervision for teaching advanced skills of psychotherapy, few studies exist that examine directly the relation of therapist performance and client change to supervision. There are virtually no studies that compare the efficacy of supervision to other training methods. If supervision is to remain an integral part of training, then standardized training manuals, analogous to those in psychotherapy, need to be developed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Graduate training in psychotherapy: Are therapy outcomes enhanced?": Comment on Stein and Lambert (1995).

Comments on the article by D. M. Stein and M. J. Lambert (Journal of Consulting & Clinical Psychology, 1995[Apr], Vol 63[2], 182–296). The authors misunderstood the meta-analysis of P. Crits-Cristoph et al (see record 1992-20595-001) as examining the relation of therapist experience to "therapist effects" (i.e., differences between therapists in their average outcomes). The Crits-Cristoph et al results did not show that experienced therapists had better outcomes than less experienced therapists. It is also noted that the data in Table 3 are, in fact, correct. However, these 2 errors do not affect the main findings of Stein and Lambert's article. (The following abstract of this article originally appeared in PA, Vol 82:26915.) Several sources of indirect evidence supporting the value of graduate training in psychotherapy are reviewed here. Training protocols that are known to enhance trainees' skills are briefly discussed, as are conclusions of meta-analytic reviews examining relationships between therapist experience and training, and therapy outcome. An updated meta-analysis of therapy outcome studies involving within-study comparisons of psychotherapists of different levels of training and experience is summarized.… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do treatment manuals undermine youth–therapist alliance in community clinical practice?

Objective: Some critics of treatment manuals have argued that their use may undermine the quality of the client–therapist alliance. This notion was tested in the context of youth psychotherapy delivered by therapists in community clinics. Method: Seventy-six clinically referred youths (57% female, age 8–15 years, 34% Caucasian) were randomly assigned to receive nonmanualized usual care or manual-guided treatment to address anxiety or depressive disorders. Treatment was provided in community clinics by clinic therapists randomly assigned to treatment condition. Youth–therapist alliance was measured with the Therapy Process Observational Coding System—Alliance (TPOCS–A) scale at 4 points throughout treatment and with the youth report Therapeutic Alliance Scale for Children (TASC) at the end of treatment. Results: Youths who received manual-guided treatment had significantly higher observer-rated alliance than usual care youths early in treatment; the 2 groups converged over time, and mean observer-rated alliance did not differ by condition. Similarly, the manual-guided and usual care groups did not differ on youth report of alliance. Conclusions: Our findings did not support the contention that using manuals to guide treatment harms the youth–therapist alliance. In fact, use of manuals was related to a stronger alliance in the early phase of treatment. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Effects of preparing children for psychotherapy.

Prior to beginning therapy, 88 6-12 yr olds participated in either a therapy preparation interview (i.e., they were told what therapy was for, what the therapist would do, and what they should do) or a social history interview that was irrelevant to therapy. Results show that prepared Ss were less likely to terminate therapy prematurely. Ratings made after the 1st, 3rd, and 6th therapy sessions revealed that over sessions therapists indicated greater liking for Ss and both therapists and parents perceived improvement in Ss, but in no case was the effect enhanced by therapy preparation. Finally, there was no agreement (r = .07) between therapists and parents when rating improvement in general, but there was very high agreement (r = .66) when rating improvement on "target symptoms," a finding with implications for future therapy research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Zeddies's relational unconscious: Some further reflections.

T. J. Zeddies's (2000) excellent article highlights the contributions relational psychoanalysis has made to rethinking psychoanalytic notions of the unconscious. His views are largely consistent with those developed from the study of intersubjective systems, in which experiential worlds are seen as variably organized according to emotional inferences (organizing principles) operating automatically and often outside awareness. One dimension of this emotional organization is consciousness and unconsciousness, understood as horizonal properties of experiential worlds within their intersubjective contexts. The concept of consciousness cannot be reduced to linguistic expression of what is inside. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the integrity of a psychotherapy protocol: assessment of adherence and competence

Manipulation checks should be used in psychotherapy trials to confirm that therapists followed the treatment manuals and performed the therapy competently. This article is a review of some strategies that have been used to document treatment integrity; also, their limitations are discussed here. Recommendations for improving these checks are presented. Specific guidelines are offered regarding when and how to assess both therapist adherence to treatment protocols and competence.