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. Clinical Impact StatementQuestion: This study examines how receiving deliberate practice training impacts therapist levels of support with real people and simulators. Findings: Clinicians should consider evaluating future continuing education workshops for their compliance with deliberate practice training. Meaning: Training should integrate the use of both simulators and real people in explicitly testing training impact because the difficulty of simulators can be increased to promote consistency in clinical skill application. Next Steps: Future training and research should explicitly evaluate the impact of deliberate practice and consider developing less complex process coding systems for easier adaptation to a training context.
workshops, the dominant model of postgraduate training, are not systematically tested and in fact are limited for improving therapist performance. This is because they typically focus more on knowledge than skill (e.g., Davis et al., 1999;Owen et al., 2016;Taylor & Neimeyer, 2017). Workshops on motivational interviewing are one of the few areas where therapist learning has been studied versus assumed (MI;Miller & Rollnick, 2002). MI workshops tend to involve relatively higher amounts of practice, and reviews of 2-day workshops indicate that they have large effects on self-reported skills and modest effects on observer-rated skills pre-to post-work-
Objective: Therapist responsivity is recognised as an important factor for improved psychotherapy process and outcome. Previous research (Aviram et al., 2016) has found that increased therapist responsivity during key moments (e.g., disagreements) is particularly impactful to post-treatment outcome. However, global scores of the observational coding system used in prior studies fail to capture more precise micromoments and specific therapist responsivity within disagreement episodes that may contribute to outcome. In response, this study analysed therapy disagreement episodes with more precise coding measures that capture moment-to-moment sequences of therapist and client utterances. Method: Sixty disagreement episodes (segment beginning with clear client disagreement with therapist and ending once they shifted to a new topic) previously abstracted from early working phase sessions of a randomised controlled trial (RCT) of cognitive behavioural therapy with and without integrated motivational interviewing (Hara et al., 2022) were utilised. To gauge responsivity within these episodes, two therapist behaviours (demand and support) were examined in response to specific moments of client counter-change talk (CCT) statements using microlevel, moment-to-moment coding systems. This resulted in indices of appropriate (CCT-Support) and inappropriate/errors in responsivity (CCT-Demand). Responsivity indices were compared with the gold standard observational coding measure for managing ambivalence and resistance, the Motivational Interviewing Treatment Integrity scale (MITI).Results: While appropriate responsivity did not predict outcome, responsivity errors significantly predicted poorer outcome at one year post-treatment. Additionally, the capacity of responsivity errors for predicting outcome was equivalent to that obtained from the global observational measure. Conclusion:These findings have significant implications for training by emphasising the need for therapists to be sensitive to context and to acquire skill at detecting and responsively managing specific moments to avoid responsivity errors and improve therapy outcomes.
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