Effects of training in time-limited dynamic psychotherapy: Mediators of therapists' responses to training.

Abstract

Sixteen therapists were enrolled in a year-long manualized training program as part of the Vanderbilt II study of time-limited dynamic psychotherapy (TLDP). The training program successfully changed therapists' interventions in line with prescriptions of the TLDP manual, but some unanticipated changes ran counter to the intent of the training, including increased negative interpersonal transactions as indicated by process measures such as the Structural Analysis of Social Behavior (SASB). We examined therapist variables, patient variables, and training variables that appeared to mediate therapist responses to the training program. Results indicate that patient difficulty may mediate certain aspects of therapists' responses to training. Therapists with self-reported hostile and controlling introjects showed the greatest technical adherence, which was intriguing because prior research has linked hostile therapist introject to greater frequency of countertherapeutic interpersonal process. Of special interest were differences in effects of training associated with individual training faculty. This finding, if generalizable, has important implications for manualized therapy research, especially multisite trials. The 5-year Vanderbilt II project examined the effects of 1 year's training in a manualized form of dynamic psychotherapy (time-limited dynamic psychotherapy [TLDP]; Strupp & Binder, 1984) on 16 experienced therapists across 80 cases. Because of the increasing use and acceptance of treatment manuals in psychotherapy research, a primary aim of the study was to explore the process of manualized training itself. A number of therapist behaviors in different domains were measured preand posttraining, with therapists serving as their own controls. Thus, the design focused on the effects of training in a single treatment manual rather than comparing the differential outcome efficacy of several competing protocol therapies. Analyses of therapist changes at the group level revealed both intended and unintended results (Henry, Strupp, Butler, Schacht, & Binder, 1993). The training program successfully changed therapists' technical interventions in line with prescriptions in the TLDP manual. Therapists showed significant increases in interventions, such as focusing the therapeutic process on in-session transactions and the articulation of cyclical maladaptive interpersonal patterns (CMPs). However, other changes were unexpected and ran counter to the intent of the training. These included an increase in negative interpersonal transactions as reflected by such process measures as the Struc

Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data)

“…157 Furthermore, therapists who participated in a training programme showed unexpected deterioration in skills after training. 158 The authors proposed that this was evidence of a 'post-training phase in which [participants'] performance actually declined in certain ways as they struggled to naturally integrate new techniques into their existing styles and approaches'. 158 It is possible that the participants in our study similarly responded to the intervention writing task in ways that parallel a choking effect or the post-training effect described in these examples.…”

Behavioral Therapies Trials

“…There is empirical evidence to suggest that competence prior to training predicts competence in the training phase (Henry, Schacht, Strupp, Butler, & Binder, 1993;Rounsaville, Chevron, Weissman, Prusoff, & Frank, 1986;Siqueland et al, 2000). Hence, a long-term personal practice of mindfulness meditation was considered to be a critical attribute for teachers in this study.…”

Complexity and Nonlinear Dynamics in Psychotherapy

“…On the contrary, sometimes manual integrity seems to undermine the natural social competencies of therapists. 26,27 Manuals mainly appear useful to beginners. Therapists obviously also wait for successes to appear, before actually employing the manual.…”