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

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-

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

“…Prior research has shown that therapists with certain self-hostile introjects engage in greater frequencies of countertherapeutic interpersonal process, such as complex communication (Henry, Schacht, & Strupp, 1990). In our earlier article (Henry, Strupp, Butler, Schacht, & Binder, 1993), we reported a significant increase in complex communications at the group level after training. Accordingly, we wanted to explore whether the posttraining increase in complex communications was caused by a subset of therapists based on introject quadrant.…”

“…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.…”

“…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.…”

A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures.

“…Although the merit in common practitioner concerns about manualized approaches (Addis, Wade, & Hatgis, 1999) may be questioned (Fonagy, 1999), the empirical literature indicates that treatment manuals do not ensure effective delivery of therapy (Binder, 1993;. However, based on a small number of studies that produced conflicting results, and given the limitations of study methodology, it is less clear whether that which is gained in adherence to specific techniques through manuals (CritsChristoph et al, 1998;Henry, Strupp, Butler, Schacht, & Binder, 1993;Hilsenroth, Defife, Blagys, & Ackerman, 2006;Multon et al, 1996) may be at the expense of other therapeutic factors and therapeutic progress (Strupp & Anderson, 1997).…”

Toward a more clinically valid approach to therapy research.

“…For example, Henry, Strupp, Butler, Schacht, and Binder (1993) found that overly conscientious adherence to the treatment manual in the Vanderbilt II study led shortterm psychodynamic therapists to achieve less favorable results. A comparable finding is reported by Castonguay, Goldfried, Wiser, Raue, and Hayes (1996) with cognitive therapists, whereby strict adherence to the manual was associated with difficulties in the therapeutic alliance.…”