The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations

Abstract

Evidence-based treatments (EBT) are underutilized in community settings, where consumers are often seen for treatment. Underutilization of EBTs may be related to a lack of empirically informed and supported training strategies. The goals of this review are to understand the state of the literature for training therapists in psychotherapy skills and to offer recommendations to improve research in this area. Results of this review of 55 studies evaluating six training methods indicate that multicomponent trainings have been studied most often and have most consistently demonstrated positive training outcomes relative to other training methods. Studies evaluating utility of reading, selfdirected trainings, and workshops have documented that these methods do not routinely produce positive outcomes. Workshop follow-ups help to sustain outcomes. Little is known about the impact of train-the-trainer methods. Methodological flaws and factors that may influence training outcome and future directions are also reviewed. Keywords therapist training; implementation; dissemination; psychosocial treatmentsThe hope that mental health problems can be successfully ameliorated is supported by the availability of an increasing number of psychosocial treatment approaches with established efficacy (e.g., Silverman & Hinshaw, 2008). For example, efficacious treatment programs have been reported to address developmental disorders, behavioral and emotional disorders, substance abuse, eating disorders, personality disorders, and psychotic disorders, among others (e.g., Eyberg, Nelson, & Boggs, 2008;Scogin, Welsh, Hanson, Stump, & Coates, 2005). However, these approaches continue to be underutilized in community settings (Street, Niederehe, & Lebowitz, 2000) where millions of consumers receive mental health services Medicine, 3811 O'Hara Street -537 Bellefield Towers, Pittsburgh, PA 15213, 412-246-5897 (phone), 412-246-5341 (fax), HerschellAD@upmc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Scope and Definitions of Evidence-Based TreatmentMore than 10 years ago, the American Psychological Associations' Division 12's (Clinical Psychology) Task Force on Promotion and Dissemination of Psychological Procedures (1995) offered recommendations to promote efforts to define, study and evaluate, teach, and disseminate EBTs (then labeled empirically validated treatments and renamed empirically supported treatments; Chambless et al., 1998;Chambless et al., 1996). These recommendations included increasing the availability of empirically supported interventions, enforcing g...

The dissemination and implementation of psychological treatments: Problems and solutions

“…All three components are thought to be essential as the clinical and research consensus is that workshops and treatment manuals on their own are inadequate in the absence of supervision. 27 These considerations apply to the eating disorder field as much as to any other, yet all too often they are neglected or sidestepped. Even in controlled treatment trials there are examples of there being little or no attempt to ensure that the therapists were trained and supervised by professionals competent, let alone expert, in the treatments concerned.…”

“…This involves one staff member of a mental health organization being trained in the treatment concerned and then this staff member becoming a trainer of the remaining members of staff. 27 This strategy has been shown to be effective in training therapists to deliver CBT for panic disorder, 28 and there is also evidence that it can be used to train therapists to use guided cognitive behavioral self-help for binge eating problems. 29 The strategy remains to be evaluated in larger controlled studies.…”

Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety

“…For instance, the research on therapist training and competencies suggests that merely attending one-time workshops are not effective in changing therapist behavior or improving competency in evidence-based approaches such as CBT (e.g., Beidas & Kendall, 2010;Herschell, Kolko, Baumann, & Davis, 2010) but that behavioral rehearsal with ongoing consultation is key to enhancing treatment integrity (e.g., Beidas, Cross, & Dorsey, 2014;Beidas, Edmunds, Marcus, & Kendall, 2012;Bearman et al, 2013). Prioritizing these research questions will take us from simply knowing what treatments work to knowing how they work and how to best implement them in everyday service systems, which would greatly expand the application of research to guide treatment planning, delivery, and refinement in a wide variety of contexts, so that more children, adolescents, families, and communities can benefit.…”

Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists (Preprint)

“…Overall P-value for including number of patients;P=0.03 when unadjusted for pretraining score and when adjusted P=0.16 5 Effect relative to treating no patients 6 Number of modules completed included as a linear term…”

“…The currently accepted method of training typically involves attending a specialist workshop, reading relevant texts and a subsequent period of supervision from someone expert in the treatment [6]. As this method is both labour-intensive and costly [7,8] and vulnerable to the shortage of treatment experts it limits the number of therapists that can be trained and therefore the number of people who might potentially receive effective treatment.…”