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Background:
Under the new psychotherapy law in Germany, standardized patients (SPs) are to become a standard component inpsychotherapy training, even though little is known about their authenticity.Objective:The present pilot study explored whether, followingan exhaustive two-day SP training, psychotherapy trainees can distinguish SPs from real patients.
Methods:
Twenty-eight psychotherapytrainees (M= 28.54 years of age,SD= 3.19) participated as blind raters. They evaluated six video-recorded therapy segments of trained SPsand real patients using the Authenticity of Patient Demonstrations Scale.
Results:
The authenticity scores of real patients and SPs did notdiffer (p= .43). The descriptive results indicated that the highest score of authenticity was given to an SP. Further, the real patients did notdiffer significantly from the SPs concerning perceived impairment (p= .33) and the likelihood of being a real patient (p= .52).
Conclusions:
The current results suggest that psychotherapy trainees were unable to distinguish the SPs from real patients. We therefore stronglyrecommend incorporating training SPs before application. Limitations and future research directions are discussed.
Public Significance Statement This study demonstrates that simulated patients (SPs) can authentically portray a depressive case. The results provide preliminary evidence of psychometrically sound properties of the rating scale that contributes to distinguishing between authentic and unauthentic SPs and may thus foster SPs' dissemination into evidence-based training. <br /> For training purposes, simulated patients (SPs), that is, healthy people portraying a disorder, are disseminating more into clinical psychology and psychotherapy. In the current study, we developed an observer-based rating instrument for the evaluation of SP authenticity-namely, it not being possible to distinguish them from real patients-so as to foster their use in evidence-based training. We applied a multistep inductive approach to develop the Authenticity of Patient Demonstrations (APD) scale. Ninety-seven independent psychotherapy trainees, 77.32% female, mean age of 31.49 (SD = 5.17) years, evaluated the authenticity of 2 independent SPs, each of whom portrayed a depressive patient. The APD demonstrated good internal consistency (Cronbach's alpha = .83) and a strong correlation (r = .82) with an established tool for assessing SP performance in medical contexts. The APD scale distinguished significantly between an authentic and unauthentic SP (d = 2.35). Preliminary evidence for the psychometric properties of the APD indicates that the APD could be a viable tool for recruiting, training, and evaluating the authenticity of SPs. Strengths, limitations, and future directions are also discussed in detail.
Up to now pathological health anxiety has been classified primarily as a somatoform disorder or a somatic symptom disorder in ICD and DSM. Theoretical and empirical evidence, however, suggest that pathological health anxiety basically represents an anxiety disorder. In this paper, it is argued that deficits in the treatment and perception of patients with pathological health anxiety as "difficult patients" are partly attributable to a lack of clarity in terms of nosology and with respect to central mechanisms of etiology and pathogenesis. Based on novel theoretical approaches for the explanation of pathological health anxiety, suggestions for an improved therapeutic practice are outlined. This approach focuses on a more intensive use of exposure-based treatment elements that are oriented to the inhibitory learning approach, which has already proven its effectiveness for other anxiety disorders.
Background:
Many authors regard counseling self-efficacy (CSE) as important in therapist development and training. The purpose of this study was to examine the factor structure, reliability, and validity of the German version of the Counselor Activity Self-Efficacy Scales-Revised (CASES-R).
Method:
The sample consisted of 670 German psychotherapy trainees, who completed an online survey. We examined the factor structure by applying exploratory and confirmatory factor analysis to the instrument as a whole.
Results:
A bifactor-exploratory structural equation modeling model with one general and five specific factors provided the best fit to the data. Omega hierarchical coefficients indicated optimal reliability for the general factor, acceptable reliability for the Action Skills-Revised (AS-R) factor, and insufficient estimates for the remaining factors. The CASES-R scales yielded significant correlations with related measures, but also with therapeutic orientations.
Conclusion:
We found support for the reliability and validity of the German CASES-R. However, the subdomains (except AS-R) should be interpreted with caution, and we do not recommend the CASES-R for comparisons between psychotherapeutic orientations.
Theoretischer Hintergrund:
Selbsterfahrung ist zentraler Bestandteil der Psychotherapieausbildung. Gleichzeitig wurde Selbsterfahrung selten empirisch untersucht.
Fragestellung:
Ziel unserer Studie war es, Bedingungen und Effekte hilfreicher Selbsterfahrung zu explorieren.
Methode:
Vierzehn verhaltenstherapeutische Ausbildungskandidat_innen wurden anhand halbstrukturierter Leitfadeninterviews befragt. Die Auswertung erfolgte mittels qualitativer Inhaltsanalyse nach Mayring (2015).
Ergebnisse:
Verschiedene Bedingungen wurden mit hilfreich erlebter Selbsterfahrung in Zusammenhang gebracht: Merkmale der Selbsterfahrungsleitung (u. a. Durchführungskompetenz), der Organisation, der Teilnehmer_innen (Lernbereitschaft), die behandelten Themen und die eingesetzten Techniken, sowie eine tragfähige Arbeitsbeziehung. Berichtete positive Effekte waren u. a. die Förderung interpersoneller Kompetenzen. Zudem wurden Nebenwirkungen und negative Effekte formuliert (u. a. Erschöpfung).
Schlussfolgerungen:
Bedingungen zur Durchführung von als hilfreich erlebter Selbsterfahrung und Effekte von Selbsterfahrung wurden aus Sicht der Teilnehmer_innen extrahiert.
Objective: Despite increasing research on psychotherapy preferences, the preferences of psychotherapy trainees are largely unknown. Moreover, differences in preferences between trainees and their patients could (a) hinder symptom improvement and therapy success for patients and (b) represent significant obstacles in the early career and development of future therapists. Method: We compared the preferences of n = 466 psychotherapy trainees to those of n = 969 laypersons using the Cooper-Norcross Inventory of Preferences. Moreover, we compared preferences between trainees in cognitive-behavioural therapy (CBT) and psychodynamic trainees. Results: We found significant differences between both samples in 13 of 18 items, and three of four subscales. Psychotherapy trainees preferred less therapist directiveness (d = 0.58), more emotional intensity (d = 0.74), as well as more focused challenge (d = 0.35) than laypeople. CBT trainees preferred more therapist directiveness (d = 2.00), less emotional intensity (d = 0.51), more present orientation (d = 0.76) and more focused challenge (d = 0.33) than trainees in psychodynamic/psychoanalytic therapy. Conclusion: Overall, the results underline the importance of implementing preference assessment and discussion during psychotherapy training. Moreover, therapists of different orientations seem to cover a large range of preferences for patients, in order to choose the right fit.
Despite the positive effects of including patients’ preferences into therapy on psychotherapy outcomes, there are still few thoroughly validated assessment tools at hand. We translated the 18-item Cooper-Norcross Inventory of Preferences (C-NIP) into German and aimed at replicating its factor structure. Further, we investigated the reliability of the questionnaire and its convergence with trait measures. A heterogeneous sample of N = 969 participants took part in our online survey. Performing ESEM models, we found acceptable model fit for a four-factor structure similar to the original factor structure. Furthermore, we propose an alternative model following the adjustment of single items. The German C-NIP showed acceptable to good reliability, as well as small correlations with Big-Five personality traits, trait and attachment anxiety, locus of control, and temporal focus. However, we recommend further replication of the factor structure and further validation of the C-NIP.
Despite the positive effects of including patients’ preferences into therapy on psychotherapy outcomes, there are still few thoroughly validated assessment tools at hand. We translated the 18-item Cooper-Norcross Inventory of Preferences (C-NIP) into German and aimed at replicating its factor structure. Further, we investigated the reliability of the questionnaire and its convergence with trait measures. A heterogeneous sample of N = 969 participants took part in our online survey. Performing ESEM models, we found acceptable model fit for a four-factor structure similar to the original factor structure. Furthermore, we propose an alternative model following the adjustment of single items. The German C-NIP showed acceptable to good reliability, as well as small correlations with Big-Five personality traits, trait and attachment anxiety, locus of control, and temporal focus. However, we recommend further replication of the factor structure and further validation of the C-NIP.
Despite the positive effects of including patients' preferences into therapy on psychotherapy outcomes, there are still few thoroughly validated assessment tools at hand. We translated the 18-item Cooper-Norcross Inventory of Preferences (C-NIP) into German and aimed at replicating its factor structure. Further, we investigated the reliability of the questionnaire and its convergence with trait measures. A heterogeneous sample of N = 969 participants took part in our online survey. Performing ESEM models, we found acceptable model fit for a four-factor structure similar to the original factor structure. Furthermore, we propose an alternative model following the adjustment of single items. The German C-NIP showed acceptable to good reliability, as well as small correlations with Big-Five personality traits, trait and attachment anxiety, locus of control, and temporal focus. However, we recommend further replication of the factor structure and further validation of the C-NIP.
Theoretischer Hintergrund: Einflüsse von therapeutenorientiertem Kompetenz-Feedback in der Psychotherapieausbildung wurden bislang wenig untersucht.
Fragestellung: Wie gehen Ausbildungstherapeuten mit Feedback um? Welchen Einfluss hat ein regelmäßiges Kompetenz-Feedback auf die Qualität psychotherapeutischer Behandlungen (insbesondere Therapiesitzungen, therapeutische Beziehung, Person des Therapeuten, Supervision)?
Methode: Elf Therapeuten wurden mithilfe eines halbstrukturierten Interviewleitfadens befragt. Die Auswertung erfolgte mittels qualitativer Inhaltsanalyse nach Mayring (2015).
Ergebnisse: Das auf Basis der Interviews erstellte Kategoriensystem umfasste die Kategorien „Erwartungen an das Feedback“, „Wahrnehmung des Feedbacks“, „Verarbeitung von und Umgang mit Feedback“, „Folgen, Auswirkungen und Veränderungen durch Feedback“ sowie „Verbesserungswünsche“.
Schlussfolgerungen: Therapeuten streben eine Umsetzung des Feedbacks an, welches sich auf die Behandlung, die Supervision, die eigene Person und die therapeutische Beziehung auswirkt.
Theoretischer Hintergrund: Einflüsse von therapeutenorientiertem Kompetenz-Feedback in der Psychotherapieausbildung wurden bislang wenig untersucht.
Fragestellung: Wie gehen Ausbildungstherapeuten mit Feedback um? Welchen Einfluss hat ein regelmäßiges Kompetenz-Feedback auf die Qualität psychotherapeutischer Behandlungen (insbesondere Therapiesitzungen, therapeutische Beziehung, Person des Therapeuten, Supervision)?
Methode: Elf Therapeuten wurden mithilfe eines halbstrukturierten Interviewleitfadens befragt. Die Auswertung erfolgte mittels qualitativer Inhaltsanalyse nach Mayring (2015).
Ergebnisse: Das auf Basis der Interviews erstellte Kategoriensystem umfasste die Kategorien „Erwartungen an das Feedback“, „Wahrnehmung des Feedbacks“, „Verarbeitung von und Umgang mit Feedback“, „Folgen, Auswirkungen und Veränderungen durch Feedback“ sowie „Verbesserungswünsche“.
Schlussfolgerungen: Therapeuten streben eine Umsetzung des Feedbacks an, welches sich auf die Behandlung, die Supervision, die eigene Person und die therapeutische Beziehung auswirkt.
Objectives: The use of simulated and standardized patients (SP) is widely accepted in the medical field and, from there, is beginning to disseminate into clinical psychology and psychotherapy. The purpose of this study was therefore to systematically review barriers and facilitators that should be considered in the implementation of SP interventions specific to clinical psychology and psychotherapy. Methods: Following current guidelines, a scoping review was conducted. The literature search focused on the MEDLINE,PsycINFO and Web of Science databases, including Dissertation Abstracts International. After screening for titles and abstracts,full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, a pre-defined form was piloted and used. Units of meaning with respect to barriers and facilitators were extracted and categorized inductively using content-analysis techniques. From the results, a matrix of interconnections and a network graph were compiled. Results: The 41 included publications were mainly in the fields of psychiatry and mental health nursing, as well as in training and education. The detailed category system contrasts four supercategories, i.e., which organizational and economic aspects to consider, which persons to include as eligible SPs, how to develop adequate scenarios, and how to authentically and consistently portray mental health patients.Conclusions: Publications focused especially on the interrelation between authenticity and consistency of portrayals, on how to evoke empathy in learners, and on economic and training aspects. A variety of recommendations for implementing SP programs,from planning to training, monitoring, and debriefing, is provided, for example, ethical screening of and ongoing support for SPs.
ObjectivesThe use of simulated and standardized patients (SP) is widely accepted in the medical field and, from there, is beginning to disseminate into clinical psychology and psychotherapy. The purpose of this study was therefore to systematically review barriers and facilitators that should be considered in the implementation of SP interventions specific to clinical psychology and psychotherapy.MethodsFollowing current guidelines, a scoping review was conducted. The literature search focused on the MEDLINE, PsycINFO and Web of Science databases, including Dissertation Abstracts International. After screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, a pre-defined form was piloted and used. Units of meaning with respect to barriers and facilitators were extracted and categorized inductively using content-analysis techniques. From the results, a matrix of interconnections and a network graph were compiled.ResultsThe 41 included publications were mainly in the fields of psychiatry and mental health nursing, as well as in training and education. The detailed category system contrasts four supercategories, i.e., which organizational and economic aspects to consider, which persons to include as eligible SPs, how to develop adequate scenarios, and how to authentically and consistently portray mental health patients.ConclusionsPublications focused especially on the interrelation between authenticity and consistency of portrayals, on how to evoke empathy in learners, and on economic and training aspects. A variety of recommendations for implementing SP programs, from planning to training, monitoring, and debriefing, is provided, for example, ethical screening of and ongoing support for SPs.
Although effective treatments exist, obsessive-compulsive disorder (OCD) is, according to the views of patients and experts, still associated with chronicity, a term with no clear and consistent definition. To improve patient care and to foster research, a clear distinction between the various concepts of chronicity cited in the literature is crucial. The aim was thus to explicate central concepts related to courses and trajectories in OCD based on an explorative, scoping search of the existing literature. Our review revealed a considerable lack in content validity, as the concepts were operationalized inconsistently. Concepts related to symptom improvement were (complete) recovery, partial/full remission and partial/full response. Terms used in relation with symptom stability or worsening were chronic/continuous, intermittent and episodic course, waxing and waning, relapse, recurrence, deterioration and treatment-refractoriness. All concepts are explained and visualized as a result of the review. Further, based on authors' remarks, we present recommendations on how to enhance care for chronic OCD patients, namely training psychotherapists to apply CBT as intended, managing patient beliefs about disease and treatment, and adapting psychotherapy to OCD subtypes. Finally, we then propose a literature-based definition of treatment-refractory OCD.
Background
Communicating a diagnosis is highly important, yet complex, especially in the context of cancer and mental disorders. The aim was to explore the communication style of an oncologist vs. psychotherapist in an online study.
Methods
Patients (N = 136: 65 cancer, 71 depression) were randomly assigned to watch a standardized video vignette with one of two communication styles (empathic vs. unempathic). Outcome measures of affectivity, information recall, communication skills, empathy and trust were applied.
Results
Regardless of diagnosis, empathic communication was associated with the perception of a significantly more empathic (p < 0.001, η2partial = 0.08) and trustworthy practitioner (p = 0.014, η2partial = 0.04) with better communication skills (p = 0.013, η2partial = 0.05). Cancer patients reported a larger decrease in positive affect (p < 0.001, η2partial = 0.15) and a larger increase in negative affect (p < 0.001, η2partial = 0.14) from pre- to post-video than depressive patients. Highly relevant information was recalled better in both groups (p < 0.001, d = 0.61–1.06).
Conclusions
The results highlight the importance of empathy while communicating both a diagnosis of cancer and a mental disorder. Further research should focus on the communication of a mental disorder in association with cancer.
Background
Communicating a diagnosis is highly important, yet complex, especially in the context of cancer and mental disorders. The aim was to explore the communication style of an oncologist vs. psychotherapist in an online study.
Methods
Patients (N = 136: 65 cancer, 71 depression) were randomly assigned to watch a standardized video vignette with one of two communication styles (empathic vs. unempathic). Outcome measures of affectivity, information recall, communication skills, empathy and trust were applied.
Results
Regardless of diagnosis, empathic communication was associated with the perception of a significantly more empathic (p < 0.001, η2partial = 0.08) and trustworthy practitioner (p = 0.014, η2partial = 0.04) with better communication skills (p = 0.013, η2partial = 0.05). Cancer patients reported a larger decrease in positive affect (p < 0.001, η2partial = 0.15) and a larger increase in negative affect (p < 0.001, η2partial = 0.14) from pre- to post-video than depressive patients. Highly relevant information was recalled better in both groups (p < 0.001, d = 0.61–1.06).
Conclusions
The results highlight the importance of empathy while communicating both a diagnosis of cancer and a mental disorder. Further research should focus on the communication of a mental disorder in association with cancer.
Background
Psychotherapy is highly effective and widely acknowledged for treating various mental disorders. Nevertheless, in terms of methods for teaching effective psychotherapeutic approaches and competencies, there has been a lack of investigation. Training and supervision are the main strategies for teaching therapist competencies, and standardized role-plays with simulated patients (i.e., trained individuals playing someone with a mental disorder) seem useful for evaluating training approaches. In medical education, this procedure is now internationally established. However, so far, little use has been made of standardized role-playing to evaluate training and supervision in the area of clinical psychology and psychotherapy.
Methods
In this study, standardized role-plays are used to evaluate methods for training and supervision. Central cognitive behavioral approaches for treating depression are taught in the training. The first experiment compares an active training approach (i.e., model learning) with a passive one (i.e., reading manual-based instructions). The second experiment compares a direct supervision technique (i.e., supervision based on video analysis) with an indirect one (i.e., supervision based on verbal reporting). In each experiment, 68 bachelor’s and master’s students of psychology will be randomly assigned to the experimental and control groups. Each student takes part in three role-plays (baseline, post and 3-month follow-up), which are all videotaped. Two independent raters assess therapist competencies in each role-play on the basis of a standardized competence scale.
Discussion
The research project aims to contribute to the development of specific training and supervision methods in order to improve psychotherapy training and patient care.
Background
Psychotherapy is highly effective and widely acknowledged for treating various mental disorders. Nevertheless, in terms of methods for teaching effective psychotherapeutic approaches and competencies, there has been a lack of investigation. Training and supervision are the main strategies for teaching therapist competencies, and standardized role-plays with simulated patients (i.e., trained individuals playing someone with a mental disorder) seem useful for evaluating training approaches. In medical education, this procedure is now internationally established. However, so far, little use has been made of standardized role-playing to evaluate training and supervision in the area of clinical psychology and psychotherapy.
Methods
In this study, standardized role-plays are used to evaluate methods for training and supervision. Central cognitive behavioral approaches for treating depression are taught in the training. The first experiment compares an active training approach (i.e., model learning) with a passive one (i.e., reading manual-based instructions). The second experiment compares a direct supervision technique (i.e., supervision based on video analysis) with an indirect one (i.e., supervision based on verbal reporting). In each experiment, 68 bachelor’s and master’s students of psychology will be randomly assigned to the experimental and control groups. Each student takes part in three role-plays (baseline, post and 3-month follow-up), which are all videotaped. Two independent raters assess therapist competencies in each role-play on the basis of a standardized competence scale.
Discussion
The research project aims to contribute to the development of specific training and supervision methods in order to improve psychotherapy training and patient care.
Aim
Although research and clinical definitions of psychotherapeutic competence have been proposed, less is known about the layperson perspective. The aim was to explore the views of individuals with different levels of psychotherapy experience regarding what-in their views-constitutes a competent therapist.
Method
In an online survey, 375 persons (64% female, mean age 33.24 years) with no experience, with professional experience, or with personal pre-experience with psychotherapy participated. To provide low-threshold questions, we first presented two qualitative items (i.e. "In your opinion, what makes a good/competent psychotherapist?"; "How do you recognize that a psychotherapist is not competent?") and analysed them using inductive content analysis techniques (Mayring, 2014). Then, we gave participants a 16-item questionnaire including items from previous surveys and from the literature and analysed them descriptively.
Results
Work-relatedprinciples, professionalism, personalitycharacteristics, caringcommunication, empathy and understandingwere important categories of competence. Concerning the quantitative questions, most participants agreed with items indicating that a therapist should be open, listen well, show empathy and behave responsibly.
Conclusion
Investigating layperson perspectives suggested that effective and professional interpersonal behaviour of therapists plays a central role in the public's perception of psychotherapy.