What can we expect from trainee therapists? A study of acquisition of competence in dynamic psychotherapy

Abstract

This study focuses on training in dynamic psychotherapy. Sessions deriving from the final phase of psychodynamic therapies (N = 21) performed by clinical trainees in an intensive psychodynamic psychotherapy training programme lasting 2 years were analysed for their level of psychotherapeutic competence. Research questions were: (i) To what extent do the trainees reflect strategic thinking in their clinical work? (ii) What characterises therapeutic attitude and interventions of therapists who have or have not achieved the capacity of strategic thinking? Three dimensions were analysed: strategic competence, attitudinal competence and technical competence. The concept “strategic competence” was developed in this study. It refers to the ability of the therapist to continuously reflect on therapeutic aims and on means designed to achieve these aims. Results: 53% of the therapists did not show operative clinical competence in terms of strategic thinking. Strategic competence was present, wholly or partially, in 47%. Only 2 therapists demonstrated high-level strategic competence. Most therapists demonstrated a lack of capability for strategic thinking and a lack of technical competence. Patients’ defence mechanisms and the therapists’ helplessness and lack of competence counteracted progress in the therapies. The study demonstrates that it is difficult to acquire dynamic understanding of the therapeutic process and that the novice therapist will need a longer period of time to acquire operative competence.

Keywords:

• psychodynamic psychotherapy
• therapeutic competence
• training

Notes

1. The intention was to select the 5th to last session. When the recording of this session had failed, the 6th last session was chosen prior to the 4th.

2. A separate presentation of the Essay Method is under preparation.

3. Anti-therapeutic relation must be distinguished from countertransference enactments, which are of a different character, and happens in an ongoing meaningful therapeutic process (Bohleber et al., 2013).

4. One should bear in mind that this was a part-time course lasting only 2 years that did not include personal therapeutic experience for the therapists.

Additional information

Notes on contributors

Bjørn Killingmo

Bjørn Killingmo, Professor emeritus, Institute of Psychology, University of Oslo. Former Director of Clinic for Dynamic Psychotherapy. Training and supervising analyst of the Norwegian Psychoanalytic Society.

Sverre Varvin

Sverre Varvin, MD, Dr. Philos. Training and supervising analyst and past President of the Norwegian Psychoanalytic Society. Senior Researcher at the Norwegian Centre for Studies on Violence and Traumatic Stress, Oslo. Several positions in the IPA. Chair of Program Committee for the International Psychoanaltyical Congress in Prague, 2013 and member of the IPA “China Committee”.

Hanne Strømme

Hanne Strømme, Associate Professor, Department of Psychology, University of Oslo, specialist in clinical psychology and candidate at the Norwegian Psychoanalytic Institute.