Training in time-limited dynamic psychotherapy: A systematic comparison of pre- and post-training cases treated by one therapist

Abstract

Objective: This qualitative study systematically compared cases treated by the same therapist in order to understand the group comparison findings of a larger study on training of experienced therapists (the “Vanderbilt II” psychotherapy project). Method: The therapist, Dr C., was selected based on the therapist's overall treatment successes. His two patients were selected based on their outcomes and the relative training cohort from which they were drawn: a case with successful outcome from the pre-training cohort and a case of negligible improvement from the post-training cohort. Results: Dr C. demonstrated a variety of interpersonal skills throughout his pre-training case, though there was also poor interpersonal process throughout. However, in the second case he had considerable difficulty in adapting his typical therapeutic approach to the requirements of the time-limited dynamic psychotherapy (TLDP) manual, even while appearing to work hard to find ways to use the manual. Conclusions: Dr C.'s spontaneity, and his unique set of interpersonal skills may enhanced his initial rapport and alliance building with clients and yet may not have interfaced well with TLDP. His unique interpersonal skills also may have contributed to problems of interpersonal process. Future research may benefit from examining the interaction of between therapist interpersonal skills and the implementation of the treatment manual.

Abstract

Objective: This qualitative study systematically compared cases treated by the same therapist in order to understand the group comparison findings of a larger study on training of experienced therapists (the “Vanderbilt II” psychotherapy project). Method: The therapist, Dr C., was selected based on the therapist’s overall treatment successes. His two patients were selected based on their outcomes and the relative training cohort from which they were drawn: a case with successful outcome from the pre-training cohort and a case of negligible improvement from the post-training cohort. Results: Dr C. demonstrated a variety of interpersonal skills throughout his pre-training case, though there was also poor interpersonal process throughout. However, in the second case he had considerable difficulty in adapting his typical therapeutic approach to the requirements of the time-limited dynamic psychotherapy (TLDP) manual, even while appearing to work hard to find ways to use the manual. Conclusions: Dr C.’s spontaneity, and his unique set of interpersonal skills may enhanced his initial rapport and alliance building with clients and yet may not have interfaced well with TLDP. His unique interpersonal skills also may have contributed to problems of interpersonal process. Future research may benefit from examining the interaction of between therapist interpersonal skills and the implementation of the treatment manual.

Zusammenfassung:

Ziele: Diese qualitative Studie vergleicht systematisch Fälle, die vom gleichen Therapeuten behandelt wurden, um die Befunde zu Gruppenvergleichen einer größeren Studie zum Training von erfahrenen Therapeuten besser zu verstehen (das „Vanderbilt II-Psychotherapie-Projekt). Methode: Der Therapeut, Dr. C., wurde anhand des therapeutischen Erfolgs über alle Behandlungen hinweg ausgewählt. Seine zwei Patienten wurden auf Basis ihres Outcomes und der Trainings-Kohorte, aus der sie stammten, ausgewählt: Ein Fall mit erfolgreichem Outcome aus der Prä-Training-Kohorte und ein Fall aus der Post-Training-Kohorte mit geringfügiger Verbesserung. Ergebnisse: Dr. C. demonstrierte durchweg eine Vielzahl von interpersonale Fähigkeiten in seinem Prä-Training-Fall, obwohl es auch wenig interpersonelle Prozesse währenddessen gab. Dennoch hatte er in seinem zweiten Fall bemerkenswerte Probleme, seine typischen therapeutischen Ansätze an die Erfordernisse des Manuals der befristeten dynamischen Psychotherapie (TLDP) anzupassen, auch wenn deutlich wurde, dass er sich sehr bemühte Wege zu finden, das Manual zu benutzen. Zusammenfassung: Dr. C.’s Spontanität und seine einzigartigen interpersonalen Fähigkeiten haben vermutlich seinen initiale Rapport und die Beziehungsgestaltung mit dem Klienten gesteigert und passen wahrscheinlich nicht so gut mit TLDP zusammen. Seine einzigartigen interpersonalen Fähigkeiten haben vermutlich auch zu den Problemen im interpersonellen Prozess geführt. Die zukünftige Forschung kann vielleicht von einer Untersuchung der Interaktion zwischen interpersonalen Fähigkeiten des Therapeuten und der Implementation des Behandlungsmanuals profitieren.

Objetivo: Este estudo qualitativo comparou sistematicamente casos tratados pelo mesmo terapeuta, de forma a compreender os resultados do grupo de comparação de um estudo mais amplo sobre a formação de terapeutas experientes (o projeto de psicoterapia "Vanderbilt II"). Método: O terapeuta, Dr. C., foi selecionado com base na generalidade do sucesso dos seus tratamentos. Os seus dois pacientes foram selecionados a partir dos resultados obtidos e do coorte de formação de que foram retirados: um caso de sucesso do coorte de pré-formação e um caso de melhoria não significativa do coorte pós-formação. Resultados: O Dr. C. demonstrou uma variedade de habilidades interpessoais ao longo do seu caso de pré-formação, embora houvesse também um processo interpessoal pobre durante o mesmo. Contudo, no segundo caso, teve considerável dificuldade em adaptar a sua abordagem terapêutica típica aos requisitos do manual da psicoterapia dinâmica breve (PDB), apesar do seu esforço para encontrar formas de o colocar em prática. Conclusões: A espontaneidade do Dr. C., e o conjunto único das suas habilidades interpessoais, poderão ter reforçado o seu rapport inicial e a construção da aliança com os clientes, mesmo não tendo estabelecido um bom interface com a PDB. As suas habilidades interpessoais únicas poderão ter também contribuído para problemas do processo interpessoal. Futuras investigações poderão beneficiar da análise da interação entre as habilidades interpessoais do terapeuta e a implementação do manual de tratamento.

目的：本質性研究系統性地對比同一名治療師服務的數個案例，以了解在一個較大型研究(“Vanderbilt II”心理治療師計畫)中有經驗的治療師訓練的團體對比結果。方法：C博士治療師因其整體治療成效佳而被選為研究對象，他的兩名案主因其治療成效與同儕案主相似而被選為研究對象：其中一位從訓練前開始即持續有正向效果；另一位則是從訓練後期發現訓練效果不彰。研究結果：C博士在受訓前的案例中展示他使用了多種人際技巧，雖然在整體過程中亦多有不佳的人際互動歷程。然而，在第二個案例中，他對於要將短期精神動力心理治療(TLDP)指導手冊中所列之要求融入他個人治療取向有相當程度的困難，雖然他已表現出很努力找到多種方式來使用該治療準則。結論：C博士的自發性，以及他個人獨特的人際技巧或許能增進他在治療初期與案主之間的治療關係建立，但也許仍沒能夠與短期精神動力心理治療有較好的整合。他個人獨特的人際技巧也許還惡化了治療人際歷程中的問題。未來研究或許能藉由檢視治療師個人人際技巧與實施治療準則之間的互動而有所助益。

Keywords:

• psychotherapist training/supervision/development
• integrative treatment models
• process research

Acknowledgements

We both wished to extend our gratitude to Jessica Londa-Jacobs for her involvement in analyzing and discussing the pre-training case. Lively discussions among the three of us were helpful in challenging many of our assumptions. We are also grateful to Jeffery L. Binder, Ph.D., William P. Henry, Ph.D., Edward Bein, Ph.D., Al Mahrer, Ph.D., Steven Hollon, Ph.D., Russell B. Hilliard, Ph.D., M.E. Crowley, Ph.D., Karen Deisseroth, and Kimi L. Carson for their helpful comments on previous drafts.

Notes

¹ Jeffrey L. Binder, Ph.D., Edward Bein, Ph.D., Al Mahrer, Ph.D., Steven Hollon, Ph.D., and William P. Henry, Ph.D. served as independent readers for our analyses of the case material and our interpretation of it.