Provision of Cognitive Behavior Therapy for Depression and Anxiety Disorders by Medical Student Trainees.

OBJECTIVE: The purpose of the article is to evaluate an innovative education program in which medical students were trained in cognitive behavior therapy (CBT) and provided CBT treatments under supervision to uninsured individuals with depressive, anxiety, adjustment, and trauma-based disorders. METHODS: The authors assessed improvements in trainees' CBT knowledge using the Cognitive Therapy Awareness Scale before and after their didactic training. CBT supervisors rated trainees' clinical competencies utilizing standardized checklist evaluations based upon supervision reports. The authors employed mixed effects ANOVA and regression modeling to test the association between the addition of CBT to treatment as usual (TAU) and improvements in patients' depressive and anxious symptom severity. The authors collected feedback and self-assessment of functioning with a Psychotherapy Feedback Questionnaire. RESULTS: Medical students showed increases in CBT knowledge that were maintained six months later and demonstrated satisfactory competency in CBT techniques. The addition of CBT to TAU was associated with greater improvements in depressive, but not anxious, symptom severity. However, among the TAU + CBT group, there was an association between the number of CBT sessions received and the magnitude of improvement in anxious symptoms from baseline. Patients gave positive feedback to medical student CBT providers and reported improvements in broad domains of psychosocial functioning. CONCLUSIONS: Medical students can provide competent and clinically beneficial CBT treatments for depression and anxiety disorders. These findings have implications for medical training and support the use of medical students to deliver care for individuals with limited access to psychotherapy.

Descriptions and Reflections on the Cognitive Apprenticeship Model of Psychotherapy Training & Supervision.

This paper offers a detailed description of a Cognitive Apprenticeship Model for psychotherapy training and supervision. This form of training has been utilized in a novel psychotherapy training program developed for psychiatric trainees, enrolled in a specialized psychotherapy scholars track, embedded in an adult psychiatric residency training program. The paper offers new elaborations of the model, reflections on the apprenticeship supervision and implementation, and clinical lessons learned. The four dimensions of this model include: (1) acquisition of psychotherapy content knowledge; (2) an application of the Cognitive Apprenticeship Model of Supervision, utilizing modeling, coaching, scaffolding, articulation, reflection and exploration as essential aids in structuring a live, real-time supervisory experience; (3) sequencing of clinical psychotherapy training activities; and (4) use of situated learning and communities of practice, as important components of psychotherapy training. The article also discusses an apprentice method of psychotherapy supervision including the intake, working through, and termination phases, Barriers impeding apprenticeship supervision and implementation, and reflections on participant experiences are discussed. This approach may be valuable to others considering the development or evolution of psychotherapy training programs for psychiatrists, psychologists, social workers, or other mental health professionals.

Relación de Supervisión: Adaptación del S-SRQ en Psicoterapeutas Argentinos / Supervision Relationship: Adaptation of the S-SRQ in Argentine Psychotherapists

Resumen Introducción: En los últimos años se ha reconocido la importancia de evaluar la supervisión clínica y su rol en el proceso psicoterapéutico. No obstante, son escasos los instrumentos que cumplen con este propósito, particularmente en Latinoamérica. En este estudio, se buscó adaptar al castellano la versión breve del Cuestionario de relación de supervisión (S-SRQ, por sus siglas en inglés de: Short Supervisory Relationship Questionnaire), compuesto de tres dimensiones: base segura, educación reflexiva y estructura; y aportar evidencias sobre su desempeño psicométrico. Método: El S-SRQ fue traducido y retraducido a su idioma original. Posteriormente, fue administrado a 374 psicoterapeutas argentinos (muestra no probabilística). Se realizaron análisis de consistencia interna (alfa de Cronbach), dimensionales (análisis paralelo y factorial confirmatorio), y a nivel del ítem (coeficientes estandarizados y correlación ítem-escala). Resultados: Los coeficientes de consistencia interna fueron adecuados para la escala total y, en general, para cada dimensión. Los análisis dimensionales se ajustaron a un modelo de tres dimensiones, base segura, educación reflexiva y estructura. El desempeño de los ítems fue bueno con relación a la escala total y cada dimensión. Discusión: El desempeño psicométrico del S-SRQ en castellano fue similar al de la escala original, con algunas diferencias. La escala presenta potencial para ser aplicada en el contexto argentino, tanto en el ámbito científico como en la práctica.

Abstract Introduction: In recent years the significance of evaluating clinical supervision and its role in the psychotherapeutic process has been recognized. However, there are few instruments for such evaluation, particularly in Latin América. This study aimed to adapt the three-dimensional (reliable basis, reflexive education and structure) Short Version of the Supervisory Relationship Questionnaire (S-SRQ) to Spanish. Method: The questionnaire was administered to 374 Argentine psychotherapists (non-probabilistic sample). The S-SRQ was translated and retranslated to its original language. It was performed internal onsistency (Cronbach's alpha), dimensional (parallel and confirmatory factor analysis), and item analyzes (standardized coefficients and item-scale correlation). Results: The internal consistency coefficients were adequate for the total scale and, in general, for each dimension. The dimensional analyses were adjusted to a three-dimensional model, reliable basis, reflective education and structure. Item performance was good in relation to the total scale and each dimension. Discussion: The psychometric performance of the S-SRQ in Spanish was like the original scale, with some exceptions. The scale has potential to be implemented in our context, both at a practical and scientific level.

Os bastidores da psicoterapia: descrição de sentidos e a supervisão clínica na abordagem fenomenológica humanista / The backstage of psychotherapy: sense's description and clinical supervision in the humanist phenomenological approach / Los bastidores de psicoterapia: descripción de sentidos y la supervisión clínica en el enfoque fenomenológico humanista

A psicoterapia é um campo científico que se aprimora de maneira contínua, especialmente pelas atuais demandas que requerem a garantia do protagonismo e a autonomia aos usuários de saúde mental. Nesse contexto, a supervisão clínica e os instrumentos construídos a partir dela aparecem como um importante fator no processo de qualificar a prática e formar novos terapeutas. O presente estudo tem por objetivo geral analisar os relatos descritivos produzidos para a supervisão de estágio, que incluem os apontamentos da supervisora, e são tomados como versões de sentido, com o intuito específico de dar visibilidade ao processo de formação do(a) futuro terapeuta. Para tanto, inspira-se no método fenomenológico com fundamento qualitativo e descritivo, que destaca a dimensão compreensiva, intersubjetiva e intencional entre consciência e mundo vivido. O corpus de análise constituiu-se de vinte e um relatórios de descrição dos sentidos no encontro psicoterapêutico com um único paciente, durante o ano de 2017. Foram selecionados três encontros psicoterapêuticos para análise das versões de sentido neste ensaio, a partir dos critérios temporal e longitudinal, procurando dar visibilidade ao processo clínico, às intervenções terapêuticas gestadas no encontro entre psicoterapeuta-paciente-descrição de sentidos-supervisão, e seu impacto na formação clínica. Há, por fim, a ressonância de novas maneiras de existir para ambos, paciente e terapeuta.

Psychotherapy is a research field in continuous improvement, mostly due to the current requiring demands on protagonism guarantee and autonomy to mental health users of the tool. In this context, clinical supervision and the instruments that have been built from it represent an important factor to the process of qualifying the practice and training new therapists. The present study aims to analyse the produced descriptive internship reports, including the supervision notes, which are taken as sense's versions, in order to draw visibility to the process of preparing future therapists. Therefore, there has been inspired by phenomenological method on a qualitative and descriptive basis in order to characterize a comprehensive, intersubjective and intentional understanding between consciousness and the living world. The corpus of the analysis consisted of twenty-one patients' sense description reports produced along individual counselling sessions during 2017. Three psychotherapeutics meetings were selected for analysis of the sense's versions in this study, based on the temporal and longitudinal criteria, in order to provide visibility to the clinical process, as well as to the therapeutic interventions generated during the sessions, embracing therapist-patient-sense description-supervision, and their impacts on clinical training. Last, there has been observed a resonance of new ways of existing, sprouting for both patient and therapist.

La psicoterapia es un campo científico que se perfecciona de manera continua, especialmente por las actuales demandas que requieren la garantía del protagonismo y la autonomía a los usuarios de salud mental. En ese contexto, la supervisión clínica y los instrumentos construidos a partir de ella aparecen como un importante factor en el proceso de calificar la práctica y formar nuevos terapeutas. El presente estudio tiene por objetivo general analizar los relatos descriptivos producidos para la supervisión de prácticas, que incluyen los apuntes de la supervisora, y se toman como versiones de sentido, con el propósito específico de dar visibilidad al proceso de formación del futuro terapeuta. Para ello, se inspiró en el método fenomenológico con fundamento cualitativo y descriptivo, que destaca la dimensión comprensiva, intersubjetiva e intencional entre conciencia y mundo vivido. El corpus de análisis se constituyó de veintiún informes de descripción de los sentidos en el encuentro psicoterapéutico con un solo paciente durante el año 2017. Se seleccionaron tres reuniones psicoterapéuticas para análisis de las versiones de sentido en esta prueba, en base a los criterios temporales y longitudinales se busca dar visibilidad al proceso clínico, a las intervenciones terapéuticas gestadas en el encuentro entre terapeutapaciente-descripción de sentidossupervisión, y su impacto en la formación clínica. Hay, por fin, la resonancia de nuevas maneras de existir, brotando para ambos, paciente y terapeuta.

The Role Of Closed-Circuit Training in Short-Term Dynamic Psychotherapy Teaching.

Closed-circuit training is a unique setting developed by Habib Davanloo, the founder of intensive short-term dynamic psychotherapy. The purpose of this setting is to achieve therapeutic benefits for the patient while providing valuable educational opportunities to the trainee. In this article, the authors present an intensive short-term dynamic psychotherapy session that was conducted in a closed-circuit setting at McGill University Health Center. The primary goal of the article is to highlight several aspects of Davanloo's metapsychological principles and the application of their corresponding technical interventions. Another goal is to convey the trainee's reflection on his experience and perception of the closed-circuit training. The authors propose that closed-circuit training could be considered a potential alternative, or at least a complementary method, to the traditional settings of psychotherapy training and supervision.

Race in Supervision: Let's Talk About It.

Addressing race and racial trauma within psychotherapy supervision is increasingly important in psychiatry training. A therapist's ability to discuss race and racial trauma in psychotherapy supervision increases the likelihood that these topics will be explored as they arise in the therapeutic setting. The authors discuss the contextual and sociocultural dynamics that contributed to their own avoidance of race and racial trauma within the supervisory relationship. The authors examine the features that eventually led to a robust discussion of race and culture within the supervisory setting and identify salient themes that occurred during three phases of the conversation about race: pre-dialogue, the conversation, and after the conversation. These themes include building an alliance, supercompetence, avoidance, shared vulnerability, "if I speak on this, I own it," closeness versus distance, and speaking up. This article reviews the key literature in the field of psychiatry and psychology that has shaped how we understand race and racial trauma and concludes with guidelines for supervisors on how to facilitate talking about race in supervision.

The ingredients of supervisor failure.

Trainees all too often learn more about how not to conduct supervision than how to conduct supervision effectively. The purpose of this article is to present a conceptualization of the theoretical, empirical, and practical elements of supervisor failures. Specifically, the article attends to the following behaviors that may lead to supervisor failure: (a) denigrate the supervisory relationship; (b) demonstrate multicultural incompetence; (c) become an unethical supermodel; (d) use evaluation instruments that could not pass for an undergraduate thesis; (e) teach your trainee how to diagnose narcissism by example; (f) apply psychotherapy models in supervision as if there is a theoretical or empirical basis; (g) infantalize your trainee; (h) collude with your trainee; (i) make your trainee your surrogate psychotherapist; and (j) go on a date with your trainee. Recommendations for increasing supervisor success and limiting supervisor failure are provided.

O contexto da supervisão grupal: ambiente para formação de terapeutas e de supervisores / The context of the supervision group: environment for training therapists and supervisors

A literatura descreve várias habilidades necessárias a um terapeuta comportamental, no entanto pouco se discute sobre o processo de formação de um supervisor. O objetivo deste artigo é apresentar uma experiência realizada em uma Especialização em Terapia Cognitiva e Comportamental, no interior de São Paulo, na formação de um supervisor-aprendiz. O supervisor-aprendiz acompanhou as supervisões, leu os relatórios e participou nas discussões dos casos. Buscou-se na literatura da Análise do Comportamento os aspectos necessários na formação de um terapeuta e comparou-se com o que foi observado através desta experiência, no que diz respeito às diferenças e semelhanças nas habilidades e nas contingências que permeiam o comportamento de cada um destes personagens (supervisor-experiente, supervisor-aprendiz e aluno). A partir desta experiência, observou-se que o ambiente da supervisão grupal pode auxiliar tanto no processo de formação de terapeutas, como também de supervisores-aprendizes, mas esta temática ainda requer o desenvolvimento de pesquisas mais sistematizadas.

The literature describes many skills necessary for a Behavioral Therapist Professional, however little is discussed on the supervisor's training process. This article presents a study carried in a Cognitive and Behavioral Therapy course on the training of a apprentice-supervisor. She followed many cases super vision's, read the reports and participated in discussions. Then, did a search on the Behavior Analysis's literature to find what were the abilities needed for the therapist education and training, and compared with her experience, the differences and similarities in skills and the contingencies of the behavior of each supervision group member (senior-supervisor, apprentice-supervisor and student). It was observed that the environment of group supervision may be helpful to the process of training therapists and apprentices supervisors. However, this issue still requires more systematized researches.

The art of psychotherapy: selecting patients for psychodynamic psychotherapy.

A preliminary challenge in learning the art of psychotherapy is mastering how to choose appropriate patients. This skill goes far beyond performing a symptom inventory and matching up those results to a diagnosis. A psychodynamic evaluation explores various innate characteristics that predict a patient's ability to participate fully in and benefit greatly from this mode of therapy. Ignoring this critical first step in the process may create unnecessary stumbling blocks in the road of treatment. In this article, we will use a case example to illustrate some of the consequences a poor fit bears for both the patient and the therapist; in addition, we will review the desired traits that support a patient's suitability for psychodynamic psychotherapy.