The competence development of German psychotherapy trainees: A naturalistic, longitudinal and multidimensional outcome study.

Objectives:This study investigated the development of German psychotherapy trainees in professional, relational, and personal competence. Methods: The study followed a naturalistic pre-post design over 3 years and included a control group of non-trainee psychologists. The sample consisted of 219 participants, including 64 cognitive-behavioral trainees, 120 psychodynamic trainees and 35 control participants. Outcomes were knowledge (multiple choice exam), case-formulation competence (Case Formulation Content Coding Method), healing and stressful involvement (Therapist Work Involvement Scales), attributional complexity (Attributional Complexity Scale), introject affiliation, and affiliation in patient treatments (Intrex questionnaire). Multilevel Modeling was used to investigate change over time and group by time interactions. Comparisons to the control group were limited to knowledge, case-formulation competence, and attributional complexity. Results: Trainees improved in knowledge, case-formulation competence, healing involvement, and affiliation in treatments with small to medium effects. There was no change in stressful involvement, attributional complexity or introject affiliation. According to reliable change indices, the majority of trainees did not change reliably. Over time, trainees outperformed the control group only in case-formulation competence. There were several main and group by time effects regarding trainee orientation. Conclusions: Results imply benefits of training on professional and relational competence but only limited effects on personal competence.

[How effective are Balint group leaders?] / Wie wirksam sind Balintgruppen-Leiter?

How effective are Balint group leaders? OBJECTIVES: Balint leadership until today is based on views of experts. Empirical research is still lacking. This paper reports about leadership effects in Balint groups measured by the newly developed Balint Group Questionnaire (BGSQ). The questionnaire comprises three scales: Scale 1 - Reflection of Transference Dynamics in the Doctor-Patient Relationship, Scale 2 - Emotional and Cognitive Learning, Scale 3 - Case Mirroring in the Group Dynamic. RESULTS: 87 out of 107 cooperating Balint group leaders had six or more participants who filled out the questionnaire after a Balint session. Based on the scale scores of the BGSQ from 1459 medical participants we found three clusters of differentially effective leadership. 52 leaders (59.8 %) belonged to the most effective cluster in scale 1, 11 leaders (12.6 %) were particularly effective in scale 2, and 21 leaders (24.1 %) in scale 3. Five out of 87 leaders were found most effective for all three scales. No other influencing factors predicted leadership effectiveness. CONCLUSIONS: This is the first quantitative study to differentiate leadership effects on learning processes of participants of Balint groups. The importance for training of Balint group leaders is discussed. More research regarding predictive variables and helpful leadership interventions is needed.

[Adverse childhood experiences, attachment representations and mentalizing capacity of psychotherapists in training]. / Aversive Kindheitserfahrungen, Bindungsrepräsentationen und Mentalisierungsfähigkeit von Psychotherapeuten in Ausbildung.

Adverse childhood experiences, attachment representations and mentalizing capacity of psychotherapists in training Objectives: In this study we analyzed the relation between adverse childhood experiences (ACEs), attachment representations and reflective functioning (RF) in psychotherapy trainees. Methods: 90 trainees in the beginning of their training of three psychotherapeutic approaches (CBT, psychodynamic and psychoanalytic) were assessed with the Adult-Attachment- Interview (AAI). AAIs were coded for attachment representation, ACE and RF. Experiences in psychotherapy as a patient before training were assessed by online inquiry. Data were analyzed via mediator- and moderator analysis. Results: Therapists in training show to be as burdened as the general population in terms of ACEs. Coding of the AAIs revealed a high percentage of secure attachment (85 %) and mentalizing capacities above the average (RF = 5.8). The relation between number of ACEs and RF was completely mediated by the degree of attachment security. The number of psychotherapy hours before training moderated the negative effect of the number of ACEs on RF. Conclusions: Results underline the importance of personal therapy during training and raise the question how reflective functioning can be fostered during training.

[Designing the doctor-patient relationship]. / Die Arzt-Patient-Beziehung gestalten.

Designing the doctor-patient relationship: How beneficial are Balint groups and for whom? OBJECTIVES: Participation in Balint groups is obligatory for some medical specialist trainings. Yet there is a substantial lack of empirical evidence for Balint group effects. METHODS: 1,460 medical specialists who participated in 352 different Balint groups were investigated using the Balint Group Questionnaire (BG-F) at the end of a Balint group session. Using mixed-model analyses, we examined the predictive value of the independent variables Experience in Balint Groups (in years), Clinical Experience in General (in years), Case Presentation vs. Nonpresentation, Facultative vs. Obligatory Participation (status) with regard to scale characteristics of the BG-F: Scale 1: Reflection of Transference Dynamics in the Doctor-Patient Relationship, Scale 2: Emotional and Cognitive Learning, Scale 3: Case Mirroring in the Group Dynamic. Mixed-model analyses were calculated separately for the subgroups Balint Experience < 1 year (vs. > 1 year) and for Balint Experience < 2 years (vs. > 2 years). RESULTS: Complete data were available for 1,400 participants. On Scale 1, "somatic" doctors scored significantly higher than "psyche" doctors. Case presenters scored significantly higher than nonpresenters. On Scale 2, "somatic" doctors showed highly significantly higher scores than "psyche" doctors. Case presenters also scored highly significantly higher than nonpresenters. Doctors with < 2 years of Balint group experience had significantly higher scores than those with > 2 years. On Scale 3, case presenters scored highly significantly higher than nonpresenters. Group participants with less Balint group experience (< 1 year) had significantly lower scores on Scale 3 than group participants with more experience with Balint groups (> 1 year). CONCLUSIONS: Participation in Balint groups generates important effects on doctors' knowledge regarding the doctor-patient relationship, both privately as well as professionally. These results confirm scientifically specific effects of Balint groups, providing empirical evidence for the importance of Balint group experiences for professionals in the medical field.

[Self-selection processes in the choice of the therapeutic training approach: differences in therapeutic attitudes, personality traits and attributional complexity]. / Selbstselektionsprozesse bei der Wahl des therapeutischen Ausbildungsverfahrens: Unterschiede in therapeutischen Haltungen, Persönlichkeitseigenschaften und dem Mentalisierungsinteresse.

AIM: Treatment approaches differ to a great extent in terms of basic psychological assumptions and practical procedures. This creates questions about the fitting of therapist and therapeutic approach. This paper examines the influence of therapeutic attitudes, mentalization interest and personality traits on the decision for an approach. METHODS: 184 participants of training programs in one of the 3 licensed treatment approaches in Germany were examined with questionnaires at the beginning of their training. RESULTS: Participants significantly differed in terms of therapeutic attitudes and the metallization interest but not in personality traits except openness. Satisfaction with training was not related to the individual fit of participants to the therapeutic attitudes typical for their approach. CONCLUSION: Therapeutic attitudes, the extent of mentalization interest, and openness may play a role in self-selection processes in the choice of the approach.

How do personal and professional characteristics influence the development of psychotherapists in training: Results from a longitudinal study.

This study examined the professional development of psychotherapy trainees over three years of training. The first objective was to investigate the long-term change of work involvement (Healing and Stressful Involvement) during psychotherapy training. The second objective was to investigate possible predictors of professional development from the areas of training context as well as professional and personal attributes of trainees. A total of 184 psychotherapy trainees with psychodynamic, psychoanalytic and cognitive behavioral orientation participated in the study. The development of work involvement was assessed over three years of training using the Work Involvement Scales. The set of possible predictors for work involvement included training context variables (training orientation, supervision), professional attributes of trainees (theoretical breadth, work satisfaction), and personal attributes of trainees (introject affiliation, attachment strategies, personality traits). Hierarchical Linear Modeling was conducted to investigate the change over time and the individual predictors of work involvement. Over three years of training Healing Involvement improved whereas Stressful Involvement did not change over time. Healing Involvement was mostly predicted by training context variables and professional attributes (therapeutic orientation, job satisfaction) as well as extraversion. Stressful Involvement was only predicted by personal attributes of trainees (age, neuroticism, conscientiousness, introject affiliation). The results imply two distinct sets of predictors for Healing and Stressful Involvement that will be discussed with regard to their implications for psychotherapy training and trainee selection.

Does interpersonal behavior of psychotherapy trainees differ in private and professional relationships?

AIM: The present study aimed to evaluate the effect of trainees' interpersonal behavior on work involvement (WI) and compared their social behavior within professional and private relationships as well as between different psychotherapeutic orientations. METHODS: The interpersonal scales of the Intrex short-form questionnaire and the Work Involvement Scale (WIS) were used to evaluate two samples of German psychotherapy trainees in psychoanalytic, psychodynamic, and cognitive behavioral therapy training. Trainees from Sample 1 (N = 184) were asked to describe their interpersonal behavior in relation to their patients when filling out the Intrex, whereas trainees from Sample 2 (N = 135) were asked to describe the private relationship with a significant other. RESULTS: Interpersonal affiliation in professional relationships significantly predicted the level of healing involvement, while stress involvement was predicted by interpersonal affiliation and interdependence in trainees' relationships with their patients. Social behavior within professional relationships provided higher correlations with WI than private interpersonal behavior. Significant differences were found between private and professional relation settings in trainees' interpersonal behavior with higher levels of affiliation and interdependence with significant others. Differences between therapeutic orientation and social behavior could only be found when comparing trainees' level of interdependence with the particular relationship setting. CONCLUSION: Trainees' interpersonal level of affiliation in professional relationships is a predictor for a successful psychotherapeutic development. Vice versa, controlling behavior in professional settings can be understood as a risk factor against psychotherapeutic growth. Both results strengthen an evidence-based approach for competence development during psychotherapy training.

The relationship of introject affiliation and personal therapy to trainee self-efficacy: a longitudinal study among psychotherapy trainees.

This study explored how introject affiliation and trainee self-efficacy (TSE) are related and change during training in cognitive-behavioral, psychodynamic, and psychoanalytic therapy. The study was conducted in Germany, where psychotherapy training contains extensive personal therapy. Therefore, we could examine the impact of both personal therapy and introjects on changes in the trainees' self-perceived efficacy. In all, 171 participants filled out questionnaires concerning introjects (Structural Analysis of Social Behavior-Intrex) and TSE (Healing Involvement subscale of the Work Involvement Scales) as well as additional questions concerning length of and satisfaction with personal therapy. Seventy-one participants filled out the same questionnaires 3 years later. The degree of affiliation in the trainees' introjects was positively correlated with their self-efficacy. Furthermore, after 3 years of training, introjects demonstrated more affiliation and TSE increased. In addition, the trainees' satisfaction with, but not length of, their personal therapy had a moderating effect on the relation between the change in their affiliative introjects and self-efficacy. Introject affiliation of psychotherapy trainees is not invariant but changes during the course of training, at least in trainings that include personal therapy. Changes in affiliation were significantly related to positive changes in TSE-but only if the trainee's personal therapy was considered to be highly satisfactory.

A systematic review of microRNA in glioblastoma multiforme: micro-modulators in the mesenchymal mode of migration and invasion.

Glioblastoma multiforme (GBM) is an incurable form of brain cancer with a very poor prognosis. Because of its highly invasive nature, it is impossible to remove all tumor cells during surgical resection, making relapse inevitable. Further research into the regulatory mechanism underpinning GBM pathogenesis is therefore warranted, and over the past decade, there has been an increased focus on the functional role of microRNA (miRNA). This systematic review aims to present a comprehensive overview of all the available literature on the expression profiles and function of miRNA in GBM. Here, we have reviewed 163 papers and identified 253 upregulated, 95 downregulated, and 17 disputed miRNAs with respect to expression levels; 85 % of these miRNAs have not yet been functionally characterized. A focus in this study has been 26 interesting miRNAs involved in the mesenchymal mode of migration and invasion, demonstrating the importance of miRNAs in the context of the cellular niche. Both oncogenic and tumor-suppressive miRNAs were found to affect target genes involved in cell migration, cytoskeletal rearrangement, invasiveness, and angiogenesis. Clearly, the distinct functional properties of these miRNAs need further investigation and might hold a great potential in future molecular therapies targeting GBM.