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2.
Tijdschr Psychiatr ; 61(3): 164-169, 2019.
Artigo em Holandês | MEDLINE | ID: mdl-30896026

RESUMO

BACKGROUND: For the Dutch psychiatrist in training 50 sessions of personal psychotherapy are required. The Netherlands are unique in this measure. Currently there is no discussion about this requirement.
AIM: To describe different aspects and arguments of supporters and opponents of the requirement of a personal psychotherapy.
METHOD: Review of the research literature and personal observations.
RESULTS: In the past there has been discussion regarding this requirement. Arguments to support the requirement of a personal psychotherapy as a good base to learn psychotherapy are: 1. the resident experiences what it means to be dependent in a clinical relationship; 2. the resident learns the essential competencies (empathy, reflective functioning, etc.); 3. personal therapy contributes to the deepening of feeling; and 4. personal therapy is a measure against stress and burn-out. Opponents of the requirement of a personal psychotherapy point at the lack of evidence demonstrating its effectiveness on the treatment results of the resident.
CONCLUSION: Personal psychotherapy is often viewed as an 'island' within the training programme, a private spot where everything can be discussed, but which also forms a logical conclusion between supervision and mentoring.


Assuntos
Competência Clínica , Psiquiatria/educação , Psicoterapia , Terapia Cognitivo-Comportamental , Humanos , Internato e Residência , Países Baixos , Psicoterapia/educação
3.
Implement Sci ; 14(1): 25, 2019 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-30866967

RESUMO

BACKGROUND: This article describes a study protocol for testing the Measurement Training and Feedback System for Implementation (MTFS-I) and comparing two implementation strategies for MTFS-I delivery. MTFS-I is a web-based treatment quality improvement system designed to increase the delivery of evidence-based interventions for behavioral health problems in routine care settings. This version of MTFS-I focuses on family-based services (FBS) for adolescent substance use. FBS, comprising both family participation in treatment and family therapy technique use, have achieved the strongest evidence base for adolescent substance use and are a prime candidate for upgrading treatment quality in outpatient care. For FBS to fulfill their potential for widespread dissemination, FBS implementation must be bolstered by effective quality procedures that support sustainable delivery in usual care. METHODS/DESIGN: Adapted from measurement feedback systems for client outcomes, MTFS-I contains three synergistic components: (a) weekly reporter training modules to instruct therapists in reliable post-session self-reporting on FBS utilization; (b) weekly mock session videos of FBS interventions (5-8 min) for supportive training in, and practice coding of, high-quality FBS; and (c) monthly feedback reports to therapists and supervisors displaying aggregated data on therapist-reported FBS use. MTFS-I is hosted online and requires approximately 20 min per week to complete. The study will experimentally compare two well-established implementation strategies designed to foster ongoing MTFS-I usage: Core Training, consisting of two 3-h training sessions focused on FBS site mapping, selecting FBS improvement goals, and sustaining MTFS-I, followed by routine remote technical assistance; and Core + Facilitation, which boosts Core Training sessions with collaborative phone-based clinical consultation and on-site facilitation meetings for 1 year to promote FBS goal achievement. The study design is a cluster randomized trial testing Core Training versus Core + Facilitation in ten substance use treatment clinics. Study aims will compare conditions on MTFS-I uptake, FBS delivery (based on therapist-report and observational data), and 1-year client outcomes. DISCUSSION: Study contributions to implementation science and considerations of MTFS-I sustainability are discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03342872 . Registered 10 November 2017.


Assuntos
Terapia Familiar/métodos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adolescente , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/normas , Ensaios Clínicos como Assunto , Análise por Conglomerados , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Terapia Familiar/educação , Retroalimentação , Pessoal de Saúde/educação , Humanos , Ciência da Implementação , Capacitação em Serviço , Estudos Multicêntricos como Assunto , Psicoterapia/educação , Psicoterapia/normas , Melhoria de Qualidade , Tamanho da Amostra , Materiais de Ensino
4.
Clin Child Fam Psychol Rev ; 22(1): 129-145, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30734874

RESUMO

Evidence-based psychotherapies or programs (EBPs) exist for most mental health disorders that occur in childhood; however, the majority of children with a mental health disorder do not receive such treatments. This research-practice gap has been attributed to a range of factors that complicate the delivery of EBPs in everyday practice. While most suggestions to bridge this gap have focused on how to develop EBPs that will have a better fit for the clinical settings in which they will ultimately be deployed, a useful adjunct is to enhance practitioners' capacity to flexibly deliver EBPs to manage these factors. We propose that the extent to which a practitioner is able to change their own behaviour in response to cues and information about the current needs of their clients, and do so while maintaining the integrity of an EBP, may be a function of practitioners' self-regulatory capacity. In this conceptual paper, we describe a model of self-regulation that can be applied to child and family practitioners. We argue that practitioners with greater self-regulatory capacity are more likely to take up EBPs, sustain their use of them and have superior outcomes with clients. We draw on our experience in disseminating a system of parenting support to illustrate how practitioners' self-regulatory capacity can be enhanced while simultaneously receiving training in an EBP. Advantages and disadvantages of a self-regulatory approach to training are discussed and directions for future research are offered.


Assuntos
Prática Clínica Baseada em Evidências/educação , Pessoal de Saúde , Poder Familiar , Psicoterapia/educação , Autocontrole , Adulto , Criança , Humanos
6.
Am J Psychother ; 72(1): 9-20, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30786737

RESUMO

This article reports on a research project investigating psychology graduate students' experiences of Y model psychotherapy training at an Australian university. Focus group interviews were conducted with clinical psychology students (N=20), and thematic analysis was used to capture core aspects of their training experience. Participants felt that the dual training in cognitive-behavioral therapy and psychodynamic therapy gave them a significant advantage over students trained in only a single approach. Notwithstanding the perceived benefits of their training, participants emphasized how intellectually and emotionally demanding it was. Students struggled to shift between therapeutic orientations, both in learning about and conducting different therapies and in accommodating differing supervisory expectations. Psychodynamic therapy was viewed as the most conceptually, technically, and personally challenging component to learn, but also as the most enriching. Despite the emphasis the students placed on the psychodynamic arm of the Y model training, participants reported a variety of therapeutic identity positions, and most maintained a flexible view of how they would practice therapeutically.


Assuntos
Psicoterapia/educação , Pesquisa Qualitativa , Estudantes/psicologia , Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-30577632

RESUMO

Resulting from prenatal exposure to alcohol, Fetal Alcohol Spectrum Disorder (FASD) is characterized by deficits in adaptive and cognitive functioning. This disorder is typically accompanied by co-occurring disorders and conditions (e.g., mood, anxiety, psychosis, and substance use disorders). This complicated presentation of diverse symptoms makes the process of screening, assessing, and diagnosing FASD very difficult, limiting the likelihood that clients receive the treatment and services that they need. Although mental health care providers have an opportunity to intervene on behalf of clients with FASD, professionals may not be very familiar or comfortable with this complicated and life-altering disorder. The present study explores the familiarity of 79 mental health outpatient treatment professionals' personal knowledge and training about FASD. Findings suggest that the majority of respondents had received at least some FASD training, understood the basic symptoms of FASD, and were realistic about FASD's impact on treatment.


Assuntos
Transtornos do Espectro Alcoólico Fetal/diagnóstico , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Saúde Mental/educação , Adulto , Competência Clínica , Feminino , Transtornos do Espectro Alcoólico Fetal/psicologia , Transtornos do Espectro Alcoólico Fetal/terapia , Pessoal de Saúde/educação , Humanos , Masculino , Minnesota , Psicoterapia/educação , Inquéritos e Questionários
8.
J Consult Clin Psychol ; 86(9): 726-737, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30138012

RESUMO

OBJECTIVE: We assessed sustainability of an empirically supported, transdiagnostic youth psychotherapy program when therapist supervision was shifted from external experts to internal clinic staff. METHOD: One hundred sixty-eight youths, aged 6-15 years, 59.5% male, 85.1% Caucasian, were treated for anxiety, depression, traumatic stress, or conduct problems by clinicians employed in community mental health clinics. In Phase 1 (2.7 years), 1 group of clinicians, the Sustain group, received training in Child STEPs (a modular transdiagnostic treatment + weekly feedback on youth response) and treated clinic-referred youths, guided by weekly supervision from external STEPs experts. In Phase 2 (2.9 years), Sustain clinicians treated additional youths but with supervision by clinic staff who had been trained to supervise STEPs. Also in Phase 2, a new group, External Supervision clinicians, received training and supervision from external STEPs experts and treated referred youths. Phase 2 youths were randomized to Sustain or External Supervision clinicians. Groups were compared on 3 therapist fidelity measures and 14 clinical outcome measures. RESULTS: Sustain clinicians maintained their previous levels of fidelity and youth outcomes after switching from external to internal supervision; and in Phase 2, the Sustain and External Supervision groups also did not differ on fidelity or youth outcomes. Whereas all 34 group comparisons were nonsignificant, trends with the largest effect sizes showed better clinical outcomes for internal than external supervision. CONCLUSIONS: Implementation of empirically supported transdiagnostic treatment may be sustained when supervision is transferred from external experts to trained clinic staff, potentially enhancing cost-effectiveness and staying power in clinical practice. (PsycINFO Database Record


Assuntos
Transtornos de Ansiedade/terapia , Transtorno da Conduta/terapia , Transtorno Depressivo/terapia , Pessoal de Saúde/educação , Psicoterapia/educação , Adolescente , Transtornos de Ansiedade/psicologia , Criança , Transtorno da Conduta/psicologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Resultado do Tratamento
9.
Psychodyn Psychiatry ; 46(2): 181-200, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29809114

RESUMO

Given many competing demands, psychotherapy training to competency is difficult during psychiatric residency. Good Psychiatric Management for borderline personality disorder (GPM) offers an evidence-based, simplified, psychodynamically informed framework for the outpatient management of patients with borderline personality disorder, one of the most challenging disorders psychiatric residents must learn to treat. In this article, we provide an overview of GPM, and show that training in GPM meets a requirement for training in supportive psychotherapy; builds on psychodynamic psychotherapy training; and applies to other severe personality disorders, especially narcissistic personality disorder. We describe the interpersonal hypersensitivity model used in GPM as a straightforward way for clinicians to collaborate with patients in organizing approaches to psychoeducation, treatment goals, case management, use of multiple treatment modalities, and safety. A modification of the interpersonal hypersensitivity model that includes intra-personal hypersensitivity can be used to address narcissistic problems often present in borderline personality disorder. We argue that these features make GPM ideally suited for psychiatry residents in treating their most challenging patients, provide clinical examples to illustrate these points, and report the key lessons learned by a psychiatry resident after a year of GPM supervision.


Assuntos
Transtorno da Personalidade Borderline/terapia , Administração de Caso/normas , Internato e Residência/normas , Psiquiatria/educação , Psicoterapia/educação , Adulto , Gerenciamento Clínico , Feminino , Humanos , Masculino , Psiquiatria/métodos , Psiquiatria/normas , Psicoterapia/métodos , Psicoterapia/normas , Adulto Jovem
10.
Prax Kinderpsychol Kinderpsychiatr ; 67(3): 224-238, 2018 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-29546824

RESUMO

Outpatient Psychotherapy for Children and Adolescents with Intellectual Disability The psychiatric morbidity risk for people with intellectual disability is considerably increased. Psychotherapy is considered as one possible treatment. Among experts the caresituation is described as substantial insufficient. This study investigated the perspective of psychotherapists for children and adolescents in the German state North Rhine-Westphalia regarding the care situation of outpatient psychotherapy for children and adolescents with intellectual disability. The participants received a questionnaire (a) about the care situation, (b) how they consider their training to treat these patients and (c) the possibility for free answers. In this cross-section study 185 licensed psychotherapists for children and adolescents filled out a semi-standardized online-questionnaire. The data were analyzed descriptively; free answers were categorized according to Mayring. Additionally, group differences were tested. (a) The psychotherapeutic supply situation for children and adolescents with intellectual disability was rated as insufficient. Clients with learning disability or minor intellectual disability are mainly treated. This group of people benefits from psychotherapy. (b) The training for treating these clients was rated as inadequate. (c) Qualitative analysis refers that request for psychotherapy is seen as difficult; cognitive orientated treatments need modification. The psychotherapeutic care situation for children and adolescents with intellectual disability appears insufficient. This topic should be part of the training curriculum for psychotherapists.


Assuntos
Assistência Ambulatorial , Deficiência Intelectual/psicologia , Deficiência Intelectual/terapia , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Psicoterapia/métodos , Adolescente , Atitude do Pessoal de Saúde , Criança , Competência Clínica , Diagnóstico Duplo (Psiquiatria) , Alemanha , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Deficiência Intelectual/diagnóstico , Transtornos Mentais/diagnóstico , Psicoterapia/educação , Inquéritos e Questionários , Resultado do Tratamento
11.
Clin Psychol Psychother ; 25(3): 415-426, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29383791

RESUMO

Although there have been some recent changes in Ireland, the practice of mandating personal therapy during training has traditionally differed between counselling and clinical psychologists. Irish psychologists (n = 258: 170 clinical, 88 counselling) took part in a survey study of experiences and views regarding this practice. Counselling psychologists reported higher rates of lifetime and current attendance at personal therapy compared to clinical psychologists, and nearly all had experienced mandated personal therapy compared to a minority of the clinical group. However, the clinical psychologists had a high rate of attendance at personal therapy compared to that reported for their British peers, indicating a high regard for personal therapy amongst Irish clinicians despite the absence of a training mandate. Five factors were found to be independent predictors of agreement with mandating personal therapy during training-lifetime experience of personal therapy, being a counselling psychologist, experience of mandated therapy, being more recently qualified, and longer attendance at personal therapy. Thematic analysis of the psychologists' open responses regarding mandated therapy indicated that the majority believed that personal therapy was an important part of ethical, effective practice, and valuable in enhancing self-awareness and learning from the client experience. Ethical concerns about a mandate were polarised between the two psychology specialisms, more counselling psychologists emphasising the dangers and questionable efficacy of psychologists practising psychotherapy without personal therapy experience, and more clinical psychologists questioning the efficacy and ethics of imposing a mandate on trainees. Recommendations are made regarding this issue for trainers of both specialisms.


Assuntos
Atitude do Pessoal de Saúde , Aconselhamento/educação , Aconselhamento/ética , Psicologia Clínica/educação , Psicologia Clínica/ética , Psicoterapia/educação , Psicoterapia/ética , Feminino , Humanos , Irlanda , Masculino
12.
Clin Psychol Psychother ; 25(2): 338-347, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29277943

RESUMO

This study presents a pilot contribution to the new collaborative, multinational study of psychotherapy trainee development that was undertaken by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (see Orlinsky, Strauss, Rønnestad, et al., ). Although the main project is longitudinal in design, this preliminary study investigated cross-sectional differences between trainees in different years of training and explored the influence of core training experiences-including supervision and personal therapy-on their perceived development as therapists. Using the trainee current-progress report that was designed for the Society for Psychotherapy Research Interest Section on Therapist Training and Development project, 90 trainees at 4 different 4-year training programs in Italy provided self-evaluations of their development and of their therapeutic work experiences. Perceived development included overall change, progress, deterioration, overcoming past limitations, and realization of potential as a therapist. Therapeutic work experiences were assessed using scales of healing and stressful involvement (Orlinsky & Rønnestad, ). Year in training and support in supervision predicted perceived development and healing involvement, whereas experiencing criticism in supervision was associated with stressful involvement. Having had personal therapy, and especially ratings of benefit from personal therapy, was also associated with perceived development and healing involvement. Results are discussed with regard of their implications for psychotherapy training.


Assuntos
Competência Clínica/estatística & dados numéricos , Psicoterapia/educação , Autoavaliação , Adulto , Comportamento Cooperativo , Estudos Transversais , Feminino , Humanos , Internacionalidade , Itália , Masculino , Inquéritos e Questionários
13.
Behav Cogn Psychother ; 46(2): 244-250, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29094663

RESUMO

BACKGROUND: Measurement of cognitive behavioural therapy (CBT) competency is often resource intensive. A popular emerging alternative to independent observers' ratings is using other perspectives for rating competency. AIMS: This pilot study compared ratings of CBT competency from four perspectives - patient, therapist, supervisor and independent observer using the Cognitive Therapy Scale (CTS). METHOD: Patients (n = 12, 75% female, mean age 30.5 years) and therapists (n = 5, female, mean age 26.6 years) completed the CTS after therapy sessions, and clinical supervisor and independent observers rated recordings of the same session. RESULTS: Analyses of variance revealed that therapist average CTS competency ratings were not different from supervisor ratings, and supervisor ratings were not different from independent observer ratings; however, therapist ratings were higher than independent observer ratings and patient ratings were higher than all other raters. CONCLUSIONS: Raters differed in competency ratings. Implications for potential use and adaptation of CBT competency measurement methods to enhance training and implementation are discussed.


Assuntos
Competência Clínica/estatística & dados numéricos , Terapia Cognitivo-Comportamental/normas , Observação , Satisfação do Paciente , Psicoterapia/normas , Autorrelato , Análise e Desempenho de Tarefas , Adulto , Competência Clínica/normas , Terapia Cognitivo-Comportamental/educação , Feminino , Humanos , Masculino , Projetos Piloto , Psicoterapia/educação , Psicoterapia/métodos
14.
Perspect Psychiatr Care ; 54(1): 74-83, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28078729

RESUMO

Radical changes in role, education, and practice have affected how education of advance practice nurses and practice deliverables occur. PURPOSE: This article examines the effects of distance education upon the teaching/learning of psychotherapy in integrating Web-based technology and platforms. DESIGN AND METHODS: With the advent and proliferation of online programs of study, the question begs: How do distance-linked programs successfully introduce, practice, and supervise one-to-one and group psychotherapy training? FINDINGS: By employing evidence-based education strategies, technology, and strong interpersonal skills and evidence-based therapies, a charter Psychiatric Mental Health Nurse Practitioner Doctor of Nursing Practice program paved an innovative and successful path. PRACTICE IMPLICATIONS: In that program, they prepared their students for full scope of practice, upon graduation, inclusive of psychotherapy as well as the other highly demanding and compressed requirements of the 3-year program. This article explores that journey and its recommendations for application derived from this 2010 cohort.


Assuntos
Prática Avançada de Enfermagem/educação , Educação a Distância/métodos , Educação em Enfermagem/métodos , Enfermagem Psiquiátrica/educação , Psicoterapia/educação , Humanos , Internet
15.
Fortschr Neurol Psychiatr ; 86(12): 778-796, 2018 12.
Artigo em Alemão | MEDLINE | ID: mdl-30616257

RESUMO

Suicide prevention is a central topic of psychiatry and psychotherapy. Times of changes in psychiatric inpatient treatment conceptions usually come along with an increase of psychopathology and with increasing suicide rates in psychiatric hospitals to, like seen in the seventies and eighties of last century in Germany. After a real increase of inpatient suicides during those years the number and rate of inpatient suicides decreased from about 280 of 100 000 admissions of patients in 1980 to about 50 in 2014. Young male schizophrenic patients were identified as the new high risk group despite the severely depressed patients with delusions as a traditional high risk group. Nowadays suicide prevention is part of all educational programs in psychiatry and psychotherapy.


Assuntos
Hospitais Psiquiátricos , Suicídio/prevenção & controle , Suicídio/estatística & dados numéricos , Delusões/complicações , Depressão/complicações , Alemanha , Humanos , Masculino , Psiquiatria/educação , Psicoterapia/educação , Fatores de Risco
16.
J Couns Psychol ; 64(5): 514-524, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29048197

RESUMO

This study is a longitudinal examination of the impact of therapist stage of training on client outcomes in psychotherapy. The study included 22 PhD-level psychologists who work in a university counseling center (8 female, 14 male) who had completed at least 2 training periods in the center where data were gathered. Therapists worked with 4,047 clients, and 40,271 sessions were included in our analyses. Clients were given the Outcome Questionnaire-45 (OQ-45) on a session-by-session basis, tracking treatment response. The effect of stage of training on both the magnitude and speed of OQ-45 change was examined through hierarchical linear modeling. Therapists were found to achieve the same amount of change or less change on average in their later stages of training. Therapists were also found, on average, to achieve the same rate of change or a slower rate of change in later stages of training. Findings suggest that as therapists progress through formal stages of training, they do not improve in their ability to effect change in their clients. Given these findings, a better understanding of expertise in psychotherapy practice and how to develop it may be an important area for future theory development, research, and training program development. We call for further work examining if and how an individual therapist can become more effective with time. (PsycINFO Database Record


Assuntos
Aconselhamento/educação , Relações Profissional-Paciente , Psicoterapia/educação , Feminino , Humanos , Masculino , Inquéritos e Questionários
19.
Neuropsychiatr ; 31(3): 127-132, 2017 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-28853017

RESUMO

The child- and adolescent psychiatry has emancipated itself 10 years ago from an additional specialist physician's area to a separate specialist medical domain with a specific curriculum. Associated with this is an irreconcilable interlacing with the psychotherapy of childhood and adolescence. Even if childhood and juvenile psychiatry is always settled within the framework of a biopsychosocial model, psychotherapy is of particular importance. In the following, the psychotherapeutic requirements and ethical issues of the human being are to be formulated according to a view on the new morbidity and the Zeitgeist in which we are working. A scientific legitimation leads to the demarcation of esoteric endeavors and the view into practice leads us from nosology to functionality in the consideration of mental disorders in children and adolescents.


Assuntos
Psiquiatria do Adolescente/tendências , Psiquiatria Infantil/tendências , Psicoterapia/tendências , Adolescente , Psiquiatria do Adolescente/educação , Áustria , Criança , Psiquiatria Infantil/educação , Comorbidade , Currículo/tendências , Ética Médica , Humanos , Transtornos Mentais/classificação , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Psicopatologia , Psicoterapia/educação , Especialização/tendências
20.
Med Teach ; 39(10): 1096-1098, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28749198

RESUMO

AIM: Empathy is a core element in the doctor-patient relationship. This study examined whether empathy in medical students can be improved by specific training. METHODS: 158 medical students were randomized into two groups. The intervention group participated in an empathy skills training with simulated patients (SPs). The control group participated in a history course. After the intervention, empathy was assessed by blinded SPs and experts in an Objective Structured Clinical Examination (OSCE). Students also filled out a self-assessment concerning their attitude on empathy (Jefferson Scale of Physician Empathy Student Version, JSPE-S-S). RESULTS AND CONCLUSIONS: Participants of the intervention group showed significantly higher levels of empathy when rated by SPs and experts than the control group. In contrast to that, no significant group differences were observed in self-rated empathy. The results underpin the value of empathy skills trainings in medical school study programs.


Assuntos
Empatia , Simulação de Paciente , Relações Médico-Paciente , Psicoterapia/educação , Estudantes de Medicina/psicologia , Adulto , Feminino , Humanos , Masculino , Psiquiatria/educação , Faculdades de Medicina , Autoavaliação
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