The influence of deliberate practice on skill performance in therapeutic practice: A systematic review of early studies.

OBJECTIVE: Deliberate practice (DP) is recommended as a new approach to facilitate the acquisition of discrete therapeutic skills, however, its implementation and effectiveness in psychotherapy remains unclear. METHOD: A systematic search on DP for therapeutic skills among psychotherapy trainees and psychotherapists yielded eleven studies for inclusion. Nine were randomized controlled studies (RCTs), including seven unique RCTs, and two were within-group studies. RESULTS: Risk of bias was assessed as "high" for one RCT, "some concerns" for the remaining RCTs, and "serious" for within-group studies. All RCTs found the DP group performed better than the control group. All studies involved efforts to improve performance based on learning objectives and iterative practice but varied in the source of expert guidance and feedback. The included studies provide limited insight into best practice for delivering DP. CONCLUSION: The results highlight the paucity of research in this field; however they offer insight into current applications of DP and provide preliminary empirical support DP for as a model for promoting the development of discrete therapeutic skills. Given the rapid dissemination of DP publications and manuals in psychotherapy, future research is strongly encouraged.

Differences in psychotherapy preferences between psychotherapy trainees and laypeople.

Despite increasing research on psychotherapy preferences, the preferences of psychotherapy trainees are largely unknown. Moreover, differences in preferences between trainees and their patients could (a) hinder symptom improvement and therapy success for patients and (b) represent significant obstacles in the early career and development of future therapists.We compared the preferences of n = 466 psychotherapy trainees to those of n = 969 laypersons using the Cooper-Norcross Inventory of Preferences. Moreover, we compared preferences between trainees in cognitive-behavioural therapy (CBT) and psychodynamic trainees.We found significant differences between both samples in 13 of 18 items, and three of four subscales. Psychotherapy trainees preferred less therapist directiveness (d = 0.58), more emotional intensity (d = 0.74), as well as more focused challenge (d = 0.35) than laypeople. CBT trainees preferred more therapist directiveness (d = 2.00), less emotional intensity (d = 0.51), more present orientation (d = 0.76) and more focused challenge (d = 0.33) than trainees in psychodynamic/psychoanalytic therapy.Overall, the results underline the importance of implementing preference assessment and discussion during psychotherapy training. Moreover, therapists of different orientations seem to cover a large range of preferences for patients, in order to choose the right fit.

Intimate and sexual feelings in psychotherapy: educational topic or still taboo?

BACKGROUND: Intimate and sexual feelings are common within psychotherapy, with negative outcomes when not managed adequately. AIMS: This study aims to investigate the understudied topic of these intimate and sexual feelings in basic education and psychotherapy training programs. METHOD: In this convergent mixed method study, both a survey (N = 786) and 8 focus groups (N = 36) were conducted among psychotherapists in Flanders, Belgium (November 2016 - June 2018), using inferential and thematic analyses respectively. RESULTS: The majority indicates that dealing with intimate and sexual feelings towards clients was hardly part of either their basic education or psychotherapy training. Talking about such feelings with peers or supervisors remained difficult because of concerns about being judged. Therapists indicating this topic was addressed in some way in their training indicated more often that they did not perceive it as a taboo topic. Therapists advocated a more open discussion and reflection on this topic. Education and training, as well as support from renowned key figures in their field, were regarded as important incentives to initiate change. CONCLUSION: Psychotherapy training should focus on how to deal with intimate and sexual feelings, referring to introspection and exploration of these feelings in a more integrated way during training.

[On the State of Training in Parent-Infant/Toddler Psychotherapy in Germany]. / Zum Stand der Aus- undWeiterbildung in Säuglings-/Kleinkind-Eltern-Psychotherapie in Deutschland.

Regulation disorders in early childhood and postpartum mental disorders of parents can be effectively treated by interventions that involve parents and child (so-called parent-infant psychotherapy, PIP). Availability of PIP in routine care remains low, even though the intervention is in high demand. This study aims to map the current situation of psychotherapy training in PIP in Germany, to record existing obstacles from the perspective of the institutes, and to obtain indications for improving training. Contact persons of training institutes all over Germany were invited to participate in an online survey. N = 95 persons answered questions about possible training in PIP and related advantages and hurdles as well as conditions for a future implementation. Nineteen (22.4 %) of the institutions indicated that PIP was part of their training concept. In 84.2 % of the cases this was aimed at child and adolescent psychotherapists. In 63.6 % of the institutes PIP was treated comprehensively. On average, 2.55 barriers were perceived, most frequently of an organizational nature. 75.9 % of the institutes that did not yet offer PIP would be willing to do so in the future under at least one condition. Among those conditions, information on PIP curricula and specific training content was most frequent (40.7 %).The low implementation of PIP in training seems to be mainly due to barriers of an organizational nature that can be overcome by some simple means, such as the dissemination of model curricula.

The Resistance Vignette Task: Validating a rapid measure of therapist skill at managing resistance.

BACKGROUND: Therapist appropriate responsivity to client ambivalence and resistance is considered an important interpersonal skill to avoid disengagement and ensure a continued collaborative, productive process. The present study examined the predictive validity of the newly developed Resistance Vignette Task (RVT), a 10-item rapidly administered measure of therapist ability to appropriately respond to various presentations of client resistance. METHODS: Following a resistance management workshop, the concurrent and prospective predictive capacity of RVT scores were examined through test interviews with ambivalent simulators and volunteers. RESULTS: Prospectively, in test interviews with ambivalent interviewees, higher RVT scores immediately postworkshop were associated with significantly greater responsivity (appropriate responsivity and fewer responsivity errors) at 4-month follow-up. RVT scores at the 4-month follow-up point were also concurrently associated with significantly greater therapist responsivity and lower levels of interviewee resistance. CONCLUSIONS: These findings provide further validation for the RVT as a measure of therapist responsivity in vivo, in actual interviews by predicting and being concurrently associated with therapist performance in response to client resistance. Thus, the RVT holds promise in advancing therapist training, as well as research on resistance as it represents an efficient measure of this key therapist skill.

Personal practice in counselling and CBT trainees: the self-perceived impact of personal therapy and self-practice/self-reflection on personal and professional development.

With growing evidence for the potential value of personal practices (PPs) in therapist training, it is important to determine which PPs may be most valuable for which therapists under what conditions. This is the first study to compare the impact of two different PPs selected by accredited therapy training programs as the most appropriate PP for their trainees. Using the same validated outcome measure, the Self-focused Practice Questionnaire, the impact of personal therapy for counselling psychology trainees was compared with the impact of self-practice/self-reflection (SP/SR) training for CBT trainees. The number of PP hours was similar across the two groups. The SP/SR group were older and may have been more experienced professionally. SP/SR was perceived by CBT trainees to be significantly more beneficial for personal and professional development than personal therapy by counselling trainees. Possible reasons are discussed. Although the study does not constitute a direct experimental comparison of personal therapy and SP/SR amongst matched trainees of the same theoretical orientation, it is notable in demonstrating that in training contexts where PP was mandatory, SP/SR was experienced more positively by the CBT trainees than personal therapy by the counselling trainees.

Developing Reflexivity through Group Processes in Psychotherapy Training: An Interpretative Phenomenological Analysis of Systemic Family Therapy Trainees' Experience.

Constructionist approaches in the field of systemic family therapy prioritize reflexivity to promote personal development within training, often leaning on group processes. Drawing from a qualitative study we conducted to address the lack of related research, we present how systemic family therapy trainees experience reflexivity development through group processes. Ten systemic family therapy trainees participated in semi-structured interviews, transcribed and analyzed with interpretative phenomenological analysis. Analysis presented here reports three superordinate themes: Developing reflexivity through challenges and rewards, A conditional reflexive space within the training group, and Encountering the dynamics of identity via reflexive group processes. Our findings suggest that trainees experience reflexivity development as a complex relational process of personal development, highlighting the training group's critical role, nonetheless depending on certain preconditions. The importance of further exploring group processes' potential for reflexivity development in psychotherapy training is underscored.

Lo enfoques construccionistas en el ámbito de la terapia familiar sistémica priorizan la reflexividad para promover el desarrollo personal dentro de la capacitación, generalmente apoyándose en procesos grupales. Valiéndonos de un estudio cualitativo que realizamos para abordar la falta de investigaciones relacionadas, presentamos la manera en la que los practicantes de la terapia familiar sistémica experimentan el desarrollo de la reflexividad mediante procesos grupales. Diez practicantes de terapia familiar sistémica participaron en entrevistas semiestructuradas, transcriptas y analizadas con el análisis fenomenológico interpretativo. Los análisis presentados aquí informan tres temas superordinados: el desarrollo de la reflexividad mediante desafíos y recompensas, un espacio reflexivo condicional dentro del grupo de capacitación, el encuentro de la dinámica de identidad mediante procesos grupales reflexivos. Nuestros hallazgos sugieren que los practicantes experimentan el desarrollo de la reflexividad como un proceso complejo de desarrollo personal relacional que destaca el papel fundamental del grupo de capacitación, pero que depende de ciertas precondiciones. Se subraya la importancia de analizar con mayor profundidad la posibilidad de desarrollo de la reflexividad en los procesos grupales durante la capacitación en psicoterapia.

Group Training for Psychiatric Residents: Support Group Facilitation and Supervision with Didactics.

OBJECTIVE: Group psychotherapy merits dedicated training during psychiatry residency yet is challenging to implement given competing educational requirements. The authors implemented a voluntary support group training intervention for psychiatry residents consisting of a 6-h didactic series followed by at least 6 months of in vivo group facilitation and supervision. We hypothesized participation would improve residents' self-reported skill and knowledge in group facilitation. METHODS: Psychiatry residents (PGY I-IV) voluntarily participated in this novel intervention that included a didactic series followed by experiential group facilitation and supervision. To assess confidence and self-reported skill level in group facilitation, residents completed two brief self-report surveys: before the didactic series (pre-intervention) and after group facilitation for at least 6 months (post-intervention). Surveys included Likert scales and open-ended questions. Quantitative data were analyzed with descriptive statistics and open-ended qualitative data were analyzed using thematic analysis. RESULTS: Twenty-three residents attended 4 to 6 h of didactics between 2016 and 2018. Of these 23 residents, 12 facilitated groups and attended supervision for at least 6 months. Twenty residents responded to pre-intervention surveys and 14 responded to post-intervention surveys. After the intervention, respondents reported a significant increase in knowledge and skills in group facilitation of 88% (15/17) on Likert scale questions. CONCLUSIONS: This study implemented a novel educational intervention to train psychiatric residents in group dynamics and group facilitation. Participation increased residents' self-reported knowledge and skills in group facilitation. Future directions include incorporating feedback about group curriculum, evaluating resident knowledge and skills using assessment measures, recruiting more group participants, and focusing on peer-to-peer mentoring.

Film as an educational tool to train psychotherapists.

Starting with Freud who wrote about Dostoyevsky, Michelangelo, and da Vinci, therapists have acknowledged that the humanities and arts contain great sources of insight into human nature. In this paper, I argue for the need to incorporate insights acquired by artists into the training of psychotherapists. Specifically, I present and describe a graduate-level seminar I teach that uses cinema as a tool to train mental health practitioners. Films are used to expose students to a range of universal human issues; we discuss film characters' conflicts, motivations, sources of suffering, and attempts to cope. Further efforts should be devoted to search for ways to use art to inform and enrich the practice, training, and teaching of psychotherapDirected by Robert Redford and produced in the United Statesy.

Validation predicting premature drop-out from treatment provided in training clinics.

BACKGROUND: Therapist validation in treatment is theorized to be related to positive outcomes (Linehan, 1993), including keeping patients in therapy longer. AIMS: We sought to evaluate the role of therapist validation from both therapists' and clients' perspectives as a predictor of drop-out from psychotherapy in three cognitive behavioural training clinics. METHOD: Clients in psychotherapy (n = 50; 80% female; 82% Caucasian) and their trainee therapists (n = 22; 68% female; 86% Caucasian) rated validation by the therapist at each of four early sessions of therapy. RESULTS: After accounting for symptom severity, clients who reported greater therapist validation were less likely to drop out of treatment. Therapist ratings of their own validating behaviours were unrelated to client drop-out. Therapist experience moderated the relation between client-rated validation and drop-out, such that validation was unrelated to drop-out for more experienced therapists. CONCLUSIONS: Assessing and attending to client perceptions of validation by the therapist early in treatment, with brief self-report inventories, can alert therapists to clients at greater risk of drop-out.

Development and Evaluation of ClientBot: Patient-Like Conversational Agent to Train Basic Counseling Skills.

BACKGROUND: Training therapists is both expensive and time-consuming. Degree-based training can require tens of thousands of dollars and hundreds of hours of expert instruction. Counseling skills practice often involves role-plays, standardized patients, or practice with real clients. Performance-based feedback is critical for skill development and expertise, but trainee therapists often receive minimal and subjective feedback, which is distal to their skill practice. OBJECTIVE: In this study, we developed and evaluated a patient-like neural conversational agent, which provides real-time feedback to trainees via chat-based interaction. METHODS: The text-based conversational agent was trained on an archive of 2354 psychotherapy transcripts and provided specific feedback on the use of basic interviewing and counseling skills (ie, open questions and reflections-summary statements of what a client has said). A total of 151 nontherapists were randomized to either (1) immediate feedback on their use of open questions and reflections during practice session with ClientBot or (2) initial education and encouragement on the skills. RESULTS: Participants in the ClientBot condition used 91% (21.4/11.2) more reflections during practice with feedback (P<.001) and 76% (14.1/8) more reflections after feedback was removed (P<.001) relative to the control group. The treatment group used more open questions during training but not after feedback was removed, suggesting that certain skills may not improve with performance-based feedback. Finally, after feedback was removed, the ClientBot group used 31% (32.5/24.7) more listening skills overall (P<.001). CONCLUSIONS: This proof-of-concept study demonstrates that practice and feedback can improve trainee use of basic counseling skills.

Assessing therapist development: Reliability and validity of the Supervisee Levels Questionnaire (SLQ-R).

BACKGROUND: Therapist development is a crucial target for clinical training in order to ensure high-quality psychotherapy. A major challenge in examining therapeutic development is the assessment of developmental processes. The Supervisee Levels Questionnaire (SLQ-R) was analyzed in this study to examine its validity, reliability, and underlying dimensional structure. METHOD: Seven hundred and sixty therapists participated in an online survey concerning their current psychotherapy training. The factor structure as well as the validity of the SLQ-R were investigated using exploratory and confirmatory factor analysis. RESULTS: In line with the results of the exploratory factor analyses, a Bifactor ESEM (exploratory structural equation modeling) model with two factors and one global factor provided the best fit to the data. The two factors were labeled professional self-confidence and professional insecurity. CONCLUSION: Empirical support for reliability and validity of the new factor structure of the SLQ-R was found. The instrument is useful for assessing the therapist's developmental level.

An Intervention in Social Connection: Medical Student Reflection Groups.

OBJECTIVE: Rates of medical student depression and suicide are higher than aged-matched peers. Although medical schools have implemented wellness interventions, no program has reported on interventions targeting social support. As one potential intervention, reflection groups for medical students led by psychiatry residents were designed and implemented. It was hypothesized that groups would encourage connectedness among peers, teach coping and emotional self-awareness skills, increase empathy, and decrease loneliness. METHODS: Voluntary, biweekly support groups were implemented between 2017 and 2018 at Stanford University School of Medicine for first- and second-year medical students. Participants were surveyed at baseline and 6 months. Surveys included qualitative assessments of groups and validated surveys to assess empathy, wellness, and loneliness. Separate surveys assessed attrition. Analyses included statistical analyses (descriptive statistics) and thematic analysis. RESULTS: In both cohorts, a total number of 30 students participated in groups, and 18 completed post-surveys. Students reported groups improved well-being (55.6% strongly agreed, 27.8% agreed), enhanced self-awareness (44.4% strongly agreed, 38.9% agreed) and ability to empathize (50.0% strongly agreed, 27.8% agreed), and promoted connection (61.1% strongly agreed, 33.3% agreed). Initial attrition was high, with 84% of students not continuing due to feeling too overwhelmed by classes. CONCLUSIONS: Thematic analysis demonstrated groups may benefit students in improving impostor syndrome and connection with others (decreased loneliness), allowing exposure and tolerance to diverse perspectives, increasing insight into the importance of self-care and emotional self-awareness, allowing practice for collaborative skills, and increasing thoughtful approaches to patient care. There is preliminary evidence reflection groups may be a feasible, effective intervention to improve loneliness and social belonging in medical school.

[Psychotherapy training in Austria: Baseline and socio-demographic background data from a SPRISTAD (Society of Psychotherapy Research Interest Section on Therapist Training and Development)-Pilotstudy]. / Psychotherapie-Berufsausbildung in Österreich: Basis- und soziodemographische Hintergrunddaten aus einer SPRISTAD-Pilotstudie (Society of Psychotherapy Research Interest Section on Therapist Training and Development).

Objectives: Description of the qualifications of psychotherapy-training candidates in Austria at the beginning of their training. Methods: Psychotherapists in training in Austria were interviewed at the beginning of their training concerning their socio-demographic background and prior education. These background data were collected using the Trainee Background Information Form (TBIF), which was designed by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (SPRISTAD). Results: The group of 197 psychotherapy trainees from Austria consists largely of women, of persons with high school education and with a satisfactory, financially secure life situation. One-third of them show a "second career" pattern, which is in line with the predominantly part-time training programs in Austria. A high percentage of the candidates have previous professional experience in the psychosocial field. Conclusions: As this is a pilot study, results can be seen as a starting point for further research in psychotherapy training and competence development. In discussing the findings, both national conditions and opportunities for future interdisciplinary research are considered.

[Difficult situations in psychotherapy and how therapists deal with them]. / Schwierige Situationen in der Psychotherapie und wie Therapeuten mit ihnen umgehen.

Difficult situations in psychotherapy and how therapists deal with them Objectives: In theory and research, it is assumed that therapeutic competences are especially relevant in difficult situations. In the present study, we collected and categorized situations that psychotherapists subjectively evaluated as difficult. Additionally, we inspected therapists' reactions to these situations and considered correlations between situations and reactions. Methods: In an online-survey, 101 therapists described difficult situations and their corresponding reactions. The reports were analyzed by qualitative content analysis (Mayring 2015) and resulted in two category systems for the difficult situations and the reactions. Results: Difficult situations reached from everyday conflicts to extreme situations (e. g. threats). The most frequent difficult situations were in context of therapeutic frame, aspects of disorder, and critics, demands, accusations of patients. The most frequent reactions concerned therapeutic frame, external help and supportive interventions. We found significant correlations between difficult situations due to aspects of disorder and asking for external help. Conclusions: Although categories were sometimes difficult to isolate and few cognitive behavioral therapists participated, the collection of difficult situations can be of help for therapists and their training.

How Supervisees on a Foundation Course in CBT Perceive a Supervision Session and what they Bring Forward to the Next Therapy Session.

BACKGROUND: There is limited research into the effect of supervision in cognitive behavioural therapy (CBT) from the supervisees' perspective. AIMS: The aim of the study was to acquire knowledge from the supervisees' perspective as to what in particular in the supervision process contributes to the therapy process. METHOD: Fourteen supervisees on a foundation course participated in the study. A qualitative approach was used with thematic analysis of the participants' written diaries after supervision and therapy sessions. RESULTS: Analyses of supervisees' experiences suggested that a variety of therapeutic interventions were easier to implement if one had the supervisor's support and felt free to decide if and when the suggested interventions could best be implemented. Evaluation in the form of positive feedback from the supervisor indicating that the supervisee was 'doing the right thing' was perceived to be important. A unifying theme when supervisees felt they were not getting anything out of the supervision was that the supervisees did not have a supervision question. CONCLUSIONS: The results of this research suggest that the supervisor's support during training is perceived to be important for the supervisee. Receiving positive feedback from one's supervisor in an evaluation is perceived to have a great impact on whether the therapist implements the suggested therapeutic interventions discussed in the previous supervision.

Trainees' self-evaluation of their development as psychotherapists: An Italian contribution to an international collaborative study on psychotherapy training.

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.

Developing a Compassionate Internal Supervisor: Compassion-Focused Therapy for Trainee Therapists.

The concept of an 'internal supervisor' has been used in psychotherapy to describe the way in which the supervisory relationship is internalized and utilized by the supervisee. This research explores the possibility, and potential benefit, of training therapists to develop a 'compassionate internal supervisor'. A training programme was developed for trainee cognitive-behavioural therapists using adapted versions of compassion-focused therapy interventions. The training focused on guided imagery exercises and reflective practices undertaken for a 4-week period. Seven trainee cognitive-behavioural therapists were interviewed, utilizing a semi-structured format, regarding their experience of the training programme. The resulting transcriptions were analysed using Interpretative Phenomenological Analysis (IPA). The analysis identified six super-ordinate themes: (1) the varied nature of the supervisor image, (2) blocks and their overcoming, (3) increased compassion and regulation of emotion, (4) impact on cognitive processes, (5) internalization and integration, and (6) professional and personal benefit. The themes describe the varied ways in which participants created and experienced their compassionate supervisor imagery. Working with the personal blocks encountered in the process provided participants with a deeper understanding of the nature of compassion and its potential to support them in their training, practice and personal lives. The process and impact of 'internalizing' a compassionate supervisory relationship is described by participants and then discussed for potential implications for psychotherapy training and self-practice. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Compassion-focused therapy, and related compassionate-mind imagery exercises, can be adapted specifically to develop compassion in trainee psychotherapists. Creating, and engaging with, an 'ideal compassionate supervisor' in an imaginal form can support psychotherapy trainees in their clinical practice and development, their supervision and their personal lives. The cultivation of therapist self-compassion can reduce unhelpful cognitive processes such as worry, rumination and self-criticism whilst increasing self-reflection, attentional flexibility and approach behaviour. Identifying, and working with, blocks to compassion is important when cultivating clinician self-compassion Therapist self-practice of compassion-focused exercises can provide important insights into the nature of compassion and its cultivation in clients.

The value of a registrar psychotherapy post to psychiatry training.

OBJECTIVES: This paper describes the psychotherapy registrar position developed at St Vincent's Hospital Melbourne in response to the Australian Government's Specialist Training Position initiative of 2009. This impressionistic piece outlines features of the registrar's clinical work, supervision and professional development. This paper will focus on: 1) the history of the position; 2) its developmental function embedded within the clinical responsibilities of the role; 3) how this position is different from the existing Royal and Australian and New Zealand College of Psychiatry psychotherapy training requirements; and 4) infrastructure issues of the position. CONCLUSIONS: This psychotherapy registrar position is a novel role that provides an opportunity to work in an intensive and sustained way with patients and within multidisciplinary teams whilst being supported by supervision and a rich teaching milieu. It offers experience of psychotherapeutic work not usually available in public mental health services. It thus assists the development of psychotherapeutic skills that are likely to enhance the future practice of those undertaking the role.

Psychotherapy and Cognitive Behavioral Therapy Supervision in Danish Psychiatry: Training the Next Generation of Psychiatrists.

OBJECTIVE: Psychotherapy training is mandatory for physicians to qualify as psychiatrists in Denmark. Evidence for the effectiveness of psychotherapy has increased, and psychotherapy is increasingly included in international treatment guidelines. The authors investigated how psychiatrists in training in Denmark evaluate the opportunities to practice psychotherapy in their training and the quality of the supervision they receive in psychotherapy training, particularly for cognitive behavioral therapy (CBT). METHOD: The authors conducted a survey regarding psychotherapy training and CBT supervision among psychiatrists in training at Danish psychiatric specialist training courses. They investigated respondents' interest and experience in psychotherapy and respondents' views on the relevance and feasibility of performing psychotherapy and receiving supervision in their psychiatry training. RESULTS: Eighty-eight percent of the psychiatrists in training found psychotherapy to be a relevant part of their training; however, 77 % found it difficult to find time to practice psychotherapy and 44 % felt that practicing psychotherapy was a strain on their employer. Thirty-six percent and 53 %, respectively, had difficulties securing psychodynamic and CBT supervision. In CBT supervision, more than 60 % reported supervision that appeared to be below the expected CBT supervision standard and often so much below it might not qualify as CBT supervision. CONCLUSIONS: There is a need to focus on how to better integrate psychotherapy and supervision in the Danish psychiatric training program. Good CBT supervision may be lacking, and a way to ensure high-quality supervision is required.