Effect of deliberate practice training of graduate students in general psychotherapeutic skills compared with theoretical teaching: protocol for the randomised controlled TRIPS trial

Ole Karkov Østergård, Jan Nielsen, Carsten Hjorthøj, Kristine Kahr Nilsson, Stig Bernt Poulsen, Ole Karkov Østergård, Jan Nielsen, Carsten Hjorthøj, Kristine Kahr Nilsson, Stig Bernt Poulsen

Abstract

Introduction: Psychology students at universities in Denmark and worldwide often receive relatively little clinical training, even though such training is crucial to job performance after graduation. Training common psychotherapeutic skills, such as being empathic and facilitating the therapeutic alliance, is critical since these skills are related to psychotherapy outcomes. In this study, a deliberate practice-based approach to student training will be compared with theoretical teaching. The main hypothesis is that deliberate practice training will result in a larger improvement in students' observer-rated interpersonal skills.

Methods and analysis: The TRaining of graduate students In general Psychotherapeutic Skills study has a double-centre, randomised, assessor-blinded, two-way crossover study design. About 200 graduate students from two Danish universities will be randomised into two groups, (a) deliberate practice training of common psychotherapeutic skills using role-play and Skillsetter, an online skill-building system with therapy videos or (b) theoretical teaching. Group a will first receive the experimental condition, followed by the control condition, while group b will receive the conditions in reverse order. Each condition consists of 15 hours of classroom participation and homework. The primary outcome is facilitative interpersonal skills-observer. Secondary outcomes include the facilitative interpersonal skills-self-report, the Counselor Activity Self-Efficacy Scales and the Interpersonal Reactivity Index. Outcomes will be measured at baseline (week 0), after the first condition (week 5; before the crossover, reflecting true randomisation) and after both conditions (week 10). Main outcome analyses will be performed at week 5. Several predictors of the effect of deliberate practice will be explored.

Ethics and dissemination: Ethical approval from university ethics boards has been obtained. All participants will be asked to provide informed consent before participation. Once completed, the study can potentially transform the training of psychotherapy in graduate education, which, ultimately, may positively influence psychotherapy outcomes (IP-IRB / 03092021).

Trial registration number: NCT05164497.

Keywords: Adult psychiatry; Clinical trials; EDUCATION & TRAINING (see Medical Education & Training).

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flowchart study design.

References

    1. Callahan JL, Watkins CE. The science of training II: Prepracticum and practicum training. Train Educ Prof Psychol 2018;12:231–44. 10.1037/tep0000209
    1. Goldberg SB, Rousmaniere T, Miller SD, et al. . Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. J Couns Psychol 2016;63:1–11. 10.1037/cou0000131
    1. Owen J, Wampold BE, Kopta M, et al. . As good as it gets? therapy outcomes of trainees over time. J Couns Psychol 2016;63:12–19. 10.1037/cou0000112
    1. Rousmaniere TG, Swift JK, Babins-Wagner R, et al. . Supervisor variance in psychotherapy outcome in routine practice. Psychother Res 2016;26:196–205. 10.1080/10503307.2014.963730
    1. Wampold BE. How important are the common factors in psychotherapy? an update. World Psychiatry 2015;14:270–7. 10.1002/wps.20238
    1. Lambert MJ. The efficacy and effectiveness of psychotherapy. In: Lambert MJ, ed. Bergin & Garfield’s handbook of psychotherapy and behavior change. 6th ed. New York: John Wiley & Sons, 2013: 169–218.
    1. Wampold BE, Imel ZE. The great psychotherapy debate: the evidence for what makes psychotherapy work. 2nded. New York, NY: Routledge, 2015.
    1. Ahn H-nie, Wampold BE. Where OH where are the specific ingredients? A meta-analysis of component studies in counseling and psychotherapy. J Couns Psychol 2001;48:251–7. 10.1037/0022-0167.48.3.251
    1. Bell EC, Marcus DK, Goodlad JK. Are the parts as good as the whole? A meta-analysis of component treatment studies. J Consult Clin Psychol 2013;81:722–36. 10.1037/a0033004
    1. Longmore RJ, Worrell M. Do we need to challenge thoughts in cognitive behavior therapy? Clin Psychol Rev 2007;27:173–87. 10.1016/j.cpr.2006.08.001
    1. Elliott R, Bohart AC, Watson JC, et al. . Therapist empathy and client outcome: an updated meta-analysis. Psychotherapy 2018;55:399–410. 10.1037/pst0000175
    1. Flückiger C, Del Re AC, Wampold BE, et al. . The alliance in adult psychotherapy: a meta-analytic synthesis. Psychotherapy 2018;55:316–40. 10.1037/pst0000172
    1. Baldwin SA, Imel Z. Therapist effects: Findings and methods. In: Lambert MJ, ed. Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change (6. ed. Hoboken, NJ: John Wiley & Sons, Inc, 2013: 258–97.
    1. Hougaard E. Psykoterapi: teori og forskning (3. ed. Copenhagen, DK: Dansk Psykologisk Forlag, 2019.
    1. Norcross JC, Lambert MJ. Psychotherapy relationships that work III. Psychotherapy 2018;55:303–15. 10.1037/pst0000193
    1. Anderson T, Patterson C. Facilitative Interpersonal Skill Task and Rating Method. Athens, OH: Ohio University, 2013.
    1. Anderson T, Ogles BM, Patterson CL, et al. . Therapist effects: facilitative interpersonal skills as a predictor of therapist success. J Clin Psychol 2009;65:755–68. 10.1002/jclp.20583
    1. Anderson T, Crowley MEJ, Himawan L, et al. . Therapist facilitative interpersonal skills and training status: a randomized clinical trial on alliance and outcome. Psychother Res 2016;26:511–29. 10.1080/10503307.2015.1049671
    1. Anderson T, McClintock AS, Himawan L, et al. . A prospective study of therapist facilitative interpersonal skills as a predictor of treatment outcome. J Consult Clin Psychol 2016;84:57–66. 10.1037/ccp0000060
    1. University of Copenhagen . Dimittendundersøgelse KU - Uddannelseszoom 2020. Copenhagen: University of Copenhagen, 2020.
    1. Skovholt TM, Rønnestad MH. Struggles of the novice counselor and therapist. J Career Dev 2003;30:45–58. 10.1177/089484530303000103
    1. Pilecki B, McKay D. The theory-practice gap in cognitive-behavior therapy. Behav Ther 2013;44:541–7. 10.1016/j.beth.2013.03.004
    1. Binder JL, Henry WP. Developing skills in managing negative process. In: Muran JC, Barber JP, eds. The therapeutic alliance: An evidence-based guide to practice. New York: Guilford Press, 2010: 285–303.
    1. Bogo M. Achieving competence in social work through field education. Toronto, ON: University of Toronto Press, 2010.
    1. Wampold BE. The basics of psychotherapy: An introduction to theory and practice. Washington, DC: American Psychological Association, 2010.
    1. Hill CE, Knox S. Training and supervision in psychotherapy: Evidence for effective practice. In: Lambert MJ, ed. Handbook of psychotherapy and behavior change. 6thed.. New York, NY: John Wiley, 2013: 775–811.
    1. Perlman MR, Anderson T, Foley VK, et al. . The impact of alliance-focused and facilitative interpersonal relationship training on therapist skills: an RCT of brief training. Psychother Res 2020;30:871–84. 10.1080/10503307.2020.1722862
    1. Anderson T, Perlman MR, McCarrick SM, et al. . Modeling therapist responses with structured practice enhances facilitative interpersonal skills. J Clin Psychol 2020;76:659–75. 10.1002/jclp.22911
    1. Skillsetter, 2022. Available:
    1. Ericsson KA, Krampe RT, Tesch-Römer C. The role of deliberate practice in the acquisition of expert performance. Psychol Rev 1993;100:363–406. 10.1037/0033-295X.100.3.363
    1. Ericsson KA, Lehmann AC. Expert and exceptional performance: evidence of maximal adaptation to task constraints. Annu Rev Psychol 1996;47:273–305. 10.1146/annurev.psych.47.1.273
    1. Miller SD, Hubble MA, Chow D. The question of expertise in psychotherapy Journal of expertise, 2018. Available:
    1. Heinonen E, Nissen-Lie HA. The professional and personal characteristics of effective psychotherapists: a systematic review. Psychother Res 2020;30:417–32. 10.1080/10503307.2019.1620366
    1. de Jong K, van Sluis P, Nugter MA, et al. . Understanding the differential impact of outcome monitoring: therapist variables that moderate feedback effects in a randomized clinical trial. Psychother Res 2012;22:464–74. 10.1080/10503307.2012.673023
    1. Hill CE. Helping skills: facilitating exploration, insight, and action. 5nd ed. Washington, D.C: American Psychological Association, 2019.
    1. Hill CE, Anderson T, Kline K. Helping skills training for undergraduate students: who should we select and train? The Counseling Psychologist 2016;44:50–77. 10.1177/0011000015613142
    1. Leary T. Interpersonal Diagnosis of Personality: A Functional Theory and Methodology for Personality Evaluation. New York: Ronald Press, 1957.
    1. Lent RW, Hill CE, Hoffman MA. Development and validation of the counselor activity self-efficacy scales. J Couns Psychol 2003;50:97–108. 10.1037/0022-0167.50.1.97
    1. Lent RW, Hoffman MA, Hill CE, et al. . Client-specific counselor self-efficacy in novice counselors: relation to perceptions of session quality. J Couns Psychol 2006).;53:453–63. 10.1037/0022-0167.53.4.453
    1. Davis MH. Measuring individual differences in empathy: evidence for a multidimensional approach. J Pers Soc Psychol 1983;44:113–26. 10.1037/0022-3514.44.1.113
    1. Benjamin LS. Intrex User’s Manual. Salt Lake City, UT: University of Utah, 2000.
    1. Monsen JT, von der Lippe AL, Havik OE, et al. . Validation of the SASB Introject surface in a Norwegian clinical and nonclinical sample. J Pers Assess 2007;88:235–45. 10.1080/00223890701268108
    1. Halvorsen MS, Monsen JT. Self-image as a moderator of change in psychotherapy. Psychotherapy Research 2007;17:205–17. 10.1080/10503300600608363
    1. Jørgensen C, Hougaard E, Rosenbaum B, et al. . The dynamic assessment interview (DAI), interpersonal process measured by structural analysis of social behavior (SASB) and therapeutic outcome. Psychother Res 2000;10:181–95. 10.1093/ptr/10.2.181
    1. Svartberg M, Stiles TC, &. Predicting patient change from therapist competence and patient-therapist complementarity in short-term anxiety-provoking psychotherapy: a pilot study. J Consult Clin Psychol 1992;60:304–7. 10.1037/0022-006X.60.2.304
    1. Riggio RE, Carney DR. Manual for the social skills inventory. 2nd ed. Mind Garden: CA, 2003.
    1. Riggio RE. Assessment of basic social skills. J Pers Soc Psychol 1986;51:649–60. 10.1037/0022-3514.51.3.649
    1. Fraley RC, Waller NG, Brennan KA. An item response theory analysis of self-report measures of adult attachment. J Pers Soc Psychol 2000;78:350–65. 10.1037/0022-3514.78.2.350
    1. Sibley CG, Liu JH. Short-Term temporal stability and factor structure of the revised experiences in close relationships (ECR-R) measure of adult attachment. Pers Individ Dif 2004;36:969–75. 10.1016/S0191-8869(03)00165-X
    1. Kooiman CG, Klaassens ER, van Heloma Lugt JQ, et al. . Psychometrics and validity of the Dutch experiences in close Relationships-Revised (ECR-r) in an outpatient mental health sample. J Pers Assess 2013;95:217–24. 10.1080/00223891.2012.740540
    1. Herold DM, Parsons CK, Rensvold RB. Individual Dirences in the generation and processing of performance feedback. Educ Psychol Meas 1996;56:5–25. 10.1177/0013164496056001001
    1. Herold DM, Parsons CK, Fedor DB. Individual feedback propensities and their effects on motivation, training success, and performance. Georgia Institute of Technology: United States Army Research Institute for the Behavioral and Social Sciences, 1997.
    1. MacKenzie KR. The clinical application of a group climate measure. In: Dies RR, MacKenzie KR, eds. Advances in group psychotherapy: Integrating research and practice (pp. 159­170. Madison, CT: International Universities Press, 1983.
    1. Kivlighan DM, Goldfine DC. Endorsement of therapeutic factors as a function of stage of group development and participant interpersonal attitudes. J Couns Psychol 1991;38:150–8. 10.1037/0022-0167.38.2.150
    1. McClendon DT, Burlingame GM. Group climate: Construct in search of clarity. In: Conyne RK, ed. The Oxford handbook of group counseling. New York: Oxford University Press, 2010: 164–81.
    1. Rousmaniere TG. Deliberate Practice Coach Competency Scale (DPCCS), 2020. Available:
    1. Faul F, Erdfelder E, Buchner A, et al. . Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 2009;41:1149–60. 10.3758/BRM.41.4.1149
    1. Perlman MR, Foley VK, Finkelstein J. Alliance-focused and facilitative interpersonal relationship training enhance students’ therapeutic skills. Manuscript in preparation 2019. 10.1080/09515070.2022.2049703

Source: PubMed

3
Se inscrever