National survey of psychotherapy training in psychiatry, psychology, and social work

CONTEXT: Approximately 3% of the US population receives psychotherapy each year from psychiatrists, psychologists, or social workers. A modest number of psychotherapies are evidence-based therapy (EBT) in that they have been defined in manuals and found efficacious in at least 2 controlled clinical trials with random assignment that include a control condition of psychotherapy, placebo, pill, or other treatment and samples of sufficient power with well-characterized patients. Few practitioners use EBT. OBJECTIVE: To determine the amount of EBT taught in accredited training programs in psychiatry, psychology (PhD and PsyD), and social work and to note whether the training was elective or required and presented as a didactic (coursework) or clinical supervision. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey of a probability sample of all accredited training programs in psychiatry, psychology, and social work in the United States. Responders included training directors (or their designates) from 221 programs (73 in psychiatry, 63 in PhD clinical psychology, 21 in PsyD psychology, and 64 in master's-level social work). The overall response rate was 73.7%.Main Outcome Measure Requiring both a didactic and clinical supervision in an EBT. RESULTS: Although programs offered electives in EBT and non-EBT, few required both a didactic and clinical supervision in EBT, and most required training was non-EBT. Psychiatry required coursework and clinical supervision in the largest percentage of EBT (28.1%). Cognitive behavioral therapy was the EBT most frequently offered and required as a didactic in all 3 disciplines. More than 90% of the psychiatry training programs were complying with the new cognitive behavior therapy requirement. The 2 disciplines with the largest number of students and emphasis on clinical training-professional clinical psychology (PsyD) and social work-had the largest percentage of programs (67.3% and 61.7%, respectively) not requiring a didactic and clinical supervision in any EBT. CONCLUSION: There is a considerable gap between research evidence for psychotherapy and clinical training. Until the training programs in the major disciplines providing psychotherapy increase training in EBT, the gap between research evidence and clinical practice will remain.     

The professionalization and training of psychologists: The place of clinical wisdom

Objective: The current study examines how clinical wisdom develops and how it both is and can be influenced by professional training processes. In this way, the project is studying the intersection of developmental and systemic processes related to clinical wisdom. Method: Researchers analyzed the interviews of psychologists practicing in the USA and Canada who were nominated for their clinical wisdom by their peers. These interviews explored how graduate training and professionalization were thought to influence the development of clinical wisdom and were subjected to an adapted grounded theory analysis. Results: The findings described both professional and personal disincentives toward developing wisdom, including the dangers of isolation. Therapists reported concerns about educational systems that rewarded quick answers instead of thoughtful questioning in processes of admittance, training, and accreditation. Findings emphasized the importance of teaching multiple psychotherapy orientations, critical self- and professional-reflection skills, and openly supporting graduate students’ curiosities and continued professional engagement. Conclusions: Recommended principles for training are put forward for the development and evaluation of psychotherapy training programs that aim to foster clinical wisdom. These principles complement training models focused upon clinical competence by helping trainees to develop a foundation for clinical wisdom.     

Effects of parent management training programs on disruptive behavior for children with a developmental disability: A meta-analysis

This meta-analysis determined the effects of parent management training (PMT) on disruptive behaviors in children with a developmental disability. Parent management training programs, based on behavioral theories of psychology, are commonly used in addressing disruptive behavior in children. Eleven studies met inclusion criteria with a total of 540 participants, with 275 in experimental groups and 265 in control groups. The effect of PMT on the disruptive behavior in children with a developmental disability was significant (g = 0.39). The moderator effects of type of PMT, delivery type and setting, and administrator level of education were also significant. The moderator effects of child age, and session number and duration were not significant in this meta-analysis.     

The Student Perspective of Psychology Practica Training

Providing practicum training to graduate students is a valued activity of many mental health settings. Practica are also crucial to the training and socialization of future mental health practitioners. This research surveyed 321 doctoral psychology students about expectations of their practicum training sites versus what they actually received in fundamental domains including supervision, client contact, assessment, and research. While the majority of students reported receiving what they expected, a large minority did not; students also indicated that they were quite hesitant to provide feedback about shortfalls in training. Implications and recommendations for administrators of mental heath settings are presented.     

More Training Needed in Eating Disorders: A Time Cohort Comparison Study of Canadian Psychiatry Residents

A time cohort comparison was conducted, via questionnaire, with Canadian psychiatry residents in 1990 and 2004 regarding their education and training in eating disorders (EDs). Instruction and clinical experiences in EDs were not perceived as adequate by senior residents in either cohort, although increases in instruction and clinical opportunities were reported in 2004. Both cohorts endorsed mandatory instruction on EDs. Negative attitudes towards EDs were encountered in training environments. Most respondents indicated some interest in working with EDs. It is recommended that training programs continue to strengthen their EDs content and ensure that residents are exposed to treatment research literature.     

More training needed in eating disorders: A time cohort comparison study of Canadian psychiatry residents

A time cohort comparison was conducted, via questionnaire, with Canadian psychiatry residents in 1990 and 2004 regarding their education and training in eating disorders (EDs). Instruction and clinical experiences in EDs were not perceived as adequate by senior residents in either cohort, although increases in instruction and clinical opportunities were reported in 2004. Both cohorts endorsed mandatory instruction on EDs. Negative attitudes towards EDs were encountered in training environments. Most respondents indicated some interest in working with EDs. It is recommended that training programs continue to strengthen their EDs content and ensure that residents are exposed to treatment research literature.     

Developmental disability training in Canadian psychiatry residency programs.

OBJECTIVE: To examine current training in developmental disabilities in Canadian psychiatry residency programs and to determine, from the programs' perspectives, how provinces across Canada are responding to the needs of persons with developmental disabilities and comorbid mental health disturbances (persons with a "dual diagnosis"). METHOD: A survey was completed by residency directors, or their designate, for all 16 psychiatry residency programs in Canada. RESULTS: Persons with developmental disabilities require psychiatric services throughout their lives, but inadequate training opportunities exist in many of the residency programs, particularly those involving adults and adolescents. While some didactic opportunities are usually available, supervised clinical opportunities are rare, and many of those reported are optional. CONCLUSIONS: Across Canada, there have been insufficient advances in clinical training and service developments to meet the needs of individuals with developmental disabilities and comorbid mental health disturbances.     

Putting "rural" into psychiatry residency training programs.

OBJECTIVE: Evidence indicates disparities in the number of psychiatrists practicing in rural America compared to urban areas suggesting the need for a greater emphasis on rural psychiatry in residency training programs. The authors offer suggestions for integrating a rural focus in psychiatry residency training to foster greater competency and interest in rural psychiatry. METHODS: The authors surveyed the limited rural psychiatry training and the more extensive family medicine rural residency literature to review efforts to develop rural focused training curricula. RESULTS: Many factors in the rural environment influence mental health care, including overlapping professional-patient relationships, caregiver isolation and stress, limited availability and access to mental health resources, disease stigma, and economic and health status. To enhance both an interest in and the quality of the training for a rural practice, the authors suggest three levels of training for integrating rural factors into psychiatry programs from a basic didactic understanding of the contextual issues affecting rural psychiatry, to creating rural clinical experiences and preceptors, to developing a rural psychiatry fellowship. CONCLUSIONS: Providing trainees with an understanding of the rural mental health issues and experiences might contribute to trainees' selecting rural practices and enhance the rural competency of psychiatrists.     

Self-Efficacy Triggers Psychological Appraisal Mechanism for Mindset Shift

This paper talks about how to insist staying in changed mindset based on the assigned cognitive reframing principles, and finally the changed mindset become a forever psychological status by PSI model proposed by this study. P is the cognitive reframing principle of positive psychology, happiness in this case; S is self-efficacy, which plays the important role in maintaining the stress taker to psychologically stay in the changed mindset in the long run. I represent of insisting power, the mental toughness to against the adverse negative emotions. Improving university students’ stress coping skills through the psychological dynamics formed by cognitive reframing principles of positive psychology, self-efficacy, and mental toughness will help them effectively deal with stressful events. This study aims to reduce university students’ stress level by increasing their ability to cope with stress, and improving their life satisfaction by understanding the mechanism for mindset-shift of university students and proposal of the new PSI reframing model for creating a new path to let students view stressors as challenge, not hindrance. Theories adopted in this study include cognitive reframing principles, appraisal theory, hindrance-challenge theory, cognitive reframing the schema. In the introduction section, the authors will clearly depict the logics for utilization of these theories in supporting the proposed PSI model. This research was divided into two studies. Study 1 postulated that cognitive reframing principles of positive psychology, self-efficacy, and mental toughness have a positive mediating effect in the causal relationship between university students’ stress level and life satisfaction. Findings revealed that stressful life events negatively predict the level of LS. Also, PP, SE, and MT exert a positive and significant impact on the relationship between stressful life events and LS. PP strengthens individuals’ perception of stressful life events as challenges instead of hindrances. This study showed that individuals need to think positively and develop self-efficacy in order to generate mental toughness when confronted with challenges from stressful life events, and needs to have self-efficacy and confidence towards cognitive reframing principles of positive psychology in their mind, and finally form a mental toughness competence to protect the newly changed mindset in the long run.     

National Survey of Clinical Neuropsychology Postdoctoral Fellows

The present study was designed to survey postdoctoral fellows in clinical neuropsychology about their perceptions of a variety of training standards and recommendations. Survey packets were mailed to the 78 training directors listed in Cripe's (1998) most recent listing of postdoctoral training programs at the time of survey. A response rate of 44% was achieved. Results were notable in that most fellows had been trained in clinical psychology, and mostly in Ph.D. programs. Approximately half had been trained and/or supervised by diplomates in clinical neuropsychology from the American Board of Professional Psychology. Continuing education was judged by respondents to be an insufficient substitute for formal training. Most respondents completed internships and postdoctoral residencies in a hospital setting, with greater than 50% of their time devoted to clinical neuropsychology.     

National survey of clinical neuropsychology postdoctoral fellows

The present study was designed to survey postdoctoral fellows in clinical neuropsychology about their perceptions of a variety of training standards and recommendations. Survey packets were mailed to the 78 training directors listed in Cripe's (1998) most recent listing of postdoctoral training programs at the time of survey. A response rate of 44% was achieved. Results were notable in that most fellows had been trained in clinical psychology, and mostly in Ph.D. programs. Approximately half had been trained and/or supervised by diplomates in clinical neuropsychology from the American Board of Professional Psychology. Continuing education was judged by respondents to be an insufficient substitute for formal training. Most respondents completed internships and postdoctoral residencies in a hospital setting, with greater than 50% of their time devoted to clinical neuropsychology.     

Supervision in Neuropsychological Assessment: A Survey of Training,Practices, and Perspectives of Supervisors

Within the psychology supervision literature, most theoretical models and practices pertain to general clinical or counseling psychology. Supervision specific to clinical neuropsychology has garnered little attention. This survey study explores supervision training, practices, and perspectives of neuropsychology supervisors. Practicing neuropsychologists were invited to participate in an online survey via listservs and email lists. Of 451 respondents, 382 provided supervision to students, interns, and/or fellows in settings such as VA medical centers (37%), university medical centers (35%), and private practice (15%). Most supervisors (84%) reported supervision was discussed in graduate school “minimally” or “not at all.” Although 67% completed informal didactics or received continuing education in supervision, only 27% reported receiving training specific to neuropsychology supervision. Notably, only 39% were satisfied with their training in providing supervision and 77% indicated they would likely participate in training in providing supervision, if available at professional conferences. Results indicate that clinical neuropsychology as a specialty has paid scant attention to developing supervision models and explicit training in supervision skills. We recommend that the specialty develop models of supervision for neuropsychological practice, supervision standards and competencies, training methods in provision of supervision, and benchmark measures for supervision competencies.     

Reading, Laterality, and the Brain: Early Contributions on Reading Disabilities by Sara S. Sparrow

Although best known for work with children and adults with intellectual disabilities and autism spectrum disorders, training in speech pathology and a doctorate in clinical psychology and neuropsychology was the foundation for Sara Sparrow’s long-term interest in reading disabilities. Her first papers were on dyslexia and laterality, and the maturational lag theory of developmental dyslexia proposed with Paul Satz, her mentor. The research program that emerged from this work had a wide impact on early neuropsychological models of reading disabilities. Although Sara went on to research focused on children with other developmental disabilities after she moved to Yale University, this initial research influenced her career- long interests in assessment, developmental models of disabilities, and early screening methods.     

Psychoanalytic Developmental Ego Psychology: A Framework for Advanced Psychiatric Nursing Practice

topic : The use of psychoanalytic developmental ego psychology (PDEP) as a theoretical framework for understanding clinical material.
methods : Thirty-four students in advanced practice psychiatric mental health nursing provided data for analysis. Interview data were organized into case studies and analyzed.
findings : PDEP provides a framework that is suitable for education and practice of advanced psychiatric nurses.
conclusion : PDEP can provide a framework that is theory-derived, outcome oriented, and suitable for a variety of clients.     

The effect of hypnotic training programs on the academic performance of students

The main objective of the present study was to empirically verify the effect of hypnotic training programs on the academic performance of students. A pre and posttest design was used. Two experimental and two control groups (total sample N=119) of volunteer second year psychology students at the University of Stellenbosch in South Africa comprised the sample. One of the experimental groups was exposed to active alert hypnosis and the other to relaxation hypnosis. One control group was exposed to progressive relaxation, while the other did not receive any intervention. The participants' April grades were used as a pretest, while their June grades served as a posttest. The two hypnotic training programs had a significant effect on the academic achievement of the participants, which was not found in the control groups. Regarding the efficacy of the two programs, however, no significant difference was found.     

Training residents to care for the mentally ill

Recent changes in Royal College training requirements have highlighted the need for residency programs to be able to offer challenging and worthwhile experiences to their trainees in caring for the chronically mentally ill. This training should bring them into contact with patients at each stage of their illness and recovery and expose them to the different settings in which treatment or management takes place. Postgraduate programs face many problems in organizing this teaching that arise from the nature and course of long-term psychiatric illnesses, the organization of residency training programs, attitudes and preconceptions of residents and teachers and competing time demands. The authors review these problems, identify specific goals for the training and suggest strategies for achieving these goals. Expectations of postgraduate programs, clinical placements, supervisors and residents themselves are outlined.     

Primary care in psychiatry residency training

The author summarizes patient perspectives and government initiatives that have fostered closer medicine-psychiatry cooperation and more comprehensive treatment of patients. Despite the growing numbers of people requiring more formal mental health care, most patients are being treated by primary health care providers. This trend will continue as long as there is a decline in the number of medical students entering psychiatry. The author summarizes several general principles that psychiatry residency program directors should consider in designing primary care experiences for their residents and for medical students rotating on their services: longitudinal primary care experiences in organized medical care settings, training in basic medical principles and techniques, and instruction in the biopsychosocial model of disease. The author also recommends three specific training experiences for psychiatry residents that would enhance their ability to provide more effective mental health services to primary care physicians and their patients: consultation psychiatry, primary mental health care, and general psychiatry. The author concludes that medical students, throught their contact with primary care-oriented psuchiatry residency programs, would be more attracted to psychiatry as a specialty choice and that residents, upon completion of training, would be more inclined to practice in primary care settings.     

Effect of training and other influences on the development of career interest in geriatric psychiatry.

OBJECTIVE: The authors examined the relationship between the timing and nature of educational exposure to geriatric psychiatry and other potential influences and subsequent development of career interest in geriatric psychiatry. METHODS: A 46-item survey was distributed to residents and fellows who attended one of the two sponsored programs for residents at the three American Association of Geriatric Psychiatry (AAGP) annual meetings held between 2000 and 2002, inclusive. RESULTS: Ninety-three percent of attendees responded (N=184). Sixty-five percent first developed interest in geriatric psychiatry during their residency years (the majority during their PGY1 or PGY2 year). The timing of individualized teaching exposure, as well as lectures in geriatric psychiatry, was associated with the development of first interest in the field. The most important influences on the development of interest in the field included specific teacher attributes, training experiences, personal experiences with seniors, and characteristics cited as unique to geriatric psychiatry, such as the medical, neuropsychiatric, and multifactorial nature of the field. Patient personal histories and outcomes, as well as non-educational experiences with seniors and cultural attitudes, also contributed to interest. CONCLUSION: It behooves geriatric psychiatry programs to create exemplary educators and commit them to teaching in the early years of general psychiatry programs as well as in medical school. These educators should be identifying potential recruits by enquiring about trainees' previous experiences with older persons as well as emphasizing the unique aspects of geriatric psychiatry that are attractive to trainees.     

The influence of developmental, education, and mentorship experiences on career paths in cultural psychiatry

Career paths in cultural psychiatry and other areas of medicine often are influenced by a combination of developmental, academic and training experiences. One of the satisfactions for the cultural psychiatrist is the opportunity to integrate lifelong interests that are not central to medical training, such as anthropology, philosophy, history or geography into one's daily work and career path, and this is not necessarily just applicable to clinical work or research. A background in social sciences can be very helpful in navigating the political and interpersonal challenges of working in an academic medical center or designing effective education programs across the career spectrum in medicine. This article traces the development of my career in academic cultural psychiatry and illustrates the way my clinical and academic interests were influenced both by early developmental and educational experiences and by positive career experiences as a clinician, teacher and researcher in the context of effective mentorship and professional peer relationships. The future of cultural psychiatry is exciting and its continued growth will be dependent on effective nurturance of young physicians who have a broad vision of the important place of cultural psychiatry and how it influences medicine, mental health, and society at large.