Effects of training in short-term psychodynamic psychotherapy: changes in graduate clinician technique

Abstract

This study investigates the effects of graduate clinician training in short-term psychodynamic psychotherapy (STPP; Book, 1998; Luborsky, 1984; Strupp & Binder, 1984; Wachtel, 1993) on the acquisition of techniques within and across two training cases. Sessions 3 and 9 from the first and second treatment cases of 15 graduate clinicians receiving structured training in STPP were examined for the frequency of psychodynamic–interpersonal (PI) therapeutic techniques. Results demonstrated that structured training in STPP led to a significantly increased use of PI therapeutic techniques both within and across cases. The authors also examined the frequency of cognitive–behavioral (CB) therapeutic techniques used by the graduate clinicians. No changes in the number of CB interventions were observed over the same set of sessions. Practical implications for the use of structured clinical training and issues pertinent to supervision in graduate education are reviewed. Finally, the impact of structured training on graduate clinicians’ ability to form positive collaborative relationships with their patients is also discussed.

Zusammenfassung

Die Effekte von Training in psychodynamischer Kurzzeittherapie: Veränderungen in der Technik bei graduierten klinischen Studenten

Diese Studie untersucht die Effekte von Training auf das Aneignen von Techniken in psychodynamischer Kurzzeittherapie innerhalb und über 2 Trainingsfälle hinweg bei graduierten klinischen Studenten. Die dritte und 9. Sitzung des ersten und 2. Trainingsfalls von 15 graduierten Klinikern, die ein strukturiertes Training für psychodynamische Kurzzeittherapie durchliefen, wurden auf die Häufigkeit psychodynamischer individueller therapeutisccher Techniken hin untersucht. Die Ergebnisse zeigten, dass eine strukturiertes Training in psychodynamischer Kurzzeittherapie zu einem signifikant häufigeren Einsatz von psychodynamisch interpersonellen therapeutischen Techniken, sowohl innerhalb eines Trainingsfalles als auch über beide Fälle hinweg, führt. Die Autoren haben auch die Häufigkeit von kognitiv-verhaltensmässigen Techniken der Auszubildenden untersucht. Hierbei gab es für die untersuchten Sitzungen keine Veränderung in den Häufigkeiten. Praktische Implikationen zur Verwendung des strukturierten klinischen Trainings und Themen, die für die Supervision der Ausbildung in der zweiten Phase relevant sind, werden durchgenommen. Schließlich wird auch der Einfluß des strukturierten Trainings auf die Fähigkeit der Auszubildenden, positive Beziehungen in der Zusammenarbeit mit ihren Patienten zu bilden, diskutiert.

Résumé

Les effets de la formation dans la psychothérapie psychodynamique brève?: changements dans la technique chez le clinicien postgradué

Cette étude investigue les effets de la formation des cliniciens postgradués en psychothérapie psychodynamique brève?(STPP?; Book, 1998?; Luborsky, 1984?; Strupp & Binder, 1984?; Wachtel, 1993) sur l'acquisition de techniques dans et entre deux cas de formation. Les séances 3 et 9 du premier et deuxième cas de formation de 15 cliniciens postgradués recevant de la formation structurée en STPP étaient examinés en fonction de la fréquence des techniques thérapeutiques psychodynamiques – interpersonnelles (PI). Les résultats ont démontré que la formation structurée en STPP a entraîné un emploi augmenté de façon significative de techniques thérapeutiques PI aussi bien dans qu'entre les cas. Les auteurs ont examiné également la fréquence de techniques thérapeutiques cognitives-comportementales (CB) utilisées par les cliniciens postgradués. Aucun changement du nombre d'interventions CB n'a été observé dans le même ensemble de séances. Des implications pratiques pour l'application d'une formation clinique structurée et des sujets en lien avec la supervision dans l’éducation postgraduée sont revues. Finalement, l'impact d'une formation structurée sur la capacité du clinicien postgradué à former des relations de collaboration positive avec leurs patients est également discuté.

Resumen

Efectos de la supervisión en psicoterapia psicodinámica breve: cambios en la técnica clínica del graduado

Este estudio investiga los efectos de la supervisión clínica del graduado en psicoterapia psicodinámica breve (STPP; Libro, 1998, Luborsky, 1984, Strupp /& Binder, 1984, Wachtel, 1993) sobre la adquisición de técnicas dentro y a través de dos casos de supervisión. Se estudiaron las 3ra. y 9na. sesiones del primero y segundo casos de supervisión de quince clínicos graduados que recibieron supervisión en STPP, para ver la frecuencia de las técnicas terapéuticas psicodinámicas-interpersonales (PI). Los resultados demostraron que la supervisión estructurada en STPP condujo a un aumento significativo del uso de técnicas terapéuticas PI tanto dentro como a través de los casos. Los autores también estudiaron la frecuencia de técnicas terapéuticas cognitivo-comportamentales (CB) usadas por los clínicos graduados. No se observaron cambios en el número de intervenciones CB en el mismo conjunto de sesiones. Se pasó revista a las implicaciones prácticas del uso de la supervisión clínica estructurada y a cuestiones pertinentes a la supervisión en la educación de los graduados. Finalmente, también se debate sobre el impacto que puede tener la supervisión estructurada sobre la capacidad de los clínicos graduados para formar relaciones colaboradoras positivas con sus pacientes.

Resumo

Efeitos do treino em psicotetrapia psicodinâmica breve: Mudanças nas técnicas de estudantes

Este estudo examina os efeitos do treino clínico de estudantes graduados em psicoterapia psicodinâmica breve (PPB; Book, 1998; Luborsky, 1984; Strupp & Binder, 1984; Wachtel, 1993) em termos de aquisições das técnicas durante e entre dois casos de treino. Foi analisada a frequência de técnicas terapêuticas de psicoterapia interpessoal (PI), nas sessões 3 e 9 do primeiro e do segundo caso de treino de 15 estudantes graduados que estavam recebendo formação estruturada em PPB. Os resultados demonstraram que o treino estruturado em PPB conduzia a um aumento significativo no uso de técnicas terapêuticas de PI durante e entre os casos. Os autores analisaram também a frequência das técnicas terapêuticas cognitivo-comportamentais (CC) utilizadas pelos estudantes. Não se verificaram mudanças no número de intervenções CC durante o mesmo conjunto de sessões. São revistas as implicações práticas para a utilização de treino clínico estruturado e aspectos pertinentes para a supervisão de estudantes graduados. Finalmente, será também discutido o impacto do treino estruturado sobre as capacidades dos estudantes para estabelecerem relações terapêuticas positivas com os seus pacientes.

     

Combined activities of secretory phospholipases and eosinophil lysophospholipases induce pulmonary surfactant dysfunction by phospholipid hydrolysis

BACKGROUND: Surfactant dysfunction is implicated in small airway closure in asthma. Increased activity of secretory phospholipase A(2) (sPLA(2)) in the airways is associated with asthma exacerbations. Phosphatidylcholine, the principal component of pulmonary surfactant that maintains small airway patency, is hydrolyzed by sPLA(2). The lysophosphatidylcholine product is the substrate for eosinophil lysophospholipases. OBJECTIVE: To determine whether surfactant phospholipid hydrolysis by the combined activities of sPLA(2)s and eosinophil lysophospholipases induces surfactant dysfunction. METHODS: The effect of these enzymes on surfactant function was determined by capillary surfactometry. Thin layer chromatography was used to correlate enzyme-induced changes in surfactant phospholipid composition and function. Phosphatidylcholine and its hydrolytic products were measured by using mass spectrometry. RESULTS: Eosinophils express a 25-kd lysophospholipase and group IIA sPLA(2). Phospholipase A(2) alone induced only a small decrease in surfactant function, and 25-kd lysophospholipase alone degraded lysophosphatidylcholine but had no effect on surfactant function. The combined actions of sPLA(2) and lysophospholipase produced dose-dependent and time-dependent losses of surfactant function, concomitant with hydrolysis of phosphatidylcholine and lysophosphatidylcholine. Lysates of AML14.3D10 eosinophils induced surfactant dysfunction, indicating these cells express all the necessary lipolytic activities. In contrast, lysates of blood eosinophils required exogenous phospholipase A(2) to induce maximal surfactant dysfunction. CONCLUSION: The combined activities of sPLA(2)s and eosinophil lysophospholipases are necessary to degrade surfactant phospholipids sufficiently to induce functional losses in surfactant activity as reported in asthma. CLINICAL IMPLICATIONS: The phospholipases and lysophospholipases expressed by eosinophils or other airway cells may represent novel therapeutic targets for blocking surfactant degradation, dysfunction, and peripheral airway closure in asthma.