The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations

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Abstract

Evidence-based treatments (EBT) are underutilized in community settings, where consumers are often seen for treatment. Underutilization of EBTs may be related to a lack of empirically informed and supported training strategies. The goals of this review are to understand the state of the literature for training therapists in psychotherapy skills and to offer recommendations to improve research in this area. Results of this review of 55 studies evaluating six training methods indicate that multi-component trainings have been studied most often and have most consistently demonstrated positive training outcomes relative to other training methods. Studies evaluating utility of reading, self-directed trainings, and workshops have documented that these methods do not routinely produce positive outcomes. Workshop follow-ups help to sustain outcomes. Little is known about the impact of train-the-trainer methods. Methodological flaws and factors that may influence training outcome and future directions are also reviewed.

Section snippets

Scope and definitions of evidence-based treatment

Fifteen the American Psychological Associations’ Division 12's (Clinical Psychology) Task Force on Promotion and Dissemination of Psychological Procedures (1995) offered recommendations to promote efforts to define, study and evaluate, teach, and disseminate EBTs (then labeled empirically validated treatments and renamed empirically supported treatments; Chambless et al., 1998, Chambless et al., 1996). These recommendations included increasing the availability of empirically supported

Models for dissemination of EBTs

In conjunction with refinements in these definitions, models or conceptual frameworks for the dissemination and implementation of EBTs have been proposed to guide efforts to change existing service systems and enhance overall outcomes for consumers of mental health services. The National Institute of Mental Health (2002) has defined dissemination as “the targeted distribution of information to a specific audience,” and has defined implementation as “the use of strategies to introduce or adapt

The role of training in EBTs

Community therapists and administrators have acknowledged a need for initial training as well as ongoing support, consultation, and supervision in EBT, but, at the same time, acknowledge the lack of time, support, and opportunities for learning new skills (Essock et al., 2003, Herschell et al., 2009). Concerns have also been raised about the relevance and utility of existing educational programs for professional psychologists (see Sharkin & Plageman, 2003). Recent guidelines for training

Previous reviews and context for present review

Previous reviews of therapist training studies have indicated that there is little empirical evidence to confirm that training improves therapist skills to a level that results in competent administration of treatment (e.g., Alberts & Edelstein, 1990; J. D. Ford, 1979). Instead, skill acquisition is assumed rather than confirmed (Alberts & Edelstein, 1990; J. D. Ford, 1979). Just as Alberts and Edelstein (1990) who reviewed studies from 1979 to 1990 picked up where Ford left off (reviewed 1960

Search strategy

Relevant studies were identified by using four computer-assisted searches: Psychological Abstracts (PsycINFO), Educational Resources Information Center (ERIC) database, Social Science Citation Index (SSCI), and Medline. Several keywords and authors were used as search terms such as adherence, community, community clinician, community therapist, continuing education, dissemination, empirically supported, evidence-based, evidence-based treatment, fidelity, implementation, interventions, mental

Summary of the literature: designs and types of investigations

Fifty-five studies evaluating training techniques or methods were identified. Methodologies of these studies were diverse, and included both quantitative and qualitative designs that range from single-subject designs to randomized control trials. As is demonstrated in Table 1, Table 2, Table 3, Table 4, Table 5, Table 6, each of which includes studies of different training methods (i.e., written materials (Table 1), self-directed training techniques (Table 2), workshops (Table 3), workshop

Discussion

This empirical review of 55 studies evaluating six therapist training methods has found that there are differences in the number of studies for specific training methods and their respective effectiveness. Multiple studies have been conducted on multi-component treatment packages (20), workshops (19), and workshop follow-ups (9). Fewer studies have been completed on the utility of pyramid (train-the-trainer) models (3), reading (5), and self-directed trainings (7). Not only have multi-component

References (120)

  • K.A. Hawkins et al.

    Can front-line clinicians master the conceptual complexities of dialectical behavior therapy? An evaluation of a State Department on Mental Health training program

    Journal of Psychiatric Research

    (1998)
  • S.B. Hunter et al.

    Training substance abuse treatment staff to care for co-occuring disorders

    Journal of Substance Abuse Treatment

    (2005)
  • E.P. Schoener et al.

    Effects of motivational interviewing training on mental health therapist behavior

    Drug and Alcohol Dependence

    (2006)
  • M.E. Addis et al.

    A national survey of practicing psychologists' attitudes toward psychotherapy treatment manuals

    Journal of Consulting & Clinical Psychology

    (2000)
  • American Psychological Association Presidential Task Force on Evidence-based Practice

    Evidence-based practice in psychology

    American Psychologist

    (2006)
  • S.E. Anderson et al.

    Introduction of a child sexual abuse policy in a health district

    Children and Society

    (1990)
  • R.A. Anderson et al.

    Case Study Research: The View From Complexity Science

    Qualitative Health Research

    (2005)
  • R. Bailey et al.

    The ability of staff trained in family interventions to implement the approach in routine clinical practice

    Journal of Mental Health

    (2003)
  • T. Baldwin et al.

    Transfer of training: A review and directions for future research

    Personnel Psychology

    (1988)
  • J.P. Barber et al.

    Effects of therapist adherence and competence on patient outcome in brief dynamic therapy

    Journal of Consulting and Clinical Psychology

    (1996)
  • E. Bein et al.

    The effects of training in time-limited dynamic psychotherapy: Changes in therapeutic outcome

    Psychotherapy Research

    (2000)
  • E. Bein et al.

    The effects of training in time-limited dynamic psychotherapy: Changes in therapeutic outcome

    Psychotherapy Research

    (2000)
  • D.M. Berwick

    Disseminating innovations in health care

    Journal of the American Medical Association

    (2003)
  • L. Bickman

    A continuum of care: More is not always better

    American Psychologist

    (1996)
  • S.L. Bliss et al.

    Articles published in four school psychology journals from 2000 to 2005: An analysis of experimental/intervention research

    Psychology in the Schools

    (2008)
  • C. Brooker et al.

    Training in psychosocial intervention: The impact on the role of community psychiatric nurses

    Journal of Advanced Nursing

    (1993)
  • C. Brooker et al.

    The outcome of training community psychiatric nurses to deliver psychosocial intervention

    British Journal of Psychiatry

    (1994)
  • K. Byington et al.

    Evaluating the effectiveness of a multicultural counseling and assessment training Journal of Applied Rehabilitation Counseling

    (1997)
  • K.M. Carroll

    Constrained, confounded, and confused: Why we really know so little about therapists in treatment outcome research

    Addictions

    (2001)
  • K.M. Carroll et al.

    Utility of therapist session checklists to monitor delivery of coping skills treatment for cocaine abusers

    Psychotherapy Research

    (1998)
  • M. Chaffin

    Organizational culture and practice epistemologies

    Clinical Psychology: Science and Practice

    (2006)
  • F. Chagnon et al.

    Control-Group study of an intervention training program for youth suicide prevention

    Suicide and Life-threatening Behavior

    (2007)
  • D.L. Chambless et al.

    An update on empirically validated therapies

    The Clinical Psychologist

    (1996)
  • D.L. Chambless et al.

    Update on empirically validated therapies II

    The Clinical Psychologist

    (1998)
  • J.K. Conner-Smith et al.

    Applying treatment outcome research in clinical practice: Techniques for adapting interventions to the real world

    Child and Adolescent Mental Health

    (2003)
  • P. Crits-Christoph et al.

    Training in cognitive, supportive-expressive, and drug counseling therapies for cocaine dependence

    Journal of Consulting and Clinical Psychology

    (1998)
  • D.A. Davis et al.

    Evidence for the effectiveness of CME: A review of randomized controlled trials

    Journal of the American Medical Association

    (1992)
  • D.A. Davis et al.

    The impact of formal continuing medical education: Do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes?

    Journal of the American Medical Association

    (1999)
  • M. Demchak et al.

    An evaluation of the pyramid model of staff training in group homes for adults with severe handicaps

    Education & Training in Mental Retardation

    (1990)
  • J. DeViva

    The effects of full-day and half-day workshops for health care providers in techniques for increasing resistant clients’ motivation

    Professional Psychology - Research & Practice

    (2006)
  • J. Ducharme et al.

    Comparison of staff training strategies to promote generalization

    Journal of Applied Behavior Analysis

    (1992)
  • M.V. Ellis et al.

    Clinical supervision research from 1981 to 1993: A methodological critique

    Journal of Counseling Psychology

    (1996)
  • S.M. Eyberg et al.

    Evidence-based psychosocial treatments for children and adolescents with disruptive behavior

    Journal of Clinical Child and Adolescent Psychology

    (2008)
  • G. Fadden

    Implementation of family interventions in routine clinical practice following staff training programs: A major cause for concern

    Journal of Mental Health

    (1997)
  • D.L. Fixsen et al.

    Implementation research: A synthesis of the literature

    (2005)
  • J.D. Ford

    Research on training counselors and clinicians

    Review of Educational Research

    (1979)
  • J.K. Ford et al.

    Training of transfer: An updated review

    Performance Improvement Quarterly

    (1997)
  • A.F. Garland et al.

    Clinicians and outcome measurement: What's the use?

    Journal of Behavioral Health Services & Research

    (2003)
  • C. Glisson et al.

    The ARC organizational and community intervention strategy for implementing evidence-based children's mental health treatments

    Mental Health Services Research

    (2005)
  • C. Glisson et al.

    Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure

    Administration & Policy in Mental Health

    (2008)
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    1 - The term “therapist” is used broadly and is meant to include professionals who provide psychological services to populations with clinically-significant mental or behavioral health difficulties. It is meant to include counselors, clinical social workers, psychologists, psychiatrists, and all other mental or behavior health clinicians.

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