Acad Psychiatry 30:196-199, June 2006
doi: 10.1176/appi.ap.30.3.196
© 2006 Academic Psychiatry
The Screening Role of an Introductory Course in Cognitive Therapy Training
Artemios Pehlivanidis, M.D.,
Katerina Papanikolaou, M.D.,
Antonis Politis, M.D.,
Angeliki Liossi, M.Sc.,
Evgenia Daskalopoulou, M.D.,
Rossetos Gournellis, M.D.,
Marina Soldatos, M.Sc.,
Vasiliki Maria Papakosta, M.Sc.,
Ioannis Zervas, M.D. and
Yiannis G. Papakostas, M.D.
Received April 18, 2005; revised October 17, 2005; accepted October 28, 2005. Drs. Pehlivanidis, Politis, Liossi, Daskalopoulou, Gournellis, Zervas, and Papakostas are affiliated with Athens University Medical School, Department of Psychiatry, Eginition Hospital, Athens, Greece. Drs. Papanikolaou, Soldatos, and Papakosta are affiliated with the University Mental Health Institute, Athens, Greece. Address correspondence to Dr. A. Pehlivanidis, Athens University Medical School, Department of Psychiatry, Eginition Hospital, 72-74 Vas. Sophias Ave., Athens, Greece 11528; apechlib{at}med.uoa.gr (E-mail). Copyright © 2006 Academic Psychiatry.
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ABSTRACT
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OBJECTIVE: This study examines the role of an introductory course in cognitive therapy and the relative importance of trainees’ characteristics in the selection process for an advanced course in cognitive therapy. METHOD: The authors assessed the files of all trainees who completed one academic year introductory course in cognitive therapy over the last seven consecutive years (N = 203). The authors examined variables such as previous training, overall involvement during the course, performance, and ability to relate to others, as well as the trainer’s evaluations of their performance.RESULTS: Interaction skills in group situations and performance in written assignments were better predictors for admission into the advanced course. CONCLUSIONS: Trainees’ abilities to learn and to successfully relate to others in group situations are critical for entering an advanced cognitive therapy training course. These findings question the policy of full-scale training in cognitive therapy based merely on the candidates’ professional background, stressing instead the merits of an introductory course as an appropriate screening procedure.
Key Words: Teaching • Psychotherapy • Cognitive Therapy
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INTRODUCTION
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The value of professional training among those who provide psychological therapy has not been supported consistently, and there remains a need to validate methods for identifying levels of therapist proficiency and skillfulness (1). A variety of graduate mental health students and professionals seek training in cognitive therapy and may benefit from training (2) regardless of their original therapeutic orientation (3).
In the domain of training psychiatric residents in psychotherapy, educators must ensure training methods that enable trainees to acquire competence in certain kinds of psychotherapy (4, 5) and distinguish potentially hazardous practitioners from safe ones (6, 7). An appropriate screening procedure should offer the opportunity to observe and select those trainees who have the qualities necessary for participation in a formal training program in cognitive therapy.
In this study we explore the criteria that educators follow in selecting candidates to continue to an advanced course, which includes the treatment of patients and the relative impact of trainees’ characteristics on the selection procedure, as well as the merits of an introductory course.
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Method
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Over the course of the last 7 years, a cognitive therapy educational program in the department of psychiatry at Athens University, in collaboration with the University Mental Health Institute, has undergone a process of crystallization, forming a training program consisting of an introductory and an advanced level. Acceptance to the introductory course is achieved through an open competition among mental health professionals, taking into account the amount of their previous clinical and psychotherapeutic experience. The course consists of 25 training sessions spread over one academic year. Each training session includes 2 hours of didactic presentations by university staff specializing in cognitive therapy and 2 hours of participation in one of three groups (8–12 trainees). These groups are coordinated by experienced cognitive therapists and aim at more active participation of trainees through role-playing, modeling, and group supervision of videotaped therapeutic sessions. Group coordinators rate trainees’ suitability to continue further training. Approximately the top quarter of trainees advance to further training, taking three to four patients while under both individual and group supervision. The decision to advance a trainee to the next course is influenced by the coordinator’s rating.
The study examines the strength of associations of between-group coordinators' ratings and trainees’ characteristics as described in Table 1.
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TABLE 1. Training Characteristics of the Participants in the Introductory Course Over the Last Seven Years (N = 203)
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Statistical analysis. Analysis of the data were based on descriptive statistics,  ², bivariate correlations, and linear regression. The strength of the association between each variable and competence to continue training were measured by Pearson correlation. All significantly correlating variables were entered into a simple linear regression in order to measure the overall strength of the association of the registered variables with the competence to continue training in the advanced course (dependent variable).
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Results
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Table 1 presents the training characteristics of all trainees (N = 203) who completed the introductory course in the past 7 years. The comparison between variables registered for residents in psychiatry and variables registered for psychologists showed that residents in psychiatry were rated significantly better in the variable "clinical experience" (² = 61.32, p = 0.001) than psychologists in the variable "psychotherapeutic experience" (² = 15.52, p = 0.001). Clinical experience, psychotherapeutic experience, attendance, number and quality of written assignments, and interaction in group situations were significantly correlated to the evaluated competence to continue training. All of the above-mentioned variables were entered into a simple linear regression analysis with competence as the dependent variable. Results of the analysis are shown in Table 2 and indicate that the competence to continue training was significantly predicted by the quality of written assignments and the group leaders' evaluations of the trainees’ interactions in group situations.
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TABLE 2. Coefficients of Simple Linear Regression (ß), the 95% Confidence Intervals for ß, and the Statistical Significance of All Variables Entered in Analysis With Competence to Continue Training as the Dependent Variable (N = 203)
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Discussion
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The findings of the present study support the assumption that an introductory course in cognitive therapy can be considered an appropriate screening procedure to select those trainees with the desired qualifications to participate in an advanced course with supervised clinical practice.
The quality of written assignments and interaction in group situations were the best predictors of a trainee’s suitability to advance to the next course. Quality of written assignments reflects trainees’ learning abilities while interaction in group situations reflects personality traits associated with the ability to relate successfully to other people. On the other hand, having clinical and psychotherapeutic experience was not a critical factor in predicting acquired performance in the course. This finding is consistent with previous reports that have stated that preexisting theoretical orientations may not significantly affect learning cognitive-behavioral techniques over a 9-month practicum (8). The amount of time in training or the number of years of experience are used to define levels of professional "training" or "experience," but this temporal definition of professional experience and training is subject to misinterpretation because it does not account for "what is trained." In most European countries, which comply with the requirements of a centralized European authority, it is mandatory for training programs in psychiatry to demonstrate that trainees have achieved competence in at least one form of psychotherapy (9). However, the issue of selection criteria to enter a cognitive therapy course has not been examined adequately in the literature, and the assessment of psychotherapeutic competence in residents in psychiatry training is insufficient (6, 7). On the other hand, having cognitive therapy experience prior to attending an advanced training course is known to be advantageous (2, 10); therefore, an introductory course such as the one presented by our group may be of value in satisfying training needs in psychotherapy and may help in the selection of those residents in psychiatry who wish to proceed to an advanced training level. The ability to learn and interaction in group situations cannot be assessed easily during the initial evaluation of the candidates for the introductory course.
Two important points have to be made before the interpretation of the results. First, this was a naturalistic study; therefore, circular measurement cannot be avoided, since rank ordering of the suitability for continuing training in cognitive therapy was based on the decision of staff members, who might be biased when assessing the level of competence acquired in a course they teach. That possibility forced us to consider a wider range of more "objective" variables in our evaluation procedure, such as profession, previous psychotherapeutic and clinical experience, number of sessions attended, and number and quality of written assignments.
Second, there was a degree of heterogeneity in the sample of trainees: residents in psychiatry and psychology possessed different clinical and psychotherapeutic experience. This is an expected finding since a training background in psychiatry assumes longer clinical experience and shorter psychotherapeutic experience, while a training background in psychology assumes shorter clinical experience. The two groups, though, did not show any differences in all of the remaining registered variables—overall participation in the course, quality of written assignments, and coordinators’ final evaluations.
In spite of the limitations of the study, some tentative suggestions can be made. We might need to reconsider our policy regarding trainees’ admission to cognitive therapy training programs. Having "objective" professional background criteria may be less important than having them enter an introductory course that provides a better opportunity for observing and selecting those trainees that have the desired qualities for continuation in an advanced level.
The question to be examined in forthcoming research is the association between our own evaluations of the trainees selected for the advanced course and their effectiveness in practice when treating psychiatric patients under supervision.
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REFERENCES
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- Alberts G, Edelstein B: Therapist training: a critical review of skill training studies. Clin Psychol Rev 1990; 10:497–511[CrossRef]
- James IA, Blackburn IM, Milne DL, et al: Moderators of trainee therapists’ competence in cognitive therapy. Br J Clin Psychol 2001; 40:131–141[CrossRef][Medline]
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- Program requirements for residency education in psychiatry. www.acgme.org/
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ABSTRACT
INTRODUCTION
