Effects of training in time-limited dynamic psychotherapy: Changes in therapist behavior.

TLDR

A year‑long manualized training program involving 16 therapists was evaluated using the Vanderbilt Therapeutic Strategies Scale, the Vanderbilt Psychotherapy Process Scale, and the Structural Analysis of Social Behavior to assess changes in therapist behavior. The training improved technical adherence—enhancing affect expression, relationship exploration, participant‑observer stance, and open‑ended questioning—yet unexpectedly worsened certain interpersonal dynamics, challenging the notion that manuals and adherence scales reliably control therapeutic variables.

Abstract

Sixteen therapists participated in a year-long manualized training program as part of the Vanderbilt II study of time-limited dynamic psychotherapy. Changes in therapist behavior were measured with the Vanderbilt Therapeutic Strategies Scale (an adherence measure), the Vanderbilt Psychotherapy Process Scale (VPPS), and interpersonal process codings using the Structural Analysis of Social Behavior (SASB). The training program successfully changed therapists' technical interventions in line with the manualized protocol. After training, there was increased emphasis on the expression of in-session affect, exploration of the therapeutic relationship, an improved participant-observer stance, and greater use of open-ended questions. There was also an indication of unexpected deterioration in certain interpersonal and interactional aspects of therapy as measured by the VPPS and SASB ratings. These results question the assumption that greater control of the therapy variable is straightforwardly achieved with manuals and adherence scales. Changing or dictating specific therapist behaviors to achieve technical adherence may alter other therapeutic variables in unexpected and even counterproductive ways.