In this study, a deliberate practice-based approach to therapist training will be compared to
      theoretical teaching. The main hypothesis is that deliberate practice training will result in
      a larger improvement in students' observer-rated interpersonal skills. About 200 graduate
      students from two Danish universities will be randomized into two groups, a) deliberate
      practice training of non-specific psychotherapeutic skills using role-play and Theravue, an
      online skill-building system with therapy videos; or b) theoretical teaching. Each condition
      consists of 15 hours of classroom participation and homework. The study has the potential to
      transform the training of psychotherapy skills.

Training of Graduate Students in General Psychotherapeutic Skills (TRIPS)

Deliberate Practice Training of Psychotherapeutic Skills

Theoretical Teaching of Psychotherapeutic Skills

Background: Psychology students at universities in Denmark and worldwide only receive little
      clinical training, even though such training is crucial to psychologists' job performance
      after graduation. Training non-specific psychotherapeutic skills, such as being empathic and
      facilitating the therapeutic alliance, is critical since these skills are related to
      psychotherapy outcomes. In this study, a deliberate practice approach to training will be
      compared to theoretical teaching.

      Hypothesis: The first and main hypothesis is that the students' observer-rated Facilitative
      Interpersonal Skills (FIS) will improve significantly more after deliberate practice training
      compared to theoretical teaching. The second hypothesis is that students' self-reported
      Facilitative Interpersonal Skills (FIS-SR), self-efficacy, and empathy will increase
      significantly more after training compared to theoretical teaching. The third hypothesis is
      that students reporting higher baseline levels of self-affiliation, attachment security,
      external feedback propensity, and self-efficacy will have a larger increase in FIS after the
      training program. The fourth hypothesis is that the amount of deliberate practice will
      predict improvement in FIS at post-training, whereas the students' sociodemographic
      characteristics, previous experience with psychotherapy, and preferred psychotherapy approach
      will not be associated with improvement in FIS.

      Methods: One hundred ninety-eight graduate students from the Universities of Copenhagen and
      Aalborg University will be randomized into two groups, a) deliberate practice training of
      non-specific skills using role-play and Theravue, or b) theoretical teaching. Group a will
      first receive the experimental condition (deliberate practice), followed by the control
      condition, while group b will receive the conditions in reverse order. Each condition
      consists of 15 hours of classroom participation and homework. The primary outcome is
      Facilitative Interpersonal Skills - Observer. Secondary outcomes include the Facilitative
      Interpersonal Skills-Self-Report, the Counselor Activity Self-Efficacy Scales, and the
      Interpersonal Reactivity Index. Outcomes will be measured at baseline (week 0), after the
      first condition (week 5; before the crossover, reflecting true randomization), and after both
      conditions (week 10). Main outcome analyses will be performed at week 5.

      To test deliberate practice as a predictor of FIS improvement, the amount of deliberate
      practice activity is measured on a self-report questionnaire developed for this study and
      tracked on Theravue as a) the total time spent on watching and responding to therapy videos
      and b) the average number of attempts to improve the response to each therapy video. The
      Structural Analysis of Social Behavior Intrex questionnaire (SASB; Benjamin, 2000), the
      Social Skills Inventory (SSI; Riggio, 1989), the Experiences in Close Relationships Scale
      (ECR; Brennan et al., 1998), and the Internal and External Feedback Propensity Scales (IEFPS;
      Herold et al., 1996) will be measured at week 0 and explored as possible between-condition
      moderators of the outcome. The Group Climate Questionnaire-Short Form (GCQ-S; MacKenzie,
      1983) will be used to measure the collaboration in the student groups, where approximately
      five students work together throughout the study period, performing role-plays and giving
      peer feedback in the experimental condition, and discussing theory in the control condition.
      The observer-rated DP Coach Competency Scale (DPCCS; Rousmaniere, 2020) will be used to
      evaluate adherence and quality of the deliberate practice training. Stig Bernt Poulsen,
      University of Copenhagen, and Ole Karkov Østergård, Aalborg University, are co-principal
      investigators.

      Discussion: The study can potentially transform the training of psychotherapy, not only for
      psychology students but also for psychologists in general. Furthermore, the results of the
      study can be transferred to the training of other clinical skills.

      Ethics: Ethical approval has been obtained from the Institutional Ethical Review Board,
      Department of Psychology, University of Copenhagen, and Aalborg University. Before signing up
      for the course, the students will be informed about the course and the research embedded
      herein. Informed consent will be obtained from students agreeing to participate in the study.
      Course participants can decline to participate in the study without negative consequences for
      their course participation.

Deliberate practice training

Theoretical teaching

The Effect of Deliberate Practice Training of Graduate Students in General Psychotherapeutic Skills Compared to Theoretical Teaching: the Randomized Controlled TRIPS Trial

FIS measures relationship skills exhibited in psychotherapy. The therapists are asked to respond as helpfully as possible to video clips simulating challenging therapy situations. FIS has eight dimensions: (1) verbal fluency; (2) hope and positive expectations; (3) persuasiveness; (4) emotional expression; (5) warmth, acceptance, and understanding; (6) empathy; (7) alliance-bond capacity; and (8) alliance rupture-repair responsiveness. The items are rated on a 5-point Likert scale from 1 = skill deficit to 5 = optimal presence of skill.

Assistant Professor, PhD

FIS-SR measures self-evaluated relationship skills. Following participation in the FIS task, participants rate their performance on the eight FIS dimensions mentioned above. Participants rate the extent to which they believe that their FIS responses were verbally fluent, communicated hope and positive expectations, etc., on a 5-point Likert scale ranging from 1 = strongly disagree to 5 = strongly agree.

The CASES measure therapist's experience of self-efficacy within various domains. The present study uses the 15 items measuring Helping Skill Self-Efficacy, and the 10 items measuring Session Management Self-Efficacy. Each item is rated on a 10-point Likert scale ranging from 0 = no confidence to 9 = complete confidence.

The IRI is a self-report measure of empathy, including both cognitive and emotional dimensions. The IRI has 28 items, each rated on a 5-point Likert scale from 0 = does not describe me well to 4 = does describe me very well.

The experimental condition consists of deliberate practice training of non-specific psychotherapy skills using role-play and Theravue, an online skill-building system with therapy videos.

The control condition will consist of theoretical teaching of non-specific psychotherapy skills.

Training of Graduate Students in General Psychotherapeutic Skills (TRIPS)

About this trial

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Placebo

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