View
213
Download
0
Embed Size (px)
Citation preview
A Web-Based Teaching Tool for Psychotherapy Research and Training
Developed by
Jakob Valen and Leigh McCullough
Making Psychotherapy BetterStep By Step
There have been daunting challenges in
Psychotherapy Process Research
This involves the following….
•Archives of thousands of VIDEOTAPES from Randomized Controlled Clinical Trials of Psychotherapy.
•Development of many PROCESS MEASURES to evaluate therapy
•Training of hundreds of RESEARCH RATERS
• 2,000 VIDEOTAPED SESSIONS PER TRIAL
• 2 HOURS PER SESSION TO EVALUATE
= 4,000 HOURS PER TRIAL or10 YEARS PER PERSONTo rate one clinical trial With just one instrument
CHALLENGES IN TRAININGPROCESS RESEARCHERS
But we need to rate each session with a number of well-established
PROCESS MEASURES from a wide variety of domains of psychotherapy
•For Example:
•Patient-Therapist Interaction:(Alliance, Attunement, Ruptures)
•Therapist Interventions: (Clarification, Support, Cognitive Strategies)
•Patient Responses: (Maladaptive cognitions, Affect, Defense)
In short, it would take
a small army of research
raters a few decades to
complete all the ratings
that are needed
Meanwhile….
The Traditional Method of Training is Labor Intensive and Time Consuming
Ongoing small group teaching by the originator of the instrument can take months and yield only a few reliable raters.
See Note Below
Leigh McCullough, a Visiting Professor in Trondheim, Norway, was explaining this
problem when, a doctoral student, named
Jakob Valen, had an idea…..
STDPPsychodynamic
CBTCognitive
DBTBehavioral
There is such an archive being built in Norway:The Trondheim Psychotherapy Research Program
Videotape Archives Library(Tapes from at least 3 RCT’s will be studied)
There is also a large number of graduate students in clinical psychology
At the University in Trondheim, Norway (NTNU)
Why not Build a Web-Based System for Process Research
Slide 38
So that many raters could be trained to evaluate the thousands of videotapes that have been
collected from the many clinical trials of psychotherapy
So Jakob Valen
began to build the program
www.jakobsladder.com
And Leigh McCullough helped him develop it
JakobsLadder: Internet Training
Students could go to their computer,log on to jakobsladder.com and select an instrument that they would be interestedin learning.
And now, so can you….
FIRST, REVIEW THE LIST OF INSTRUMENTS THAT ARE AVAILABLE;
Each one assesses important aspect of psychotherapy
See Note Below
THEN, SELECT AN INSTRUMENTTO EVALUATE THERAPY PROCESS
AAS - THE AFFECT ATTUNEMENT SCALEATOS – ACHIEVEMENT OF THERAPEUTIC
OBJECTIVES SCALE (COMMON FACTORS)DMRS – DEFENSE MECHANISM RATING SCALE
For example, we will first select the DMRS
The menu to the left allows you to select the DMRS Manual
or to select segments to be Rated
See Note Below
See Note Below
When you click on one of the ‘Ratings’ buttonsyou will receive transcripts of sessions -
as you see above.
As you read the transcript and note a defensemechansim, click on the menu to the right, where you see “Defence Mechanism #1”.…
The Defense Drop-Down Menuguides the process……
When you select the Defense Mechanism buttonYou will be asked to do three things:1. Select a defense from the drop down list2. Briefly state your reason for the selection3. Cut and paste the example from the text that illustrates the defensive behavior
Use the cursor to select a
defense, in this case ‘Reaction
Formation’
The Defense drop-down menu will giveyou a list of Defensesto choose from
The selected defense will appear in the defense box, and the rater will be able to type in the reason for the selection
The rater proceeds through the transcripts until all defenses have
been identified.
This process provides important information on the psychological
functioning of the patient for both research and clinical training.
Let’s take another example…Maybe you want to learn about common factors
in psychotherapy such as insight, motivation, or experiencing of feeling…
Go to the Instrument List
and select the ATOS Scale
With the ATOS Scale…. You can choose to rate a
Transcript Or you can rate from
Videotapes.
First we’ll show an example of a
Transcript.
It is much more enjoyable and educational to
watch and discuss a videowith another rater
See Note Below
45 60 15
See note below
The rater then can compare their rating to the Gold Standard ratings…as wellas see an explanation of why the group of experts gave the rating they did.
When the rater has completed rating approximately 20 segments on a specific
instrument, the rater may receive a “grade” or a proficiency rating in the
form of a RELIABILITY STATISTIC
.43
RESULTS OF RATINGS
See Note Below
Sometimes the rater will receive this message; “You’re not quite reliable,
but keep practicing and you’ll improve!”
BENTE
JOHANSEN
has met
criteria
for Reliability
on the
DMRS Scale
At .75
When the rater becomes reliable on the rating instrument, a Reliability Certificate can be printed out
The ICC reliability rating can then be given to the Principal Investigator of a study to verifiy tat the rater is able to begin research ratings.
But a reliability score also informs clinicians-in-training that they satisfactorily understand the clinical concepts that are being evaluated; such as the types of defense
mechanisms a patient uses or the degree of affect experienced in the session.
EXCEL FILE
Once research ratings have been entered, they are storedon an Excel file to be easily accessed and analyzed by the
Investigators in the study.
See Note Below
Also available is a program for a
Videotape Grid for each study. Like a card catalog of a library, each session is
identified by a box and the signs in the box indicate whether it is available, checked out, rated by one or more process instruments and by how many raters.
See note below for more info.
Thus, JakobsLadder is not only useful for:
TRAINING PROCESS RESEARCHERS
But is also an excellent tool for
TEACHING PSYCHOTHERAPY
AIRLINE PILOT STANDARDS
Just as pilots have to log hundreds of hours in the ‘test cockpit’ before being given the responsibility of flying a plane
and transporting live passengers, hopefully we will develop ‘simulated therapy sessions’ that will adequately prepare therapist trainees before they are given the
responsibility of working with suffering patients.
Someday we hope there will be archives of videotapes available for therapist trainees to review and evaluate
hundreds of hours of pre-selected segments of therapy demonstrated by senior therapists,
so that they will have ample exposure to
how therapy might optimally be conducted.
A web based tool for teaching psychotherapy
JAKOBSLADDERDeveloped by
Jakob Valen and Leigh McCullough
Making Psychotherapy BetterStep By Step
www.affectphobia.com To obtain ATOS manual for coding
psychodynamic processes