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Cognitive Therapy and Research
Gepubliceerd in:

07-07-2023 | Original Article

Is a Gradualist Approach to Clinical Training Helpful or Necessary?

Auteur: Thomas E. Joiner Jr.

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 6/2023

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Abstract

Objective

A goal of this effort is to explicate two differing views on training models in clinical psychology and allied fields, namely, the gradualist view—which assumes that trainees’ exposure to patients with severe clinical presentations should be restricted until clinical experience accrues—and the anti-fragilist view—which, under certain conditions, encourages trainees’ exposure to the full range of severity regardless of experience. A related aim is to empirically test a prediction arising from the tension between these two perspectives.

Methods

Patient and therapist data were available from a low-cost population-facing treatment center (N = 399; 69.8% women; 73.6% Non-Hispanic White), which collected data on patients’ severity of clinical presentation at intake and over time and on therapist experience, and which does not restrict assignment based on therapist experience. The statistical interaction between severity of clinical presentation at intake and therapist experience predicting clinical outcomes was tested.

Results

There was no evidence that inexperienced therapists’ patients had worse outcomes in general, including if the patients’ initial presentations were clinically severe.

Conclusions

There are reasons to favor an anti-fragilizing training model, including that it better respects and serves patients and trainees, and that the current results do not support a core assumption of the gradualist model.
volgende artikel Harnessing AI to Optimize Thought Records and Facilitate Cognitive Restructuring in Smartphone CBT: An Exploratory Study
Voetnoten
1
Regarding severe presentations of eating disorders, Anorexia Nervosa (AN), more so than most or all other conditions, certainly may require medical care. Two points in this regard, however: (1) So may other conditions (e.g., a case in my own clinical experience of a patient with NSSI severe enough that it resulted in the loss of a body part); (2) for severe AN, though no mental health profession has good answers in the short-term, the most astute long-term approach in my awareness was described by psychiatrist Michael Strober (2004), and it is one that psychologists and their trainees are at least as able to provide if not more so as compared to other mental health professionals.
 
2
For the years in which this data collection occurred, data on binary sex were collected; the term from the assessment form was “gender” (a term-of-art when this effort was initiated years ago). Gender identity data were not systematically collected for clients, a definite limitation.
 
3
My research program is on suicidal behavior, and though the clinic and that research program are mostly separate, the research does influence the clinic, for example, in signaling that we have familiarity and expertise with regard to the complex issue of suicidality. Moreover, the clinic sees virtually anyone who approaches us who has a mental disorder, including people whom many other providers will not see (e.g., due to clinical severity, lack of resources, students whose conditions require more intensive services than those provided by the campus’ student counseling center, etc.). It is in these ways that we have an overall above-average level of clinical acuity in our patient group.
 
4
Though by far most supervisors are licensed psychologists, licensure is not required, because psychologist employees of the state of Florida are exempt from state licensure requirements as long as their work is fully limited to the state’s remit. FSU is a state university; FSU personnel are thus employees of the state of Florida.
 
5
These meetings lasted two hours until 2006, at which point they were shortened to one hour. This returned approximately 50 h per year to students to focus on non-clinic work, especially their scientific work.
 
6
Analyses were run and are presented in an unnested fashion. When multilevel models (cf. Bryk & Raudenbush, 1992) were run to account for nestedness, results and conclusions were very similar.
 
7
Over the years, patient clinical acuity has heightened at our clinic, and at the same time, over the years we have had increasingly good outcomes. Thus, we are performing better and better even as our patients’ clinical severity became more and more severe over time (cf. Joiner et al., 2022).
 
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Metagegevens
Titel
Is a Gradualist Approach to Clinical Training Helpful or Necessary?
Auteur
Thomas E. Joiner Jr.
Publicatiedatum
07-07-2023
Uitgeverij
Springer US
Gepubliceerd in
Cognitive Therapy and Research / Uitgave 6/2023
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI
https://doi.org/10.1007/s10608-023-10405-5

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