Thirty years of teaching psychotherapy skills.

The author outlines a basic model for teaching psychotherapeutic skills that includes five modules relating to (1) the dynamics of exploration, designed to encourage the patient's affective expression; (2) relationship structure, considering patterns of patient-therapist interaction along a closeness/separateness continuum; (3) affect, empathy, and distance regulation, emphasizing the crucial significance of identifying correctly and responding empathically to patients' affective messages; (4) basic cognitive interventions, focused on techniques for facilitating the patient's narrative flow and capacity to analyze experiences, and for formulating the patient's psychopathology; and (5) the therapist's use of self. The author concludes by examining why systematic psychotherapy training is particularly important at this time, in light of such pressures as managed health care, neuroscientific advances and psychopharmacologic breakthroughs, and the wave of self-help organizations.