Rief Winfried
Clinical Psychology, University of Marburg, Marburg, Germany
Evid Based Ment Health. 2021 Jan 19;24(3):115-20. doi: 10.1136/ebmental-2020-300219.
Current education and training in psychological interventions is mostly based on different 'schools' (traditions such as cognitive-behavioural or psychodynamic therapy), and strong identification with these specific traditions continuously hinders a scientifically based development of psychotherapy. This review is selective rather than systematic and comprehensive. In addition to the consideration of other influential publications, we relied on a literature search in Web of Science using the following terms (update: 24 December 2020): (psychotherapy AND meta-analy* AND competence*). After summarising current problems, a pathway for solving these problems is presented. First, we have to recategorise psychological interventions according to the mechanisms and subgoals that are addressed. The interventions can be classified according to the foci: (1) skills acquisition (eg, communication, emotion regulation, mentalisation); (2) working with relationship patterns and using the therapeutic relationship to modify them; and (3) clarification of motives and goals. Afterwards, the training of psychotherapists can switch from focusing on one theoretical framework to learning the different competences for modification according to these new categories. The selection of topics to be addressed should follow best evidence-based mechanisms and processes of mental disorders and interventions. Psychology offers knowledge about these mechanisms that can be understood as a basic science for psychological treatments in general. This requires better connection with basic science, new research efforts that focus on treatment subgoals, theory-overarching optimisation of the selection and personalisation of treatments, and new types of training for psychotherapists that are designed to optimise therapists' competences accordingly, instead of limiting training programmes to one single theoretical framework.
当前心理干预方面的教育与培训大多基于不同的“流派”（如认知行为疗法或精神动力疗法等传统流派），而对这些特定传统的强烈认同持续阻碍着心理治疗基于科学的发展。本综述是选择性的，而非系统性和全面性的。除了考虑其他有影响力的出版物外，我们还依靠在科学网（Web of Science）上使用以下检索词进行文献检索（更新时间：2020年12月24日）：（心理治疗 AND 元分析* AND 胜任力*）。在总结当前问题之后，提出了解决这些问题的途径。首先，我们必须根据所涉及的机制和子目标对心理干预进行重新分类。这些干预可根据重点分为：（1）技能习得（如沟通、情绪调节、心理化）；（2）处理关系模式并利用治疗关系对其进行改变；（3）动机和目标的澄清。之后，心理治疗师的培训可以从专注于一个理论框架转向根据这些新类别学习不同的改变胜任力。要解决的主题选择应遵循基于最佳证据的精神障碍机制和过程以及干预措施。心理学提供了关于这些机制的知识，这些知识总体上可被视为心理治疗的基础科学。这需要与基础科学建立更好的联系，开展专注于治疗子目标的新研究工作，对治疗的选择和个性化进行理论总体优化，以及为心理治疗师设计新型培训，以便相应地优化治疗师的胜任力，而不是将培训项目局限于单一的理论框架。
