Psychotherapy skill profiles of psychiatric residents.

A survey of experienced clinicians has suggested that negative outcomes of psychotherapy may be related to misapplications or deficiencies of technique. The present study was, therefore, concerned with two questions: a) does the more competent psychiatric resident have a different profile of therapeutic skills from the less competent resident; and b) are the more competent residents more aware of their own behavior with patients than less competent residents? To answer these questions, a Supervisors' Evaluation Scale and a parallel Psychotherapy Self-Evaluation Scale were developed, and their reliability, content, and discriminant validities were established on the basis of their use with a group of psychiatric residents being supervised in an outpatient clinic. Results demonstrated that the more and less competent trainees, selected on the basis of global ratings, differed significantly on almost every item of the Supervisors' Evaluation Scale, but did not differ on most of the items of the Psychotherapy Self-Evaluation Scale. Residents reported it to be particularly difficult to deal with patients' aggression and acting out behavior, fee setting and collecting, and understanding the patients' defensive structures. The rating scales can be used to assist in supervision by assessing the level of acquired skills in psychotherapy, and can also be used to help identify special areas of strengths and weaknesses.