Process-focused psychotherapy training is evidence-based psychotherapy training: Commentary on Westra and Di Bartolomeo (2024).

Abstract

Westra and Di Bartolomeo (2024) made a strong case for psychotherapy training to focus more on psychotherapy process rather than content (e.g., manuals). Their recommendations are consistent with the preponderance of the evidence that finds that psychotherapy process variables (and psychotherapist variables related to the process, such as empathy) account for most of the variance in psychotherapy outcomes. Despite the overwhelming evidence, the Great Psychotherapy Debate (Wampold & Imel, 2015) rages on. In this commentary, I emphasize and strive to extend Westra and Di Bartolomeo’s recommendations. I describe how and when we might time the training of process monitoring to be most effective in the context of trainee development, and how such process monitoring may be useful both generally, as well as for cultural responsiveness. I begin, however, by addressing the substantial barriers we face in the integration of process-based training approaches given the prevailing avoidance of process. As the authors note, despite the proliferation of psychotherapy models and manuals, client outcomes have not improved in kind. If the field of psychotherapy is to make progress in helping to address the ongoing mental health crisis, it will necessitate that we finally heed the scientific evidence and orient our practice and our training (as Westra & Di Bartolomeo, 2024, recommend) to the process of psychotherapy.

Developing process sensitivity: Reply to Wilcox (2024) and Boswell (2024).

“…Furthermore, we agree with Wilcox (2024) that integrating process sensitivity training may be timely in that it could provide a platform and method for facilitating the awareness of culture-related markers, opportunities, and responsivity. In fact, there are also ways in which the methods of process sensitivity training could be an opportunity to enhance clinical supervision at multiple developmental stages.…”

“…Wilcox (2024) and Boswell (2024) make a number of important observations about facilitating process sensitivity training, and here, we respond to those suggestions. We postulate that cultivating process sensitivity is complementary, not antithetical, to traditional training in viewing therapy from a theoretical lens, and thus, can serve to enhance, rather than replace one’s existing psychotherapy skills.…”

“…We were pleased to see the strong support in the commentaries of both Wilcox (2024) and Boswell (2024) for the ideas regarding process sensitivity training espoused in our original article, “Developing Expertise in Psychotherapy: The Case for Process Coding as Clinical Training” (Westra & Di Bartolomeo, 2024). In this reply, we offer our reaction to their important suggestions.…”

“…Wilcox (2024) also notes that process-centered training requires uncertainty tolerance and openness to self-critique which can be uncomfortable. Indeed, such challenges are similar to those faced by integrating any form of routine outcome monitoring (Boswell et al, 2015).…”

“…As Wilcox (2024) notes, schisms continue to exist in our field between theory-driven and process-driven approaches to therapy. And as Boswell (2024) notes, "exclusively emphasizing training in comprehensive theory-unique treatment packages for particular disorders has potential to lead the field further astray" (p. 180).…”