Research on clinical training

In this project, we use meta synthesis as a method and analyze what competence is expected of a clinical psychologist, as formulated in various management documents (e.g. RETHOS, National Plan, EuroPsy, American and Australian accreditation documents, etc.).

We who collaborate on this project are Signe H. Stige, Jon Vøllestad, Endre Visted og Elisabeth Schanche. 
 

As part of the work to find out how we can measure the development of relevant, clinical skills through training, we have chosen to look at FIS (Facilitating Interpersonal Skills - Anderson et al., 2009). FIS constitutes a standardized stimulus material, to which one responds. The response is recorded and then scored on 8 domains, which constitute an operationalization of the common factors. FIS scores have been shown to be related to client outcomes in therapy (Anderson et al., 2009; 2016). Looking at FIS and its development through education therefore has potential. We have therefore secured training in FIS scoring from Timothy Anderson and Katie Aafjes-van Doorn together with colleagues at UiO and NTNU. Although FIS has potential, there is still much we do not know about FIS - and we therefore have concrete plans for research projects related to this: 

• FIS stability: Although it has been observed that FIS scores on the standardized test predict client outcomes, less is known about the stability of FIS. We therefore want to use videos of therapy sessions from an RCT that compares emotion-focused and cognitive therapy for depression and score FIS on therapy videos and look at stability over time and across time for the same therapist. We who collaborate on this are Elisabeth Schanche, Signe H. Stige, Aslak Hjeltnes og Jan Reidar Stiegler.
• FIS proxy: We also want to do a specific research project that explores the relationship between FIS scores on the standardized test and FIS scores on actual therapy videos. We will therefore do a project where we use the same data from RCT that we use for FIS stability and compare this with the same therapists’ scores on the standardized FIS test. We who collaborate on this are Signe H. Stige, Elisabeth Schanche, and Jan Reidar Stiegler. 

In the extension of these projects, we want to investigate the movement of students on FIS throughout the professional study, as well as use FIS to test the effect of various changes we introduce in clinical training. 

To make good choices regarding how we structure our clinical training, it is important to know something about the situations Norwegian clinicians often face and find particularly challenging. We have therefore conducted a sequential, mixed-methods study with two survey studies and a focus group study with this focus.

The first survey study was sent to a representative sample of Norwegian psychologists, in collaboration with the Norwegian Psychological Association. The study showed that suicidality, difficulties in establishing common focus, and passive clients were among the most frequent and most demanding from a therapist perspective (Stige et al., 2019 - https://psykologtidsskriftet.no/vitenskapelig-artikkel/2019/08/kva-typar-mellommenneskelege-situasjonar-opplever-norske-psykologar, in Norwegian).

The second survey study was sent to employees in child and adolescent mental health services, in collaboration with Helse Bergen. The study showed that suicidality, passive clients, and situations where parents are very disagreeable about the situation were among the most frequent and most demanding from a therapist perspective (Stige et al., 2023 - https://psykologtidsskriftet.no/vitenskapelig-artikkel-originalartikkel/2023/01/krevjande-situasjonar-i-psykisk-helsevern-born-og, in Norwegian). 

The focus group study built on these two surveys and explored the therapist’s perspective on what made these situations so challenging and how it could be useful to practice this type of situation. We conducted 5 focus group interviews with clinicians in child and adolescent mental health services and 4 focus group interviews and an individual interview with clinicians in adult mental health services. Marion Hernes Torrissen submitted her thesis (Norwegian) on this data in the spring of 2023. 

We at UiB who have collaborated on these projects are Signe H. Stige, Elisabeth Schanche, Ingrid Dundas, Aslak Hjeltnes og Endre Visted.

In addition, we have collaborated with Irene Elgen and Gro Fjellheim at Helse Bergen. These projects have been completed.

The transition from theory to sitting with a client in practice is significant, and we have therefore been concerned with exploring ways we can better prepare students for practice. One area where we are working to improve clinical training is to establish a video library with a wide range of films with short scenes from relevant, clinical situations in a Norwegian context. The scripts for the films are based on the three studies of the situations Norwegian clinicians often face and find particularly challenging (see above). We have developed scripts for both the child and adult fields and have recorded some films with the help of professional actors. We are in the process of securing funds to record more films. The films are available in both VR (virtual reality) 360 films and regular 2D films. The video library is intended to be part of clinical training by strengthening basic capacities and skills, such as getting to know and being able to handle one’s own reactions in different situations; supporting clinical supervision by providing the opportunity to practice challenging situations encountered in practice; and a possibility to practice specific interventions and skills. We want to use deliberate practice as a pedagogical framework. Therefore, we are also working on means to establish a room with VR headsets that students can access outside class, so that we can facilitate the solitary practice of deliberate practice. 

Once we have secured funding for recording videos and have established the video library, we will systematize experiences with the video library by researching changes in clinical skills, psychophysiology, as well as student experiences with the video library.

At UiB, those collaborating on this project are Signe H. Stige, Elisabeth Schanche, Ingrid Dundas, Endre Visted, and Yngvild S. Danielsen at IKP, as well as Frode Ims (photographer) from UiB Learning Lab. In addition, we are collaborating with Candice Fisher in Chile, who has established a Spanish video library used in clinical training in Latin America. 

We want to offer students the opportunity to use both VR and regular films when using the video library. We believe that VR provides some opportunities to prepare students for practice by making situations feel more real - but is this true? Very little research has been done on the difference between screen and VR, and we want to explore this systematically by measuring psychophysiological activation and how immersive the films are, and whether this varies systematically depending on whether the stimuli are VR or 2D films. The project is under planning, and those collaborating on this are Signe H. Stige, Endre Visted, and Berge Osnes. 

We have also been concerned with finding pedagogical models that can improve clinical training. Deliberate practice has received a lot of attention in the field in recent years as a possible way to work systematically to improve clinical skills (e.g. Rousmaniere, 2017). However, there is almost no research on the effectiveness of deliberate practice in clinical training, and we want to explore this further. We currently have many elements in place in the internal clinical training that are needed to use deliberate practice as a framework for education, and we want to do a pilot project where we investigate whether the use of deliberate practice as a framework can improve clinical education - for example, by combining this with the use of the video library. We have also established contact with other environments in Norway that are interested in this, such as Vidar Husby and Høgskolen i Innlandet.

One of the competencies that has been highlighted as central to understanding how and why psychotherapy works is therapist responsiveness (e.g. Stiles, 1998; Watson & Wiseman, 2021) - or the therapist’s ability to be attentive to the present and adapt treatment to the individual client and context. However, therapist responsiveness is notoriously difficult to measure, and little attention has been paid to how to train or strengthen this competency. Given that therapist responsiveness is particularly important in demanding clinical situations, we used data from the sequential mixed-methods study on demanding clinical situations to draw implications for education focused on strengthening therapist responsiveness. We developed six implications:

1. The importance of building self-awareness and conceptualization skills;
2. Adapting education to the individual student;
3. Helping students transform disturbing activation into engagement;
4. Ensuring that students are exposed to a wide range of clinical situations throughout their education;
5. Offering training opportunities on situations that therapists often encounter; and
6. Focusing on building tolerance in students to tolerate uncertainty and capacity to seek support (Stige et al., 2024).

Those who have collaborated on this are Signe H. Stige, Ingrid Dundas, Yngvild S. Danielsen, Reidar Jakobsen, Katharina T. E. Morken, and Marion H. Torrissen. 

As part of process research, we do a lot of coding of therapy films. Students often contribute to this work. We are interested in whether this opportunity to see real therapy sessions with a specific focus (what is being coded) contributes to increasing therapist skills and self-efficacy among students by using video coding as modeling. We will investigate this by testing students on FIS and self-efficacy before and after they do video coding, and where we compare their changes with the changes that a control group of students who only follow regular teaching on the course experience at the same time. Those who collaborate on this are Elisabeth Schanche and Signe H. Stige.