1. A Web-Based Teaching Tool for Psychotherapy Research and Training Developed by Jakob Valen and Leigh McCullough Making Psychotherapy Better Step By Step

2. There have been daunting challenges in Psychotherapy Process Research This involves the following…. Archives of thousands of VIDEOTAPES from Randomized Controlled Clinical Trials of Psychotherapy. Development of many PROCESS MEASURES to evaluate therapy Training of hundreds of RESEARCH RATERS

3. 2,000 VIDEOTAPED SESSIONS PER TRIAL 2 HOURS PER SESSION TO EVALUATE = 4,000 HOURS PER TRIAL or 10 YEARS PER PERSON To rate one clinical trial With just one instrument CHALLENGES IN TRAINING PROCESS RESEARCHERS

4. But we need to rate each session with a number of well-established PROCESS MEASURES from a wide variety of domains of psychotherapy For Example: Patient-Therapist Interaction: (Alliance, Attunement, Ruptures) Therapist Interventions: (Clarification, Support, Cognitive Strategies ) Patient Responses: (Maladaptive cognitions, Affect, Defense)

5. In short, it would take a small army of research raters a few decades to complete all the ratings that are needed

6. Meanwhile…. The Traditional Method of Training is Labor Intensive and Time Consuming Ongoing small group teaching by the originator of the instrument can take months and yield only a few reliable raters. See Note Below

7. So what are we to do?

8. Leigh McCullough, a Visiting Professor in Trondheim, Norway, was explaining this problem when, a doctoral student, named Jakob Valen, had an idea…..

9. STDP Psychodynamic CBT Cognitive DBT Behavioral There is such an archive being built in Norway: The Trondheim Psychotherapy Research Program Videotape Archives Library (Tapes from at least 3 RCT’s will be studied)

10. There is also a large number of graduate students in clinical psychology At the University in Trondheim, Norway (NTNU)

11. Why not Build a Web-Based System for Process Research Slide 38 So that many raters could be trained to evaluate the thousands of videotapes that have been collected from the many clinical trials of psychotherapy

12. So Jakob Valen began to build the program www.jakobsladder.com And Leigh McCullough helped him develop it

13. JakobsLadder: Internet Training Students could go to their computer, log on to jakobsladder.com and select an instrument that they would be interested in learning. And now, so can you….

14. The Introductory Page of Jakobsladder

15. FIRST, REVIEW THE LIST OF INSTRUMENTS THAT ARE AVAILABLE; Each one assesses important aspect of psychotherapy See Note Below

16. THEN, SELECT AN INSTRUMENT TO EVALUATE THERAPY PROCESS AAS - THE AFFECT ATTUNEMENT SCALE ATOS – ACHIEVEMENT OF THERAPEUTIC OBJECTIVES SCALE (COMMON FACTORS) DMRS – DEFENSE MECHANISM RATING SCALE For example, we will first select the DMRS

17. When you select the DMRS ( The Defense Mechanisms Rating Scale), you would go to this page….

18. The menu to the left allows you to select the DMRS Manual or to select segments to be Rated See Note Below

19. When you click on one of the ‘Ratings’ buttons you will receive transcripts of sessions - as you see above.

20. EXAMPLE FROM THE TEXT See if you can find a defense mechanism in this selection….

21. As you read the transcript and note a defense mechansim, click on the menu to the right, where you see “Defence Mechanism #1”.…

22. The Defense Drop-Down Menu guides the process…… When you select the Defense Mechanism button You will be asked to do three things: 1.Select a defense from the drop down list 2.Briefly state your reason for the selection 3.Cut and paste the example from the text that illustrates the defensive behavior

23. See Note Below

24. Use the cursor to select a defense, in this case ‘Reaction Formation’ The Defense drop- down menu will give you a list of Defenses to choose from

25. The selected defense will appear in the defense box, and the rater will be able to type in the reason for the selection

26. The rater proceeds through the transcripts until all defenses have been identified. This process provides important information on the psychological functioning of the patient for both research and clinical training.

27. Let’s take another example… Maybe you want to learn about common factors in psychotherapy such as insight, motivation, or experiencing of feeling… Go to the Instrument List and select the ATOS Scale

28. This is the Home Page for the ATOS Scale See Note Below

29. Use the Menu to select the ATOS Manual or Practice Ratings See Note Below

30. With the ATOS Scale …. You can choose to rate a Transcript Or you can rate from Videotapes. First we’ll show an example of a Transcript.

31. This is what the transcript page looks like….

32. See Note Below Close up of the ATOS Transcript Rating Page

33. Or you can PRACTICE RATING A VIDEOTAPED SEGMENT

34. It is much more enjoyable and educational to watch and discuss a video with another rater See Note Below

35. This is the page that is shown when videotapes are rated.

36. See note below

37. Some examples of data the ATOS rater enters…

38. 45 60 15 See note below The rater then can compare their rating to the Gold Standard ratings…as well as see an explanation of why the group of experts gave the rating they did.

39. 60

40. Another example of feedback provided by the ATOS program.

41. When the rater has completed rating approximately 20 segments on a specific instrument, the rater may receive a “grade” or a proficiency rating in the form of a RELIABILITY STATISTIC.43 RESULTS OF RATINGS See Note Below

42. JakobsLadder: ICC Rating GRADING SYSTEM Above.7 = GOOD.4 -.7 = FAIR Below.4 = POOR

43. Sometimes the rater will receive this message; “You’re not quite reliable, but keep practicing and you’ll improve!”

44. So, JUST KEEP PRACTICING…

45. AND PRACTICING…

46. .75 And before too long, you’ll be able to say, “I’M RELIABLE!”

47. BENTE JOHANSEN has met criteria for Reliability on the DMRS Scale At.75 When the rater becomes reliable on the rating instrument, a Reliability Certificate can be printed out The ICC reliability rating can then be given to the Principal Investigator of a study to verifiy tat the rater is able to begin research ratings. But a reliability score also informs clinicians-in-training that they satisfactorily understand the clinical concepts that are being evaluated; such as the types of defense mechanisms a patient uses or the degree of affect experienced in the session.

48. EXCEL FILE Once research ratings have been entered, they are stored on an Excel file to be easily accessed and analyzed by the Investigators in the study.

49. See Note Below Also available is a program for a Videotape Grid for each study. Like a card catalog of a library, each session is identified by a box and the signs in the box indicate whether it is available, checked out, rated by one or more process instruments and by how many raters. See note below for more info.

50. Thus, JakobsLadder is not only useful for: TRAINING PROCESS RESEARCHERS But is also an excellent tool for TEACHING PSYCHOTHERAPY

51. AIRLINE PILOT STANDARDS Just as pilots have to log hundreds of hours in the ‘test cockpit’ before being given the responsibility of flying a plane and transporting live passengers, hopefully we will develop ‘simulated therapy sessions’ that will adequately prepare therapist trainees before they are given the responsibility of working with suffering patients. Someday we hope there will be archives of videotapes available for therapist trainees to review and evaluate hundreds of hours of pre-selected segments of therapy demonstrated by senior therapists, so that they will have ample exposure to how therapy might optimally be conducted.

52. How does Freud fit into all this?

53. Freud envisioned a “Scientific Psychology”

54. What might Freud think of JakobsLadder? ?

55. A web based tool for teaching psychotherapy JAKOBSLADDER Developed by Jakob Valen and Leigh McCullough Making Psychotherapy Better Step By Step

56. The End Hmm...

57. OTHER INFORMATION ABOUT HOW TO LEARN MORE ABOUT THE ATOS RATING SYSTEM

58. www.affectphobia.com To obtain ATOS manual for coding psychodynamic processes

59. A treatment manual that describes the interventions on which the ATOS Scale is based

60. Great Resources for Psychotherapy Process Research! But how do we train all these graduate students to rate thousands of tapes?