Clinical psychology trainees outperform experienced therapists on knowledge and skills

Conducted in Germany, this study pitched undergrad psychology students, postgrad clinical psychology trainees and experienced psychological therapists against each other on tests of psychological knowledge and skills. The slightly worrying result is that the trainees aced it, outperforming not just the students (on most tests) but also the experienced therapists. "The picture is not so bright" for the seasoned therapists, the researchers said. "Our results point to a decrease in knowledge and variability in clinical competence."

The research led by Sabine Vollmer had two parts. The first involved 55 novice, intermediate and advanced students, 15 graduate trainee therapists, and 15 experienced therapists who'd been working in the profession for at least 10 years. In terms of basic psychological knowledge, it was the students who came out on top, presumably because they were currently immersed in learning the basics of the discipline. In applying
psychological knowledge to clinical psychology, the intermediate students beat the novice students, and they matched the advanced students, trainees and seasoned therapists, all of whom performed at a similar level. On clinical knowledge, the trainee therapists came out tops, beating all the students and the experienced therapists.

Another challenge involved the participants reading about two client case studies (one was social phobia, the other was OCD), then they had to recall the important details, as well as explain and diagnose the disorder. Here, performance improved from novice to experienced students up to trainees. However things stalled at the level of trainees, with the experienced therapists actually showing a slight decrease in performance.

The second part of the research attempted to better capture the dynamic nature of therapeutic work. Five advanced students, five trainee therapists, and five veteran therapists with at least 10 years experience took part in a "case-based interview". While reading about a complex client, they were first asked to think out loud about the case, then they had to diagnose the client (major depression and borderline personality disorder) and recommend appropriate treatment (e.g. dialectical behavioural therapy).

The students struggled. The trainee therapists aced it. The experienced therapists were a mixed bag - two performed well, but three of them failed to "develop an individual case conceptualisation, their diagnoses were incomplete or wrong, and they didn't adapt their treatment plan to the patient's history."

The poor performance of the seasoned therapists is worrying but tricky to diagnose. Clinical psychology training in Germany has changed since the experienced therapists underwent their training. Today, as in the UK, German trainee clinical psychologists undertake a doctoral programme made up of research, study and clinical practice, whereas training in the past was much shorter (also true in the UK). This means it's impossible to know whether the disappointing performance of the experienced therapists was due to the nature of their training, or rather an adverse side-effect of expertise and time on the job - over-confidence perhaps, or a failure to keep up to date with the latest knowledge and theory.

It would have been useful to know more about the theoretical orientations of the therapists and the researchers. Would the veteran therapists have agreed with the way their performance was scored? Can we trust the expertise of the scorers who rated the performance of the participants? It is reassuring that we're told the research group comprised experts in cognitive science, clinical psychology and psychotherapy.

The good news from the study is that contemporary clinical psychology training seems to be equipping the next generation well (at least in Germany). A concern is that experienced therapists seem to need more support than they're getting to ensure their expertise is sustained and developed. Vollmer's team said this tallies with research in the medical profession suggesting that doctors are not very good at judging the holes in their own knowledge and skills.