Online Training of Psychotherapists Appears to Be Effective Adjunct

Training psychotherapists in how to use evidence-based psychotherapeutic tools through online techniques appears to be as effective as traditional in-person training, according to a study published May 1 in Psychiatric Services in Advance.

The study found that patients of clinicians receiving Internet-supported e-learning and of those receiving in-person training reported comparable clinician use of interpersonal and social rhythm therapy (IPSRT), an evidence-based psychotherapy for bipolar disorder.

Bradley Stein, M.D., a researcher with the RAND Corporation and an adjunct associate professor of psychiatry at the University of Pittsburgh, and colleagues randomly assigned five community mental health outpatient clinics to an Internet-supported e-learning intervention arm or a comparison arm (three clinics were assigned to e-learning; two clinics were assigned to in-person training).

Thirty-six clinicians who treated patients with bipolar disorder agreed to participate in IPSRT training, including 19 social workers, 14 licensed professional counselors, two clinical psychologists, and one nurse. The clinics participating in the study were not routinely implementing any evidence-based psychotherapy for bipolar disorder; however, many clinicians had been independently trained in other evidence-based psychotherapies, such as cognitive-behavioral therapy.

The researchers invited clinicians and clinical supervisors in the e-learning arm to receive IPSRT training at their convenience via an interactive 12-hour online program. For the first three to six months after starting to use IPSRT with clients, most of the e-learning clinicians participated in a 60-minute clinical group supervision with an IPSRT expert by telephone each month.

E-learning clinics also formed implementation teams consisting of three to four clinicians and administrators to participate in a learning collaborative comprising all three e-learning clinics in the study. Implementation teams set goals for their clinics related to implementing IPSRT, made changes designed to achieve aims, and chose simple metrics to determine whether changes helped to achieve the aims.

Clinicians and clinical supervisors from clinics in the comparison group participated in a traditional, two-day, 12-hour workshop conducted by IPSRT developers. Clinicians also received on-site supervision of IPSRT cases as part of routine weekly supervision.

Stein and colleagues later obtained information about clinicians’ use of various therapeutic techniques from 136 individuals with bipolar disorder who were receiving treatment from the IPSRT-trained clinicians. Patients completed the Psychotherapy Practice Scale adapted for IPSRT (PPS-IPSRT) on a monthly basis after their therapy sessions with IPSRT-trained clinicians.

They found that clinicians’ use of IPSRT techniques was comparable for the in-person training and e-learning groups in three distinct time periods—the first six months after training, the second six months post-training, and a year or more after training. Statistical analysis revealed no significant difference in use of IPSRT techniques between the e-learning and in-person training groups overall or during any time period.

“Our findings suggest that e-learning can provide an efficient and scalable approach to training large numbers of clinicians in new evidence-based treatments,” Stein said in a statement released by RAND. “This may be a way to improve patient care and solve the problem of how to get new treatments to the front-line mental health workforce.”

Eric Plakun, M.D., chair of APA’s Psychotherapy Caucus, who reviewed the study, told Psychiatric News that the results are not surprising. “We already know, for example, that reading a book helps [clinician training in psychotherapeutic concepts] and reading or listening to a PowerPoint or webinar online seems pretty comparable,” Plakun said. “But online training alone is not enough,” he continued, noting that the e-learning training arm in the study included supervision, consultation, and support from other clinicians.

“Online training doesn’t replace traditional learning that requires supervision and case discussion, but is a nice teaching tool to add to our toolbox,” said Plakun, who is the associate medical director and director of admissions at the Austen Riggs Center in Massachusetts.

He added, “At Austen Riggs, we recently introduced free online psychodynamic CME in the hope this will be useful to clinicians who want to broaden and deepen their psychodynamic treatment skills—but it is clear to us this would require more than just taking the online course. Some kind of supervision and support would be an additional essential ingredient.” ■

“Implementing a Web-Based Intervention to Train Community Clinicians in an Evidence-Based Psychotherapy: A Pilot Study” can be accessed here.