What can we expect from trainee therapists? A study of acquisition of competence in dynamic psychotherapy

This study focuses on training in dynamic psychotherapy. Sessions deriving from the final phase of psychodynamic therapies (N = 21) performed by clinical trainees in an intensive psychodynamic psychotherapy training programme lasting 2 years were analysed for their level of psychotherapeutic competence. Research questions were: (i) To what extent do the trainees reflect strategic thinking in their clinical work? (ii) What characterises therapeutic attitude and interventions of therapists who have or have not achieved the capacity of strategic thinking? Three dimensions were analysed: strategic competence, attitudinal competence and technical competence. The concept “strategic competence” was developed in this study. It refers to the ability of the therapist to continuously reflect on therapeutic aims and on means designed to achieve these aims. Results: 53% of the therapists did not show operative clinical competence in terms of strategic thinking. Strategic competence was present, wholly or partially, in 47%. Only 2 therapists demonstrated high-level strategic competence. Most therapists demonstrated a lack of capability for strategic thinking and a lack of technical competence. Patients’ defence mechanisms and the therapists’ helplessness and lack of competence counteracted progress in the therapies. The study demonstrates that it is difficult to acquire dynamic understanding of the therapeutic process and that the novice therapist will need a longer period of time to acquire operative competence.