Development of a competence scale for brief psychodynamic investigation: A pilot study

Abstract

Background: The Brief Psychodynamic Investigation (BPI) is an ultra-brief psychodynamic psychotherapy used at the time of intake interviews in order to investigate a patient's difficulties. Inspired by the brief psychodynamic psychotherapy tradition, BPI focuses mainly on the patient's initial request for treatment, which is then explored for a maximum of four sessions. A therapist's competence in using proper techniques, which refers to the level of skill shown by the therapist in delivering the treatment, is one among multiple variables that may influence the psychotherapeutic process in BPI. In order to assess this variable, we have developed an instrument: the brief psychodynamic Investigation Competence Scale (ICS), composed of 33 items divided into 5 subscales. The first two subscales refer to the therapist's general and psychoanalytic attitude, whereas the other three subscales refer to his competence in investigating and interpreting, the BPI's specific techniques and the therapist's global competence. The aim of this study was to validate the ICS by testing its (a) inter-rater reliability, (b) internal consistency, (c) content validity and (d) construct validity. Method: A pilot study was done on 16 BPIs, half of which were done in consensus sessions. The interviews used in this study were taken from a larger project on the development of early alliance during BPIs (Lausanne Early Alliance Project, LEAR). All interviews had been video or audio recorded. The subjects were chosen amongst adults requesting an appointment with a therapist from the Lausanne University Adult Psychiatry Department's outpatient clinic. The patients had been diagnosed as presenting anxiety, mood disorders or personality disorders. Seven therapists participated in this study: 4 therapists were considered to be experts in BPI while the other 3 were considered to be junior therapists. Two raters participated in assessing the 16 available BPIs according to a rating manual. The raters were blinded to the outcome of the therapeutic intervention. Results: Inter-rater reliability was assessed using intra-class correlations (ICC). ICCs ranged from 0.54 to 0.84 with an average of 0.71: these scores are in the range of scores obtained in other studies on adherence and competence scales. Significant scores are also obtained for the internal consistency of the scale. The content of the ICS was found significant by 4 independent expert therapists and the author of BPI. Finally, using the ICS permitted to discriminate between senior (>5 years of experience in BPI) and junior (<5 years experience) therapists. Conclusions: Initial results concerning the psychometric properties of the ICS are promising. The instrument reflects four basic aspects of psychodynamic investigation: (1) the general attitude in receiving the patient, (2) the psychoanalytic attitude during the investigation, (3) the exploration of conflicts and repetitions and, (4) the meaning given to the patient's conflicts in an initial interpretation. The limits of this pilot study must be pointed out, regarding mainly: (1) the relatively small size of the sample, (2) the fact that the raters sometimes knew the therapists and how much clinical experience they had, and (3) a limitation related to the necessity to give clear explanations on how to use the instrument.