Apprenticeship Model of Psychotherapy Training and Supervision: Utilizing Six Tools of Experiential Learning.

Apprenticeship experiences have existed for centuries asways to gradually introduce individuals to professionaltrades, skills, and roles. Cobblers, blacksmiths, attorneys,artists, healers, and surgeons have all learned as appren-tices. Traditional apprenticeships focus on specificmethods for carrying out physical skills instrumental toaccomplishing meaningful practical tasks (e.g., buildinga house). Apprenticeship learning occurs through a com-bination of observing, coaching, and practice. The cogni-tive apprenticeship model, initially described by Collins[1] and elaborated by Stalmeijer et al. [2, 3], shares thetraditional apprenticeship’s focus on learning complextasks from experts, but further emphasizes cognitive skillsof the teachers and learners, not as readily observable [1,2]. Cognitive psychotherapy skills refer to clinical reason-ing, the development of a differential diagnosis, and caseformulation. Cognitive skills also include the ability touse emotions, behaviors, precise therapeutic language,and the strategies, tactics, and interventions needed toconduct psychotherapy. Developing psychotherapeuticcognitive skills requires that both supervisor and residentexternalize or think out loud, sharing their thoughts, emo-tional process, and the rationales for their therapeuticchoices. The problems and tasks that supervisors addressare chosen to illustrate the effectiveness of a psychother-apeutic task, discuss mistakes, or demonstrate psychother-apeutic interventions so that psychiatric residents canpractice and improve their reflective psychological andemotion-focused skills.MethodsThe “Apprenticeship Model” is utilized as part of ourPsychotherapy Scholar’s Track (PST) described elsewhere indetail [4]. This track emphasizes use of the common factorsinfluencing psychotherapy outcomes. Residents learn a mini-mum of five psychotherapeutic modalities, including our brieftreatment model [5], psychodynamic, cognitive and behavioraltherapies, family, and group psychotherapies. We consistentlyuse symptom and functional rating scales at the beginning andendofthetreatmentstohelpresidentsquantifypatientoutcomes.Supervisors are a broadly trained scholarly group of psy-chiatrists and psychologists, having 8–45 years of experienceaspsychotherapists.Weareallsalariedpreceptors,workinginour university outpatient department, conducting apprentice-ship cases carved out of our preceptor time.Since no objective measures of psychotherapy supervi-sion competency have ever been consistently validated,we rely on faculty who by virtue of experience, tempera-ment, and reputation are thought to have the necessary“wisdom” and capabilities to teach the skills required toconduct several different forms of psychotherapy.“Wisdom” as used here, is defined by Sternberg [6, 7]as a clinician who has“a deeper understanding of reality,used toward a common good, encompassing the definingcharacteristics of concern for others, psychological under-standing of others, capacity for self-knowledge, the abilityto reframe information, the ability to take the long view ofproblems, readily admitting to and learning from mis-takes, maturity, intuition, and the ability to“see through”situations and circumstances. Our “wise” [6, 7] supervi-sors emphasize common factors affecting psychotherapyoutcomes and psychotherapeutic principles derived from avariety of theoretical perspectives.