Developing expertise in psychotherapy: The case for process coding as clinical training.

Routine outcome monitoring (ROM) is a major development in the field since it offers likely outcome trajectories and is particularly helpful for failing cases. However, ROM has not led to improved skill development more generally, and it is debatable as to whether expertise is even possible to acquire in psychotherapy. What is missing but crucial to expertise is feedback on the outcome of one's actions in real time, which would enable responsive adjustments and improve outcomes. It is argued in this article that by identifying empirically validated moment-to-moment markers capable of differentiating later clinical outcomes, process researchers have uncovered the possibility of extracting prognostic information in real time, but one must develop the requisite observational skills. Multiple lines of research are reviewed to support the contention that real-time outcome information is available to guide responsivity and improve outcomes. And the typically hidden nature of these important signals further underscores the need for systematic training in process acuity. Given the pressing need to improve training methods, process coding training should not be restricted to research laboratories but should be exported to the clinical setting and tailored to the needs of clinicians for use in real time during therapy sessions. These are testable hypotheses that, if successful, hold the possibility of improving training and reversing the worrying trend of experience in psychotherapy being unrelated to outcome. (PsycInfo Database Record (c) 2024 APA, all rights reserved).