Before training, trainees took a 38-item pretest on their knowledge of IPT concepts and principles. Following the pretest, they received a username and password to access the Web-based tutorial and completed it at their own pace. Trainees could email the instructors with questions about the material. After completing the Web-based tutorial, trainees took a posttest of IPT knowledge and a user satisfaction questionnaire. Trainees then received a 45-60 min live applied training session conducted via videoconference with an experienced IPT trainer (JDL, JCM, or KLB). During this session, the trainer portrayed a standardized depressed patient, whereas the trainee role-played as therapist (see below). After completing the video session, trainees completed a satisfaction questionnaire and received a link to the IPT posttraining website. The posttraining website was designed to facilitate implementation and adherence following training and to guide the clinician in structuring sessions with their first IPT patients.

A two-tailed paired t test was computed to examine the mean change knowledge assessment from pretest to posttest on the Web-based tutorial. The standardized mean effect size for the t test was calculated using methods described by Cohen [46]. Effect sizes were considered large at 0.80, medium at 0.50, and small at 0.20 [46]. Descriptive statistics were used for the feasibility measure results.

This study has been approved by the Allendale Institutional Review Board. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study. This article does not contain any studies with animals performed by any of the authors.

Clinicians were recruited through advertisements in professional journals from National Association of Social Work and the American Psychological Association and through an announcement on the International Society for Interpersonal Psychotherapy (ISIPT) listserv. A total of 35 clinicians inquired about the study and were offered free participation. Of these, 26 (74%, 26/35) enrolled in the study and started the tutorial, and 22 (62%, 22/35) completed it. Furthermore, 18 (51%, 18/35) trainees participated in the live applied training session after completing the tutorial. The Allendale Institutional Review Board approved the study protocol, and all participants signed informed consent statements.

Of the 26 community clinicians starting the Web-based tutorial, 23 (88%) were female, 22 (85%) white, 1 (4%) African American, 4 (15%) Hispanic, and 3 (11%) other or mixed racial categories. Participants came from 15 US states and one each from Mexico, Brazil, Canada, and the United Kingdom. Mean age was 41.6 years (standard deviation [SD]=11.5, range: 26-63 years), and mean years of clinical experience was 10.5 (SD=7.6, range: 1-26 years). Eleven (42%, 11/26) were social workers, 11 (42%, 11/26) psychologists, 2 (8%, 2/26) marriage and family therapists, 1 (4%, 1/26) a psychiatrist, and 1 (4%, 1/26) a psychiatric nurse. Additionally, 24 (92%, 24/26) were actively conducting psychotherapy with clients. Only 3 (11%) reported having received any prior formal training in IPT: one through a continuing education workshop, one as part of undergraduate coursework, and one in graduate coursework. Three participants (14%, 3/26) reported having used some IPT techniques in their practice before participating in the study.

User satisfaction with the applied training session via videoconference appears in Figure 3. Overall, trainees felt the program enhanced their professional expertise and felt able to apply the skills learned to actual treatment. Mean global rating of user satisfaction with the applied training was 3.5 (range: 1=very dissatisfied to 4=very satisfied). Mean rating of learning from the applied training was 3.94 (scale range from 1=very little to 5=a great deal).

Figure 4 shows user satisfaction with the Web portal. Trainees thought the website helpful in preparing for IPT sessions, identifying the client’s IPT focus area, developing an interpersonal formulation, and monitoring changes in the client symptoms. Overall, satisfaction rating was 3.3 (range: 1=very dissatisfied to 4=very satisfied).

The mean time it took trainees to complete the Web-based tutorial was 3.3 hours (SD=0.8, range 2.3-5.0 hours). The average module was 29.1 min (SD 18.3). The tutorial was completed over a mean of 27.4 days (SD=22.9, range 1-66 days). The mean duration for participation in the entire training protocol (start of Web-based tutorial to evaluation of Web portal) was 91 days (SD 18.5).

This pilot study provides evidence to support the efficacy and feasibility of this technologically advanced, three-part therapist training intervention on IPT for major depression. Results supported both our hypotheses: the tutorial increased trainee knowledge of IPT, and trainees reported high levels of satisfaction with the three training components. User satisfaction has critical importance: if trainees do not like a training program, find it too difficult to use, or not useful, they will not complete it. In our study, trainees described high satisfaction with both technical aspects and clinical content of the training components and had a completion rate of 85% for the Web-based tutorial and 69% for the live applied training. This ranks somewhat higher than average compared with other Web-based trainings [47]. Although we could not assess the total number of possible participants who received notification of the study training opportunity, impressions from ease of recruitment further support the potential demands and interest in this vehicle (enrollment was limited to 35 participants due to budgetary constraints).

If successfully disseminated, this intervention may assist academic training programs in solving the dual challenges they face in expanding training curricula to include EBT’s and ensuring the training is effective. IPT in particular is an EBT in which most practitioners do not receive training, despite its strong empirical standing. As no treatment is universally effective, expanding training options to include multiple EBTs helps produce more well-rounded clinicians and provides more treatment options for patients, some of whom may prefer or respond better to IPT than other EBTs. IPT has been far less disseminated than CBT (which has comparable supportive evidence) and psychodynamic therapy (which has far less empirical support). IPT uses the medical model of illness which makes it very compatible with clients treated with a combination of psychotherapy and medication.

From a practical standpoint, the model this study used augments traditional approaches to training rather than replacing them [48-50]. Web-based tutorials can lay conceptual groundwork, like a textbook, but with the added advantages the technology affords in enhancing learning. Through the use of video recordings and illustrated vignettes, trainees can observe demonstrations of skills being correctly implemented in a variety of situations. Ongoing self-tests incorporated in the tutorial helps ensure and document that participants understand concepts, which has particular importance in evidence based practice. Videoconferencing can overcome logistical barriers to access to domain experts and be used for supervision, including role playing. The use of role plays with supervisors when learning new skills has been found superior to simple discussion [51]. Evaluation of clinical skills by actually observing trainees applying skills is critical to success but underutilized. In our sample, only 1 trainee reported prior live skills observation as part of their IPT training, a number consistent with the 10% rate reported in other studies [21,29]. Live observation has been found to enhance learning compared with observing videotapes of trainees [52].

The technology may also enhance posttraining supervision in several ways. Videoconferencing facilitates access to training supervisors. Access to a training supervisor following training has been found an essential ingredient of posttraining success superior to other forms of posttraining options such as peer consultation [53]. The technology facilitates ongoing case discussion following training, which is critical to ensure therapist efficacy in patients seen posttraining. The Web portal helps transfer learning from classroom to practice by providing a tool to help structure sessions, monitor application of and adherence to techniques, and monitor treatment outcome. It may also help prevent “therapist drift,” as trainees could return to the website to refresh their knowledge and for ongoing retesting and monitoring [54]. While not included as part of this study, evaluation of ongoing posttraining therapist supervision using videoconference and Web portals would be informative.

Results from this study are consistent with other studies on the use of these technologies for training clinicians on other EBTs such as CBT [29,55]. This is the first application of this technology to IPT training to be empirically evaluated that we are aware of (there has been one Web-based training pilot for Interpersonal Social Rhythms Therapy [IPSRT], an adaptation of IPT for patients with bipolar disorder [56]). Although IPT is less structured than CBT, there was no reason to think the methodology would have less success. In this study, we did not formally assess clinical competence, as the study goal was to assess user satisfaction with the methodology and improvement in conceptual knowledge. Thus, the degree of clinical competence the trainees attained is unknown. The number of live applied sessions necessary to achieve varying levels of competence in IPT using this methodology needs exploration, as does the differential impact of didactic and applied training on clinical skills. In a prior CBT study, the Web-based tutorial sufficed to improve clinical skills from poor to minimally acceptable, but the addition of four 1-hour videoconference role play sessions further improved rated clinical skills to between adequate and good [29]. Competence was assessed using role plays conducted via videoconference, which were recorded and evaluated for clinical skills by a blind rater. Such a methodology may be one way to assess competence via Web-based training. Further studies are needed to explore the relationship between the number of applied sessions and levels of competence and the relative impact of didactic and applied on-line training with IPT.

Limitations of this pilot study include lack of randomization and a control group, such as comparison to current standard methods of clinical instruction. The small sample size limits generalizability of results. In addition, since we did not collect patient data, it is impossible to know how the training program affected clinical practice. Although trainees received no feedback following pretesting on conceptual knowledge, there is the potential for practice effects. In the absence of a control group, it is difficult to determine the extent to which improvement in scores on the tutorial was due to training as opposed to induction bias. However, some studies have found pretests increase learning by orienting learners to subsequent information [35].

Future studies could include a larger sample size, as well a cohort of recent graduates from academic internships who are interested in additional psychotherapy training following graduation. Such training could count toward continuing education credits [48]. In addition, further study of the stability of training is warranted. In summary, results support the use of these technologies in training clinicians in EBTs and warrant further study to empirically evaluate these training methods compared to and in conjunction with current methodologies.