Process-Focused Psychotherapy Training Is Evidence-Based Psychotherapy Training: Commentary on Westra and Di Bartolomeo (2024)

Westra and Di Bartolomeo (2024) made a strong case for psychotherapy training to focus more on psychotherapy process rather than content (e.g., manuals). Their recommendations are consistent with the preponderance of the evidence that finds that psychotherapy process variables (and psychotherapist variables related to the process, such as empathy) account for most of the variance in psychotherapy outcomes. Despite the overwhelming evidence, the Great Psychotherapy Debate (Wampold & Imel, 2015) rages on. In this commentary, I emphasize and strive to extend Westra and Di Bartolomeo's recommendations. I describe how and when we might time the training of process monitoring to be most effective in the context of trainee development, and how such process monitoring may be useful both generally, as well as for cultural responsiveness. I begin, however, by addressing the substantial barriers we face in the integration of process-based training approaches given the prevailing avoidance of process. As the authors note, despite the proliferation of psychotherapy models and manuals, client outcomes have not improved in kind. If the field of psychotherapy is to make progress in helping to address the ongoing mental health crisis, it will necessitate that we finally heed the scientific evidence and orient our practice and our training (as Westra & Di Bartolomeo, 2024, recommend) to the process of psychotherapy.