Assessing microprocess clinical discrimination in psychodynamic psychotherapy: A vignette-based approach with expert consensus and sensitivity to structured exposure.

Abstract

Objective: This study examined the development of a vignette-based instrument to assess therapists' microprocess-level clinical discrimination, the ability to identify and differentiate moment-to-moment psychological dynamics within therapeutic dialogue. Addressing a gap in psychotherapy process research, we evaluated whether this capacity can be systematically articulated and measured using a structured, dimensional framework.

Method: Fifty-three participants (36 trainees, 17 experienced clinicians) completed a vignette-based questionnaire before and after structured exposure to the Dimensional Model, which organizes moment-to-moment therapeutic processes. A nonrandomized pre-post design assessed sensitivity to short-term changes in evaluative judgments. The instrument was developed through expert consensus and administered in parallel forms.

Results: Discrimination scores and confidence increased from pre- to post-assessment. Experts showed higher baseline performance, whereas trainees demonstrated larger gains, resulting in comparable post-assessment scores. Participants also reported increased reliance on explicit and reflective judgment processes.

Conclusions: The findings support the feasibility of assessing microprocess-level clinical discrimination using a structured, vignette-based approach and suggest that such discrimination can be systematically measured. The instrument further demonstrates sensitivity to short-term changes in participants' evaluative judgments following structured exposure. The dimensional framework may offer a useful organizing structure for the articulation and interpretation of vignette-based assessments, warranting further longitudinal and ecological.