Developing a Compassionate Internal Supervisor: Compassion-Focused Therapy for Trainee Therapists

Focusing the Clinical Supervision on the Therapist's Developmental Trauma: A Single Case Study

The term developmental trauma (DT) refers to the impact of stressful events which occur cumulatively within the child's relevant relationships and contexts, and usually early in life. According to several authors, DT depends on the caregiver's inadequate intersubjective recognition of one or more aspects of the evolving individual's identity. In the clinical and empirical literature, the study of therapists' developmental trauma, and how it might constitute a relevant variable in the clinical exchange, seem to be underrepresented. In this paper, through the analysis of the supervision process of a clinical case, we show how the therapeutic relationship may implicitly take the form of a "dance" between the patient's and therapist's DT, that prevents the therapist from intersubjectively attuning with the patient; and how a supervision process peculiarly focused on the therapist's DT can effectively promote this attunement and a good clinical outcome.

Improving the therapist's metacognition and capacity to intersubjectively attune with a patient with psychosis through the exploration of the therapist's developmental history: a case report

Clinical literature emphasizes how symptoms of psychosis can be efficiently targeted by psychological treatments. The most well-known approach to these symptoms is cognitive-behavioral therapy; but in the last few decades also other approaches are enriching the landscape, focusing on the dysfunctions in mentalization or metacognition, a spectrum of mental activities involving thinking about one's own and others' mental states. This huge amount of theoretical reflection and empirical research focused on the implementation of treatments does not seem to be associated with an attention to the inner world of the therapist who relates to the patient with psychosis; for example, to the impact of the therapist's developmental history on the therapeutic relationship. In this paper the authors are inspired by an intersubjective perspective, according to which although the treatment is for the patient's benefit, both the patient's and the therapist's developmental history and psychological organization are equally relevant for understanding the clinical exchange. On this basis, the authors make a "parallel" analysis of the clinical case of a young woman with symptoms of psychosis (i.e., persecutory delusions, auditory verbal hallucinations, social withdrawal) and its supervision process. They show how the therapeutic relationship can be significantly conditioned by the therapist's developmental history; and how a process of supervision focused on the exploration of the traumatic elements of this history can effectively promote the therapist's metacognitive capabilities, a functional patient-therapist intersubjective attunement, and a good clinical outcome.

Recognizing and Managing Performance Anxiety in First-Year Supervised Pastoral Education (SPE) Students: Description, Causes and Remedies

Describes the nature of performance anxiety that can appear in students doing their first clinical placement in Supervised Pastoral Education¹ in the Canadian Association of Spiritual Care. Explores origins of performance anxiety drawing on research, the Diagnostic and statistical manual of mental disorders-5, theology of Paul Tillich and supervisory experiences of authors. Examines Canadian contextual factors like COVID-19, culture and multi-faith. Offers ways students might manage anxiety with help from supervisors and peers.

The Benefits of Self-Compassion in Mental Health Professionals: A Systematic Review of Empirical Research

The importance of cultivating self-compassion is an often neglected issue among mental health professionals despite the risks to occupational well-being present in psychological care, such as burnout or compassion fatigue. In this context, this literature review has a twofold aim. Firstly, to contribute to raising awareness of the benefits of self-compassion among professionals, based on empirical research findings. Secondly, to coherently organize the available evidence on this topic, which to date appears scattered in a variety of articles. A systematic search on the APA PsycInfo database was conducted, and 24 empirical studies focused on the topic of the benefits of self-compassion in mental health professionals were finally selected. Concerning their methods, only 4 of the selected studies used experimental or quasi-experimental designs, 14 were cross-sectional studies, 3 presented qualitative research, and 3 were literature reviews. The research, regardless of methods used, points mainly to the benefits of self-compassion on the therapists’ mental health and well-being; prevention of occupational stress, burnout, compassion fatigue, and secondary traumatization as well as improvement of therapeutic competencies and professional efficacy-related aspects. In the review, self-compassion appeared as a process that could explain the benefits (eg on burnout) of cultivating other skills (eg mindfulness). To further explore this point, an additional review included 17 studies focused on the effects of mindfulness or compassion-based interventions on therapists’ self-compassion. In conclusion, our work joins those who have recommended the inclusion of self-compassion trainings in the curricula of mental health professionals.

Multiple emotions, multiple selves: compassion focused therapy chairwork

Compassion focused therapy (CFT) is rooted in an evolutionary view of the human mind as formed of a multitude of contrasting, and often conflicting, motivations, emotions and competencies. A core aim of the therapy is to help clients understand the nature of their mind in a way that is de-pathologizing and de-shaming. The approach is also focused on the cultivation of compassion to work with these difficult aspects of mind. CFT includes the ‘multiple-selves’ intervention which involves the differentiation of threat-based emotion and an exploration of their conflict. Compassion is then applied to the client’s affective world to aid regulation and integration. This paper focuses on clients’ experiences of a chairwork version of multiple-selves, wherein clients personify their emotions in separate chairs. Nine participants with depression were interviewed directly following the intervention and the resulting data were analysed using interpretative phenomenological analysis. Three interconnecting themes were identified: appreciating emotional complexity; the role of chairwork process; and compassionate integration. The results highlight the importance of emotional differentiation in understanding internal multiplicity and conflict in depression, and the role of compassion in creating a sense of personal coherence. The embodied and enactive nature of chairwork was found to be of benefit in identifying and separating emotion, and in developing new forms of self-relating. The paper discusses the clinical implications of such findings for the treatment of depression.

Key learning aims

As a result of reading this paper, readers should: (1)

What Is the State of Compassion Education? A Systematic Review of Compassion Training in Health Care

PURPOSE

To investigate the current state and quality of compassion education interventions offered to health care providers during training or practice, determine how the components of each education intervention map onto the domains of an empirically based clinical model of compassion, and identify the most common approaches to compassion education.

METHOD

The MEDLINE, Embase, CINAHL Plus with Full Text, Sociological Abstracts, Web of Science, ERIC, and Education Research Complete databases were searched from inception to March 2020 in this systematic review. Studies that evaluated a compassion education intervention for health care providers or those in training to enhance compassion toward patients and/or families were included. A narrative synthesis of the included studies was performed. The components of each intervention were mapped onto the domains of compassion described in the Patient Compassion Model.

RESULTS

One hundred eight peer-reviewed publications describing 103 interventions were included. Modalities ranged from establishing curricula and interventions in clinical settings to programs that used humanities-based reflective practices, clinical simulation, role modeling, and contemplative practices, with many education interventions adopting a multimodal approach. Most interventions mapped to the virtuous response domain of the Patient Compassion Model; very few mapped to the other domains of this model.

CONCLUSIONS

Most interventions were limited as they focused on a single domain of compassion; did not adequately define compassion; were assessed exclusively by self-report; were devoid of a comparator/control group; and did not evaluate retention, sustainability, and translation to clinical practice over time. The authors suggest that compassion education interventions be grounded in an empirically based definition of compassion; use a competency-based approach; employ multimodal teaching methods that address the requisite attitudes, skills, behaviors, and knowledge within the multiple domains of compassion; evaluate learning over time; and incorporate patient, preceptor, and peer evaluations.

Are you sitting (un)comfortably? Action-based supervision and supervisory drift

Action-based methods such as behavioural experiments, role-play and (by extension) ‘chairwork’ are powerful techniques recommended in core supervisory texts for cognitive behavioural therapy (CBT). Despite this, experiential methods are seldom used by supervisors, suggesting that supervision often drifts from a ‘doing process’ to a ‘talking process’. A number of factors contribute to this divergence from best practice, including limited confidence and a lack of familiarity with experiential procedures amongst supervisors. To address this, the current paper presents a variety of action-based techniques for enhancing supervisees’ technical, perceptual, interpersonal, reflective and personal competencies. Behavioural experiments, empty-chair, multi-chair and role-playing exercises for maintaining treatment fidelity, enhancing empathic attunement, repairing therapeutic ruptures, resolving impasses and working through negative countertransference are described, amongst others. Further research is needed to establish the nature and extent of supervisory drift, as well as the efficacy of action-based methods.

Key learning aims

As a result of reading this paper, readers should:(1)