Should personal practice be part of cognitive behaviour therapy training? Results from two self‐practice/self‐reflection cohort control pilot studies

The influence of deliberate practice on skill performance in therapeutic practice: A systematic review of early studies

OBJECTIVE

Deliberate practice (DP) is recommended as a new approach to facilitate the acquisition of discrete therapeutic skills, however, its implementation and effectiveness in psychotherapy remains unclear.

METHOD

A systematic search on DP for therapeutic skills among psychotherapy trainees and psychotherapists yielded eleven studies for inclusion. Nine were randomized controlled studies (RCTs), including seven unique RCTs, and two were within-group studies.

RESULTS

Risk of bias was assessed as "high" for one RCT, "some concerns" for the remaining RCTs, and "serious" for within-group studies. All RCTs found the DP group performed better than the control group. All studies involved efforts to improve performance based on learning objectives and iterative practice but varied in the source of expert guidance and feedback. The included studies provide limited insight into best practice for delivering DP.

CONCLUSION

The results highlight the paucity of research in this field; however they offer insight into current applications of DP and provide preliminary empirical support DP for as a model for promoting the development of discrete therapeutic skills. Given the rapid dissemination of DP publications and manuals in psychotherapy, future research is strongly encouraged.

Therapist perceptions of experiential training for exposure therapy

BACKGROUND

Despite evidence for its efficacy, exposure therapy for anxiety is rarely used in routine care settings. Efforts to address one major barrier to its use - therapists' negative beliefs about exposure - have included therapist-level implementation strategies, such as training and consultation. Experiential training, in which therapists themselves undergo exposures, has recently demonstrated feasibility, acceptability and preliminary effectiveness for increasing exposure use.

AIMS

This study aimed to assess: (1) therapists' perceptions of experiential training and (2) barriers and facilitators to implementing exposure following training.

METHOD

Therapists who underwent experiential training (n=12) completed qualitative interviews and quantitative questionnaires. Interviews were coded using an integrated approach, combining both inductive and deductive approaches. Mixed methods analyses examined how themes varied by practice setting (community mental health versus private practice) and exposure use.

RESULTS

Results highlight how therapist-level factors, such as clinician self-efficacy, interact with inner- and outer-setting factors. Participants reported positive perceptions of exposure after training; they noted that directly addressing myths about exposure and experiencing exposures themselves improved their attitudes toward exposure. Consistent with prior literature, issues such as insufficient supervisory support, organizational constraints, and client characteristics made it challenging to implement exposures.

DISCUSSION

Results highlight the benefits of experiential training, while also highlighting the need to consider contextual determinants. Differences in responses across practice settings highlight areas for intervention and the importance of tailoring implementation strategies. Barriers that were specific to therapists who did not use exposure (e.g. hesitancy about its appropriateness for most clients) point to directions for future implementation efforts.

What characterizes helpful personal practice in psychotherapy training? Results of an online survey

BACKGROUND

Personal practice (PP) is often considered as a central component in psychotherapy training aiming to promote personal and therapeutic competences. However, its implementation varies considerably in practice.

AIMS

The purpose of this exploratory study was to examine the current practice of PP regarding the frequency/occurrence and perceived usefulness/impairment of topics, techniques and effects, as well as its helpful characteristics in psychotherapy training.

METHOD

407 German psychotherapy trainees (214 cognitive behavioural therapy; 178 psychodynamic therapy) were surveyed online as to their current practice of PP.

RESULTS

For trainees, personal and therapeutic related topics were discussed. Reflection techniques and self-experiential practice were among the most frequently reported strategies, while the fostering of personal and interpersonal competences was among the effects with the strongest occurrence. However, negative PP effects were recorded as well. Differences in PP practice emerged between therapeutic orientations.

CONCLUSIONS

As certain techniques which are central to PP (e.g. self-experience) were also rarely or not used, and negative effects reported, its potential might not be fully utilized.

A Stage 1 Pilot Cohort Exploring the Use of EMDR Therapy as a Videoconference Psychotherapy During COVID-19 With Frontline Mental Health Workers: A Proof of Concept Study Utilising a Virtual Blind 2 Therapist Protocol

Objective

The COVID-19 pandemic has had a major impact on the delivery of psychological treatment. Due to social distancing requirements, the provision moved to videoconferencing psychotherapy (VCP). There is a paucity of empirical data supporting the efficacy of EMDR therapy as a VCP. This stage 1 pilot study tested an EMDR therapy scripted protocol, such as Virtual Blind 2 Therapist (VB2Tr), on frontline mental health workers as a VCP regarding fitness for purpose, distinctiveness, relevance, and efficiency.

Methods

A total of 24 participants were recruited for the study. The design included a one-session treatment intervention with pre, post, 1-month, and 6-month follow-up (FU) measurements. This treatment session used a “Blind 2 Therapist” EMDR therapy scripted protocol as videoconference psychotherapy that involves non-disclosure of traumatic memory. The research explored the treatment effect on the core characteristics of trauma memory, including subjective disturbance, belief systems, memory intensity (MI), vividness, and levels of emotionality. Additionally, the research explored participants’ experiences of adverse and benevolent childhood experiences (ACEs/BCEs) during their childhood.

Results

Regarding the four tests, namely, fitness for purpose, distinctiveness, relevance, and efficiency, results are favourably suggesting potential clinical benefits of using EMDR as videoconference psychotherapy. Although this is a proof-of-concept study showing positive results, no clinical population or control group was used. The purpose of the study is to explore the potential for scalability toward a larger clinical trial. The treatment intervention was achieved irrespective of either ACEs/BCEs during childhood.

Conclusion

The research tentatively supports the case for EMDR therapy as a credible treatment when used as video conference psychotherapy and in using the Blind 2 Therapist protocol. However, more research is needed to scale toward a clinical trial.

Clinical Trial Registration

Clinical Trial Registration:https://www.isrctn.com/ISRCTN12099530, identifier ISRCTN12099530.

Use of a low frustration tolerance exercise for trainee therapists in a SP/SR framework

Application of a self-practice self-reflection (SP/SR) framework to clinical training programmes for those learning cognitive behavioural therapy (CBT) have demonstrated positive outcomes. These programmes have typically resulted in reports of enhanced learning, improved clinical skills, heightened empathy, improved interpersonal skills, increased self-awareness, and self-development for those undertaking such training. However, the utility of specific activities within this framework for enhancing trainees’ learning still requires exploration. This study sought to explore the use of a low frustration tolerance (LFT) exercise to enhance trainee’s learning around issues relating to frustration and discomfort tolerance. It also further explored the possible application of SP/SR as a form of competency-based assessment. The study was based on 41 student trainees that engaged in a self-directed LFT exercise. Written reflections on these exercises were then thematically analysed. From a competency basis, the exercise provided an approach for observing the trainee’s competency with formulation skills, intervention planning, and self-reflective capacity. Participants reported both personal and professional development outcomes from the exercise. These included a ‘deepened’ understanding of cognitive behavioural principles related to their experiences, both in terms of principles relating to maintenance of dysfunction and to creating change. Increased self-awareness and learning outcomes relating to the development of interpersonal skills were also commonly reported by trainees.

Key learning aims

(1)

[Effects of Personal Therapy during psychotherapy training - A Systematic Review]

BACKGROUND

Self-experiential work/personal therapy as part of psychotherapeutic training is often under critical discussion. In the German system, self-experiential work will remain an established part of training in psychosocial medical specialties and will continue to be part of the future curriculum in psychotherapy and in practical training subsequent to the study.

OBJECTIVES

Identification of different impacts of self-experiential work on psychotherapy trainees.

MATERIAL AND METHOD

Systematic literature review of studies between 2005 and 2020. Literature search via electronic databases, prior literature search and searches through reference lists of previous research. Selection via previously determined inclusion and exclusion criteria.

RESULTS

Thirteen studies were selected for this review. Results were summarised related to 7 outcome variables which mostly displayed positive impacts of self experience related to interpersonal skills, self-perception, knowledge and understanding of therapeutic work, well-being and relief. Satisfaction and the acceptance of the subjective importance of personal therapy for increasing competence were more common than reports about intensive emotions and stress.

CONCLUSION

Self-experiential work is highly valued by psychotherapy trainees and is therefore correctly considered as an obligatory part of training. Nonetheless, it should be evaluated regularly. For further research, self-reports, the most commonly used method, should be combined with objective measures, representativeness of samples should be enhanced and long-term effects should be investigated.

Personal practice in counselling and CBT trainees: the self-perceived impact of personal therapy and self-practice/self-reflection on personal and professional development

With growing evidence for the potential value of personal practices (PPs) in therapist training, it is important to determine which PPs may be most valuable for which therapists under what conditions. This is the first study to compare the impact of two different PPs selected by accredited therapy training programs as the most appropriate PP for their trainees. Using the same validated outcome measure, the Self-focused Practice Questionnaire, the impact of personal therapy for counselling psychology trainees was compared with the impact of self-practice/self-reflection (SP/SR) training for CBT trainees. The number of PP hours was similar across the two groups. The SP/SR group were older and may have been more experienced professionally. SP/SR was perceived by CBT trainees to be significantly more beneficial for personal and professional development than personal therapy by counselling trainees. Possible reasons are discussed. Although the study does not constitute a direct experimental comparison of personal therapy and SP/SR amongst matched trainees of the same theoretical orientation, it is notable in demonstrating that in training contexts where PP was mandatory, SP/SR was experienced more positively by the CBT trainees than personal therapy by the counselling trainees.