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Vivolo M, Owen J, Fisher P. Building resilience in the Improving Access to Psychological Therapy (IAPT) Psychological Wellbeing Practitioner (PWP) role: a qualitative grounded theory study. Behav Cogn Psychother 2024; 52:135-148. [PMID: 37545324 DOI: 10.1017/s1352465823000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
AIM Staff retention, particularly in the Psychological Wellbeing Practitioner (PWP) workforce, has historically been challenging for Improving Access to Psychological Therapy (IAPT) services. This study sought to develop an explanatory model of the resilience-building process in PWPs working within the IAPT programme. METHOD A qualitative design was conducted, using a grounded theory methodology. Participants were recruited from two IAPT services in the National Health Service (NHS), which were part of the same Mental Health Trust. Ten PWPs were interviewed via videoconferencing using semi-structured interviews. RESULTS An explanatory model of resilience in PWPs encompassed three phases: the experience of work-related challenges, the connection with their values and the related appraisal of adversity in resilient ways, and the implementation of effective coping strategies. CONCLUSIONS The model highlights that PWPs develop resilience through values-based sensemaking and by proactively engaging in effective coping mechanisms. This study contributes to the current understanding of the process of resilience in PWPs. More research is needed to explore the developmental processes underlying PWPs' resilience. The implications of the findings in relation to existing conceptualisations of resilience, staff wellbeing and retention are explored. Recommendations for future research are also given.
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Affiliation(s)
- Marco Vivolo
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Joel Owen
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Paul Fisher
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
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Schaffrath J, Bommer J, Schwartz B, Lutz W, Deisenhofer AK. Where it all begins: Predicting initial therapeutic skills before clinical training in cognitive behavior therapy. PLoS One 2024; 19:e0294183. [PMID: 38386643 PMCID: PMC10883575 DOI: 10.1371/journal.pone.0294183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/27/2023] [Indexed: 02/24/2024] Open
Abstract
To train novice students adequately, it is crucial to understand where they start and how they develop their skills. This study examined the impact of novice students' characteristics on their initial clinical micro-skills when treating simulated patients with cognitive behavior therapy. The sample consisted of 44 graduate psychology students treating seven simulated patients. Clinical micro-skills were measured both using video-based ratings in reaction to short video clips of simulated patients (via the Facilitative Interpersonal Skills (FIS) performance task) and by using video-based ratings within a session with a simulated patient (using the Inventory of Therapeutic Interventions and Skills; ITIS). Two separate LASSO regressions were performed using machine learning to select potential predictors for both skills assessments. Subsequently, a bootstrapping algorithm with 10,000 iterations was used to examine the variability of regression coefficients. Using LASSO regression, we identified two predictors for clinical micro-skills in standardized scenarios: extraversion (b = 0.10) and resilience (b = 0.09), both were not significantly associated with clinical micro-skills. Together, they explained 15% of the skill variation. Bootstrapping confirmed the stability of these predictors. For clinical micro-skills in sessions, only competitiveness was excluded by LASSO regression, and all predictors showed significant instability. The results provide initial evidence that trainees' resilience and extraversion should be promoted in the clinical training of cognitive behavior therapy. More studies on clinical micro-skills and training with larger sample sizes are needed to fully understand clinical development.
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Affiliation(s)
- Jana Schaffrath
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Jana Bommer
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Brian Schwartz
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
| | - Wolfgang Lutz
- Department of Clinical Psychology and Psychotherapy, University of Trier, Trier, Germany
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Zhang J, Li WC, Braithwaite G, Blundell J. Practice effects of a breathing technique on pilots' cognitive and stress associated heart rate variability during flight operations. Stress 2024; 27:2361253. [PMID: 38859613 DOI: 10.1080/10253890.2024.2361253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
Commercial pilots endure multiple stressors in their daily and occupational lives which are detrimental to psychological well-being and cognitive functioning. The Quick coherence technique (QCT) is an effective intervention tool to improve stress resilience and psychophysiological balance based on a five-minute paced breathing exercise with heart rate variability (HRV) biofeedback. The current research reports on the application of QCT training within an international airline to improve commercial pilots' psychological health and support cognitive functions. Forty-four commercial pilots volunteered in a one-month training programme to practise self-regulated QCT in day-to-day life and flight operations. Pilots' stress index, HRV time-domain and frequency-domain parameters were collected to examine the influence of QCT practice on the stress resilience process. The results demonstrated that the QCT improved psychophysiological indicators associated with stress resilience and cognitive functions, in both day-to-day life and flight operation settings. HRV fluctuations, as measured through changes in RMSSD and LF/HF, revealed that the resilience processes were primarily controlled by the sympathetic nervous system activities that are important in promoting pilots' energy mobilization and cognitive functions, thus QCT has huge potential in facilitating flight performance and aviation safety. These findings provide scientific evidence for implementing QCT as an effective mental support programme and controlled rest strategy to improve pilots' psychological health, stress management, and operational performance.
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Affiliation(s)
- Jingyi Zhang
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
| | - Wen-Chin Li
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
| | - Graham Braithwaite
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
| | - James Blundell
- Safety and Accident Investigation Centre, Cranfield University, Bedfordshire, UK
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Lee MS, Kim SJ, Chae JH, Bhang SY, Lee M, Kim HB, Huh HJ. Pilot Study About the Effects of the Soma Experiencing Motion (Soma e-Motion) Program on Interoceptive Awareness and Self-Compassion. Psychiatry Investig 2023; 20:284-292. [PMID: 36990672 PMCID: PMC10064203 DOI: 10.30773/pi.2022.0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/07/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE The purpose of this study was to examine the effects of the Soma experiencing motion (Soma e-motion) program on interoceptive awareness and self-compassion among novices. METHODS A total of 19 adults (clinical group=9, non-clinical group=10) participated in the intervention. Psychological and physical changes after program were qualitatively analyzed using in-depth interviews. The Korean Multidimensional Assessment of Interoceptive Awareness (K-MAIA) and the Korean version of the Self-Compassion Scale (K-SCS) were used as quantitative measures. RESULTS The non-clinical group showed statistically significant differences in the K-MAIA scores (z=-2.805, p<0.01) and K-SCS scores (z=-2.191, p<0.05); however, the clinical group showed no significant differences (K-MAIA: z=-0.652, p>0.05; K-SCS: z=-0.178, p>0.05). According to the in-depth interviews, the results of the qualitative analysis were categorized into five dimensions (psychological and emotional, physical, cognitive, behavioral, and aspects participants found challenging and needs improvement). CONCLUSION The Soma e-motion program was feasible for improving interoceptive awareness and self-compassion in the non-clinical group. However, further research is needed to investigate the clinical efficacy of the Soma e-motion program for clinical group.
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Affiliation(s)
- Mi-Sun Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Center for School Mental Health, Eulji University, Seoul, Republic of Korea
| | - Sun Je Kim
- Soma Yoga Movement Center, Seoul, Republic of Korea
| | - Jeong-Ho Chae
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Soo-Young Bhang
- Center for School Mental Health, Eulji University, Seoul, Republic of Korea
- Department of Psychiatry, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Mimi Lee
- Department of Psychology, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Hyeong Beom Kim
- Department of Social Welfare, Soongsil University, Seoul, Republic of Korea
| | - Hyu Jung Huh
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Psychiatry, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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Compton L, Schoeneberg C, Drye K, Palen C. Counselor Preparation Using the Revised Trauma Egg and Resiliency Intervention. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2022. [DOI: 10.1080/15401383.2022.2143976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lisa Compton
- Department of Counseling, Regent University, Virginia Beach, Virginia, USA
| | - Corie Schoeneberg
- Department of Counselor Education and Family Studies, Liberty University, Lynchburg, Virginia, USA
| | - Kelly Drye
- Department of Counseling, Regent University, Virginia Beach, Virginia, USA
| | - Cindy Palen
- Department of Counseling, Regent University, Virginia Beach, Virginia, USA
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Salim O, Davidsson E, Carlsson J, Norberg J. The development of facilitative interpersonal skills during 5-year psychology training programs: a cross-sectional study. NORDIC PSYCHOLOGY 2022. [DOI: 10.1080/19012276.2022.2144937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- O. Salim
- Örebro University, Örebro, Sweden
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Ratzon A, Farhi M, Ratzon N, Adini B. Resilience at Work, Burnout, Secondary Trauma, and Compassion Satisfaction of Social Workers Amidst the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095500. [PMID: 35564893 PMCID: PMC9099676 DOI: 10.3390/ijerph19095500] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 12/05/2022]
Abstract
Social workers during the COVID-19 pandemic are at risk due to exposure to varied populations in need, which may impact their resilience, burnout, secondary trauma, and compassion satisfaction. The study assessed resilience at work, burnout, secondary trauma, and compassion satisfaction among social workers in Israel during the first wave of the COVID-19 pandemic (May to June 2020). A convenience sample of 332 social workers (291 women (87.6%)) filled out an online, structured questionnaire that included demographics, a professional quality of life scale (ProQOL) (including three subscales), and resilience at work (RAW) (including seven subscales). The overall mean of the RAW was medium (M = 71, SD ± 8.9) compared to standardized scores. The mean scores of two of the subscales of the RAW, maintaining perspective and staying healthy, were low. The mean scores of the sub-scales of ProQOL were: compassion satisfaction was close to the 50th percentile (M = 48.25); burnout (M = 30.18) and secondary trauma (M = 26.27) were below the 25th percentile. Significant low to medium positive associations were found between all the dependent variables, except for staying healthy. A negative association was identified between compassion satisfaction and burnout, as well as between compassion satisfaction and secondary trauma. High levels of compassion satisfaction and contentment, low levels of secondary trauma, and having a managerial position were predicted to be 40% of the RAW. Lower levels of maintaining perspective, secondary trauma, and being younger predicted 27% of burnout. Higher levels of finding your calling, living authentically, maintaining perspective, interacting cooperatively, being older, and not being a manager predicted 58% of compassion satisfaction. Lower levels of burnout, maintaining perspective, and being younger predicted 36% of secondary trauma. As the COVID-19 pandemic still challenges most societies, policymakers should consider ways to integrate mechanisms that will enhance social workers’ resilience at work.
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Affiliation(s)
- Anva Ratzon
- Independent Researcher, Tel Aviv 6997801, Israel
- Correspondence:
| | - Moshe Farhi
- Social Work Department, Tel-Hai College, Qiryat Shemona 1220800, Israel;
| | - Navah Ratzon
- Occupational Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Bruria Adini
- Department of Emergency & Disaster Management, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
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Stress, resilience and coping in psychological wellbeing practitioner trainees: a mixed-methods study. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
In this study, a convergent parallel mixed-methods design was used to explore stress, resilience and coping in psychological wellbeing practitioner (PWP) trainees (n = 90) at the beginning of their training. Psychometric tests were used to measure levels of self-reported stress, resilience and dispositional coping styles. Open-text survey data regarding the perceived sources of stress at the beginning of training were also qualitatively analysed using thematic analysis (TA). Results indicated that in the early weeks of their training, trainees reported lower levels of resilience and higher levels of stress than those found in the general population. Statistically significant negative correlations were found between stress and resilience, and between stress and the coping styles ‘Planning’, and ‘Active Coping’. Statistically significant positive correlations were found between stress and the coping styles of ‘Denial’ and ‘Focus on and Venting of Emotions’. The qualitative findings provided a context within which to understand these quantitative results. The three themes ‘I can find the unknown quite unsettling’, ‘I question my competences’ and ‘Learning, consolidating and putting it all into practice’ were generated through the qualitative analysis. These themes were connected by an over-arching theme which suggests that the perceived responsibility of the role is an important source of stress for PWP trainees. Implications for future research and the training of PWPs are discussed.
Key learning aims
(1)
To establish the levels and perceived sources of stress in trainee PWPs at the beginning of their training.
(2)
To identify relationships between stress and resilience, and between stress and styles of coping at the beginning of training.
(3)
To use a mixed-methods approach to provide a comprehensive account of stress at the outset of training.
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Matiz A, Crescentini C, Bergamasco M, Budai R, Fabbro F. Inter-brain co-activations during mindfulness meditation. Implications for devotional and clinical settings. Conscious Cogn 2021; 95:103210. [PMID: 34562699 DOI: 10.1016/j.concog.2021.103210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 07/27/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022]
Abstract
Mindfulness meditation usually takes place as personal, introspective activity. It is not known if this practice activates the brain differently when done alone or with someone else. Sixteen couples of expert meditators performed mindfulness-oriented meditation (MOM) and instructed mind-wandering (IMW) tasks in two conditions: once sitting in the same room (SR) and once in two different rooms (DR). Spontaneous electroencephalographic (EEG) data was collected during 7-minute recording sessions in the four experimental settings (MOM/SR, MOM/DR, IMW/SR, IMW/DR). Power in band was computed in separate clusters of independent components of the EEG signals. In addition to significant task effects, found in frontolimbic (MOM > IMW in gamma) and frontoparietal locations (MOM < IMW in theta), significant condition effects were found in frontal (SR > DR in delta) and in temporo-occipital regions (SR > DR in theta and alpha). Moreover, a significant interaction between task and condition revealed higher gamma activity in limbic areas during MOM/SR vs. MOM/DR settings. This effect was not attributable to gender, age nor the meditation expertise of participants. We thus show that the brains of two people work differently when they are doing something together or alone; some of these differences are specific to mindfulness meditation. Implications for devotional and clinical settings are discussed.
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Affiliation(s)
- Alessio Matiz
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy; Perceptual Robotics (PERCRO) Laboratory, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Cristiano Crescentini
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy.
| | - Massimo Bergamasco
- Perceptual Robotics (PERCRO) Laboratory, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Riccardo Budai
- Department of Neuroscience, University-Hospital "S. Maria della Misericordia", Udine, Italy.
| | - Franco Fabbro
- Department of Languages and Literatures, Communication, Education and Society, University of Udine, Udine, Italy; Perceptual Robotics (PERCRO) Laboratory, Scuola Superiore Sant'Anna, Pisa, Italy.
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Deisenhofer AK, Meyer L, Schaffrath J, Weinmann-Lutz B, Poster K, Bennemann B, Prinz J, Lutz W. Vermittlung psychotherapeutischer Fertigkeiten durch die Arbeit mit Simulationspatientinnen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2021. [DOI: 10.1026/1616-3443/a000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: In der Ausbildung von Psychotherapeutinnen konnte bereits ein subjektiver Kompetenzgewinn durch die Arbeit mit Simulationspatientinnen (SP) belegt werden. Fragestellung: Neben der Replikation dieser Befunde, welche auf Selbstberichten basieren, untersuchte vorliegende Studie die objektive Behandlungsintegrität von Studierenden anhand von Beobachterratings. Methode: Die Stichprobe setzte sich aus 39 Studierenden aus 4 Fallseminaren zusammen. Zur Validierung der objektiven Behandlungsintegrität wurde eine Vergleichsstichprobe von Psychologischen Psychotherapeutinnen in Ausbildung (PPiA) herangezogen (Videos N = 763). Zusätzlich wurden Charakteristika der Studierenden hinsichtlich ihrer prädiktiven Fähigkeiten untersucht. Ergebnisse: Die Ergebnisse belegten neben einem selbstberichteten Kompetenzzuwachs auch eine zufriedenstellende objektive Behandlungsintegrität, die signifikant niedriger ausfiel als die der PPiA. Zusätzlich konnten Prädiktoren für die Behandlungsintegrität identifiziert werden. Schlussfolgerungen: Die Ergebnisse zeigen, dass Studierende Therapiesituationen, die ihrem Novizen-Status entsprechen, in zufriedenstellendem Maße ausgestalten können.
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Affiliation(s)
| | - Lukas Meyer
- Fachbereich I – Psychologie, Universität Trier
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11
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Was macht Psychotherapeuten erfolgreich? Psychother Psychosom Med Psychol 2020; 70:533-534. [PMID: 33271608 DOI: 10.1055/a-1230-0564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Wakefield S, Kellett S, Simmonds‐Buckley M, Stockton D, Bradbury A, Delgadillo J. Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 60:1-37. [DOI: 10.1111/bjc.12259] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 05/14/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Sarah Wakefield
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
| | - Stephen Kellett
- University of Sheffield and Sheffield Health and Social Care NHS Foundation Trust UK
| | | | | | - Abigail Bradbury
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
| | - Jaime Delgadillo
- Clinical Psychology Unit Department of Psychology University of Sheffield UK
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McDevitt-Petrovic O, Shevlin M, Kirby K. Modelling changes in anxiety and depression during low-intensity cognitive behavioural therapy: An application of growth mixture models. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 59:169-185. [PMID: 31696972 DOI: 10.1111/bjc.12237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 10/05/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Research largely supports the clinical effectiveness of low-intensity cognitive behavioural therapy (LICBT) for mild-to-moderate anxiety and depression, delivered by psychological well-being practitioners (PWPs). Knowledge regarding the predictors of treatment response, however, is relatively limited. The primary aim of this study was to model the heterogeneity in longitudinal changes in anxiety and depression throughout LICBT provided by PWPs in Northern Ireland (NI), and to explore associations between pre-treatment variables and differences in treatment response. METHODS Growth mixture modelling (GMM) techniques were employed to examine changes in psychological status in clients (N = 253) over the first six sessions of treatment, to identify divergent early response trajectories. A series of pre-treatment variables were used to predict class membership using chi-square tests and binary logistic regression models. RESULTS There was one class representing improvement and one representing no improvement for both anxiety and depression. Class membership was predictive of treatment outcome. Pre-treatment variables associated with less improvement included unemployment, risk of suicide, neglect of self or others, using medication, receiving previous or concurrent treatments, a longer duration of difficulties, and comorbidities. CONCLUSIONS Findings indicate most of the sample populated an 'improvers' class for both depression and anxiety. Pre-treatment variables identified as predictive of poor treatment response may need to be considered by practitioners in potential triage referral decision policies, supporting cost-effective and efficient services. Further research around predictors of clinical outcome is recommended. PRACTITIONER POINTS Most of the sample belonged to an 'improvers' class. Several pre-treatment variables predicted poor treatment response (unemployment, suicide risk, neglect, medication, previous or concurrent treatments, longer duration of difficulties, and comorbidities). Few studies have utilized GMM to determine predictors of outcome following LICBT Regarding pre-treatment variables, the possibility of self-report bias cannot be excluded. The time period was relatively short, although represented the optimum number of sessions recommended for LICBT. The lack of a control group and random allocation were the main limitations.
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Heinonen E, Nissen-Lie HA. The professional and personal characteristics of effective psychotherapists: a systematic review. Psychother Res 2019; 30:417-432. [PMID: 31122157 DOI: 10.1080/10503307.2019.1620366] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: Psychotherapists differ notably in the outcomes their patients achieve, and the characteristics that may explain these differences have attracted increasing interest. We systematically review studies on therapist pre-treatment characteristics predicting patient outcomes. Method: Systematic searches on databases for psychotherapy research, clinical psychology, and medical science for the years 2000-2018 identified published research examining therapist characteristics and psychotherapy outcomes. Of 2041 studies, 31 met inclusion criteria. Results: Findings show a few direct effects of therapist intrapersonal variables (e.g., self-relatedness, attachment) and several interaction effects with other constructs (e.g., patient pathology) on outcome. There is little support for the relevance of self-rated social skills. However, more consistent evidence has recently emerged for performance-based measurements of professional interpersonal skills, especially when elicited in challenging situations. Patient outcomes were also predicted by therapists' self-rated professional characteristics, such as their experienced difficulties in practice, coping mechanisms, and attitudes towards therapeutic work, indicating that therapist self-perception also matters, although not always in the direction expected. Conclusions: More effective therapists seem characterized by professionally cultivated interpersonal capacities, which are likely rooted in their personal lives and attachment history. Research guidelines are proposed for moving this field forward (including larger samples, multilevel modeling, and in-depth qualitative work).
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Affiliation(s)
- Erkki Heinonen
- National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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15
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Bennett-Levy J. Why therapists should walk the talk: The theoretical and empirical case for personal practice in therapist training and professional development. J Behav Ther Exp Psychiatry 2019; 62:133-145. [PMID: 30391704 DOI: 10.1016/j.jbtep.2018.08.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/07/2018] [Accepted: 08/19/2018] [Indexed: 12/27/2022]
Abstract
The key proposition of this invited essay is that personal practice (PP), coupled with self-reflection, is central to the development of the most effective therapists. To date, the discussion about personal practice in therapist training and professional development has largely revolved around the value of personal therapy, subscribed to by some schools of psychotherapy but not by others. However, since the turn of the century a new landscape of personal practices for therapists has emerged. In particular, two forms of personal practice, meditation programs and self-practice/self-reflection (SP/SR) programs, have developed a growing evidence base. Here it is proposed that there is now a strong theoretical and empirical case to accord personal practice an explicit role in therapist training and professional development. The case rests on recent research suggesting that: (1) personal and interpersonal qualities of therapists play a key role in client outcomes; and (2) personal practice is the most effective way to achieve changes in therapists' personal and interpersonal qualities. It is suggested that the research agenda needs to move beyond asking whether or not personal practice is effective towards a more sophisticated set of questions: what personal practice, facilitated by whom, is most effective with which practitioners, in what contexts, at what point in time? To make further progress, trainers and researchers need to be supported to include personal practices in therapist training and to undertake research to evaluate their impacts.
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Affiliation(s)
- James Bennett-Levy
- University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia.
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Delgadillo J, Saxon D, Barkham M. Associations between therapists' occupational burnout and their patients' depression and anxiety treatment outcomes. Depress Anxiety 2018; 35:844-850. [PMID: 29719089 DOI: 10.1002/da.22766] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 03/17/2018] [Accepted: 03/31/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Occupational burnout is common in mental health professionals, but its impact on patient outcomes is as yet uncertain. This study aimed to investigate associations between therapist-level burnout and patient-level treatment outcomes after psychological therapy. METHODS We used multilevel modeling using depression (PHQ-9) and anxiety (GAD-7) outcomes data from 2,223 patients nested within 49 therapists. Therapists completed a survey including the Oldenburg Burnout Inventory (OLBI) and a job satisfaction scale (JDSS). RESULTS After controlling for case-mix, around 5% of variability in treatment outcomes was explained by therapist effects (TE). Higher therapist OLBI-disengagement and lower JDSS scores were significantly associated with poorer treatment outcomes, explaining between 31 and 39% of the TE estimate. Higher OLBI scores were also correlated with lower job satisfaction ratings. CONCLUSIONS Therapist burnout has a negative impact on treatment outcomes and could be the target of future preventive and remedial action.
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Affiliation(s)
- Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom.,Centre for Psychological Services Research, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - David Saxon
- Centre for Psychological Services Research, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, United Kingdom.,Centre for Psychological Services Research, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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17
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Johns RG, Barkham M, Kellett S, Saxon D. A systematic review of therapist effects: A critical narrative update and refinement to review. Clin Psychol Rev 2018; 67:78-93. [PMID: 30442478 DOI: 10.1016/j.cpr.2018.08.004] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the therapist effects literature since Baldwin and Imel's (2013) review. METHOD Systematic literature review of three databases (PsycINFO, PubMed and Web of Science) replicating Baldwin and Imel (2013) search terms. Weighted averages of therapist effects (TEs) were calculated, and a critical narrative review of included studies conducted. RESULTS Twenty studies met inclusion criteria (3 RCTs; 17 practice-based) with 19 studies using multilevel modeling. TEs were found in 19 studies. The TE range for all studies was 0.2% to 29% (weighted average = 5%). For RCTs, 1%-29% (weighted average = 8.2%). For practice-based studies, 0.2-21% (weighted average = 5%). The university counseling subsample yielded a lower TE (2.4%) than in other groupings (i.e., primary care, mixed clinical settings, and specialist/focused settings). Therapist sample sizes remained lower than recommended, and few studies appeared to be designed specifically as TE studies, with too few examples of maximising the research potential of large routine patient datasets. CONCLUSIONS Therapist effects are a robust phenomenon although considerable heterogeneity exists across studies. Patient severity appeared related to TE size. TEs from RCTs were highly variable. Using an overall therapist effects statistic may lack precision, and TEs might be better reported separately for specific clinical settings.
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Affiliation(s)
- Robert G Johns
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK
| | - Michael Barkham
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK.
| | - Stephen Kellett
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK
| | - David Saxon
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield S10 2TN, UK
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18
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Bennett-Levy J, Finlay-Jones A. The role of personal practice in therapist skill development: a model to guide therapists, educators, supervisors and researchers. Cogn Behav Ther 2018; 47:185-205. [DOI: 10.1080/16506073.2018.1434678] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- James Bennett-Levy
- University Centre for Rural Health, University of Sydney, Lismore, Australia
| | - Amy Finlay-Jones
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia
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19
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Winblad NE, Changaris M, Stein PK. Effect of Somatic Experiencing Resiliency-Based Trauma Treatment Training on Quality of Life and Psychological Health as Potential Markers of Resilience in Treating Professionals. Front Neurosci 2018; 12:70. [PMID: 29503607 PMCID: PMC5820455 DOI: 10.3389/fnins.2018.00070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/29/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Individuals who treat trauma are at significant risk of vicarious traumatization and burnout. Somatic Experiencing® (SE®) is a resiliency-focused trauma treatment modality designed to address autonomic nervous system (ANS) dysregulation and its impacted physical health and mental health symptoms e.g., anxiety, depression, post-traumatic stress disorder, migraines, fibromyalgia, and chronic fatigue, etc. The SE® training supports the development of clinical skills to reduce physical health/mental health symptoms as well as increase clinician resilience. Individuals who display resilience often have increased experiences of well-being (quality of life) and decreased levels of self-reported psychological symptoms. Greater resilience could mitigate the risks to providers and the clients they treat. Materials and Methods: This within-groups, longitudinal study assessed students (N = 18) over the course of a 3-year SE® practitioner training. This training focuses on increased ANS, physical, and emotional regulation skills. The convenience of a web-based survey allowed for: measures of a general quality of life (WHOQOL-BREF), psychological symptoms, somatic, anxiety, and depressive symptoms (PHQ-SADS), as well as a measure of early life exposure to adversity (CDC/Kaiser Permanente ACE Score Calculator Questionnaire). The clinician survey was conducted yearly for 3 years. Future studies would do well to also include laboratory-based objective measures of ANS functioning. Results: ANOVA with repeated measures showed that there were significant reductions in anxiety symptoms (GAD7, p < 0.001) and somatization symptoms (PHQ15, p < 0.001). Health-related quality of life (a measure of physical well-being) and social quality of life (a measure of interpersonal well-being) both increased significantly (Health QoL p = 0.028; Social QoL p = 0.046). Conclusions: Results suggest that professionals attending the 3-year SE® training course experience a significant improvement in self-reported measures associated with resiliency including: quality of life (well-being) and psychological symptoms (anxiety and somatization). Our results support the importance of future research in a larger sample and support the exploration, cross-sectionally and prospectively, of the relationship of clinician resiliency and changes in clinician resiliency with SE® training and clinical outcomes. These data have implications for other professions at risk of exposure to vicarious trauma (VT) including nurses, medical providers, and paramedics.
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Affiliation(s)
- Neal E Winblad
- Private Pracitce Truama and Developmental Trauma Specialist, Pleasanton, CA, United States
| | - Michael Changaris
- Health Psychology Department, Integrated Health Psychology Training Program, The Wright Institute, Berkeley, CA, United States
| | - Phyllis K Stein
- Heart Rate Variability Laboratory, Cardiovascular Division John T. Milliken Department of Medicine, School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
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20
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The Therapist's Role in Effective Therapy: Three Key Priorities for Research. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 44:729-731. [PMID: 28466370 DOI: 10.1007/s10488-017-0804-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Goldberg SB. Why mindfulness belongs in counseling psychology: A synergistic clinical and research agenda. COUNSELLING PSYCHOLOGY QUARTERLY 2017. [DOI: 10.1080/09515070.2017.1314250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Simon B. Goldberg
- Department of Counseling Psychology, University of Wisconsin – Madison, Madison, WI, USA
- Center for Healthy Minds, University of Wisconsin – Madison, Madison, WI, USA
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22
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Development and Evaluation of Cognitive Analytic Guided Self-Help (CAT-SH) for Use in IAPT Services. Behav Cogn Psychother 2017; 45:266-284. [PMID: 28325165 DOI: 10.1017/s1352465816000485] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is a lack of treatment plurality at step 2 of Improving Access to Psychological Therapies (IAPT) services. This project therefore sought to develop and pilot a cognitive analytic informed guided self-help treatment for mild-to-moderate anxiety for delivery by Psychological Wellbeing Practitioners (PWPs). METHOD Medical Research Council treatment development guidelines were used. Phase I included development of the six-session treatment manual using practice guidelines, small-scale modelling (n = 3) and indicated manual iterations. Phase II consisted of a mixed methods case series design (n = 11) to index feasibility, uptake and clinical outcomes. RESULTS Cognitive analytic guided self-help (CAT-SH) met established quality parameters for guided self-help. A high treatment completion rate was observed, with 10/11 patients who attended the first treatment session subsequently completing full treatment. Six out of ten patients completing full treatment met reliable recovery criteria at follow-up. Effect sizes and recovery rates equate with extant PWP outcome benchmarks. Practitioner feedback indicated that delivery of CAT-SH was feasible. CONCLUSION CAT-SH shows promise as a low-intensity treatment for anxiety, and so further, larger and more controlled evaluations are indicated.
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