Therapist Feelings of Incompetence and Suboptimal Processes in Psychotherapy

Assessment of professional self-efficacy in psychological interventions and psychotherapy sessions: Development of the Therapist Self-Efficacy Scale (T-SES) and its application for eTherapy

OBJECTIVE

This study aimed to develop the Therapist Self-Efficacy Scale (T-SES), and test its validity in a sample of Italian mental health therapists, to assess their professional self-efficacy concerning their practice of eTherapy in a synchronous video-based setting.

METHODS

A sample of 322 Italian mental health professionals (37.6% psychologists, 62.4% psychotherapists; M_age  = 38.48, SD = 8.509) completed an online survey.

RESULTS

The T-SES showed a clear, one-factor structure with good psychometric properties. Significant associations were found with insight orientation, general self-efficacy, self-esteem, and personality traits of openness, conscientiousness, and agreeableness. The results showed no differences between psychologists and psychotherapists, or differences based on years of experience.

CONCLUSION

The T-SES is an agile and versatile self-report measure for mental health professionals to assess their self-efficacy concerning their therapeutic activity, which can provide information for tailoring training for eTherapy.

Introducing the QACP: development and preliminary validation of an instrument to measure psychotherapist's core competencies

The movement towards the conceptualization, description and evaluation of psychotherapists' competencies has been widely developed in the last years and has relevant implications for psychotherapy, training, and continuous education. In Italy, this movement has been supported by the Committee for Psychotherapists' Competencies established in 2010 by FIAP (Italian Federation of Psychotherapy's Associations) and CNSP (National Association of Psychotherapy's Training Institutes) and has involved more than 1000 psychotherapists from different approaches, by means of conferences, expert meetings, workshops, and focus groups. One of the outcomes of this process has been the development of a new self-assessment tool for core competencies (i.e., those that are shared by therapists from all modalities): the QACP (Questionario per l'Autovalutazione delle Competenze dello Psicoterapeuta). The present study aims to present the process of development and the preliminary proofs of the validity of this tool. Construct and knowngroup validity of the questionnaire were examined, and reliability was estimated by computing the internal consistency reliability coefficients for both the overall and the subscale scores. Overall, the instrument showed satisfactory psychometric characteristics. The limitations of the study and the results are discussed and directions for further research are proposed.

What about the therapist? – a quantitative exploration of the pathways from a therapist’s professional life to their personal well-being

Occupational stress has been identified as one of the biggest contributors to therapists’ poor mental well-being; however, these ‘wear and tear’ effects are not universal. This study aimed to distinguish between these experiences, by exploring potential avenues through which a therapist’s professional life may impact their well-being. Previous research has highlighted four avenues: self-doubt, developmental depletion, developmental growth, and years of experience. A sample of 65 cognitive behavioural therapists were recruited from four Improving Access to Psychological Therapies (IAPT) services and a cognitive behavioural therapy training course at Buckinghamshire New University. A quantitative cross-sectional survey design was employed. Each participant completed a questionnaire consisting of subscales of the ‘Development of Psychotherapist Common Core Questionnaire’ to measure potential avenues (Orlinsky et al., 1999a), and the Warwick-Edinburgh Mental Well-being Scale to measure mental well-being (Tennant et al., 2007). A multiple regression and post-hoc mediation analyses were conducted. The multiple regression analysis found three significant direct pathways predicting well-being: self-doubt, developmental depletion, and developmental growth. The post-hoc mediation analyses found two significant indirect pathways between self-doubt and well-being mediated by developmental experience (growth and depletion). Years of experience had a non-significant direct and indirect pathway predicting well-being. The results suggested that therapists experiencing more growth, less depletion and less self-doubt experienced more positive mental well-being than those experiencing depletion and self-doubt, and less growth. When therapists experience high self-doubt, whether they also experience depletion or growth, they experience poor mental well-being. The implications for practice and future avenues of research are discussed.

Key learning aims

(1)

Kompetenzerleben von Psychotherapeut_innen im Umgang mit Kindern und Jugendlichen mit Gewalterfahrungen und Traumafolgestörungen

Zusammenfassung. Theoretischer Hintergrund: Die psychotherapeutische Versorgung von Kindern und Jugendlichen mit psychischen Störungen nach Gewalterfahrungen ist ungenügend. Zu ihrer Verbesserung wird eine routinemäßige Exploration von Gewalterfahrungen und Traumafolgestörungen und eine evidenzbasierte Behandlung empfohlen. Behandelnde berichten jedoch Unsicherheiten und Befürchtungen dahingehend. Fragestellung: Beeinflusst das therapeutische Kompetenzerleben das konfrontative Vorgehen, den Einbezug von Bezugspersonen, die berufliche Belastung und das Interesse an Weiterbildungen? Methode: 323 Psychotherapeut_innen nahmen an der Online-Umfrage teil. Zur Beantwortung der Fragestellung wurde ein Strukturgleichungsmodell spezifiziert und geprüft. Ergebnisse: Ein höheres Kompetenzerleben ist mit einem konfrontativeren Vorgehen, einem häufigeren Einbezug von Bezugspersonen und einer geringeren beruflichen Belastung assoziiert, nicht jedoch mit einem geringeren Weiterbildungsinteresse. Organisatorische Aspekte werden als häufigste Gründe gegen Weiterbildungen genannt. Diskussion und Schlussfolgerung: Es ergeben sich praktische Implikationen für die inhaltliche und organisatorische Gestaltung von Weiterbildungen und Supervisionen.

What Novice Family Therapists Experience During a Session… A Qualitative Study of Novice Therapists' Inner Conversations During the Session

"What do novice family therapists experience during a session with a couple or family?" This is the central question in this article. A videotape-assisted recall procedure was used to study novice family therapists' inner conversations. The therapists' reflections were analyzed using thematic analysis. This resulted in a coding system that distinguishes four main domains: (a) reflections concerning the self; (b) reflections about the therapy process; (c) reflections on emotions about the family members; and (d) managing the session as well as own emotions. The study furthermore revealed that during a session, novice family therapists experience strong emotions, such as self-criticism and irritation. Both emotions may encompass dangers, as well as opportunities for the therapeutic alliance and the process.