'Am I a good enough therapist?': Self-doubt among speech and language therapists

BACKGROUND

The therapeutic process is fraught with various feelings. This research focused on a specific type of negative feeling, namely self-doubt (SD).

AIM

To explore and characterize the nature of SD among speech and language therapists (SLTs) (the frequency of SD, situations that trigger SD, emotions and thoughts related to SD, and coping strategies) in various stages of occupational experience.

METHODS & PROCEDURES

A total of 267 SLTs answered an online survey. Respondents represented SLTs in all stages of vocational experience, with varying academic degrees, from a variety of employment settings. The survey addressed situations that trigger SD, thoughts, and emotions associated with SD and the background information of the respondents. Frequency distributions of the responses of the participants were determined, and independent-samples Kruskal-Wallis tests were conducted to examine if there were differences between groups that differed in their occupational experience on the frequency of SD, attitudes towards SD and emotions related to SD.

OUTCOMES & RESULTS

Differences were found between SLTs in various stages of professional development in several aspects of SD. Novice SLTs reported significantly higher levels of SD compared with experienced SLTs. In the face of SD, novice SLTs consider career abandonment significantly more than do experienced SLTs. They perceive themselves as a failure when experiencing SD to a significantly greater extent than do more experienced SLTs. In addition, SD is associated with various negative emotions.

CONCLUSIONS & IMPLICATIONS

Self-doubt is a natural professional feeling. It may be harmful especially in the early stages of professional development. Our findings call for support and guidance in the face of SD.

WHAT THIS PAPER ADDS

What is already known on the subject Healthcare professionals report feeling SD. This feeling may have deleterious effects on well-being and career satisfaction and is especially harmful in young therapists. What this paper adds to existing knowledge This study characterizes the nature of SD among SLTs in various stages of occupational experience. Our findings indicate that SD is reported among SLTs at all career stages, especially in novice SLTs. Self-doubt is associated with a range of negative thoughts and emotions, and it may be triggered by various situations. Nonetheless, it is a topic that our respondents rarely learn about. What are the potential or actual clinical implications of this work? Normalising and validating SD is important to SLTs' resilience and may facilitate coping. This may be achieved by learning about the subject of SD in graduate programmes. In addition, mentors should create a safe learning culture to allow sharing SD and challenging situations, especially in the first years of occupational experience.

Self-Differentiation, Psychological Flexibility, and Difficulties in Practice in Social Workers and Social Work Students

Practicing social work involves unique difficulties, which may vary with seniority. This study aimed to identify these difficulties among social workers and social work students and to examine the associations between psychological flexibility (PF), self-differentiation (SF), and difficulties in practice in both groups. Ninety-one social work students and seventy-five social workers completed the following questionnaires: Difficulties in Practice, the Acceptance and Action Questionnaire-II, and Differentiation of Self Inventory. Results showed higher difficulties among social work students regarding their professional competence. Social workers demonstrated higher levels of PF, while no significant difference was found in SF. SF and PF were positively correlated, and both were negatively correlated with difficulties in practice in both groups. Among social work students, a moderating effect of PF was found for the association between SF and difficulties in practice. The current study emphasizes the importance of developing SF and cultivating PF during social work education to enhance professional competence and reduce difficulties in practice.

Definition and Criteria for the Assessment of Expertise in Psychotherapy: Development of the Psychotherapy Expertise Questionnaire (PEQ)

Therapist expertise is a complex, multifaceted, and continually evolving concept. Defining this construct and its constituent components can yield a substantial contribution to the field of psychotherapy, consequently enhancing the comprehension of the fundamental factors that underlie its effectiveness. Within this framework, the present research aimed at developing and assessing the psychometric properties of the Psychotherapy Expertise Questionnaire (PEQ), a self-report measure to assess therapist expertise. A sample of 260 psychotherapists of various theoretical orientations were involved in this research. They completed a survey that included the PEQ as well as other self-reported measures aimed at evaluating personality traits, self-efficacy, self-esteem, and insight orientation. The analysis provided evidence of a good fit for both a correlational model with eight factors and a higher-order model, where the eight subdimensions were grouped into subjective (performance; cognitive functioning; personal and relational qualities of the therapist; therapist self-assessment) and objective (experience; reputation with clients and colleagues; training and professional updating; deontological ethics and setting rules) factors. The eight dimensions, two higher-order factors, and total score all showed excellent levels of internal consistency. Furthermore, significant associations were found between PEQ scores and insight orientation, general self-efficacy, self-esteem, personality traits, and time exercising clinical practice. To conclude, the Psychotherapy Expertise Questionnaire (PEQ) is a valuable, theoretically guided, and psychometrically robust self-report measure designed to assess therapist expertise and its constitutive dimensions. This measure can have practical applications in guiding tailored training and customised supervision.

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

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Psychotherapists' perception of their clinical skills and in-session feelings in live therapy versus online therapy during the COVID-19 pandemic: a pilot study

During the coronavirus disease 2019 (COVID-19) pandemic, many psychotherapists who were used to seeing their patients in face-toface setting adapted to providing therapies online. In the present pilot study, we investigated therapist current experiences of online therapy compared to live therapy. Twenty-nine therapists completed Clinical Skills, Difficulties in Practice, and in-sessions feelings of Flow, Boredom and Anxiety of the Trainee Current Progress Report, giving a score for each item in two different conditions: Live Therapy and Online Therapy. Compared to Live Therapy, in Online Therapy therapists reported significantly less Clinical Skills, whereas Difficulties in Practice did not differ in the considered conditions. With regard to in-sessions feeling, therapists reported significantly lower scores of Boring and higher scores of Flow in Live Therapy compared to Online Therapy, whereas Anxiety did not differed in the considered conditions.

A Mixed-Method Modified Delphi Study toward Identifying Key Elements of Psychotherapy in Iran

PURPOSE

In Iran, psychotherapy is regarded as an effective treatment for psychiatric disorders. However, no previous research has identified the key elements of psychotherapy that may be specific to Iranian society. The current study was conducted in an attempt to identify these elements.

METHODS

A mixed-method modified Delphi approach was used, taking place over several stages during 2017-2018. The first stage involved interviewing 12 experts in psychotherapy to identify key elements of psychotherapy in Iran by thematic analysis. Then, successive Delphi rounds were conducted to obtain consensus (75% agreement) from 70 psychotherapy experts on these key elements.

RESULTS

Key elements of psychotherapy were grouped into the following themes: (1) systematic education/training; (2) psychotherapist competency; (3) psychotherapy reflective of Iranian societal needs; and (4) the substrate (scientific/ethical principles) of psychotherapy. Consensus was reached during two Delphi rounds. In Delphi round 1, 52.8% of the statements reached consensus, and all remaining statements reached consensus in round 2.

CONCLUSIONS

The key elements of psychotherapy in Iran are a set of conditions for the education and training of competent psychotherapists who can perform psychiatric interventions appropriate to Iranian society under supervised rules. These should serve as a framework for improving the current delivery of psychotherapy in Iran.

Rule Emission: A Possible Variable for Improved Therapeutic Practice

It has been suggested that achieving greater effectiveness in psychotherapeutic treatment requires analyzing what therapists actually do and say, how they do this and when it is done. Based on this approach, in this study we focused on the rules emitted by therapists, since providing rules is thought to be of fundamental importance in promoting effective and efficient clinical change. Specifically, we sought to determine whether the experience level of therapists and the brevity of therapy would be related to patterns of therapist rule emission as categorized by the Category System of Rules emitted by the Therapist (SISC-RULES-T) (Vargas-de la Cruz & Pardo-Cebrián, 2014). Greater therapist experience and shorter therapy duration were found to be reliably predictive of more rule emissions across most rule categories (Z values between: Z = -3.68 and Z = -2.05; p values: p < .05 and p < .001). These variables were also predictive of more emissions of rules that specified all three operant contingency elements (situation, behavior, and consequence) rather than fewer elements (Z = -2.59, p < .05; Z = -2.26, p < .05). In the expert therapists and therapist with shorter cases, there was a nonsignificant tendency for the emission of general and conceptual rules to increase over sessions whereas emissions of concrete and particular rules tended to decrease; the explicitness of the three contingency elements also tended to decrease as treatment progressed. These findings may help to identify verbal characteristics of therapists that could lead to improved therapeutic practice.

Cross-Cultural Research on Psychotherapy: The Need for a Change

Psychotherapy models, some of which now have a history over a century, have been practiced worldwide. However, considering that the most prevalently applied psychotherapy models are the products of Western culture, questioning the extent of these models’ effectiveness and efficiency for people belonging to diverse cultural backgrounds is legitimate. No doubt, ethno-cultural groups living in Western multicultural societies will interact with Western culture more deeply compared with people living in non-Western countries; therefore, to also think that their needs will differ is reasonable. In this case, the quantity and quality of the required adaptations may also change. Although a promising number of studies exist on intercultural adaptations necessitated by the needs of multicultural societies, the literature on the effectiveness of these models in the non-Western world and the local psychotherapy models is quite limited. One important question is whether psychotherapy models can be adapted to address non-Western cultures without transforming their fundamental assumptions, and if so, can this be conducted efficiently? With these questions in mind, the aim is to review the current state of scientific studies on psychotherapy practices in various cultures. In addition, considering the large spectrum of cultural migration taking place in modern days and the difficulty of receiving mental health services in underdeveloped countries, the importance of adapted and local psychotherapy research has been emphasized and some suggestions for consideration in future research have been made.

The Journey of the Counselor and Therapist: Research Findings and Perspectives on Professional Development

This article summarizes a reformulation of the main findings and perspectives from a cross-sectional and longitudinal qualitative study of the development of 100 counselors and therapists. The results are presented as a phase model and as a formulation of 14 themes of counselor/therapist development. The following six phases are described: The phases of the lay helper, the beginning student, the advanced student, the novice professional, the experienced professional, and the senior professional. The themes describe central processes of counselor/therapist development. The themes are addressing different issues such as shifts in attentional focus and emotional functioning, the importance of continuous reflection for professional growth, and a life-long personal/profession integration process. Sources of influence for professional functioning and development are described. The results show consistently that interpersonal experiences in the personal life domain (early family life

Multiple Factors in the Development of the Expert Counselor and Therapist

Expertise in counseling and therapy is both desirable and elusive. Increasing our knowledge about expertise in counseling and therapy enhances understanding of the role it plays in our profession. This understanding has the potential to improve the training of counselors and therapists. Yet expertise in counseling and therapy appears to be a multifaceted and dynamic concept needing further definition and description. In this article, we outline challenges faced trying to describe expertise in counseling and therapy and present research-based factors that contribute to developing expertise in counseling and therapy. Important factors include: experience, personal characteristics of the counselor and therapist, cultural competence, and comfort with ambiguity.

Creating a Space for Acknowledgment and Generativity in Reflective Group Supervision

Small group supervision is a powerful venue for generative conversations because of the multiplicity of perspectives available and the potential for an appreciative audience to a practitioner's work. At the same time, the well-intentioned reflections by a few practitioners in a room can inadvertently duplicate normative discourses that circulate in the wider culture and the profession. This article explores the use of narrative practices for benefiting from the advantages of group supervision while mindful of the vulnerability that comes with sharing one's work among colleagues. The reflective group supervision processes described were modified from the work of Tom Andersen and Michael White to provide a venue that encourages the creative multiplicity of group conversation while discouraging unhelpful discourses which constrain generative conversation.

Does interpersonal behavior of psychotherapy trainees differ in private and professional relationships?

Aim: The present study aimed to evaluate the effect of trainees’ interpersonal behavior on work involvement (WI) and compared their social behavior within professional and private relationships as well as between different psychotherapeutic orientations.

Methods: The interpersonal scales of the Intrex short-form questionnaire and the Work Involvement Scale (WIS) were used to evaluate two samples of German psychotherapy trainees in psychoanalytic, psychodynamic, and cognitive behavioral therapy training. Trainees from Sample 1 (N = 184) were asked to describe their interpersonal behavior in relation to their patients when filling out the Intrex, whereas trainees from Sample 2 (N = 135) were asked to describe the private relationship with a significant other.

Results: Interpersonal affiliation in professional relationships significantly predicted the level of healing involvement, while stress involvement was predicted by interpersonal affiliation and interdependence in trainees’ relationships with their patients. Social behavior within professional relationships provided higher correlations with WI than private interpersonal behavior. Significant differences were found between private and professional relation settings in trainees’ interpersonal behavior with higher levels of affiliation and interdependence with significant others. Differences between therapeutic orientation and social behavior could only be found when comparing trainees’ level of interdependence with the particular relationship setting.

Conclusion: Trainees’ interpersonal level of affiliation in professional relationships is a predictor for a successful psychotherapeutic development. Vice versa, controlling behavior in professional settings can be understood as a risk factor against psychotherapeutic growth. Both results strengthen an evidence-based approach for competence development during psychotherapy training.

The relationship between continuing education and perceived competence, professional support, and professional value among clinical psychologists

INTRODUCTION

Continuing education is one of the means by which professionals maintain and increase their level of competence. However, the relationship between continuing education and the professional's sense of personal competence and other practice-related variables remains unclear. This study examined practicing psychologists' continuing education activities and how these relate to feelings of perceived competence, professional value, and professional support.

METHODS

Psychologists (n = 418) licensed to practice in Quebec were surveyed by pencil-and-paper mail-in survey concerning their continuing education activities, as well as their perceptions of their competence in practice, and their feelings of being professionally valued and professionally supported.

RESULTS

Results indicated that feelings of competence in practice were related to professional reading, taking courses/workshops, years being licensed, and attending psychology conferences/conventions. Feelings of professional value were related to age and participating in psychology networking groups, and feelings of professional support were related to participating in case discussion groups, supervision groups, and psychology networking groups.

DISCUSSION

The results showcase the complexity of professional development. Although relationships were found between continuing education activities and the 3 factors of interest, these relationships were moderate. Findings are discussed in the context of their value to individual psychologists, as well as to psychology licensing and regulatory boards, such as promoting participation in those activities related to feelings of competence and support.

Evaluation of a Therapeutic Concept Diagram

Documentation used in psychotherapy for quality assurance can be useful, but also time consuming and inflexible. In the process of behavior analysis, therapy planning and conducting therapy, a large amount of clinical data have to be structured and organized. We present an economical documentation method that contains information about the most important causes of problem behavior and expectations about how much certain therapy components will achieve the therapist and client therapy aims. This documentation method can assist therapy planning, serve as a communicative tool for colleagues and supervisors, serve as an educational tool for clients, and be utilized as a self-reflective therapy discourse (quality assurance). The paper describes and pilots the use of a transtheoretical, graphic approach, the therapeutic concept diagram, for the above-mentioned aspects of quality assurance. Four experienced analytic therapists and six experienced cognitive-behavioral therapists documented therapeutic concept diagrams for five clients each. These 50 recorded therapeutic concept diagrams are described. In general, the diagrams were rated as useful for documentation and treatment planning. Ratings of the diagrams as a communicative tool and for a self-reflective therapy discourse were heterogenic, with analytical therapists tending to benefit more. The discussion focuses on application settings and limitations and highlights the heuristic value of assessing idiographic hypotheses.

Definitions of homework, types of homework, and ratings of the importance of homework among psychologists with cognitive behavior therapy and psychoanalytic theoretical orientations

A random sample of 827 psychologists were surveyed to assess their definitions of homework, use of homework tasks, and perceived importance of homework. Theoretical orientation distinguished practitioners' responses. Cognitive-behavioral therapists defined homework as being closer to empirically supported therapy, whereas psychodynamic therapists rated homework as less characteristic of a process that embraces client responsibility and adaptive skills. Cognitive-behavior therapists did not limit their choices to activity-based tasks, and psychodynamic therapists reported using behavioral tasks "sometimes." Monitoring dreams and conscious thought were also used among the entire sample surveyed. Psychodynamic therapists rated homework as "somewhat" or "moderately" important, whereas cognitive-behavior therapists more often rated homework as "very important." Data suggest some homework may be common to different psychotherapeutic approaches. Findings are discussed in the context of recent theoretical work on homework in psychotherapy and recommendations for future research.