Towards an empirically grounded model of psychotherapy training: Four thousand therapists rate influences on their development

The interplay between mentalization, personality traits and burnout in psychiatry training: Results from a large multicenter controlled study

BACKGROUND

A better characterization of educational processes during psychiatry training is needed, both to foster personal resilience and occupational proficiency.

METHODS

An adequate coverage of medical residents at the national level was reached (41.86% of the total reference population, 29 out of 36 training centers-80.55%). Controls were recruited among residents in other medical specialties. All participants were assessed by questionnaires to evaluate early life experiences, attachment style, personality traits, coping strategies, emotional competencies. A Structural Equation Model (SEM) framework was employed to investigate the interplay between individual factors.

RESULTS

A total sample of 936 people was recruited (87.9% response-rate; 645 residents in psychiatry, 291 other medical residents). Psychiatry trainees reported a higher prevalence of adverse childhood experiences (emotional abuse, emotional neglect, physical neglect), greater attachment insecurity (anxious or avoidant) in comparison to other medical trainees. Psychiatry residents also reported higher social support-seeking as a coping strategy, lower problem-orientation, and lower transcendence. Lower neuroticism, higher openness to experience, and higher emotional awareness were also observed in psychiatry trainees. Psychiatry training was associated with a redefinition of conflict management skills as a function of seniority. The SEM model provided support for an interplay between early traumatic experiences, mentalization skills (coping strategies, emotion regulation), interpersonal competencies and occupational distress.

CONCLUSIONS

The findings of the present study supported a theoretical model based on mentalization theory for the interactions between personal and relational competencies in psychiatry training, thus providing potential target of remodulation and redefinition of this specific process of education.

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.

Perceived professional development of Chinese psychotherapy trainees: a pilot study

For more than 30 years counselling and psychotherapy services in China have progressed rapidly. Currently, various Chinese universities, hospitals, official mental health centres, and private mental health service organizations provide psychotherapy training programs. However, little is known about Chinese psychotherapy trainees and their development. This pilot study investigated the characteristics and perceived professional development of 20 Chinese trainees during and after an advanced training program for psychosomatic medicine and psychotherapy, which is a collaboration project between Peking Union Medical College Hospital and the Department of Psychosomatic Medicine and Psychotherapy from the University Medical Center Freiburg in Germany. Trainees completed questionnaires from the SPRISTAD (Society for Psychotherapy Research Interest Section on Therapist Training and Development) study at the beginning (T1), at the end (T2), and one year after finishing the program (T3). Seventeen of the twenty participants were clinicians. Trainees reported a prominent rise of Currently Experienced Growth throughout the training period, which nearly dropped to the baseline level after the training, although Retrospective Career Development showed a trend of an overall increase. Both ‘experience in therapy with patients’ and ‘participation in courses or seminars’ were the most important positively perceived sources of influence on trainees’ development. This implies the importance of continuous psychotherapy training for the development of therapists during their career. Future research with a larger sample size should also assess trainees’ development from the viewpoint of trainers, supervisors, and patients.

Group cohesion in group-based personal practice

BACKGROUND

Personal practice (PP) is an integral component of many psychotherapy training programmes. It aims to promote personal and professional growth and is often conducted in a group format (g-PP). Group cohesion is one of the most researched mechanisms in group psychotherapy, but has rarely been studied in the context of g-PP.

AIMS AND METHOD

This exploratory study examines the associations between cohesion, satisfaction with g-PP, its impact on personal and professional development, and theoretical orientation in a sample of n = 329 German psychotherapy trainees. Cohesion was assessed with the group questionnaire (GQ-D; Positive Bonding, Positive Working, Negative Relationship).

RESULTS

Overall, participants reported high levels of all outcome variables. Positive Bonding was the strongest predictor of satisfaction with g-PP (β = 0.46, p<.001). While trainees in cognitive behaviour therapy reported significantly better cohesion scores (d≥0.31), trainees in psychodynamic therapy reported significantly higher satisfaction with g-PP and its impact on their developments (d≥0.30).

CONCLUSIONS

Group cohesion appears to be an important factor in g-PP that should be actively promoted by group leaders. However, longitudinal study designs are needed to better understand the emergence of cohesion in g-PP as well as potential moderating factors.

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.

Die „Facilitative interpersonal skills“-Übung – Messen therapeutischer Kompetenz mit der deutschsprachigen Version

Hintergrund

Sowohl für die Erforschung von Therapeuteneffekten als auch für die Aus- und Weiterbildung ist es von hoher Bedeutung, interpersonelle Fähigkeiten von Psychotherapeuten zu messen. Eines der wenigen dafür zur Verfügung stehenden Instrumente ist die Facilitative-interpersonal-skills(FIS)-Übung.

Ziele der Arbeit

1. Vorstellung der FIS-Übung, 2. Prüfung der psychometrischen und deskriptiven Eigenschaften und 3. Untersuchung der Zusammenhänge des FIS-Gesamtwerts mit Alter, Geschlecht und Ausbildungsstand der Testteilnehmer.

Material und Methoden

In die Querschnittsuntersuchung wurden Psychologiestudierende und Psychologen in psychotherapeutischer Ausbildung eingeschlossen. Die Teilnehmer sollten in der FIS-Übung auf herausfordernde Therapiesituationen, die in 13 Videoclips nachgestellt sind, verbal reagieren. Die audioaufgezeichneten Reaktionen wurden von je 3 geschulten Ratern eingeschätzt.

Ergebnisse

Der durchschnittliche FIS-Gesamtwert der 115 Studienteilnehmer (Alter: M = 31,97 Jahre, SD ± 7,94 Jahre; weiblich: n = 90, 78,3 %; in psychotherapeutischer Ausbildung: n = 72, 66,1 %) betrug 3,24 (SD ± 0,42). Die Reliabilität erwies sich als gut (Intraklassen-Korrelationskoeffizient[ICC]2FIS-Gesamtwert = 0,69; Cronbachs α = 0,958). Unter den Videoclips befanden sich 3 signifikant leichtere und 4 schwierigere. Über die Clips hinweg wurden sowohl ein Lern- als auch ein Ermüdungseffekt ersichtlich. Ausbildungskandidaten erzielten signifikant höhere Werte als Psychologiestudierende.

Diskussion

Die FIS-Übung erwies sich in einer größeren Stichprobe als reliabel. Es sollten mindestens 3 und maximal 9 Clips eingesetzt werden, die je nach Ausbildungsstand der Durchführenden und Clip-Schwierigkeit ausgewählt werden können. Die FIS-Übung ist zur standardisierten, empirisch fundierten Messung interpersoneller therapeutischer Fähigkeiten in Forschung und in der Aus- und Weiterbildung von großem Nutzen.

Manifestações Emocionais do Terapeuta Durante as Sessões: Por que Arriscar-se e Quais Benefícios Esperar?

Resumo A teorização contemporânea enfatiza o envolvimento emocional do terapeuta no relacionamento terapêutico. O objetivo desse estudo é compreender como esse envolvimento se dá na prática clínica e por que terapeutas escolham esse caminho. Foi desenvolvido um estudo a partir de entrevistas a 14 terapeutas, com perguntas sobre como utilizam suas emoções em sessão e quais benefícios visam com essa ação. A análise e categorização dos dados encontrados foram pautadas nos preceitos da Grounded Theory Analysis. Os resultados sugerem que terapeutas expõem suas emoções em sessão com objetivo de diagnóstico e como intervenção terapêutica, promovendo comportamentos alvo e maior consciência de processos interpessoais no cliente. Para o terapeuta, trabalhar com suas emoções pode acarretar em transformações tanto pessoais quanto profissionais. Em uma relação emocionalmente próxima, aberta e genuína no consultório, não só o cliente, mas também o terapeuta é transformado. Assim, a mudança que ocorre no processo terapêutico não deve ser pensada como um processo unilateral.

A qualitative investigation of the nature of "informal supervision" among therapists in training

Objective: This study investigated how, when, why, and with whom therapists in training utilize "informal supervision"-that is, engage individuals who are not their formally assigned supervisors in significant conversations about their clinical work. Method: Participants were 16 doctoral trainees in clinical and counseling psychology programs. Semi-structured interviews were conducted and analyzed using the Consensual Qualitative Research (CQR) method. Results: Seven domains emerged from the analysis, indicating that, in general, participants believe that informal and formal supervision offer many of the same benefits, including validation, support, and reassurance; freedom and safety to discuss doubts, anxieties, strong personal reactions to patients, clinical mistakes and challenges; and alternative approaches to clinical interventions. However, several differences also emerged between these modes of learning-for example, formal supervision is seen as more focused on didactics per se ("what to do"), whereas informal supervision is seen as providing more of a "holding environment." Conclusions: Overall, the findings of this study suggest that informal supervision is an important and valuable adjunctive practice by which clinical trainees augment their professional competencies. Recommendations are proposed for clinical practice and training, including the need to further specify the ethical boundaries of this unique and essentially unregulated type of supervision. Clinical or Methodological Significance of this article: This is the first study to detail the wide-ranging uses and impact of "informal supervision," with significant clinical implications for psychotherapy training, education, and development, including a proposal for legitimizing and integrating informal supervisory practice into doctoral training programs, and an important discussion of ethics. Thus, this paper highlights the diverse range of important ways that trainees use "informal supervision" throughout their training to enhance their clinical and professional development. Results of our study show that "informal supervision" is a ubiquitous and often secretive practice that is a valuable complement to, rather than replacement for, formal supervision. Several important differences between these modes of learning (formal versus informal supervision) are also discussed.

Nutzung von psychometrischem Feedback als empirische Unterstützung des Supervisionsprozesses bei Ausbildungstherapien

Zusammenfassung. Theoretischer Hintergrund: Trotz der gut belegten generellen Wirksamkeit von Psychotherapie wird die Zahl der Patienten, die nicht auf eine Therapie ansprechen oder sich sogar im Verlauf verschlechtern, auf etwa ein Drittel geschätzt. Da Therapeuten im Vergleich zu empirischen Algorithmen weniger gut in der Lage sind negative Entwicklungen zu entdecken oder zu prognostizieren, brauchen sie zusätzliche Unterstützung in Form von kontinuierlichen Rückmeldungen über den Fortschritt ihrer Patienten. Solche Feedbackinterventionen können als empirisch basierte Unterstützung des Supervisions- oder Intervisionsprozesses verstanden werden. Diese Interventionen haben ihre Wirksamkeit zur Reduktion therapeutischer Misserfolge in zahlreichen Einzelstudien und Meta-Analysen wiederholt zeigen können. Fragestellung: Wie nutzen Therapeuten ein solches Feedback in ihrer praktischen Arbeit und in welchem Ausmaß spielen Therapeutenfaktoren dabei eine Rolle? Methode: In der vorliegenden Studie wurden 72 Therapeuten für 648 ihrer Patienten unmittelbar nach der Therapie dazu befragt, wie sie das psychometrische Feedback genutzt haben. Therapeutenunterschiede wurden mittels Mehrebenenmodellen ermittelt. Ergebnisse: Es konnte gezeigt werden, dass Therapeuten für einen Großteil ihrer Patienten das Feedback verwendeten. In etwa einem Drittel der Fälle gab es den Therapeuten den Anstoß zusätzliche Hilfen (z. B. Supervision/Intervision) zu beanspruchen. Ähnlich einer personengestützten Supervision wurde für über die Hälfte der Patienten das Feedback genutzt um therapeutische Interventionen anzupassen. Ob und in welcher Form es genutzt wurde hing jedoch stark von dem Therapeuten ab. Je nach Verwendungsart konnten Therapeutenunterschiede zwischen 27 % und 52 % der Feedbacknutzung erklären. Die Wahrscheinlichkeit, dass Therapeuten die Nutzungsmöglichkeiten des Feedbacks anwendeten war größer, wenn diese angaben im Durchschnitt zufriedener mit den grafischen Rückmeldungen zu sein. Schlussfolgerungen: Diese Ergebnisse machen deutlich, dass es zu einem großen Teil nicht nur vom Therapieverlauf oder den Charakteristika der jeweiligen Patienten abhängt wie Therapeuten das Feedback nutzen, sondern auch von Variablen, die den Therapeuten betreffen.

Struggles of the Novice Counselor and Therapist

The novice journey can be arduous. This article draws from empirical and conceptual literature on counselor and therapist development to describe seven stressors of the novice practitioner. The ambiguity of professional work is the major catalyst for novice stress. The elements are: acute performance anxiety, the illuminated scrutiny of professional gatekeepers, porous or rigid emotional boundaries, the fragile and incomplete practitioner-self, inadequate conceptual maps, glamorized expectations, and an acute need for positive mentors.

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

The Trainees’ Perspective

Few empirical studies have inquired into the process of learning therapeutic skills or have focused on the interaction between trainees and trainers from the trainees’ perspective. We implemented a qualitative study focusing on the experiences of Norwegian therapists’ participation in an empathy training program. The aim of the study was to better understand the trainees’ conception of the learning process. The trainers’ use of an individualized, noncritical, and empathic orientation toward the trainees was reported as important for learning. The trainees reported much strain and considerable challenge when trying to change their therapeutic style. The results are discussed in relation to pedagogical principles of empathy training.

The gap between science and practice: how therapists make their clinical decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists' practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists' choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists' theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.

The divide between "evidenced-based" approaches and practitioners of traditional theories of family therapy

Evidenced-based approaches continue to grow in the field of family therapy. However, practicing family therapists do not always embrace these approaches. In this article, we explore factors contributing to practitioners' concerns with evidence-based treatments and suggest a broader, more clinically palatable view of evidenced-based treatment. We also suggest how family therapy researchers, practitioners, and educators might begin to close the researcher-clinician divide in the best interest of all concerned.

The impact of mentalization training on the reflective function of novice therapists: a randomized controlled trial

This study examined whether training can increase the reflective function (RF) of novice therapists about patients with Borderline Personality Disorder (BPD). A total of 48 students in clinical psychology were randomly assigned to mentalization training or didactic training. Their RF regarding patients was assessed with the Therapist Mental Activity Scale (TMAS: Normandin, Ensink, & Maheux, 2012). The RF of trainees assigned to the mentalization training improved significantly, while participants who received traditional didactic training actually became significantly less reflective. These findings show that brief mentalization training can help beginner therapists develop their mentalization capacities with challenging patients.

Novel unsupported and empirically supported therapies: patterns of usage among licensed clinical social workers

BACKGROUND

While considerable attention has been focused in recent years on evidence-based practice, less attention has been placed on clinical social workers' choice to use ineffective or harmful interventions, referred to in the present paper as Novel Unsupported Therapies (NUSTs).

METHOD

The present study surveyed 400 Licensed Clinical Social Workers (LCSWs) across the United States in order to determine the extent of their usage of NUSTs, as well as their usage of conventional therapies that lacked support and empirically supported therapies (ESTs). Reasons for selecting interventions were also assessed.

RESULTS

While the vast majority (97.5%) reported using some form of EST, 75% of our sample also reported using at least one NUST. Logistic regression analysis revealed that NUST usage was related to female gender and trauma specialization. A split plot ANOVA revealed that respondents rated positive clinical experience higher than published research as a reason for selecting an intervention. LCSWs with a CBT theoretical orientation rated research evidence more highly than those of other theoretical orientations. However, even within the group of LCSWs with a CBT orientation, clinical experience was rated more highly than research evidence.

CONCLUSIONS

Implications for practice are discussed.

Couple therapy research and the practice of couple therapy: can we talk?

As has been true in every other realm of psychotherapy, couple therapy research generally has had very little impact on the day-to-day practice of couple therapists. To a significant degree, this unfortunate disconnection may be attributable to an overemphasis by researchers in the field on treatment packages and therapeutic methods/techniques. Insufficient attention has been paid to other important sources of influence on treatment outcomes, especially the couple therapist herself/himself. It is argued that effective couple therapy requires a good "fit" between the person of the therapist and her primary theoretical orientation, and that couple therapists may be more influenced by research that addresses process aspects of the therapeutic approaches to which they have their primary theoretical allegiances.