Engagement With Self‐Practice/Self‐Reflection as a Professional Development Activity: The Role of Therapist Beliefs

Reliability of the Reflective Essay Marking Scale (REMS): a scale for marking of students’ reflective essays

Personal practice (PP) is widely practised and a requirement across major psychology and psychotherapy organizations and modalities. However, one of the challenges for training institutions is how to assess the quality of such PP. The Reflective Essay Marking Scale (REMS) was developed to improve standardization of marking reflective essays in cognitive behavioural psychotherapy (CBT) training. A small sample of 16 expert CBT participants recruited by email used the REMS to rate two mock reflective essays in a within-subjects design. The internal consistency of REMS was acceptable (Cronbach’s α=.73) with excellent inter-rater reliability. Across the raters, it sufficiently differentiated quality (t12=4.91; p<.0001). Although these are the results of a preliminary and very small study with a small sample using mock essays, the REMS may be a useful scale, allowing CBT courses to account for students’ reflective work in a standardized way. A larger validation study is required in the future.

Key learning aims

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

BACKGROUND

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

AIMS

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Maladaptive therapist schemas in CBT practice, training and supervision: A scoping review

BACKGROUND

Maladaptive therapist schemas are hypothesized to generate difficulties within cognitive behavioural therapy (CBT) practice, training and supervision. Without adequate identification and management, they negatively affect the cognitions and emotions of the therapist, leading them to behave in ways that risk ruptures or therapy and supervision being delivered in a suboptimal fashion. Consequently, there is a need to synthesize the research that has been undertaken to date on the content, prevalence, identification and management of maladaptive therapist schemas.

METHOD

A scoping review was undertaken of studies that have been published since 2001 on the impact of maladaptive therapist schemas (also referred to interchangeably as beliefs or cognitions) in CBT practice, training and supervision. Thirteen studies were identified in a literature search from four electronic databases, a reference list search of identified articles and hand searches.

RESULTS

Three overall themes were identified in the research: (1) prevalence of therapist schemas, (2) specific therapist beliefs and (3) therapist characteristics associated with the delivery of suboptimal CBT or supervision. While there is little empirical support for therapist schemas, therapist resistance and beliefs relating to the fear of using exposure therapy were identified. Therapist intolerance of uncertainty and self-esteem were recurrent factors.

CONCLUSION

There is no consensus on how to define, identify, formulate or respond to maladaptive therapist beliefs or schemas in clinical practice, training or supervision. Further research is needed to better understand their origins, maintaining factors and appropriate management of their impact.

Conceptualizing the complexity of reflective practice in education

In higher education, reflective practice has become a dynamic, participatory, and cyclical process that contributes to educators’ professional development and personal growth. While it is now a prominent part of educators, many still find it challenging to apply the concept for it carries diverse meaning for different people in different contexts. This article attempts to (re)conceptualize the complexity of reflective practice in an educational context. Scholars in this field have taken different approaches to reflective practice, but all these approaches consist of four main components in common: (i) reflecting; (ii) planning for future action; (iii) acting; and (iv) evaluating the outcomes. We extend the existing literature by proposing a model which integrates these four components with three key aspects of reflection: problem-solving, action orientation, and criticality. The novelty of this model lies within its alignment of the three key aspects with different levels of criticality in a comprehensive framework with detailed descriptors provided. The model and its descriptors are useful in guiding individuals who directly or indirectly involve in critical reflection, especially educators, in appraising their levels of criticality and consequently engage in a meaningful reflection.

Exploring CBT therapists’ experience of feeling of safety within self-practice/self-reflection: an interpretative phenomenological analysis

Self-practice/self-reflection (SP/SR) is an experiential training strategy implemented to develop the skills of CBT therapists through the self-application of CBT techniques and subsequent reflection on the experience in relation to clinical practice. Outcome studies report significant personal and professional benefits from SP/SR but engagement studies suggest that CBT therapists’ experience is mixed. In order to inform the design and implementation of SP/SR within CBT, this study aims to explore CBT therapists’ experience of feeling of safety (FOS) within SP/SR. FOS has been identified as an important engagement factor. Three CBT therapists were interviewed using semi-structured interviews. The data, which took the form of verbatim transcripts, were subjected to interpretative phenomenological analysis. Four superordinate themes relating to participants’ experience of FOS within SP/SR emerged: FOS and its absence as embodied and non-verbal, role of the instructor, awareness of others and venturing beyond safety. Ensuing recommendations for instructors include proactive use of interventions within SP/SR which directly impact embodied FOS, monitoring the wellbeing and engagement of participants through awareness of physical cues and employment of measures designed to promote a sense of equality among group members. Areas of future research include exploration of factors which influence FOS, investigation of the effect on FOS of pre-existing relationships within the SP/SR group and review of interventions which are currently used by SP/SR instructors to promote FOS.

Key learning aims

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Measuring therapist cognitions contributing to therapist drift: a qualitative study

Therapist beliefs have been identified as a contributing factor to ‘therapist drift’ in cognitive behavioural therapy (CBT). Scales have been developed to measure therapist beliefs, but none explicitly measure ‘therapy-interfering cognitions’, and there is no research on their usage. The aim of this study was to explore how best to conceptualise such a scale’s content and usage, based on clinicians’ perceptions and experiences of current scales. Three focus groups were conducted, involving 12 participants who were either qualified or trainee CBT therapists. Transcripts were analysed using thematic analysis. Four main themes were generated: (1) The Awareness and Importance of Cognitions, (2) Factors Fuelling Therapist Cognitions, (3) Addressing Therapist Cognitions, and (4) Using the Scale. Participants thought it important to be aware of and address therapist cognitions (not underlying beliefs). Participants emphasised that therapist cognitions are not just products of the individual, but are influenced by external factors. A scale could enable therapists to do better work through reflective practice, as long as it was used not just to identify cognitions but also to support changes in therapist behaviour. A scale could also meet a perceived need for making this part of routine practice. However, participants discussed how therapists might have reservations about disclosing cognitions in this way. Recommendations for current practice, and future research developing such a scale, are made.

Key learning aims

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

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

‘Courses for Horses’: designing, adapting and implementing self practice/self-reflection programmes

Self-Practice/Self-Reflection (SP/SR) has been proposed both as an adjunct to therapy training programmes, and also as a means for therapist development among experienced therapists. Research suggests it develops aspects of knowledge and skill that may not be addressed through other training methods. With increasing interest in SP/SR, a growing evidence base regarding both participant benefits and potential risks from SP/SR, and the development of SP/SR programmes across a range of therapeutic modalities, we argue it is timely to identify a set of principles that can guide the design, adaptation and implementation of SP/SR programmes. At this stage, there is little empirical evidence to guide trainers wishing to implement SP/SR in different contexts. Accordingly, these principles have been derived from reflection on developing, testing and implementing SP/SR programmes as well as on other training and supervisory experience. The first set of principles detailed in Section 1 draw on various theories of learning and development and frame the processes involved, the next principles speak to the content of SP/SR programmes, and the final principles address structure. Within Section 2, the principles are then considered for their practical implications. In Section 3, the sharing of what are initially private self-reflections is then considered together with some implications for SP/SR programmes, especially when there is assessment involved. We argue that SP/SR will continue to progress with well-designed standard programmes, careful implementation, thoughtful adaptation, ongoing innovation, and especially more evaluation.

Key learning aims

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