Listening quality leads to greater working alliance and well-being: Testing a social identity model of working alliance

OBJECTIVES

Characterization of psychotherapy as the "talking cure" de-emphasizes the importance of an active listener on the curative effect of talking. We test whether the working alliance and its benefits emerge from expression of voice, per se, or whether active listening is needed. We examine the role of listening in a social identity model of working alliance.

METHODS

University student participants in a laboratory experiment spoke about stress management to another person (a confederate student) who either did or did not engage in active listening. Participants reported their perceptions of alliance, key social-psychological variables, and well-being.

RESULTS

Active listening led to significantly higher ratings of alliance, procedural justice, social identification, and identity leadership, compared to no active listening. Active listening also led to greater positive affect and satisfaction. Ultimately, an explanatory path model was supported in which active listening predicted working alliance through social identification, identity leadership, and procedural justice.

CONCLUSIONS

Listening quality enhances alliance and well-being in a manner consistent with a social identity model of working alliance, and is a strategy for facilitating alliance in therapy.

Implementing a resilience coach program to support first year housestaff during the COVID-19 pandemic: early pilot results and comparison with non-housestaff sessions

BACKGROUND

In response to the COVID-19 pandemic, we launched the Penn Medicine Coping First Aid program to provide psychosocial supports to our health system community. Our approach leveraged lay health worker volunteers trained in principles of Psychological First Aid to deliver coaching services through a centralized virtual platform.

METHODS

We emailed all (n = 408) first year housestaff (i.e., residents and fellows) with an invitation to schedule a session with a resilience coach. We compared the mental health concerns, symptoms, and Psychological First Aid techniques recorded in (n = 67) first year housestaff sessions with (n = 91) sessions of other employees in the health system.

RESULTS

Between June and November 2020, forty-six first year housestaff attended at least one resilience coaching session. First year housestaff most commonly presented with feelings of anxiety and sadness and shared concerns related to the availability of social support. Resilience coaches most frequently provided practical assistance and ensured safety and comfort to first year housestaff. First year housestaff reported fewer physical or mental health symptoms and held shorter sessions with resilience coaches than non-housestaff.

CONCLUSIONS

This work offers insights on how to address psychosocial functioning through low-intensity interventions delivered by lay personnel. More research is needed to understand the efficacy of this program and how best to engage housestaff in wellness and resilience programs throughout training, both during and beyond COVID-19.

Improving Clinical Competence Through Simulated Training in Evidence-Based Practice for Stuttering: A Pilot Study

PURPOSE

The purpose of this pilot study was to determine the effectiveness and acceptability of an initial module (1.1; active listening skills) of the Simulated Training in Evidence-Based Practice for Stuttering (STEPS) program, a theory-driven, multimodule, content and learning platform designed to advance knowledge and skills in working with culturally and linguistically diverse persons who stutter of all ages.

METHOD

Fifteen preservice speech-language pathologists (SLPs) were randomly assigned to complete either the STEPS 1.1 module or a control module. In both conditions, all participants engaged in pre- and post-clinical interviews with a standardized patient portraying a parent of a child who stutters. Prior to participation, all participants provided self-ratings on the Jefferson Scale of Physician Empathy-Health Profession Student. Post participation, trained observers rated all participants' active listening behaviors using the Active Listening Observation Scale-Modified. Post participation, the STEPS 1.1 participants also completed an intervention acceptability questionnaire.

RESULTS

No differences between groups were found in self-perceived clinical empathy prior to participation. Participants who completed the STEPS 1.1 condition utilized paraphrasing and client-directed eye gaze significantly more frequently at posttest than at pretest and significantly more than the control group at posttest. Quantitative and qualitative responses from the participants who completed STEPS 1.1 indicated high acceptability of its content, structure, duration, and perceived impact.

CONCLUSION

Preliminary data from the present pilot study support use of the STEPS 1.1 module to improve preservice SLPs' use of skills that have been shown to predict perceived clinical empathy and increase assessment and treatment effectiveness.

Impact of Providing Peer Support on Medical Students’ Empathy, Self-Efficacy, and Mental Health Stigma

Background: Peer-support programs in medical school can buffer feelings of inadequacy, anxiety, social isolation, and burnout, drawing upon the benefits of near-peer-support resources. This study examined the effects of providing support to students in a medical school peer-support program. Methods: Using a pre-post, quasi-experimental study design, the investigators surveyed medical students who were peer supporters in their second through fourth years of medical school with four measures assessing (1) empathy, (2) self-efficacy, (3) mental health stigma, and (4) likelihood to assist peers with mental health problems to examine if serving as a volunteer peer supporter had any effect. Participants included 38 medical students that were actively enrolled peer supporters during the 2020–2021 year at a United States allopathic medical school. Results: Medical students who participated as peer supporters were found to have higher ratings of empathy scores (Z = −1.964, p = 0.050, r = 0.34) and self-efficacy scores (Z = −2.060, p = 0.039, r = 0.35) after participation in the program. No significant changes were noted for mental health stigma or likelihood to assist peers with mental health problems. Discussion: Peer-support programs present a low-cost, sustainable modality to promote wellbeing in medical students. There is a growing body of literature documenting the benefits of peer-support services. This brief, novel study examined the effects of providing peer support on the peer supporters and found higher self-reported ratings of empathy and self-efficacy after participation. These findings underscore peer-support programs as a valuable wellness resource not only for medical students who use the services but for those who provide them as well.

Implementation of the Wolverine Mental Health Program, Part 2: Implementation Phase

To enhance mental health care for youth in a midwestern residential treatment facility, Wolverine Human Services partnered with the Beck Institute (an intermediary) and an implementation research team to implement cognitive-behavioral therapy (CBT). CBT has strong evidence supporting effectiveness for treating youth internalizing and externalizing problems, but it is a complex psychosocial intervention that demands a thoughtful implementation approach. This study outlines the implementation phase (2.5 years) of a 5-year collaborative effort. The implementation phase focused on (a) adapting CBT to fit the complex youth needs and the roles of the multidisciplinary team members resulting in a new comprehensive and coordinated care model, and (b) the strategies utilized to support its competent integration by all team members. Six blended implementation strategies were deployed in this phase: forging implementation teams, installing progress monitoring, adapting CBT, training, providing supervision and consultation, and training the trainers. A components-based approach to CBT yielded six core skills: active listening, problem solving, mood monitoring and intervention mapping, activity scheduling, distress tolerance, and cognitive restructuring. By the end of this phase, all staff had robust exposure to and experience with the adapted form of CBT. The work of our academic-community partnership has both research and clinical implications, with respect to integrating an adapted version of CBT for residential environments (CBT-RE).

Integrating video-modeling into counseling skills and techniques course and its impact on counseling self-efficacy

Counselor education requires a comprehensive curriculum including entry-level courses as counseling skills and techniques which foster students’ basic knowledge in counseling and perceived counseling self-efficacy (CSE). Counselor candidates are provided opportunities to observe skills and techniques in practice through video modeling (VM) as one of the most favored teaching methods. The use of VM is not a common method in counselor training in Turkey; therefore, first aim of the current study was to investigate how VM-integrated counseling skills and techniques course affected students’ perceived counseling techniques efficacy and CSE. The second aim was to gain a deeper understanding of the use of VM as a teaching method in this course. A mixed-methods sequential explanatory design was used. The research setting of the current study was the undergraduate counseling skills and techniques course that integrated 10 previously developed short videos about counseling techniques or processes. There were 41 third-year students enrolled in this course who participated in the study (quantitative phase). Seven voluntary students (out of 41) participated in the focus group (qualitative phase). The paired samples t-test was applied to analyze the effectiveness of VM and the content analyses were conducted to examine qualitative data. Results showed that the VM-integrated course increased students’ perceived efficacy in using techniques and general CSE. Results of the focus group were categorized under four themes and provided critical insights to better understand the factors leading to increased self-efficacy. The results of this study were discussed in the light of previous literature on counselor education.

Can high quality listening predict lower speakers' prejudiced attitudes?

Theorizing from humanistic and motivational literatures suggests attitude change may occur because high quality listening facilitates the insight needed to explore and integrate potentially threatening information relevant to the self. By extension, self-insight may enable attitude change as a result of conversations about prejudice. We tested whether high quality listening would predict attitudes related to speakers' prejudices and whether self-insight would mediate this effect. Study 1 (preregistered) examined scripted conversations characterized by high, regular, and poor listening quality. In Study 2, we manipulated high versus regular listening quality in the laboratory as speakers talked about their prejudiced attitudes. Finally, Study 3 (preregistered) used a more robust measure of prejudiced attitudes to test whether perceived social acceptance could be an alternative explanation to Study 2 findings. Across these studies, the exploratory (pilot study and Study 2) and confirmatory (Studies 1 & 3) findings were in line with expectations that high, versus regular and poor, quality listening facilitated lower prejudiced attitudes because it increased self-insight. A meta-analysis of the studies (N = 952) showed that the average effect sizes for high quality listening (vs. comparison conditions) on self-insight, openness to change and prejudiced attitudes were, ds = 1.19, 0.46, 0.32 95%CIs [0.73, 1.51], [0.29, 0.63] [0.12, 0.53], respectively. These results suggest that when having conversations about prejudice, high-quality listening modestly shapes prejudice following conversations about it, and underscore the importance of self-insight and openness to change in this process.

Using a Standardized Client Encounter to Practice Death Notification after the Unexpected Death of a Feline Patient Following Routine Ovariohysterectomy

Death notification is an important skill for health care providers to carry out, yet few clinicians feel adequately prepared to complete this task. To address these gaps in clinical training, some medical educators have incorporated standardized patients (SPs) into the curriculum to allow students to practice death notification in a safe, controlled environment. Veterinary educators agree that end-of-life communication skills are essential for success in clinical practice, and many rely on standardized clients (SCs) for role-play concerning euthanasia. However, anticipatory loss is distinct from unexpected death, and death notification is strikingly absent from the veterinary literature. To introduce students to death notification, Midwestern University College of Veterinary Medicine (MWU CVM) developed a communications curriculum that culminated in a scripted encounter, "Basil, the Scottish Fold." Students must explain to an SC that his kitten died following routine ovariohysterectomy. Pre- and post-event surveys completed by 19 students demonstrated valuable lessons in death notification word choice, particularly what not to say. I hope that this teaching tool may be adapted for use by other colleges of veterinary medicine to allow students to practice death notification.

Personal and Job Factors Associated with Teachers’ Active Listening and Active Empathic Listening

Active listening is important for effective interpersonal communication, a prerequisite for successful teaching. The presented cross-sectional study examined personal and work factors associated to active listening in 3.995 Greek schools’ educators of all teaching levels and specialties. The study questionnaire posted on official and main teachers’ portals included personal and working data items, the Active Empathic Listening Scale (AELS), and the Active Listening Attitude Scale (ALAS). Multiple linear regression was used to identify independently associated factors with AELS and ALAS dimensions, and standardized regression coefficients were performed to measure the effect of independent variables. Regarding AELS, gender had the greatest effect on the Sensing subscale, followed by age and mental health promotion training. Years of teaching had the greatest effect on Processing subscale, followed by higher studies. Gender had the greatest effect on Responding subscale, followed by age, higher studies, and mental health promotion training. Concerning ALAS, mental health promotion training and support from colleagues had the greatest effect on Listening attitude subscale, gender and mental health promotion training had the greatest effect on Listening skill subscale, and gender, age, and years of teaching had the greatest effect on Conversation opportunity subscale. The identification of enhancing factors like training in mental health promotion could significantly contribute in designing training that can simultaneously benefit teachers’ skills and students’ psychosocial well-being.

Disaster Mental Health and Community-Based Psychological First Aid: Concepts and Education/Training

Any community can experience a disaster, and many traumatic events occur without warning. Psychologists can be an important resource assisting in psychological support for individuals and communities, in preparation for and in response to traumatic events. Disaster mental health and the community-based model of psychological first aid are described. The National Preparedness and Response Science Board has recommended that all mental health professionals be trained in disaster mental health, and that first responders, civic officials, emergency managers, and the general public be trained in community-based psychological first aid. Education and training resources in these two fields are described to assist psychologists and others in preparing themselves to assist their communities in difficult times and to help their communities learn to support one another.

Teaching Active Listening Skills to Pre-Service Speech-Language Pathologists: A First Step in Supporting Collaboration With Parents of Young Children Who Require AAC

Purpose

This study examined the effect of instruction in an active listening strategy on the communication skills of pre-service speech-language pathologists (SLPs).

Method

Twenty-three pre-service SLPs in their 2nd year of graduate study received a brief strategy instruction in active listening skills. Participants were videotaped during a simulated parent meeting before and after the strategy instruction. Simulated parent meetings addressed issues that parents of children who use augmentative and alternative communication (AAC) may face. Social validity measures were gathered from the participants and from parents of children who use AAC.

Results

Pre- and postinstruction use of the active listening strategy was scored and compared using a Wilcoxon signed-ranks test, with statistically significant results. Postinstruction scores were significantly higher than preinstruction scores, providing evidence of the effectiveness of the instruction. Furthermore, participants and parents of children who use AAC described the postinstruction interactions more positively than the preinstruction interactions, suggesting that the pre-service SLPs benefited from the instruction.

Conclusion

The current study provides evidence of the effectiveness of strategy instruction in active listening skills that may be incorporated into SLP preparation programs.

Final-year veterinary students' perceptions of their communication competencies and a communication skills training program delivered in a primary care setting and based on Kolb's Experiential Learning Theory

Veterinary graduates require effective communication skills training to successfully transition from university into practice. Although the literature has supported the need for veterinary student communication skills training programs, there is minimal research using learning theory to design programs and explore students' perceptions of such programs. This study investigated veterinary students' perceptions of (1) their communication skills and (2) the usefulness of a communication skills training program designed with Kolb's Experiential Learning Theory (ELT) as a framework and implemented in a primary care setting. Twenty-nine final-year veterinary students from the Ontario Veterinary College attended a 3-week communication skills training rotation. Pre- and post-training surveys explored their communication objectives, confidence in their communication skills, and the usefulness of specific communication training strategies. The results indicated that both before and after training, students were most confident in building rapport, displaying empathy, recognizing how bonded a client is with his or her pet, and listening. They were least confident in managing clients who were angry or not happy with the charges and who monopolized the appointment. Emotionally laden topics, such as breaking bad news and managing euthanasia discussions, were also identified as challenging and in need of improvement. Interactive small-group discussions and review of video-recorded authentic client appointments were most valuable for their learning and informed students' self-awareness of their non-verbal communication. These findings support the use of Kolb's ELT as a theoretical framework and of video review and reflection to guide veterinary students' learning of communication skills in a primary care setting.