Psychotherapist Trainees' Quality of Life: Patterns and Correlates

While psychotherapists are trained to improve their clients' quality of life, little work has examined the quality of life experienced by psychotherapist trainees themselves. Yet their life satisfactions and stresses would plausibly affect both their ability to learn new skills and conduct psychotherapy. Therefore, in the Society for Psychotherapy Research Interest Section on Psychotherapist Development and Training study, we investigated the patterns of self-reported life quality and their correlates in a multinational sample of 1,214 psychotherapist trainees. A comprehensive questionnaire was used at the outset of trainings to assess trainees' professional background, current life situation, personal characteristics, family background, and social and national origin. The findings indicated 54.3% of trainees' lives could be characterized as fortunate or happy (i.e., experiencing great life satisfaction and not much stress), whereas 14.3% could be characterized as clearly distressed or troubled (i.e., experiencing great life stress and not much satisfaction). The strongest correlates of high life stress, a contributor to poor life quality, were economic insecurity, self-protectiveness, and attachment-related anxiety in relationships, and economic or psychological hardship in childhood. In turn, greater wellbeing was most strongly associated with a warm and open interpersonal style, being married, having sufficient economic means, and material and emotional security in childhood. While the results indicate the majority of therapists experience a relatively good quality of life, the findings also suggest potential targets for increasing trainees' life quality when it may be deficient, such as those on a societal level (e.g., availability of low-cost student loans), training program level (e.g., promoting supportive supervision, positive between-trainee relationships and group collaboration), and individual level (e.g., personal therapy and learning self-care), in order to promote effective learning and therapy practice.

[Psychotherapy training in Austria: Baseline and socio-demographic background data from a SPRISTAD (Society of Psychotherapy Research Interest Section on Therapist Training and Development)-Pilotstudy]

Objectives: Description of the qualifications of psychotherapy-training candidates in Austria at the beginning of their training. Methods: Psychotherapists in training in Austria were interviewed at the beginning of their training concerning their socio-demographic background and prior education. These background data were collected using the Trainee Background Information Form (TBIF), which was designed by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (SPRISTAD). Results: The group of 197 psychotherapy trainees from Austria consists largely of women, of persons with high school education and with a satisfactory, financially secure life situation. One-third of them show a "second career" pattern, which is in line with the predominantly part-time training programs in Austria. A high percentage of the candidates have previous professional experience in the psychosocial field. Conclusions: As this is a pilot study, results can be seen as a starting point for further research in psychotherapy training and competence development. In discussing the findings, both national conditions and opportunities for future interdisciplinary research are considered.

The personal self of psychotherapists: Dimensions, correlates, and relations with clients

OBJECTIVE

The personal self of psychotherapists, that is, experiences of self in close personal relationships and its association with therapists' individual and professional attributes is explored. The study aimed to: (a) describe therapists' self-ratings on specific self-attributes; (b) determine their dimensionality; (c) explore demographic, psychological, and professional correlates; and (d) assess the convergence with professional self.

METHOD

Data from the Development of Psychotherapists Common Core Questionnaire were available for > 10,000 psychotherapists of various professions, theoretical orientations, career levels, and nations.

RESULTS

Most psychotherapists described themselves in close relationships in affirming terms (e.g., warm/friendly), although a substantial minority also described themselves in negative terms. Factor analyses yielded four dimensions: Genial/Caring, Forceful/Exacting, Reclusive/Remote, and Ardent/Expressive. Being Genial/Caring was associated with life satisfaction. Among professional attributes, personal self-experiences, and parallel dimensions of relationship with clients correlated strongly.

CONCLUSIONS

Analyses of > 10,000 psychotherapists revealed meaningful variations in personal self relevant to personal and professional life.

Lessons from literature for psychotherapy practice and research1

Insights from the study of literature can inform and clarify concepts to guide psychotherapy practice and research. The author offers instances from narrative fiction (Durrell's Alexandria Quartet) and poetry (Hopkins, Baudelaire) to illustrate how the formulation of experience in words that are evocative (vs. ordinary), original (vs. trite), and precise (vs. approximate) are able to capture attention, move the emotions, and challenge beliefs; and how linkages among experiences, vividly and precisely expressed, create and enhance narrative meaning-revealing the inherent relativity of individual meanings and the need to consider the aggregate of relevant perspectives in every interpersonal situation.

Psychotherapists Growing Older: A Study of Senior Practitioners

A sample of 1,102 psychotherapists aged 60 years and older was selected from the multinational database of the Society for Psychotherapy Research Collaborative Research Network. These older therapists were first described in terms of gender, generation, years in practice, civil status, professional background, and theoretical orientation. To compare them on practice-related characteristics with cohorts of younger therapists, the following age-based taxonomy was developed: young adult (21 < 30); prime adult (30 < 45); mature adult (45 < 60); senior adult (60 to 90). Senior adults were further differentiated into young old (60 to 66), mid old (67 to 74), and long old (75 to 90). Comparisons between therapist age groups were made regarding practice setting, quality of therapeutic involvement, current use of supervision and personal therapy, currently experienced professional growth, personal life quality, and perceived aspects of self in close personal relationships. Given a series of positive results favoring senior adults as a group, and even long old compared to young old, it is suggested that these hardy "surviving" therapists typically have succeeded in mastering the developmental tasks of previous phases of professional development.

Professional development perceptions and activities of psychiatrists and mental health nurses in New Zealand

AIMS

Psychiatrists (n=26) and mental health nurses (n=18) engaged in the practice of psychotherapy were surveyed regarding their perceptions and engagement in professional development activities.

METHODS

Collaborative Research Network's (CRN) methodology was followed, and comparisons with CRN samples from Canada and the United States of America (USA) were undertaken.

RESULTS

New Zealand psychiatrists reported perceived development across their careers, but their ratings were lower than those of nurses. Both professional groups rated their overall development lower their Canadian counterparts. However, New Zealand nurses reported more involvement in supervision than psychiatrists, and both groups reported rates that exceeded those reported in Canadian and USA samples. New Zealand subgroups reported low involvement in personal therapy in comparison to overseas samples. Supervision and personal therapy were highly regarded by New Zealand practitioners, but didactic training was rated as less important.

CONCLUSIONS

New Zealand mental health professionals reported attainment of therapeutic mastery and skill acquisition. New Zealand psychiatrists reported less involvement in case supervision, but rated supervision as having the greatest influence to their development. The results highlight areas of need for continuing professional development for these professions.

Internalization of the therapeutic process: differences between borderline and neurotic patients

Intersession process in psychotherapy refers to the thoughts, memories, and feelings about each other and about their therapy sessions that participants experience during the intervals between sessions. This study compared the intersession process experienced by patients who had been diagnosed with severe borderline personality disorders (BPD) with others who had not. A total of 76 patients with neurotic disturbances and 20 patients with BPD were treated in a therapeutic day clinic and completed the Intersession Experience Questionnaire (IEQ) before sessions of individual psychotherapy and the Session Questionnaire (Stundenbogen) after those sessions. Comparison of the two groups on these measures of intersession process and postsession outcome showed markedly different patterns in patients' evaluations and internalizations of in-session therapeutic experiences: most prominently, that BPD patients internalize therapy sessions with much more negative and contradictory emotions.

Becoming and being a psychotherapist: A psychodynamic memoir and meditation

The author reflects on the circumstances of his becoming a psychotherapist and meditates on their meaning. He notes the effect on his survival through childhood of his grandparents' emigration from Europe and the influence of his close-knit family on his personal needs and values. He then reflects on his early vocational interests; the transformational power of his education, as a student and faculty, at the University of Chicago; and the constructive force of his professional collaboration and personal friendship with Kenneth Howard. Finally, he considers why it is important to him not only to have become but to continue to be a psychotherapist.

Der Inter-Session-Fragebogen (ISF) - Ein Instrument zur Erfassung von psychotherapierelevanten Prozessen zwischen Sitzungen

In the intervals between psychotherapy sessions, patients often make use of the experiences that they have during sessions with their therapists, but these "intersession processes" (ISP) have been largely neglected in psychotherapy research. This study presents a German version of the Intersession Experience Questionnaire (IEQ, Orlinsky et al. ) called the Inter-Session-Fragebogen (ISF). The ISF was used to study a total of 3.778 intersession intervals in 249 therapy episodes involving 229 patients. The factor structure of the ISF appears to be stable over therapy (up to 25 or even 50 sessions), and also over therapy settings (outpatient, day clinic, inpatient). Just as in the original American samples, there were evidently cross-culturally invariant factors like "Recreating the therapeutic situation", "Applying therapy," and "Relationship fantasies". The emotional qualities of ISP are assessed by two independent factors, called "Remoralizing emotions" and "Negative emotions" (regarding therapy). Differences between therapy settings are evident concerning intensity and trajectories of the factor scores over time.

Ironies in the history of psychotherapy research: Rogers, Bordin, and the shape of things that came

This paper discusses Bordin's (1948) contribution to this journal in the context of the historical period in which it was written, in relation to Bordin's later contributions to the field of psychotherapy research, and in anticipation of issues that seem likely to emerge as critical in that field during the coming decades.

Supervisors of Psychotherapy

Levels of supervisory activity and confidence were investigated in relation to a number of therapist characteristics. Analyses of data from more than 1600 therapists of various professions, orientations, and career levels in several countries, two-thirds of whom were resident in Europe, showed that: (1) supervising the work of other therapists becomes a normal part of the professional development of psychotherapists as therapist experience levels increase; (2) supervisory confidence increases noticeably with the initial supervisory experiences, and thereafter increases progressively and slowly; (3) some therapists with little supervisory experience claim high levels of supervisory confidence; and (4) supervisors' confidence about guiding the development of others can not be predicted by the amount of supervision received, or by duration or type of therapist experience, but can be predicted on the basis of self-assessed therapeutic skill and, to some extent, by amount of experience as a supervisor. The results are discussed in the light of existing models of supervisor development.

Psychotherapy research in historical perspective. Implications for mental health care policy

This article is a sketch of the historical development of the field of behavioral and non-behavioral therapy research. Four phases are characterized: (1) establishing scientific research (1927-1954), (2) searching for scientific rigor (1955-1969), (3) expansion and organization (1970-1983), and (4) consolidation and reformulation (1984-present). Continuities between and key developments within successive phases are outlined, with emphasis given to methodological innovations. The corroboration of select findings about process and outcome and the development of several critical discourses within the third and fourth phases have implications for the provision of mental health care and for policy discussions.

[Quality of the therapeutic relationship: do common factors in psychotherapy correspond with common characteristics of psychotherapists? SPR Collaborative Research Network]

In view of the great diversity to be found among psychotherapists in many countries in terms of professional background, theoretical orientation, and other personal and demographic characteristics, it is surprising to find certain areas of great commonality. Among the most striking of these are therapists' reports of their ideals and perceptions concerning their manner of relating to their patients. A very large majority of nearly 2,400 therapists surveyed in an on-going study of psychotherapeutic development wanted to and did see their behavior vis-a-vis patients as accepting, friendly, warm, tolerant, committed, and involved. These traits, which indicate a strong proclivity toward forming a positive therapeutic bond or alliance, also closely match qualities that therapists perceive in their own personal relationships. Discussion of these findings focuses on the possible sources and therapeutic consequences of this common pattern of interpersonal behavior.

Clinically relevant outcome research in individual psychotherapy. New models guide the researcher and clinician

How can we design relevant psychotherapy research? The answer must be shaped by the objectives and potential consumers of such research. For over 40 years, “does psychotherapy work?” (Eysenck, 1952) held the attention of psychotherapy researchers, and randomised clinical trial methodology seemed the most appropriate empirical option for answering this question. There are now well over 500 studies that attest to the efficacy of psychotherapy (see Smith et al, 1980; Shapiro & Shapiro, 1982; Lipsey & Wilson, 1993, for meta-analytic research summaries); it seems that psychotherapy is one of the best documented medical interventions in history. But the conclusion that psychotherapy “works” is akin to finding that antibiotics “work”. We are left with the daunting task of determining which of the wide variety of treatments (psychotherapies, antibiotics) are appropriate for which variety of illnesses (psychopathologies, infections). Morris Parloff (1982) warned us of this need for specificity in his classic article, “Bambi meets Godzilla”, but our preoccupation with documenting the efficacy of psychotherapy has only recently abated enough to mount empirical studies of such specificity.

Patients' representations of psychotherapy: a new focus for psychodynamic research

This article presents a psychodynamic framework and research methods for investigating the significance of patients' internal representations of therapy-with-their-therapists. In this article, 2 instruments developed for this purpose--the Therapist Representation Inventory and the Intersession Experience Questionnaire--are introduced, and their psychometric characteristics are described. Also, findings from a series of studies conducted with these instruments are summarized. Finally, the types of questions these instruments appear to be well suited to are proposed for addressing in future research.

Patients' representations of psychotherapy: a new focus for psychodynamic research

This article presents a psychodynamic framework and research methods for investigating the significance of patients' internal representations of therapy-with-their-therapists. In this article, 2 instruments developed for this purpose--the Therapist Representation Inventory and the Intersession Experience Questionnaire--are introduced, and their psychometric characteristics are described. Also, findings from a series of studies conducted with these instruments are summarized. Finally, the types of questions these instruments appear to be well suited to are proposed for addressing in future research.

Patterns of psychotherapy utilization

Epidemiologic research indicates that a small minority of patients make the great majority of outpatient mental health visits. This small group of long-term patients constitutes the bulk of psychotherapeutic practice and creates a disproportionate impression on mental health professionals. The authors confirmed this finding by studying 405 patients in a clinical setting with an orientation toward long-term psychotherapy: 68% of the patients attended 26 or fewer psychotherapy sessions, representing 23.3% of the total number of sessions used by all patients; 32% attended more than 26 sessions, representing 77% of the total number of sessions used by all patients.

Conjoint Psychotherapeutic Experience: Some Dimensions and Determinants

In our previous reports we have specified the empirical structure of patients' and therapists' experiences in psychotherapeutic sessions. The present report explores the structure of experience within the therapeutic dyad -- conjoint experience. Seven factors were derived from the reports of 28 patient-therapist pairs. One factor reflected the therapist's approach to his role as a help-giver, and another reflected the patient's approach to her role. Other patterns showed convergent perceptions, while still others showed conjoint experiential processes -- inter-experience. Determinants of these experiences were sought among the personal and social characteristics of the participants. Several clinically suggestive patterns of determinants emerged.

THE THERAPIST'S EXPERIENCE OF PSYCHOTHERAPY: SOME DIMENSIONS AND DETERMINANTS

Eleven dimensions of therapists' experiences during psychotherapy ses- sions were derived, factor analytically, for a sample of 17 therapists. These therapists completed a standard questionnaire after each of 8 or more sessions with 31 female patients. In general, the 11 dimensions reflected various experiences of (a) being helpful towards patients, (b) attempting to deal with difSicult patients, (c) making non-therapeutic responses to patients, and (d) entrapment in personally distressing situations with patients. Personal-social characteristics of patients and therapists were examined as possible determinants of therapist experience. Among other characteristics, patients' employment and marital status, diagnosis and previous treatment, influenced certain therapist experience dimensions-as did therapists' profession, marital status, and personal psychotherapy.