Influence of personal therapy on learning and development of psychotherapeutic skills

The aim of the present study was to investigate psychodynamic psychotherapists’ experience of the influence of personal therapy on professional growth during training with a focus on the acquisition of knowledge and the development of psychotherapeutic skills. Thematic analysis was conducted on interviews with former students (N=10) at two training institutes for psychoanalytic psychotherapy. The resulting theme “professional subjectivity” indicated that personal therapy was experienced as having a positive effect on learning and growth of professional skill by facilitating the development of a theory- and knowledge-based professional subjectivity, a personally founded, professional attitude. Important elements of this development are “shared experience,” “personal influence,” and “knowledge integration.” The emergence of professional subjectivity proved to be an important factor in terms of professional advancement for future psychotherapists. Finding and relating to their own subjectivity was crucial in the process of developing a personally founded, professional attitude in the clinical work.     

Tips to make research teaching and learning enjoyable and productive for counsellors,psychotherapists and their tutors

This article identifies the learning expectations and experiences of qualified counsellors and psychotherapists undertaking higher education awards with specific regard to research activity. Drawing on the current literature and some early findings from focus group research with students, combined with our personal and professional experiences, we identify what contributes to a productive research experience. This is used as a basis to provide tips for both teachers and those new to research to make counselling and psychotherapy research enjoyable and productive. A full research paper is in preparation.     

Therapist attitudes and countertransference as predictors of professional quality of life and burnout among psychotherapists

This study aimed to examine the role of attitudes towards psychotherapy and countertransference dimensions as predictors of professional quality of life and burnout among psychotherapists in Iran. Participants were 259 psychotherapists who worked in mental health centres in Tehran (Iran), and they completed the Professional Quality of Life questionnaire, the Therapist Response Questionnaire and the Therapist Attitudes Scale. Professional quality of life was associated with countertransference dimensions and attitude towards psychotherapy. This study concludes that psychotherapists can benefit from working on their specific countertransference issues and re-evaluating their basic attitudes towards psychotherapy to achieve the highest levels of professional satisfaction. Culture may play a role in a specific therapist's attitude and difficulties in addressing certain aspects of countertransference.     

Child psychotherapy with looked after and adopted children: a UK national survey of the profession

Relatively little empirical data is available about the range of work undertaken by child psychotherapists in the UK; however, previous surveys have shown high levels of complexity amongst children referred to child psychotherapists and an increasing proportion of work with children in foster or adoptive placements. Aims: We sought to examine child psychotherapists’ working practices with looked after and adopted children (LAAC), including the types of activities undertaken and their views on this work. Method: An online survey was designed to elicit this information from the members of the Association of Child Psychotherapists (ACP), the regulatory body for child psychotherapists in the UK. The survey included a number of categorical and open-ended questions, which were analysed quantitatively and qualitatively. Findings: 215 responses were received (24.5% of the eligible ACP membership). The vast majority of the sample were working with LAAC in some context (87.9%). Respondents were conducting a range of work: the most frequently conducted activities were assessment (83.7%), direct psychotherapy (82.3%), work with foster carers and adoptive parents (80.9%) and consultation with the professional network (76.7%). Thematic analysis of qualitative data suggested the complexity of problems amongst the children attending psychotherapy, as well as the perceived need for long-term work with these children. Many respondents placed emphasis on the importance of working with the professional network around the child, including foster carers and adoptive parents, despite feeling that this was often an under-resourced area of child and adolescent mental health services. The implications of the survey for practice and future research are discussed.     

Exploring the bio-psycho-social

The United Kingdom Council for Psychotherapy (UKCP) was formed to provide a professional body for all psychotherapists in the UK. It maintains a register of trained practitioners who abide by the ethical standards ratified by UKCP, which includes psychotherapists working in all the modalities recognized by UKCP irrespective of their primary professional training. In the absence of statutory registration, there is no fully representative list of UK psychotherapists, but the UKCP register is probably the nearest thing to it. The UKCP board recognized that a survey of registrants would provide a snapshot of the state of UK psychotherapy, which would be valuable in understanding the contribution of psychotherapists to health services in the UK.

A questionnaire was designed, and sent out to all 4005 practitioners registered by UKCP in December 1997. One thousand three hundred and thirty-one questionnaires were returned, a response rate of 34 per cent. The respondents were representative of all registered psychotherapists in 1998 in those characteristics that are published in the paper register, or that can be inferred from it. The respondents were aged 51 years on average, predominantly white (97 per cent described themselves this way) women (69 per cent) practising in London and the South East of England (55 per cent). All the respondents described themselves as being influenced by psychotherapeutic approaches rooted in psycho-analysis. Ninety-five per cent of respondents had another profession previous to psychotherapy. This was most commonly teaching (27 per cent), social work (22 per cent) or counselling (21 per cent). Only 11 per cent of respondents were psychologists.

The contribution of UKCP registrants to the National Health Service has never previously been estimated. A breakdown of the diaries provided by respondents in this survey suggests that UKCP registrants may contribute as many as 44,760 hours of psychotherapy per week to the British National Health Service and other health sectors. Assuming that a whole-time-equivalent psychotherapist works 37 hours per week, this means that UKCP registrants may provide the equivalent work to health service organizations, both public and private, of more than 1,311 full-time psychotherapists.     

Do Psychotherapists with Different Theoretical Orientations Stereotype or Prejudge Each Other?

This study investigates a possible threat to the progress of psychotherapy. It aims to detect and compare stereotyped or even prejudiced views among psychotherapists of different theoretical orientations, building on social psychological theory of in-groups and out-groups. Swedish psychotherapists (n = 416) of four different orientations (psychodynamic, cognitive, behavioural, or integrative/eclectic) used the valuable elements in psychotherapy questionnaire to rate the importance of various elements in psychotherapy. They also estimated how therapists of other orientations would rate these elements. These estimates were then compared with therapists’ actual self-ratings in order to detect patterns of stereotyping or prejudiced views. Psychotherapists exaggerate the differences between their own and other orientations in a stereotyped way, but correctly predict what members of their own orientation (in-group) find important. However, they overestimate how important ‘orientation-typical features’ are to those of other orientations (out-group), indicating a clear tendency to stereotype. Overall, integrative/eclectic therapists’ estimates were less stereotyped than the estimates of therapists of other orientations. A somewhat unexpected finding was that cognitive and behavioural therapists seem more inclined towards stereotyping. The stereotyped views of other theoretical orientations among psychotherapists can be argued to have negative connotations and may thus be seen as prejudices. These prejudices could create irrational and unnecessary obstacles to the development of both the science and the practice of psychotherapy and signal the need for psychotherapists of all orientations to develop a more balanced picture of each other.     

The Initial Psychotherapy Interview with Adolescent Clients

Initial psychotherapy sessions with adolescents can be very challenging due to the need to balance assessment, relationship building, caretaker/parent management, and case formulation with a client population that sometimes has little motivation for psychotherapy. This article combines empirical evidence, theoretical knowledge, and clinical experience to describe strategies for how psychotherapists can prepare themselves for initial psychotherapy sessions and manage tasks associated with five stages of the clinical interview: (a) the introduction, (b) the opening, (c) the body, (d) the closing, and (e) termination. Using case vignettes and short examples, there is an emphasis on how psychotherapists can develop and maintain a strong therapeutic alliance while simultaneously helping adolescent clients focus on psychotherapy tasks and goals. The overall goal of this article is to help psychotherapists smoothly navigate the potentially stormy stages of the initial clinical interview with adolescents.     

The Hope,Promise, and Possibility of Psychotherapy

In this paper, five values—diversity, science, education, practice, and spirit—(a) are examined within the professional context of psychotherapy, (b) are presented as forming the foundation of much if not all that is psychotherapy, and (c) are considered as binding values that join us as a community of practicing, theorizing, and researching psychotherapists. Some of the positives of each value are reviewed. Diversity has heightened our sensitivity to and respect for individual and cultural differences. Science has kept us focused on empirically challenging and empirically informing our practice. Education has maintained emphasis on providing solid training/supervision in psychotherapy and transmitting its culture. Practice has provided us with opportunities to increasingly implement and expand on our role as helpers and healers. Spirit has been the guiding light—the heart and soul—that supports, infuses and informs all of our therapeutic endeavors and gives them meaning. What follows is a celebration of sorts—(a) capturing some of what we have done and are doing right in psychotherapy, (b) reflecting some of the weight of those “right” efforts, and (c) conveying some of the inherent hope, promise, and possibility that forever guide us in our work.     

Integrative counselling and psychotherapy: A relational approach,by Ariana Faris and Els van Ooijen

The movement towards registration of psychotherapists, especially towards statutory registration is under way across Europe. This is seen as a way of ‘protecting the public’ against abusive and/or incompetent psychotherapists. In what follows I argue that the dominant ethos of contemporary psychotherapy is based upon a metaphysics of subjectivism and that registration will reinforce this coercively through the law. My concern is that this subjectivistic notion of psychotherapy compounds the estrangement of soul (psyche) and world; that it continues, by way of rationalization and bureaucratization, the process of the ‘disenchantment of the world’. Psychology and psychotherapy are then ‘logically’ constituted out of this rupture between the psyche and nature. This closes our psychological consciousness off from a deeper ecological awareness and from a critical self-reflection on the way this rupture is maintained in psychological and psychotherapeutic theory and practice.     

Making a case for case studies in psychotherapy training: A small step towards establishing an empirical basis for psychotherapy training

The evidence debate in psychotherapy pays little attention to developing an evidence base for training practices. Understanding effective training requires an examination of what makes training work. This article examines the role of case studies in psychotherapy training. This has not been articulated explicitly or researched systematically in spite of its cardinal importance. An analysis of the role of case studies in psychotherapy training is presented. Reading, watching, or hearing about cases can offer novice psychotherapists access to a closed world; access to psychological theory in action; access to whole courses of therapy; access to different approaches; access to significant moments; access to the therapeutic relationship; access to a wide range of client types; access to working in different contexts; and the opportunity of identifying with therapists and clients. Writing or presenting cases offer students the opportunity of: learning to integrate information into a relevant whole; being in the ‘hot seat’; learning to give appropriate feedback; assessing the validity of interpretations, inferences, and interventions; adapting methods to suit the client; and learning to collaborate with other professionals. The paper presents directions for future research into psychotherapy training, specifically proposing an international survey of training practices at psychotherapy training institutions.     

Israeli Psychotherapy,Politics and Activism: Is There a Way Out of the Trap?

This article examines psychotherapy in context—political, social, cultural and historical. It does so by taking a close look at the Israeli psychotherapeutic community and how it changed over the years. Through this narrative and analysis the author wishes to illustrate how social-political context and professional practices plug into each other. It will be demonstrated how at difficult times when their country faces internal and external hardship and threats, Israeli psychologists have tended to withdraw and, whether unwittingly or not, affirm and support the status quo. This is paradoxical: when mostly needed psychotherapists may become silent and socially or politically passive. A possible way out of this trap, through a change in psychotherapists’ professional position and views, will be discussed. In addition, a politically sensitive alternative will be presented, one that may enable psychotherapists to maintain an independent praxis, which models a proactive and optimistic stance while serving society as agents of personal, social and political change.     

Experiences of psychotherapists transitioning to private practice during COVID-19

The purpose of this qualitative phenomenological study was to gain insight into the lived experiences of psychotherapists transitioning to private practice during the COVID-19 pandemic. With an ever-expanding need for targeted and accessible mental health care, it is vital to understand this phenomenon and how it impacted patient access and care, and the providers themselves. Eighteen licensed psychotherapists were interviewed and their responses highlighted meaningful professional and clinical implications. As a result of the participant interviews, three major themes were identified: (1) the unknown related to COVID-19, (2) ease of transition and (3) work–life balance. Eleven additional subthemes emerged. Results suggested that psychotherapists had various personal and professional stressors exacerbated by the pandemic, along with a desire to balance work and life, manage the changes brought on by the pandemic, and gain or retain autonomy in their professional careers. Ultimately, the results of the study point to some shared experiences among psychotherapists, potential issues of access to psychotherapy, issues related to career satisfaction among psychotherapists, as well as some important areas for future research.     

Examining the role and functions of self-development in healthcare therapy trainings: A review of the literature with a modest proposal for the use of learning agreements

Many healthcare trainings with a psychodynamic orientation encourage or require students to commit to a process of personal development, such as provided through attending individual psychotherapy and/or an experiential ‘as if therapy’ group. This paper reviews recent literature about training in psychodynamically oriented practices within counselling psychotherapy, psychiatry, the creative arts therapies and clinical psychology. The results indicate that the mandatory personal development dimension of therapy training needs urgent reassessment. Results of studies consistently call for further research about the direct benefits of personal development on students’ development of skills for therapy practice. There is minimal evidence to indicate what self-development through individual psychotherapy can specifically deliver in terms of eventual professional competence. To address some aspects of the current lacuna, this paper summarises the recommendations for training programmes available from the current research, and makes a modest proposal for the use of learning agreements, rather than only mandated hurdle requirements, to ensure that the incremental steps by which the student attains expected requirements is negotiated and agreed within regularised, and widely accepted university course procedures.     

Die Therapeutenvariable

Background

The objective of this study was to investigate the therapeutic attitude as a self-contained dimension of the therapeutic process.

Patients and methods

The psychotherapists’ beliefs and attitudes in therapeutic matters are measured according to the Therapeutic Attitude Scales (TASC) of the Therapeutic Attitude Questionnaire (ThAt) and were applied to investigate the therapist variable. The investigation concentrated on the therapist’s belief in the curative value of a number of ingredients of psychotherapy, on the therapist’s individual style of conducting psychotherapy and on basic assumptions about the nature of psychotherapy and the nature of the human mind. A total of 451 psychotherapists (81 psychodynamic psychotherapists, 208 psychoanalytic psychotherapists and 162 behaviour therapists) were investigated.

Results

There were highly significant differences between the three groups of therapists, a finding which is in line with the basic theory. Adaptation and insight of the assumed curative factors as well as supportiveness and neutrality of the technique factors, differentiate the groups highly significantly. The multivariate analysis underlines the importance of adaptation and insight to differentiate between all groups.

Conclusion

The results by and large confirm the general assumptions held on the differences between the groups. Thus the ThAt appears to be a valid instrument to grasp more subtle features of the therapist variable that may influence the outcome of psychotherapy.     

A developmental perspective on psychotherapy process, psychotherapists' expertise, and “Meaning-Making Conflict” within therapeutic relationships: A two-part series

Part I (in this issue)—A Dialectical-Constructivist View of Human Development, Psychotherapy, and the Dynamics of Meaning-Making Conflict Within Therapeutic Relationships— reviews a dialectical-constructivist model of human development and articulates, in the language of that model, how psychotherapy, in general, works. It describes and illustrates three generic processes, which contribute to the frequent successes of an extremely diverse range of psychotherapy theories and practices. This view of psychotherapy focuses on both the client's meaning-making processes and the therapist's meaning-making processes and how they contribute together to effective psychotherapy. Part I also offers a way of understanding what is going on when therapeutic progress is blocked by conflict between the client's and the therapist's meaning-making processes. Part II—Dialectical Thinking and Psychotherapeutic Expertise: Implications for Training Psychotherapists and Protecting Clients from Theoretical Abuse—explores those experiences in which the therapist's own exercise of his or her meaning-making structures, and maintenance of the integrity of his or her theories, has a limiting or destructive impact on the value of therapy to the client. It considers the concept of “theoretical abuse” by psychotherapists as a way of characterizing the most destructive of these experiences. This serves as a rhetorical device for introducing comparisons between these phenomena and the phenomena of sexual abuse by psychotherapists, in terms of dynamics, prevalence, and appropriate strategies for prevention. Part II uses work on the development of dialectical thinking in adulthood to conceptualize how different understandings of the nature of psychotherapists' expertise increase or decrease the likelihood and severity of “theoretical abuse”. Finally, it derives implications for training psychologists and other psychotherapy professionals.     

Transference and countertransference in an applied setting — education

This paper offers an overview of current clinical approaches to psychoanalytically informed work with parents by child psychotherapists. The analysis is based on practice at the Tavistock Clinic and on broader knowledge of trends in work with children and families within the National Health Service. A brief history sets the scene. Four varieties of approach are described, with clinical examples. The particular sensitivity of child psychotherapists to infantile features in the personality is highlighted, and it is argued that this, together with their broad clinical experience, provides a proper basis for psychoanalytic psychotherapy with parents. Such work significantly extends and enriches the clinical contribution of child psychotherapists and has involved a shift in professional identity. It also raises ethical issues which are discussed.     

Therapeutische Arbeit und berufliche Entwicklung

The authors Orlinsky and Rønnestad present as a preview for their book titled How psychotherapists develop (2005) a short selective review of the main findings of their comprehensive international study about how psychotherapists experience their work with patients, what impacts therapists’ work experiences have on their professional development and which other factors influence their therapeutic work and their professional development, including the interactions of those factors. Briefly they discuss the main practical implications of these findings, e.g. for the training of psychotherapists.