Outsider Witness Groups as a Means of Professional Growth in Family Therapy Training: An Exploratory Qualitative Study

This exploratory qualitative study examines the experiences and meanings associated with family therapy trainees’ participation in the narrative practice of Outsider Witness Groups (OWG). At the Barcai Institute in Tel Aviv, we incorporate OWGs into our live clinical supervision courses. In some sessions, we offer the families undergoing therapy the opportunity to listen to the reflections of the group of trainees regarding what they witnessed during the session. Twenty-nine family therapy trainees participated in the study in five focus group interviews. Analysis of the interviews yielded four core themes regarding the trainees’ experiences: (i) Exploring the stance of the therapist; (ii) The art of listening; (iii) Reflection on hierarchy and boundary setting; and (iv) Negotiating self-disclosure. The findings indicate that family therapy trainees stand to benefit significantly in their professional journey, development, and growth from integrating OWG practices into their training. OWG fosters the development of critical reflectivity in trainees, including the deconstruction of common and taken-for-granted assumptions. It also fosters practices related to family therapy, and perhaps also to therapy in general. The findings also suggest that taking part in OWGs during training may contribute to family therapy trainees’ development of critical reflectivity as a means of introducing a more critical and political approach to therapy and developing their own preferred stories as therapists.     

Women counsellors' experiences of personal therapy: A thematic analysis

Background: Following recent moves to relax the requirements for clinical mental health trainees to undergo personal therapy, this qualitative project explored the effects of personal therapy on volunteer counsellors. Method: Interviews were conducted with 19 volunteer counsellors at a women's community centre, and the data were analysed using thematic analysis. Findings: Emerging themes included the importance of personal therapy for trainee development, key elements of personal therapy and the idea that personal therapy is ‘a double‐edged sword’. Discussion: Allowing for evident methodological difficulties in evaluating the impact of personal therapy on trainees, this study suggests that close consideration should be given to the potentially adverse effects of reducing requirements for personal therapy in clinical trainings.     

Training family therapists in observational skills

A study was conducted to develop procedures for training observational skills using concepts derived from structural family therapy. Experienced family therapists provided operational definitions of key concepts in family interaction, and videotaped segments of interactions were prepared which exemplified the concepts. A group of trainee family therapists was compared with a group of experienced therapists in the way they applied the concepts to interaction sequences in therapeutic sessions. In demonstrating that inexperienced trainees can be instructed relatively rapidly to identify and use structural concepts, the results suggested that this analytical approach to the training of family therapists shows considerable promise.     

Repurposing process measures to train psychotherapists: Training outcomes using a new approach

Aims: First, this paper presents the rationale for a novel approach to training counsellors in which measures for psychotherapy process research are taught to students before moving on to teaching basic empathic reflections and interventions. The rationale for this is that client process measures can be re‐purposed to help orient and sensitise trainees to key in‐session moments. Second, we present a training outcome study that assesses the effectiveness of this approach. Method: Using an experiential‐integrative therapy approach, a 13‐week training program was used to teach psychotherapy skills and process research measures to22 clinical graduate students taken from two cohorts. As part of the course, trainees conducted several single sessions with volunteer clients on four separate occasions. Training outcomes were measured using both trainee and client reports. Results: Compared to baseline, therapists reported significant and steady gains (all p's<.05) in session management, reducing their anxious self‐awareness, and in improved sense of self‐efficacy, with the latter having the largest effect (partial Eta Sq.=.381). Discussion: While the findings provide some support for a new training strategy, a dismantling design is needed next to more closely examine the process‐measure approach to training.     

'Stuckness' in live supervision: Expanding the therapist's style

'Stuckness' in the live supervision of family therapy trainees can be used creatively to affect their style and expand their use of self in therapy. Supervisors, after clarifying the contract with their trainees, need to examine how their therapeutic style is constrained by personal qualities. These personal constraints may be related to generic difficulties in their personal, professional and cultural context. These include anxieties generated by the situation oflive supervision, or learning to increase stress to a greater level than the trainees learned to tolerate in their families of origin. Observing an impasse that is influenced by these qualities, the supervisor, who also analyses his or her part in the process, can change the supervisory relationship.     

The role of personal development groups in counsellor training: understanding factors contributing to self-awareness in the personal development group

Personal development groups (PD groups) are widely employed in counsellor training with the aim of developing the self-awareness of trainee counsellors, and the intention of this paper is to open a discussion forum of the use of these groups and understand their use more fully. A quantitative and qualitative approach was employed in this study, using focus groups with a cross section of 88 trainees of counselling, at different points in their training, to establish those factors that were felt to contribute to developing self-awareness in the group. A questionnaire was used to measure both trainees' perceptions of their own self-awareness and the extent to which the contributory factors were felt to be both present and helpful in their current PD group (this is referred to as the 'comfort fit'). Statistical findings, from the full cohort of 88 trainees, indicated that they were more comfortable in the PD group at the start of their training and less comfortable at the end, although there was no clear relationship between there being a better 'comfort fit' and increased self-awareness. These findings are discussed in relation to alternative methods of facilitating the self-awareness of trainees of counselling (such as mandatory personal therapy) alongside the associated complexities of undertaking research of this kind.     

“Bridging the Gap”: A reflexive thematic analysis of the experiences of therapy trainees transitioning from psychodynamic counselling to cognitive behavioural therapy

There is limited empirical research and insight into the experiences of therapy trainees who are being taught more than one psychotherapeutic approach during their training. Further understanding is warranted to ensure that a dual modality approach to training (that is, where therapists are trained in two paradigmatically distinct modalities) is experienced as worthwhile and acceptable to trainees and to better understand any challenges faced when transitioning between approaches. The aim of this study was to investigate trainees' experiences of transitioning from psychodynamic counselling to cognitive behavioural therapy (CBT) on a two-year master's degree that offers a dual modality approach to training. Data were collected from a sample of 8 trainees using an online semistructured questionnaire. These data were analysed using Braun and Clarke's (2020) reflexive thematic analysis. Four main themes were identified: (1) perceived competence; (2) preparedness; (3) professional advantages; and (4) external challenges. The findings suggested considerable individual variation in the ease with which participants navigated the transition between therapeutic modalities. Those who found the transition easier used the structure of CBT to provide a framework and point of difference that allowed them to temporarily suspend their psychodynamic learning in order to embrace a new therapeutic approach. Others experienced the move to CBT as posing a threat to their developing identities as counsellors. Recommendations are made on how to prepare trainees for the transition including exploring the psychological impact of transitions, increasing opportunities for reflective practice and facilitating exploration of what it means to be a therapist trained in two distinct therapeutic modalities.     

The Empirical Evaluation of Family Therapy Training

This paper presents the results of the first comprehensive and empirical evaluation of a family therapy training program. Focusing on the first year of a two-year training program, the study found significant changes in the clinical conceptualizations and in-therapy verbal behaviors of a group of trainees. Additionally, this study involved the development and/or first use of various research instruments and procedures that can be used to facilitate further research on family therapy training.     

A Preliminary Longitudinal Study of Multicultural Competence in Counselor Education

The purpose of this study was to investigate longitudinal changes in master’s-level counselor trainees’ (N = 78) self-perceptions of their multicultural counseling competence over the course of their counseling program. Multilevel modeling results indicated an increase in scores across 3 time points. The authors discuss study limitations and how counselors and counselor educators can incorporate the study’s findings into their practice and into the education and supervision of counselor trainees.     

The impact of structural family therapy training on conceptual and executive therapy skills

The importance of empirical evaluations of family therapy training is gaining increased recognition. This study reports the results of a controlled assessment of a training seminar in structural family therapy. Changes in the conceptual and executive skills of 44 therapy trainees (22 family trainees and 22 controls) were assessed over a 16-week period using repertory grid and videotaped therapy simulation techniques. Results indicated significant conceptual gains in family therapy trainees, but only among those with little previous exposure to family training. Differences in the overall number as well as the type of interventions were also noted. Results generally supported the predicted impact of therapy training, but left unanswered questions regarding the unique impact of family therapy training over individual training. These qualifications are discussed and directions for future work are highlighted.     

Psychodynamic therapists' dilemmas in providing personal therapy to therapists in training: An exploratory study

Aim: This study explores dilemmas facing psychodynamic therapists who provide personal therapy to therapists in training. Method: Eight experienced psychodynamic psychotherapists were interviewed using a semi‐structured interview format during which they were asked about the importance of personal therapy, if they encountered any dilemmas and, if so, how they resolved those dilemmas. Their responses were analysed using a qualitative form of content analysis. Findings: Two categories of dilemma emerged: clinical and personal. Clinical dilemmas arose out of the mandatory requirement for therapy, boundaries, fitness to practice and the suitability of trainees. Personal dilemmas included pressure to model, sense of responsibility, therapeutic narcissism, countertransference reactions, over‐use of self and stressful involvement. The therapists' strategies for resolving the dilemmas are described. Conclusion: The results show participants considered personal therapy to be essential for trainees and thought it should be mandatory even though it led to difficulties in the therapy. Questions arose about the suitability of some trainees, the person of the therapist and stressful involvement. Further research into these important areas is recommended.     

The skeleton in the cupboard: experiential geneogram work for family therapy trainees

This paper outlines the experiences of five family therapy trainees, relating to seminars which involved visual geneogram analysis and research into their extended families of origin. Changes induced by the seminars and their impact on the trainees' personal lives and clinical performance will be examined. These findings are discussed in the light of some of the literature dealing with the relevance, for the family therapy trainee, of an appropriate family-oriented experiential training.     

Therapeutic attitudes and practice patterns among psychotherapy trainees in Germany

Aim: This study aims to explore if and how values and attitudes from trainees of different psychotherapeutic schools vary during training. Another aim has been to evaluate the extent of their therapeutic self-confidence during training. Methods: In a cross-sectional study, 171 trainees in German institutes with different theoretical orientations (Psychoanalysis – PA, Psychodynamic Therapy – PT and Cognitive Behavioral Therapy – CBT) participated. Results are reported for two questionnaires: Therapeutic-Attitudes-Candidate-Version (ThAT-CV) and Work-Involvement-Scales (WIS). Results: Therapeutic attitudes showed significant differences between trainees with different theoretical orientations but no significant difference between different levels of training within the same school. Whereas the PA and CBT trainees endorsed contrasting attitude profiles, the PT group displayed less differentiated attitudes in between those contrasts. Most trainees experienced their psychotherapeutic practice as challenging, and Stressful Involvement in therapy sessions was lower with more years in training. Female trainees reported more Healing Involvement and felt more competent in general than their male colleagues. Self-reported competence was higher the more congruent the trainees’ attitudes with their school's theoretical orientation. Conclusions: The ThAT-CV discriminates significantly between trainees of different therapeutic schools. Our sample demonstrates high identification with attitudes belonging to their theoretical orientation. This may account for high ratings of self-reported therapeutic competence. Attitudes seem to be formed before training and change little thereafter. Less differentiated attitudes may explain PT-trainees’ higher levels of Stressful Involvement.     

Cognitive behavioral therapy in practice: treatment delivered by trainees at an outpatient clinic is clinically effective

Cognitive–behavioral therapy (CBT) is known to be effective for a number of disorders, and can be delivered effectively by trainees in controlled settings. However, the effectiveness of trainee therapists in general practice compared to that of more experienced therapists is unknown. In this study, the authors used a benchmarking strategy to compare the outcomes of naturalistic CBT delivered by trainee therapists to those of efficacy and effectiveness studies using primarily professional therapists. Patients (N = 249) with mood and anxiety disorders were treated by trainees (primarily by interns and postdocs) using nonstandardized nonmanualized CBT at an outpatient clinic in an urban academic medical center. Changes in anxiety and depression were assessed using effect sizes, reliable and clinically significant change, and benchmarked to efficacy and effectiveness studies. Symptoms of anxiety and depression significantly improved from start to end of treatment. Rates of improvement and recovery compared favorably to those achieved in other studies, with the exception of recovery rates in severe depression. Effect sizes were in the medium to large range, but generally lower than those achieved in other studies. Results suggest that CBT can be delivered effectively by trainees in an outpatient setting.     

A Pilot Study of a Method for Teaching Clinical Psychology Trainees to Conceptualise and Manage Countertransference

There is evidence that therapists' countertransference responses can affect the therapeutic relationship. There is also evidence that trainee therapists can experience difficulty understanding and managing countertransference. This evidence suggests the need for greater focus on countertransference in the training of professionals, such as psychologists, for whom therapy is a core activity. However, little is currently known about the best way of providing such training or the impact of such training on recipients. This pilot study examined clinical psychology trainees' responses to a teaching and learning method for conceptualising and managing countertransference. The method was designed to be accessible to a range of psychology trainees including those in cognitive behavioural therapy programmes. This article outlines the method and its pilot evaluation. An anonymous online questionnaire was completed by 55 trainees pre‐intervention and 40 post‐intervention. Qualitative methods were used to examine changes in trainees' analyses of countertransference pre‐ and post‐intervention, and their reports of understanding and managing countertransference. Trainees also rated the intervention. The majority of participants who completed the post‐intervention questionnaire reported that training increased awareness of or the ability to conceptualise countertransference. They reported strategies for managing countertransference, although they were less confident in this area.     

Misperceptions of Motivation of Economically Disadvantaged Employees in Work Settings

The present study was designed to assess the cross-cultural perceptions of appropriate and inappropriate behaviors for three sets of role relationships. Employers and economically-disadvantaged job trainees were asked to rate the appropriateness of various behaviors for superordinate/subordinate, subordinate/superordinate, and peer/peer relationships. Results suggest that job trainees perceived the role of a superordinate as being more punitive, more deceitful, and less friendly than the employers thought would be appropriate. The findings are discussed in light of the concept of “ecosystem distrust”.     

THE PERILS OF PARTICIPATION: EFFECTS OF CHOICE OF TRAINING ON TRAINEE MOTIVATION AND LEARNING

This study presents an empirical test of the effects of trainee choice of training on subsequent motivation and learning. 207 trainees were randomly assigned to one of three conditions: (a) no choice of training; (b) choice of training–but choice not received; (c) choice of training–with choice received. A pilot study was used to create a unique training context whereby trainees could be differentiated on the three conditions of choice, while all ultimately received the identical training module. Results indicated that, after controlling for cognitive ability, those trainees having a choice of training did have greater motivation to learn, provided they were ultimately given the training of their choice. On the other hand, trainees allowed to choose but whose choice was not the training module subsequently delivered were less motivated and learned less than those not asked to participate in the choice of training at all. These findings suggest that, in an organizational training context, there may be some "perils of participation." Implications for future research and practice are discussed.     

An Exploration of Trainees’ Perception of Clinical Psychology Training in India: A Qualitative Analysis

This study explored trainees’ perception of clinical psychology training in India. A sample of 20 (18 females; 2 males; Mean age?=?25 years) clinical psychology trainees participated in the study following written informed consent. Participants were interviewed individually (40–50 min) using a semi-structured interview schedule developed for the study. Interviews were audio recorded and transcribed. Broader themes were identified using principles of content analysis. The findings indicated trainees’ great enthusiasm about practical training, supervisor supervision and hospital based training. Results also showed poor recognition of the role of research and theory in training, unilateral view of supervision, poor perception of secondary goals and components of training and limited awareness about variety of clinical material. The results are indicative of trainees’ preference of clinical component of training over theory and research components of training, the backbone of prevailing systems of training globally. The preliminary findings suggest the need for further research in this area.     

Psychopolitics

Neophyte group therapy trainees often encounter significant difficulties in their initial experiences as group therapists. In this article, we report and discuss the results of a semistructured interview conducted with each of 16 neophyte group therapy trainees in an academic training program. The interview focused on the trainees' subjective experiences related to their initial training and group therapy clinical practice, with particular emphasis on their satisfaction with their training and the role and impact of supervision. All trainees reported strong emotional reactions to their group experience and numerous technical concerns. However, trainees reported a broad range of degrees of satisfaction with their training. Overall satisfaction with training strongly paralleled satisfaction with supervision and the supervisory relationship. Recommendations for improving the group therapy training experience that emerge from the evaluation of the trainees' subjective experiences are suggested.