Supervising Integrative Psychotherapy in the 21st Century: Pressing Needs,Impressing Possibilities

Supervisors and teachers who are interested in advancing integrative psychotherapy in the 21st century have the dual task of surveying the range of treatment approaches that have been developed and distilling these approaches down to a manageable number of influences that have been found to have the greatest impact on clinical practice over time. It has been proposed that there are four bona fide schools of psychotherapy that would be most useful for comprehensive training and supervision that would contribute to either (a) case conceptualization or (b) the process of clinical interviewing: psychodynamic psychotherapy; cognitive-behavioral psychotherapy; family systems therapy; and, humanistic/client-centered therapy. The goal for such broadly based clinical instruction would be for students, trainees, and interns to have an ability to provide a multi-level case conceptualization for any of the psychotherapy cases for which they are providing treatment. Thorough instruction in clinical reasoning and decision-making in this type of multi-level case formulation can provide some of the most valuable tools for novice and experienced clinicians alike.     

Conflicting internalizations: Effect on development of trainees' professional role

Training in psychoanalytic psychotherapy stimulates both trainee regression and development-enhancing intemalization of supervisors. The internalization processes of introjection, identification and ego-integration influence both trainees' personal development and development of a professional role. Since both supervisors and the personal therapist are introjected and identified with, the possibility of trainee-perceived conflict arises. Where the identifications seem incompatible, trainees will tend to reject the supervision if it is overly dogmatic. If their personal therapy is conflictual, trainees will apply ego-ideal and superego structures to their personal therapy experience and reject their personal therapist. The reasons for this choice suggest the possible value of supervisor-personal therapist collaboration and a supervisory stance of identification with the learning process itself.     

The making of the group therapist: The role of experiential learning

The purpose of this paper is to review the necessary components of a comprehensive group therapy program. The balancing between the didactic and the experiential portions, and an analysis of the selection criteria, along with the rationale for a particular sequencing of elements in the curriculum, are discussed. A line between supervision and personal therapy is drawn. The author describes the milieu necessary for a successful training program to evolve and makes suggestions for improvements. The various experiential aspects of training are presented and critically evaluated. The training situation is examined from the point of view of the faculty, the trainee and the patients involved. The author marshalls evidence indicating that personal group psychotherapy in a patient group is the preferred form for most trainees for the experiential part of the program. The paper concludes that the sharing and cohesiveness of training philosophies and methods by the faculty is a prerequisite to the success of any training program.     

A training outline for conducting psychotherapy process ratings: An example using therapist technique

Aims: This study addresses the effects of structured training on the development of coding skills used in psychotherapy process research. Method: Participants included graduate trainees enrolled in an APA approved Clinical PhD programme. A course outline for training is reviewed and examined in relation to ratings of therapist techniques used during psychotherapy sessions. Results: The effects of this structured training protocol for raters resulted in good to excellent levels of interrater reliability. Different groups of raters were compared along multiple factors such as level of graduate training, training received on a particular measure, and psychotherapy experience. Discussion: The implications of these findings for rater training in psychotherapy process research are discussed.     

Preinternship Preparation of Clinical and Counseling Students in Psychological Testing, Psychotherapy, and Supervision: Their Readiness for Medical School and Nonmedical School Internships

Internship directors have been critical of students' preinternship preparation in test-based assessment and psychotherapy but have not, until recently, expressed their quantitative expectations for this training. Using data from the Association of Psychology Postdoctoral and Internship Centers application form, this study investigated the quantitative statements of 96 counseling and 238 clinical students regarding their preinternship testing, psychotherapy, and supervision training, comparing findings to medical school and nonmedical school directors' quantitative expectations. Results generally demonstrated adequate psychotherapy training but suggested deficiencies in testing training, particularly as related to medical school directors' expectations. Counseling students received more training in individual therapy with adults but not in other forms of therapy. Clinical students produced more integrated test-based reports. Both groups received similar amounts of supervision.     

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.     

Mangelnde Eignung bei angehenden Psychotherapeuten

Background

Psychotherapy research has shown that some therapists have systematically more negative outcomes than their colleagues. Many attempts have been made to answer the question of whether these unsuccessful therapists have specific features but as yet no consensus has been reached. Particularly in the field of psychotherapy training this issue has rarely been discussed.

Aims

This study focused on the following questions: how many trainees are incompetent, what characteristics do they have and how to deal with them? How are trainees selected?

Material and methods

In a research expertise on psychotherapy training for the German Ministry of Health, directors of training institutions were interviewed and 129 responses were analyzed using, for example content analysis.

Results

A total of 4–5?% of trainees were judged as being not sufficiently competent to become a psychotherapist. Relevant criteria were mainly the lack of personal and interpersonal competencies.

Conclusions

Future psychotherapy training should focus more and earlier on recognizing and intervening regarding incompetence in the given areas.     

An advanced specialist-level training programme in psychodynamic individual psychotherapy of psychotic and borderline patients: the Finnish approach

Most training programmes in individual psychotherapy, including psychoanalytic training are, in practice, restricted to the treatmentof lessdisturbed patients than those who have succumbed to psychotic or severely borderline-level disorders. This has had a delaying effect on the development of psychotherapy with such patients. Psychotherapy of severely disturbed patients is usually regarded as a difficult domain and is often practised only by psychoanalysts or other psychotherapists specially dedicated to working with patients of this kind. Between 1994 and 1997, an advanced multi-professional training programme in psychodynamic individual therapy with an emphasis on borderline and psychotic-level disorders was organized through the Centre for Extension Studies of the University of Turku, Finland, to close the gap in systematic training for the treatment of the most serious psychic disorders, and also to integrate some of the special requirements of public and private psychiatric health care. Here we briefly describe the main elements of our training programme as well as some of our training experiences. It is important to emphasize that the training was not meant to replace psychoanalytic training. It is a question of a separate multi-professional programme based on psychoanalytic premises but with particular objectives of its own.     

“Not a little Mickey Mouse thing”: How experienced counselling psychologists describe the significance of personal therapy in clinical practice and training. Some results from an interpretative phenomenological analysis

The British Psychological Society's Division of Counselling Psychology currently specifies a mandatory period of personal therapy for trainees. However, evidence for the role of personal therapy in developing practitioner competence is sparse. This paper presents part of a wider ongoing interpretative phenomenological analysis exploring how counselling psychologists describe the meaning and significance of personal therapy in clinical practice and training. Detailed examination of a subset of data from this study suggests that personal therapy is valued as a vehicle for a genuine, often extremely intense relationship with the therapist, through which participants become able to establish authentic emotional contact with themselves and their clients. Whilst most participants felt that personal therapy should remain an obligatory part of the training curriculum, they were ambivalent about specifying its aims or evaluating its outcomes. Results are discussed in terms of the importance of establishing a sense of integrity and authenticity within the personal therapy experience and are tentatively situated within a possible theoretical framework drawing on current developmental literature.     

Correlates of empathic understanding among neophyte trainees in psychotherapy.

Results are summarized of an empirical study testing the associations among various academic, demographic, and personal characteristics and rated empathic understanding among 93 neophyte psychotherapy trainees from six universities. Multiple regression analyses suggested that completion of a graduate group counseling course with a specific personal growth component was the only characteristic significantly correlated with ratings of empathic understanding.     

Evaluation of a Combined Cognitive Behavioural Therapy and Interpersonal Process Group in the Psychotherapy Training of Clinical Psychologists

It is now widely acknowledged that both content and process elements of psychotherapy play a part in client treatment outcomes. Despite this, there are pressures on Australian clinical psychology training programs to teach evidence‐based approaches in a relatively short time frame. Producing clinical psychology graduates who have an adequate level of competence in evidence‐based practice and meeting the demands of professional accreditation requirements can mean that less time is available to teach the process elements of psychotherapy. The aim of this study was to conduct a preliminary evaluation of a clinical psychology psychotherapy training program that combines an interpersonal process group with a cognitive behavioural therapy training model that incorporates self‐reflection and self‐practice. Eleven participants who participated in the training in 2008 completed the Counseling Self‐Estimate Inventory at pre‐ and post‐training. Significant improvements on the majority of the subscales of this inventory were found. A separate sample of nine trainees and clinical psychology registrars who also previously completed the program attended individual interviews in 2010 aimed at gaining their perspective regarding various aspects of the program. Self‐practice of cognitive behavioural therapy techniques was found to be important in the identification and management of trainees’ own core beliefs, and to their appreciation of how challenging this process may be for clients. The interpersonal process group was described by participants as enhancing their competency as psychotherapists. Common themes included the experience of anxiety and a high level of emotion, and understanding how this experience might be similar for clients; increased self‐awareness; and increased competence in process issues. Many participants believed the process and content components of training were equally important to their development as psychotherapists.     

Joining with resistance: addressing reluctance to engage in group therapy training

Although research has documented the effectiveness of group psychotherapy, trainees are often reluctant to embrace this modality. This reluctance may reflect an informed choice based on knowledge, interest, and skill. Alternatively, reluctance may reflect misinformation or resistance due to conflicted feelings that arise from group dynamics. The latter are a major obstacle to the success of group therapy training and treatment programs. Understanding the origins of this reluctance and the developmental challenges of group therapy for trainees better equips supervisors to address this difficulty. This article uses case examples to illustrate how trainee reluctance emerges. It also provides strategies for working with hesitant trainees. The success of group therapy programs rests on the supervisor's ability to manage trainees' inhibitions to group therapy.     

Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

The path towards a professional identity: An IPA study of Greek family therapy trainees

Objective: Contemporary psychotherapy research has focused mainly on practitioners' training and education. The impact of training on professional development and the application of therapeutic skills have been the primary foci of the empirical literature. The aim of this paper is to present the experiences of seven family therapy trainees regarding their personal paths toward the development of professional identity as they underwent training in systemic psychotherapy. Method: In‐depth interviews were conducted and analysed using Interpretative Phenomenological Analysis. Results & Conclusions: Seven themes were identified: The Quest, Developing by Relating, Learnings, Personification of Training, Use of Self, Self‐Care and Empowerment, and Reflecting on the Role of the Therapist. The findings are discussed with regard to the development of the ‘therapist as a person’, gaining acknowledgement and autonomy, and the development of a community of therapeutic practice.     

Some thoughts on counsellor training

The main object of counsellor training is to help trainees to offer an effective counselling relationship. It is suggested that this requires three main training elements: personal, practical, and academic. Ways in which the personal development of trainees may be fostered include individual support counselling and a weekly encounter group session. While constructive feedback is necessary, a minimum of evaluation is suggested so that the trainee can feel safe and free to explore himself. Pre-placement training focused on empathic understanding is considered essential before the trainee is allowed to embark upon supervised placement, and a programme of practical work training is outlined. Reasons for including academic work are also discussed, and appropriate academic content is suggested. Finally, the problem of obtaining suitably qualified trainers is considered, along with the desirability of trainers continuing to counsel, and the need for adequate administrative support for training programmes.     

Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

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.     

How do trainees choose their first psychotherapy training? The case of training in psychotherapy integration

Future trainees go through difficult decision-making processes when starting their first psychotherapy training. The choice of training in psychotherapy integration is a specific type of this process. In this study, qualitative data were obtained from the motivational letters, in-depth semi-structured interviews and e-mail questionnaires of 26 future trainees to answer the research question, ‘How do trainees choose their first psychotherapy training?’ We primarily employed the grounded theory approach as well as consensual qualitative research to shed light on the central category of Gaining Certainty to enter the training. This category was elaborated into a four-phase model, specifically comprised of the: (1) Critical Comparison, (2) Identification, (3) Self-Confirmation and (4) Waiting phases. The model was then discussed in connection with relevant concepts, such as the degree of complexity and flexibility within the epistemological development of trainees [Vasco, A. B., &; Dryden, W. (1994). The development of psychotherapists’ theoretical orientation and clinical practice. British Journal of Guidance &; Counselling, 22(3), 327–341].     

The Benefits of Group Therapy Observation for Therapists-in-Training

The authors contend, based on a survey of group therapy trainees, that observing an ongoing psychotherapy group in vivo provides an exceptional learning opportunity. Clinicians often experience resistance and anxiety regarding therapy group leadership, and group therapy is notoriously challenging to teach. Trainees consistently described the Group Observation course as one of the most effective training experiences that they have had. The observation group model mitigates many concerns that trainees have about group leadership and inspires enthusiasm and confidence for leading groups. Group observers learned vital group leadership skills, most notably: the ability to bear affect and trust the group process, the ability to follow and use group themes, metaphors, and underlying dynamics, and the ability to highlight attachment themes, work in the here and now, and promote immediacy.