Clients’ perceptions of personal psychotherapy or counselling for therapists

The purpose of this study was to examine clients’ opinions of therapists’ personal use of psychotherapy or counselling. Participants in this study, a nationwide sample of clients recruited through Amazon’s MTurk system, were asked to complete an online survey assessing their attitudes towards treatment use by therapists as well as their general attitudes towards psychological help-seeking and perceptions of stigma (social and self) with psychological treatments. In this study, we found that clients generally had positive views about therapists’ personal use of psychotherapy or counselling. Although overall positive attitudes were found, the results from repeated measures ANOVAs indicated that attitudes depended somewhat on whether the therapist had sought out treatment as part of a training requirement for self-enrichment, or for the treatment of a psychological problem. In addition, participating clients were less supportive of therapists disclosing a treatment use history with their clients. Regression analyses also indicated that attitudes towards treatment use by therapists were significantly predicted by general help-seeking attitudes and perceptions of stigma (social and self), but attitudes towards disclosure were not. The findings from this study have important implications regarding therapist treatment use and disclosure in practice.     

Listening to Both Sides of the Therapeutic Dyad: Self-Disclosure of Gay Male Therapists and Reflections From Their Gay Male Clients

Clinicians vary as to their beliefs about the use of self-disclosure in psychotherapy depending on theoretical framework, experience level, and the problem focus. Given the limited number of studies examining therapeutic pairs (client and clinician), this study used qualitative methodology to interview gay male therapists and their gay male clients about how therapist self-disclosures affected their therapy. Results show that clients often felt aware of therapist self-disclosures, whether explicit or implicit, and believed the disclosures assisted them in feeling connected to their therapists and served to normalize the clients’ experiences. Limitations to the study are discussed.     

Teaching mindfulness to psychotherapists in clinical practice: The Mindful Therapy Programme

Introduction: Initially proposed as a treatment modality for psychological disorders, mindfulness is now being promoted as a means of enhancing both therapist self care and therapeutic efficacy. The degree to which mindfulness can be learned by therapists to manage their own and clients' processes in therapy is as yet unknown. This study examines training outcomes of a standardised introductory mindfulness programme for mental health professionals. Methods: Forty-seven mental health professionals completed an eight-week mindful therapy (MT) training programme and associated measures. Results: Compared with baseline scores, participants demonstrated knowledge acquisition on all measures, including increased mindfulness in clinical work, increased capacity to intentionally invoke mindful states of consciousness, and higher participant ratings of well-being over the course of training sessions. Discussion: This research provides preliminary evidence that a brief, standardised mindfulness training programme can achieve acceptable knowledge and skills outcomes for therapists that can aid their therapeutic practice. Of note, increased ‘therapeutic mindfulness’ in this study resulted from changed mindfulness ‘attitudes’ (i.e. a more accepting and equanimous orientation within therapeutic work) as opposed to a clear demonstration of increased attention-regulation skills. The implications of these and other results for programme development and wider research are discussed.     

The role of personal practice in therapist skill development: a model to guide therapists,educators, supervisors and researchers

Prior to 2000, personal practice (PP) for therapists mostly meant personal therapy. Recently a new landscape of PPs has emerged, with meditation-based programs and therapy self-practice/self-reflection (SP/SR) programs playing an increasing role in training and personal/professional development. The challenge now for practitioners and researchers is to refocus on the role of PPs in training and professional development. Are PPs of value - or not? Do they have a role in therapist development? How might PPs enhance therapist skilfulness? Do different PPs act in similar or different ways? Currently, the PP literature lacks a theoretical framework to guide practitioners in their choice of PPs or researchers in their choice of research questions and measures. The purpose of this article is to provide such a framework, the Personal Practice (PP) model. The PP model proposes primary impacts of PPs in four domains: personal development/wellbeing, self-awareness, interpersonal beliefs/attitudes/skills and reflective skills. The model also suggests a secondary impact on therapists’ conceptual/technical skills when therapists use reflection to consider the implications of their PP for their “therapist self”. We offer some suggestions to enhance the quality of future research, and conclude that PPs may play an important and perhaps unique role in therapist training.     

Attitudes towards psychotherapy manuals among clinicians treating eating disorders

Clinicians have relatively low uptake and implementation of evidence-based psychotherapies for the eating disorders, and this problem appears to be associated with low use of manualized approaches. This study examines clinicians' positive and negative attitudes to manuals, and possible beliefs and emotional factors that might drive those attitudes. The participants were 125 psychological therapists working with eating-disordered patients. Each completed standardised measures of attitudes to manuals and emotional states. A number of beliefs about the content of manuals were associated with both positive attitudes to the outcome of treatment and negative attitudes to their impact on the treatment process. In addition, a more positive mood was associated with more positive attitudes. Suggestions are made regarding how attitudes might be made more positive, in order to facilitate the use of evidence-based therapies for eating disorders.     

Psychotherapists’ psychological well-being: The role of epistemic orientation and emotion regulation

Psychotherapists’ mental health has been traditionally associated with the harmful consequences of clinical practice. In contrast to this dominant model, a growing body of research in positive psychology has sparked an interest in therapists’ positive well-being. The main objective of this study was to examine the relations between therapists’ epistemic orientation modes, emotion regulation strategies and psychological well-being (PWB). This was a cross-sectional study in which participants were 674 therapists (78.5% women), with a mean age of 42.02 years (SD = 13.06). Therapists completed an online questionnaire containing self-report measures of all study variables. Structural equation modelling using latent variables was performed to test the study hypotheses. Results revealed no significant direct effects of epistemic orientation on PWB. Up- and downregulation strategies had the most substantial direct effects on total PWB. Furthermore, emotion regulation mediated the association between therapists’ epistemic orientation modes and PWB, accounting for 57% of the variance in the outcome variable. Implications for training, practice and therapist self-care are discussed.     

Therapists facing masks: A qualitative study of the nature of relationships between masks and relational depth

Background

Central to this research was exploring characteristics facilitating and disinhibiting meetings at relational depth to explore underlying driving factors of change. The overall aim was to explore relationships between masks and relational depth. Viewing masks as a characteristic sought to understand further the socio-cultural impacts of masks on client/patient care and decision-making to meet at depth. This research demonstrates immediate social and international context due to COVID-19.

Methods

A phenomenological methodology was utilised. The primary research vehicle was an examination of primary data from semi-structured interviews. Four therapists who had used masks within sessions (where both therapist and clients wore masks) provided data on meetings at relational depth.

Findings

Interpretative phenomenological analysis revealed four themes: ‘epicentre of aetiology’, ‘loss’, ‘masked-disinhibition’ and ‘disconnection paradox: depth through disconnection’. Findings suggest masks are a characteristic that can facilitate and inhibit meetings at depth—acknowledging common factors, including how therapists related to masks as an extended part of the client, and mutuality within disconnection to masks, not one another, was significant.

Conclusions

Findings suggest the exigent presence of masks could facilitate or inhibit meetings at depth, regulated by what masks represented to therapists/clients at moments of contact. Yet, when both therapist and client appeared mutually disconnected (to masks, not each other), they found moments of relational depth within the disconnection. Masks are suggested as a characteristic that can influence meetings at depth. Opportunities for depth seemed reliant on individual capabilities to offer depth, emphasising therapists' experiential awareness of their interoceptive process.     

‘Coming out’ in therapy? Perceived risks and benefits of self‐disclosure of sexual orientation by gay and lesbian therapists to straight clients

Primary objective: The study's primary objective was to investigate the experiences of gay and lesbian therapists, when considering self‐disclosure of their sexual orientation to straight (i.e. heterosexual) clients. This qualitative study set out to ascertain the key factors gay therapists take into account when considering this decision and to explore the effects this self‐disclosure may have on themselves, their clients and their therapeutic relationships. Research design: The research design was based on the use of semi‐structured interviews, undertaken with a non‐random, purposive sample of counsellors and psychotherapists (n=8) in current practice. The rationale for this method was to aid exploration of therapists' experiences of the process of self‐disclosure. Methods and procedures: Inclusion criteria were for therapists who self‐identified as being gay or lesbian, and who were experienced in clinical work with straight clients. Transcribed data was analysed using inductive thematic analysis. Main outcomes and results: Some therapists reported being confident with self‐disclosure relating to their own sexual orientation. However, a common theme related to the reportedly high levels of anxiety and vulnerability, which therapists identified. Key themes emerged around: respondents' fears of client judgement; a need for therapist self‐protection; self‐awareness of the potential impact of their own fears and prejudices on the therapeutic relationship; and the potential relevance of internalised homophobia, as an overall constraining factor. Conclusions: Self‐disclosure of their sexual orientation to straight clients is constructed, in this initial survey, as being potentially problematic and risky for some gay therapists.     

Women’s preference of therapist based on sex of therapist and presenting problem: An analog study

An analog study was conducted to examine differences in women’s preference for and anticipated comfort self-disclosing to hypothetical therapists of different sexes based on the type of hypothetical presenting problem. The impact of general level of self-disclosure was also examined. Participants included female college students (n?=?187). Anticipated comfort self-disclosing to male or female therapist was rated by subjects when presented with therapists of each sex with the same qualifications. Women preferred and reported higher levels of anticipated comfort self-disclosing to a female therapist. The type of hypothetical presenting problem and general level of self-disclosure also impacted anticipated comfort self-disclosing. There was an interaction between general level self-disclosure and the sex of therapist on anticipated comfort self-disclosing. General level of self-disclosure only impacted anticipated comfort self-disclosing when the therapist was male. This information is relevant for therapists or organizations that provide psychosocial services to women. Organizations may want to inquire about a client’s preferences about sex of therapist beforehand and, if possible, cater to the client’s preference.     

Perceptions of the Limitations of Confidentiality Among Chinese Mental Health Practitioners,Adolescents and Their Parents

The present study aims to (a) survey Chinese mental health professionals’ attitudes toward therapeutic confidentiality with adolescent patients in specific clinical situations, and (b) compare Chinese adolescents’ and parents’ beliefs about when most mental health professionals would breach confidentiality. A sample of 36 mental health practitioners, 152 parents, and 164 adolescents completed a survey to assess their opinions about when confidentiality should be breached in 18 specific clinical situations (e.g., an adolescent tells his or her therapist that he or she smoked a cigarette, had unprotected sex, or attempted suicide). Nearly half of the parents (46%) and adolescents (41%) and 78% of the therapists in our sample selected “yes” in response to the question of whether the principle of confidentiality applies to adolescents. However, 49% of parents indicated “no,” and 53% of adolescents indicated “not sure.” Compared to adolescents, parents were significantly more likely to believe that therapists would breach confidentiality for the high-breach-likelihood items. For the low-breach-likelihood items, adolescents and parents were significantly more likely than therapists to believe confidentiality should be breached. Results from this study provide data to inform the development, refinement, practical implementation, and communication of guidelines and recommendations specific to adolescents receiving psychotherapy in China.     

Salience of Anti-Abortion Beliefs and Commitment to an Attitudinal Position: On the Strength,Structure, and Predictive Validity of Anti-Abortion Attitudes1

The role of beliefs in attitude formation and the impact of commitment to an attitude on its predictive validity were studied in the context of anti-abortion attitudes. Undergraduates (N= 152), identified as pro-choice or pro-life, expressed their beliefs, attitudes, intentions, and restriction preferences with respect to making abortion illegal. In addition, they indicated their commitment to their positions and their willingness to distribute a pro- or anti-abortion petition. Salient beliefs—identified in a pilot study—were found to predict attitudes, intentions, restriction preferences, and petition choice significantly better than nonsalient beliefs. Salient beliefs also discriminated significantly between pro-choice and pro-life respondents, providing useful information about the cognitive underpinnings of anti-abortion attitudes. In addition, accuracy of predictions increased significantly with commitment, even when attitude extremity was statistically controlled. These findings support the summation theory of attitude (Fishbein, 1963) and demonstrate the importance of attitude strength in determining the structure and predictive validity of attitudes.     

PSYCHOTHERAPISTS'KNOWLEDGE ABOUT AND ATTITUDES TOWARD SEXUAL ASSAULT VICTIM CLIENTS

The present research investigated the question of how therapists'attitudes toward sexual assault victims predict their inferences about and treatment of clients. In addition, this study asked the following questions: (a) What percentage of female psychotherapy clients have been victims of sexual assault? (b) What treatment approaches are therapists using with victims and what attitudes toward victims do these therapists hold? (c) On the average, which demographic groups of therapists hold the most positive views of victims and are the most knowledgeable about working with victims? The results of the study indicated that therapists who held negative attitudes toward victims were more likely to endorse victim-blaming themes and therapeutic treatments which blame victims for sexual assault. Of therapists'current female clients, 18.5% ( n = 257) had been sexually assaulted at some point in their lives. On the average, therapists were knowledgeable about working with victims and showed positive attitudes toward victims.     

Does theoretical background influence therapists' attitudes to therapist self‐disclosure? A qualitative study

Aims: This study investigated therapists' attitudes towards therapist self‐disclosure over different theoretical orientations and to establish how classical theoretical background and training effected and informed practice. Classical theoretical background was intended to refer to traditional Psychodynamic understanding. Method: Participants were experienced therapists drawn from four groups by a recruitment screening measure. Three groups were from the students’ cohort within a university Masters programme in Psychological Therapies. Participants were practicing from CBT, Systemic and Psychodynamic orientations. A further group was drawn from Person‐Centred therapist/trainers at a further education College. Data was gathered using focus groups and analysed using thematic analysis. Findings: Three major and one lesser theme emerged. These revealed that there was a spectrum of willingness to disclose throughout all groups, classical training influenced all participants; total restriction of TSD was impracticable and attitudes were affected by concerns for the therapeutic relationship. Implications for practice: TSD needs to be more thoroughly explored within therapy training and supervision. A structured framework could help inform practice. Conclusions: The study supported the idea that Classical Training influenced TSD.     

Justice Beliefs,Personal Well-Being and Harsh Social Attitudes: Initial Demonstration of a Polynomial Regression and Response Surface Methodology

Tendencies to believe in justice are multidimensional and include beliefs that the world is fair to one’s self (personal justice beliefs) as well as to others (general justice beliefs). Previous research suggests that personal and general justice beliefs are divergently linked to well-being and harsh social attitudes, respectively. However, whether and how these justice tendencies conjointly affect well-being and harsh social attitudes is less well known. Guided by equity theory, the current study used polynomial regression and surface response methodology to demonstrate how specific discrepancies between justice beliefs for self and others predict personal well-being and harsh social attitudes. Participants (N?=?1079) completed measures of tendencies to believe in personal and general justice, as well as measures of physical symptoms associated with illness and attitudes towards the poor. Results suggested that discrepancy between personal and general justice beliefs had detrimental effects on these outcomes (i.e., higher number of illness symptoms and harsher attitudes towards the poor). Moreover, discrepancy resulting from a strong belief in general justice and a weak belief in personal justice (i.e., other-favorable discrepancy) was more strongly negatively associated with well-being and positively associated with harsh attitudes towards the poor than discrepancy resulting from a strong personal justice belief and a weak general justice belief (i.e., self-favorable discrepancy). The current research highlights the potential for personal and general justice beliefs to conjointly predict well-being and social attitudes, while simultaneously demonstrating the capacity to better understand these interactive relationships through the use of surface response methodology.     

Psychotherapy across languages: beliefs,attitudes and practices of monolingual and multilingual therapists with their multilingual patients

Aims: The present study investigates beliefs, attitudes and practices of 101 monolingual and multilingual therapists in their interactions with multilingual patients. Method: A mixed‐method approach was adopted using an online questionnaire with closed questions, and informed questions in interviews with one monolingual and two multilingual therapists. Results: A principal component analysis yielded a four‐factor solution accounting for 41% of the variance. The first dimension, which explained 17% of variance, reflects therapists' attunement towards their bilingual patients (attunement versus collusion). Further analysis showed that the 18 monolingual therapists differed significantly from their 83 bi‐ or multilingual peers on this dimension. The follow‐up interviews confirmed this result. Discussion: Recommendations based on these findings are made for psychotherapy training and supervision.     

What Happens When Therapists Feel Bored or Anxious? A Qualitative Study of Distracting Self-Awareness and Therapists' Management Strategies

Using a qualitative methodology, we investigated novice and experienced therapists' experiences of and strategies for managing distracting self-awareness. We found that novice therapists were most aware of anxiety and critical self-talk, whereas experienced therapists were most aware of boredom and outside distracters. In addition, although therapists tended to manage distracting self-awareness through self-coaching and refocusing on the client, novice therapists specifically mentioned managing problematic self-awareness through self-disclosure. In contrast, experienced therapists tended to manage problematic self-awareness by using thought stopping techniques. The results provide new avenues for examining therapists' in-session experiences and for investigating the effectiveness of different management strategies.     

What do psychodynamic therapists make of their reveries in the therapeutic encounter? A constructivist grounded theory study

ABSTRACT

The therapist’s mind can wander to daydreams, fantasies and preoccupations: mental events termed “reveries” in this study. As therapists attend to the current of their thought in the therapeutic encounter, the question of how to approach their reveries can arise. This qualitative study used semi-structured interviews with nine qualified psychodynamic therapists to investigate therapists’ attitudes to reveries. The research design and analysis followed the principles of Charmaz’s [Charmaz, K. (2006). Constructing grounded theory: A practical guide through qualitative analysis. London: Sage; Charmaz, K. (2014). Constructing grounded theory (2nd ed.). London: Sage] constructivist grounded theory. Results showed that therapists experienced diverse reveries sometimes felt to yield deeper clinical understanding. Reveries were also seen to have a “freeing-up” function for the therapist and patient, and to require mental freedom to operate. Implications for theoretical understanding and recommendations for clinical technique are discussed.