Engagement With Self‐Practice/Self‐Reflection as a Professional Development Activity: The Role of Therapist Beliefs

A number of research studies support self‐practice/self‐reflection (SP/SR) as an experiential learning process that facilitates the acquisition of therapeutic skill in a number of cognitive‐behavioural therapy (CBT) competencies and as showing potential as a valuable professional development activity. Engaging therapists to participate in SP/SR programmes is sometimes difficult, and when they are offered the option to participate in SP/SR programmes as part of professional development, relatively few volunteer. This study investigates the role of therapist beliefs about SP/SR as a potential obstacle to engagement. An online survey was developed to assess the strength of 14 commonly held therapist beliefs concerning the consequences of participating voluntarily in a SP/SR programme. Participants were a combined sample of 44 Psychological Wellbeing Practitioners and high‐intensity CBT therapists employed by an Improving Access to Psychological Therapies service in the United Kingdom. Few negative beliefs about SP/SR emerged. The majority of respondents believed SP/SR programmes were relevant to their work situation, but perceived “lack of time” as a significant barrier to participation. Three factors are considered in relation to introducing SP/SR as a workforce professional development activity: (a) The importance of managing therapist perceptions regarding time; (b) SP/SR as a mechanism to increase self‐care and reduce burnout; and (c) The need to focus mental health services' attention on the potential of SP/SR programmes to increase staff morale and improve service delivery.     

Enhancing Cognitive‐Behavioural Therapy (CBT) Skill Acquisition Through Experiential and Reflective Learning: A Commentary on Studies Examining the Impact of Self‐Practice and Self‐Reflection in CBT

Self‐practice and self‐reflection (SP/SR) is a targeted training tool that is intended to increase CBT competency in therapists. The four articles reviewed in this commentary examine the benefits of SP/SR with various types of therapists, and survey the significant obstacles faced in implementing this tool with clinicians. Collectively, these articles conclude that SP/SR is a valuable tool in improving CBT skill acquisition and preventing burnout, particularly with difficult patients, but that most therapists elect not to use it largely because of the time involved in engaging in it. In this commentary, I suggest that empirical studies with larger samples and controlled designs are needed to build on the wealth of qualitative data collected to date in order to assess the value added by SP/SR compared with other training methods, and in order to determine its impact on a range of therapeutic outcomes. I also suggest that future studies should examine the efficacy of required SP/SR engagement, isolate its critical ingredients, and assess if there are clients and therapists for whom SP/SR is comparably more effective.     

Commentary on Three Articles on Self‐practice/Self‐reflection in Cognitive‐Behavioural Therapy

The commentary embraces three valuable contributions to the development of professional practice: (a) engagement with self‐practice/self‐reflection as a professional self‐development: the role of therapist beliefs; (b) spontaneous self‐practice of cognitive‐behavioural therapy (CBT) by aboriginal counsellors during and following CBT training: a retrospective analysis of the facilitating conditions and impact; (c) developing metacompetence in low intensity CBT interventions: evaluating a self‐practice/self‐reflection programme for experienced low intensity CBT practitioners. Each article provides different perspectives of the self‐practice and self‐reflection benefits for efficient therapy and their use as powerful resources in therapeutic training skills in general and CBT in particular. Conclusions of their contributions close the commentary.     

Spontaneous Self‐Practice of Cognitive Behavioural Therapy (CBT) by Aboriginal Counsellors During and Following CBT Training: A Retrospective Analysis of Facilitating Conditions and Impact

Previous cognitive behavioural therapy (CBT) training studies have suggested that therapists who practice CBT strategies on themselves during training may experience professional and personal benefits. However, it has also been reported that some CBT trainees are reluctant to engage in self‐practice. The present study reports an incidental finding from a CBT training study with Aboriginal counsellors: all five counsellors reported that they practiced CBT techniques on themselves without specific encouragement by the trainers to do so. This paper therefore posed three questions: (a) Why—in contrast to some other trainees—did this group choose to apply CBT to themselves? (b) How did they apply it—with what purpose, in what contexts, and which skills? (c) What was the impact of CBT self‐practice? Data from the group's reflections were qualitatively analysed by two of the researchers, and “member checked” by the remainder. Results indicated that the counsellors were motivated to practice CBT on themselves for two principal reasons: the value they placed on CBT, and their personal need resulting from the high number of crises experienced while living and working in their communities. The counsellors reported practicing CBT in a wide variety of contexts as part of their learning. As in previous studies, the impact of CBT self‐practice was that it increased their confidence and competence as therapists. It also appeared to be a valuable burnout prevention strategy. If the results are generalisable, they suggest that self‐experiential training in CBT may be a culturally responsive and adaptive way for Aboriginal counsellors to enhance their learning of CBT skills.     

Invited Response to Commentaries: Self‐Practice/Self‐Reflection (SP/SR): Contexts,Challenges and Ways Forward

McGinn (2015) and Fernández‐Álvarez, Castañeiras, and Wyss (2015) make valuable suggestions in their commentaries on the three self‐practice/self‐reflection (SP/SR) articles in this issue of the Australian Psychologist. In our response, we use their commentaries as a springboard to highlight contextual influences and challenges for future SP/SR research, and suggest potential ways forward.     

Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Need for Cognition Promotes Adaptive Style of Self‐Focusing with the Mediation of Effortful Control

Previous studies have indicated that “need for cognition” (NfC), which is the tendency to enjoy effortful cognitive activity, affects various cognitive processes and behaviors. However, the effects of NfC on mental adaptation have not been investigated. According to previous studies, it can be hypothesized that NfC decreases maladaptive self‐focusing, which is called self‐rumination, through increasing effortful control (EC); therefore, we hypothesized that NfC would indirectly inhibit self‐rumination through the mediation of EC. As we expected, the results of a cross‐sectional questionnaire study with 152 undergraduate participants indicated a negative indirect association between NfC and self‐rumination through the mediation of EC. Secondarily, the present results revealed a direct positive association between NfC and adaptive type of self‐focusing, which is called self‐reflection. The present study is the first to propose the possible contribution of NfC to mental health through decreasing self‐rumination and increasing self‐reflection.     

A Path of Counselor Self‐Awareness

This article explores self‐reflection and self‐awareness from an ethical standpoint, proposing that counselors have a responsibility to themselves, their clients, and the profession to engage in these practices. The authors propose a path to counselor self‐awareness and a 2nd process that assumes counselor mastery.     

Self‐reported inner speech use in university students

Remarkably little is known regarding what people talk to themselves about (inner speech use) in their everyday lives. Existing self‐directed speech measures (e.g., thought sampling and questionnaires) either uniquely capture inner speech frequency and neglect its content or classify self‐reported thoughts instances in overly simplistic categories determined by the researchers. In the current study, we describe an open‐format thought listing procedure as well as a refined coding scheme and present detailed inner speech content self‐generated by 76 university students. The most frequently self‐reported inner speech activities were self‐regulation (e.g., planning and problem solving), self‐reflection (e.g., emotions, self‐motivation, appearance, behavior/performance, and autobiography), critical thinking (e.g., evaluating, judging, and criticizing), people in general, education, and current events. Inner speech occurred most commonly while studying and driving. These results are consistent with the self‐regulatory and self‐referential functions of inner speech often emphasized in the literature. Future research avenues using the open‐format inner speech listing procedure and coding scheme are proposed.     

Self‐criticism and self‐reassurance as mediators between mental health attitudes and symptoms: Attitudes toward mental health problems in Japanese workers

Japanese workers suffer high rates of mental health symptoms, recognised recently by the Japanese government, which has enacted workplace well‐being initiatives. One reason for poor mental health concerns negative attitudes about mental health problems such as shame, which may be mediated by self‐reassurance and self‐criticism. This study aimed to evaluate shame‐based attitudes toward mental health problems and explore the relationship between mental health attitudes, self‐criticism, self‐reassurance, and mental health symptoms. Japanese workers (n = 131) completed three measures: attitudes toward mental health problems, mental health symptoms, and self‐criticism/reassurance. A high proportion of workers reported negative attitudes about mental health problems. There were strong relationships between mental health attitudes, mental health symptoms, self‐criticism, and self‐reassurance. Path analyses revealed that the total and indirect effects (through self‐criticism and self‐reassurance) of mental health attitudes on mental health were larger than the direct effect alone. Hated‐self and family reflected shame were identified as predictors for mental health symptoms. The findings suggest the importance of self‐criticism and self‐reassurance in mental health and mental health attitudes. Implications for help‐seeking behaviours also are discussed. Interventions aimed at reducing self‐criticism and enhancing self‐reassurance are recommended to improve mental health attitudes and increase help‐seeking in Japanese workers.     

Self‐absorption paradox is not a paradox: Illuminating the dark side of self‐reflection

Although considered an important component of a healthy personality, self‐reflection has not so far been shown to have any specific benefits for mental health. This research addresses this issue by taking into consideration two important suppressor variables, self‐rumination and the need for absolute truth. The latter is an innovative variable, defined and presented in this research. The first two studies aimed to validate a new measure that acts as an operational definition of the need for absolute truth. The first study was conducted with two group of participants; the first group consisted of 129 females and 67 males, mean age = 20 years, and the second 182 females and 104 males, mean age = 27. In the second study, participants were 22 females and 18 males, mean age = 20.5. In the final study, conducted with 296 female, 163 male participants (mean age = 37), suppressor effects were tested using structural equation modeling. The results showed that by taking account of these two suppressor variables, particularly the need for absolute truth, the expected relationship between self‐reflection and mental health was revealed. The need for absolute truth was shown to be crucial for understanding the effects of self‐reflection on mental health, therefore it should be considered in all processes of psychotherapy.     

The Moderating Effects of Age on the Relationships of Self‐Compassion,Self‐Esteem,and Mental Health

This study investigated the interactive effects of self‐compassion, self‐esteem, and age on mental health. Numerous previous studies have found that self‐compassion has a significant positive association with well‐being but most of these studies were conducted with young adults represented by college students. This study extended the previous findings by comparing its distinctive functions in different age groups. A total of 1,813 adults whose age ranged from twenties to fifties (M = 39.28 years, SD = 11.27) completed a questionnaire measuring self‐compassion, self‐esteem, subjective well‐being, and depression. The results of hierarchical regression analysis indicated that the positive relationship between self‐compassion and subjective well‐being was rendered stronger with older adults. In addition, self‐compassion moderated the relationship between self‐esteem and depression regardless of age. These results imply that self‐compassion may be complimentary to self‐esteem in improving mental health, especially for older adults.     

Predictors of Diabetes Self‐care,Metabolic Control,and Mental Health in Youth with Type 1 Diabetes

The purpose of this study was to explore the psychosocial predictors of diabetes self‐care (adherence to care regimes), metabolic control (glycated haemoglobin), and mental health among rural‐ and urban‐dwelling youth with type 1 diabetes. One hundred and twenty three adolescents/young adults (aged 13?25 years, mean = 16 years, standard deviation = 3.8 years) with type 1 diabetes, 50 males and 73 females, completed questionnaires reporting on diabetes self‐care, metabolic control, mental health (negative affect, quality of life), risk‐taking behaviours and attitudes, diabetes self‐efficacy, community engagement, and perceived social support. No rural/urban differences were detected on key predictors or outcome variables. Structural equation modelling revealed that high diabetes self‐efficacy, lower risk behaviour, and more conservative attitudes to risk taking predicted better diabetes self‐care, which in turn predicted better metabolic control and mental health. Social support and engagement in community activities did not influence diabetes self‐care. The study has significance because both diabetes self‐efficacy and propensity towards risk behaviour are potential targets for educational and counselling interventions designed to improve diabetes self‐care regimes and resultant metabolic and mental health outcomes.     

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.     

Self‐Stigma,Mental Health Literacy,and Attitudes Toward Seeking Psychological Help

This study examined self‐stigma of seeking psychological help and mental health literacy as predictors of college students’ (N = 1,535) help‐seeking attitudes, with additional attention to psychological and demographic correlates. Results indicated that mental health literacy predicted help‐seeking attitudes above and beyond self‐stigma. Asian American race/ethnicity, male gender, current psychological distress, and help‐seeking history were also significant predictors. Implications for addressing mental health literacy and self‐stigma while attending to demographic and psychological variations in help seeking are discussed.     

Mental health professionals' support of self‐help groups

Objective. Self‐help groups and other consumer‐led services are viewed as valuable additions to mental health services. This study describes professional support for self‐help groups and examines the hypothesis that professional support of self‐help is influenced by the degree to which professionally‐led groups are viewed as more helpful than self‐help groups. Method. Survey data were obtained from a representative sample of over 900 mental health professionals employed in mental health agencies in a large US State. The survey assessed beliefs, behaviours, attitudes, and intentions toward professional and self‐help groups. Results. Respondents who perceive professionally‐led groups to be significantly more helpful than self‐help groups were less inclined to support self‐help groups through referrals, help in organizing groups, or financially. Conclusion. To the extent that professional support of the self‐help movement is diminished, valuable allies in the struggle to expand the reach of mental health services are lost. It is proposed that mental health professionals should obtain additional information about the benefits of self‐help and the constructive role that self‐help groups can play in expanding the availability and continuum of beneficial mental health services. Copyright © 2001 John Wiley & Sons, Ltd.     

Comment on “The Self‐Care of Psychologists and Mental Health Professionals” (Dattilio, 2015)

Professor Frank Dattilio's article “The Self‐care of Psychologists and Mental Health Professionals” provides an overview of stress and related mental health problems among psychologists, and a proposition that psychologists are not vigilant in regard to self‐care. Dattilio offers a range of self‐care strategies and recommendations, and highlights self‐care practices within various psychology frameworks, and concludes with some “healthy tips” for managing stress. In my commentary I underscore Dattilio's message that self‐care is of critical importance in psychology practice, given the responsibility of caring for others inherent in the work psychologists undertake. However, I raise additional points of consideration and suggest an alternative approach to addressing the self‐care needs of the profession. My commentary makes the following points: (a) the need to distinguish between psychology trainees and practising qualified psychologists when addressing stress and self‐care requirements in the profession; (b) the importance of developing a culture of self‐care among psychologists by providing self‐care instruction during training; (c) the need to temper research findings on stress and mental health among psychologists by the methodological weakness of the studies in this area; (d) adhering to the recent call from colleagues to shift from a focus on pathology and punishment to a positive acceptance, mindfulness, and values‐based approach for encouraging self‐care among psychologists; (e) the use of a systematic framework for organising the presentation of self‐care strategies that makes them more accessible; and (f) an appeal to professional bodies to take their responsibility in promoting self‐care in the profession.     

Positive Self‐regard and Claim to Leadership: Two Fundamental Forms of Self‐evaluation

The present article examines the common factor structure of various self‐evaluative personality constructs. Consistent with previous research, we found considerable redundancy between constructs. Two basic forms of self‐evaluation could be distinguished: Positive Self‐regard (PSR) reflects people's contentedness with themselves in comparison with their own standards. Constructs such as depression, self‐esteem and neuroticism have very high loadings on this factor. In contrast, Claim to Leadership (CTL) reflects the subjective conviction that one is called to take charge and lead others. This conviction is often called ‘narcissism’. PSR mainly reflects an intra‐personal kind of self‐evaluation, whereas CTL reflects an inter‐personal kind. Both forms of self‐evaluation independently predict intellectual self‐enhancement, but only one of them (PSR) also predicts self‐reported mental health. Moreover, the two forms of self‐evaluation are differentially associated with self‐reported and peer‐reported inter‐personal traits (Dominance and Affiliation). Finally, the concepts of ‘Grandiosity’ and ‘Vulnerability’ from narcissism research may easily be reframed in terms of CTL and PSR. The two‐dimensional framework may help overcome the conceptual confusion that exists around different forms of self‐evaluation and streamline the field for future research. Copyright © 2013 European Association of Personality Psychology     

Online Cognitive Behavioural Therapy Training for Therapists: Outcomes,Acceptability, and Impact of Support

The objectives of the present study were to assess the effects of online cognitive behavioural therapy (CBT) training for therapists on measures of CBT knowledge, skills, confidence, and utilisation; to determine what differences might exist between a group supported by regular telephone contact and an independent group who undertook online training without additional support; and to determine the acceptability of CBT online training among rural and remote mental health professionals. Mental health practitioners were randomly allocated to a supported training group (six sessions of 15‐min support) or an independent group. They undertook a 12‐week online CBT training program. The two groups showed similar gains on an objective test of knowledge of CBT, and on self‐report measures of knowledge, skills, confidence levels, and utilisation of skills. However, the supported training group had a significantly higher program completion rate than the independent group. Participants evaluated the program favourably. The results suggest that online CBT training represents a promising and cost‐effective approach to training the mental health workforce, and may be particularly attractive for those who live in regional, rural, and remote communities. A challenge is to determine the most cost‐effective ways to enhance program completion rates and trainee skills.     

Self‐Stigma,Mental Health Literacy,and Health Outcomes in Integrated Care

The authors describe research on the self‐stigma of mental illness and help seeking, mental health literacy, and health outcomes in an integrated care medical center. Results revealed that self‐stigma of mental illness and self‐stigma of seeking help had an inverse relationship with mental health literacy. No statistically significant relationships were found between health outcomes, either type of self‐stigma, and mental health literacy. The authors discuss these and other findings and offer research and counseling implications.