Developing Metacompetence in Low Intensity Cognitive‐Behavioural Therapy (CBT) Interventions: Evaluating a Self‐Practice/Self‐Reflection Programme for Experienced Low Intensity CBT Practitioners

Self‐practice/self‐reflection (SP/SR) is a targeted training and professional development strategy in which clinicians practice cognitive‐behavioural therapy (CBT) techniques and processes on themselves and then working through a structured process of self‐reflection. Previous studies with CBT trainees and experienced mental health practitioners have found that SP/SR or experiencing CBT “from the inside out” has been perceived by participants as increasing competency in a number of important areas and increasing therapist flexibility and artistry. Low intensity (LI) practitioners are identified as a relatively new addition to mental health service delivery in the UK. These workers are differentiated from traditional mental health practitioners by a shorter training period, the delivery of a circumscribed number of CBT interventions, and a very high weekly patient load. This study, the first of its kind, reports outcomes from an SP/SR programme undertaken by seven experienced LI CBT practitioners. Participants used the following measures to track their experience of the programme: time spent on programme, personal‐ and therapy‐related belief rating, goals attained, and perceived skill rated for average and most difficult patients. Results showed a positive change in work‐related skill and behaviour change, particularly when working with the more difficult patients. The findings are consistent with those found in other groups of therapists (e.g., trainee CBT therapists and highly experienced CBT therapists), suggesting that SP/SR may be a valuable addition to LI intensity training and professional development. These findings are discussed in the context of the particular needs of LI practitioners.     

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.     

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.     

Self‐Images and “Perspicuous Representations”: Reflection,Philosophy, and the Glass Mirror

Reflection names the central activity of Western philosophical practice; the mirror and its attendant metaphors of reflection are omnipresent in the self‐image(s) of Western philosophy and in metaphilosophical reflection on reflection. But the physical experiences of being reflected by glass mirrors have been inadequately theorized contributors to those metaphors, and this has implications not only for the self‐image and the self (or selves) of philosophy but also for metaphilosophical practice. This article begins to rethink the metaphor of reflection anew. Paying attention to the history of the glass mirror in Europe reveals and challenges the modern emergence of clear ontological distinctions between disembodied subjects and the objects of their knowledge, and suggests a compelling terrain of metaphilosophical analysis. On the reading offered by the article, the inherent complexity of the relationship between selves and their mirror images, a complexity mediated by social location, historical situation, and particular projects, points to significant spaces of unknowing, of indeterminacy, and of ontological ambiguity.     

Self‐compassion Is Best Measured as a Global Construct and Is Overlapping with but Distinct from Neuroticism: A Response to Pfattheicher,Geiger, Hartung,Weiss, and Schindler (2017)

Pfattheicher and colleagues recently published an article entitled ‘Old Wine in New Bottles? The Case of Self‐compassion and Neuroticism’ that argues the negative items of the Self‐compassion Scale (SCS), which represent reduced uncompassionate self‐responding, are redundant with neuroticism (especially its depression and anxiety facets) and do not evidence incremental validity in predicting life satisfaction. Using potentially problematic methods to examine the factor structure of the SCS (higher‐order confirmatory factor analysis), they suggest a total self‐compassion score should not be used and negative items should be dropped. In Study 1, we present a reanalysis of their data using what we argue are more theoretically appropriate methods (bifactor exploratory structural equation modelling) that support use of a global self‐compassion factor (explaining 94% of item variance) over separate factors representing compassionate and reduced uncompassionate self‐responding. While self‐compassion evidenced a large correlation with neuroticism and depression and a small correlation with anxiety, it explained meaningful incremental validity in life satisfaction compared with neuroticism, depression, and anxiety. Findings were replicated in Study 2, which examined emotion regulation. Study 3 established the incremental validity of negative items with multiple well‐being outcomes. We conclude that although self‐compassion overlaps with neuroticism, the two constructs are distinct. © 2018 European Association of Personality Psychology     

Simple discrimination in stingless bees (Melipona quadrifasciata): Probing for select‐ and reject‐stimulus control

Simple and conditional discrimination training may produce various types of controlling relations. Responses may be controlled primarily by the positive stimulus (select–control relation) or by the negative stimulus (reject–control relation; the subject excludes the negative stimulus and chooses the positive). Bees learn to respond in simple and conditional discriminations. However, no study has searched for reject–control responding in Melipona bees. We trained Melipona quadrifasciata on a simple discrimination task (S+ vs. S‐; e.g., blue vs. yellow) and then probed for stimulus control with two types of probe trials, S+ versus a new stimulus (Select–control probes) and S‐ versus a new stimulus (Reject–control probes). For Group Different, a new‐stimulus color (e.g., white) was used in one type of probe and another color (e.g., black) was used in the other type. For Group Same, a single new‐stimulus color was used in both types of probes. On Select probes, the bees always preferred S+ to the new stimulus. On Reject probes, results were mixed. Depending on the colors used in training and probing, bees responded to both stimuli, and even preferred the S‐. The data suggest no control by the negative function of the S‐ and support the select‐stimulus control hypothesis of responding.     

Further evidence of the Narcissistic Personality Inventory’s validity problems: A meta-analytic investigation—Response to Miller, Maples, and Campbell (this issue)

Miller, Maples, and Campbell (this issue) present evidence that Rosenthal and Hooley’s (2010) concerns regarding the Narcissistic Personality Inventory’s (NPI) relation to psychological health may be unwarranted. To resolve this issue empirically, we conducted a meta-analysis (k = 54, N = 38,932). Meta-analytic results revealed that a subset of NPI items were indeed problematic; items that function poorly at differentiating narcissists from non-narcissists accounted entirely for the NPI’s connection to psychological health. These items were also strongly associated with self-esteem, but unrelated to aggression/anger. In contrast, the remaining NPI items were unrelated to psychological health, but associated with aggression/anger. We conclude that although the NPI measures narcissism, its poorest functioning items also link it to outcomes unrelated to narcissism.     

Four Keys to Success (Theory, Implementation, Evaluation, and Resource/System Support): High Hopes and Challenges in Participation

In this article, I attempt to merge two themes. First, there is often a large gap between high hopes about impacts of policies or programs and the demonstrated results. I describe four keys/threats to success in any social problem area: theory, implementation, evaluation, and resource/system support. Second, I present theory and research from over 30 years of work on participation, conducted by my colleagues and myself that can illuminate and be illuminated by theory, implementation, evaluation, and resource/system support. I offer ideas for solutions that increase the probability of success. I conclude with the need to have high hopes tempered by theory and research to develop realistically ambitious solutions to social problems.     

Public attitudes to,and perceived impacts of 20mph (32 km/h) speed limits in Edinburgh: An exploratory study using the Speed Limits Perceptions Survey (SLiPS)

Between 2016 and 2018 a policy was implemented to increase the proportion of 20mph (32km/h) streets in Edinburgh, UK from approximately 50% to 80%, providing the opportunity to evaluate how behaviour and public perceptions change over time. This is important as negative public responses have been reported to limit the implementation of transport policies and may reduce the effectiveness of the policy. The Speed Limits Perception Survey (SLiPS) was developed to assess changes in public perceptions from baseline to 6 and 12 months post-implementation. We collected 3,485 individual responses to the survey, 64.6% (n = 2,253) of which included complete perceptions data. Using exploratory factor analysis, the following perception factors were identified: i) Detraction and resistance, ii) Support, iii) Rule following, iv) Child safety, and v) Walking safety. Following the 20mph implementation at 6–12 months: Support (ii) and Rule following (iii) had increased; Detraction and resistance (i) had decreased; and Child safety (iv) and Walking safety (v) had not changed significantly. These findings indicate that the public in Edinburgh became more positive towards the policy once it was implemented. However, more extensive policy or ongoing communication of the safety benefits of 20mph limits are needed to increase perceptions of safety that might lead to increased walking and cycling. Future research should aim to understand how those implementing speed limit interventions can positively influence public perceptions and how public perceptions about speed limits influence behaviour.     

The early history of lay analysis,especially in Vienna,Berlin and London: Aspects of an unfolding controversy (1906‐24)1,2

Before the First World War, it had been taken for granted that psychoanalysis was carried out by doctors. The IPA, however, also included non‐physicians. This corresponded to Freud's view that psychoanalysis was a basic science (psychology of the unconscious) with manifold fields of application in medicine as well as in the humanities. It was for the latter application that Freud specifically recruited a number of researchers, e.g. Rank. After 1918, helped by a general boom in psychotherapy, these people too began to work as therapists. This led to a debate about lay analysis within the ‘Secret Committee’ that has so far received little attention and is one focus of this paper. Abraham had only allowed doctors to become members of his group. Similarly the Berlin Policlinic was established as a place for the postgraduate training of doctors. On the other hand, Freud (together with Rank) continued to maintain his broader view of psychoanalysis. In 1920/21, he already wished that analysts would not become a subgroup within the medical profession, but a profession of their own, defined by their special training. The big problem of the late 1920s, that different attitudes to the lay question threatened the autonomy of local or national groups and the integration of the IPA, also became visible at that early time in a conflict between London (Jones) and Vienna/Berlin.     

Self‐report measures,facial feedback,and personality differences (BEES) in cooperative vs. noncooperative situations: Contribution of the mimic system to the sense of empathy

The present study integrated three different measures of emotional empathic behavior in a social context: verbal self‐report measures (empathic response, emotional involvement, emotional significance, and valence), facial mimicry (activity of corrugator and zygomaticus muscles), and personal response to the Balanced Emotional Empathy Scale (BEES). Participants were presented with different interpersonal scene types (cooperation, noncooperation, conflict, indifference). Firstly, self‐rating on empathy, emotional involvement, and valence varied as a function of interpersonal context. Secondly, corrugator activity increased in response to conflictual and noncooperative situations; zygomatic activity increased in response to cooperative situations. Third, high‐ and low‐BEES subjects showed different empathic behavior: High‐empathic subjects were more responsive to empathy‐related situations than low‐empathic subjects. The convergence and divergence of these multidimensional measures was discussed.