A Common Factors Approach to Psychotherapy Training

This article addresses training in psychotherapy integration from the perspective of common factors. Problems related to this training perspective are first reviewed. As an attempt to deal with such problems, current teaching and supervision efforts by the author are briefly described. Based on a developmental model of clinical learning, a sketch of a more comprehensive program of integrative psychotherapy training is advanced.     

A Participant-Observer's Perspective on Psychotherapy Integration

Jacobson has raised a number of issues about the usefulness of psychotherapy integration. Some of his concerns stem from his doubt that people are capable of change, and some that appear to be the result of a misinterpretation of what constitutes psychotherapy integration. This article attempts to clarify some of these misunderstandings, which seem to be the result of equating psychotherapy integration with the integration of theories. Comments are also made about the research underpinings related to work in this area.     

Psyche and System: On Progress in the Integration of Individual Psychotherapy and Family Psychotherapy

This article addresses the frequency with which the same group of patients utilizes individual and family therapies, and at the same time do not constitute actual integration. The conditions under which such serial or concurrent utilization of the two forms of psychotherapy may be considered to be integrative are discussed.     

Psychotherapy Integration: Contributions from Lifestyle Theory

The lifestyle theory of intervention is evaluated with respect to its status as an integrated psychotherapy using theoretical integration, technical eclecticism, and the common factors approach as criteria. Because lifestyle theory integrates concepts from evolutionary biology, existential philosophy, cognitive psychology, social learning theory, and various therapeutic models it satisfies preliminary criteria for theoretical integration. To the extent that it provides an internally consistent model and makes use of techniques from disparate schools of psychotherapy, it adopts a technical eclectic approach to intervention. The lifestyle model also appears to qualify as an integrated psychotherapy by virtue of its attention to several common factors in psychotherapy.     

A Developmental Approach to the Supervision of Therapists in Training

Supervision is considered essential to therapeutic effectiveness yet trainees frequently report negative supervisory experiences. Although such experiences may be due to inadequate or poor supervision, more often they result from differing needs or expectations among trainees. Thus, supervisors must struggle to determine how to best conduct supervision. We propose that many negative experiences result from a supervisors inattention to the trainees development as a mature individual. By examining the cognitive and emotional development of trainees supervisors are offered a framework from which to select interventions and strategies that encourage rather than discourage trainees.     

Eclecticism and Integration: A Personal Retrospective View

As indicated in the title, this article presents a personal retrospective account of the development of the author's eclectic and integrative views of psychotherapy. Although this period covers more than 50 years, I have tried my best to recall events as accurately as possible.     

A fertile matrix: the birth of the Forensic Psychotherapy Society

This paper traces some aspects of the fertile matrix within which, over many years, the application of a psychoanalytic perspective to clinical work with the most severely mentally ill, difficult and at times frightening patients in secure and community settings has evolved and now led to the recent inauguration of the Forensic Psychotherapy Society (FPS), a new Member Institution of the British Psychoanalytic Council. The Society provides both a framework for a national, multidisciplinary professional training in psychodynamic forensic psychotherapy and the potential launching pad for an active post-qualification organisation supporting CPD and all other forms of professional development. The particular contributions to the birth of the FPS of the Forensic Psychotherapy Department at West London Mental Health NHS Trust, partly because we know it best but also because it is part of the largest forensic psychiatric service in the United Kingdom, are described.     

Toward an Integrative Theoretical Basis for Training Psychotherapists

The purpose of this paper is to describe a training program for integrative psychotherapy that is based on an as-yet-nonexistent integrative theory of psychotherapy. It is therefore to be considered a thought experiment. A partially integrative theory of psychotherapy is presented—a work in progress—which is used as the basis for planning a 3-year postdoctoral training program for advanced psychotherapists. The curriculum would include (1) several courses on specific pure-form therapies, (2) core courses in the integrative theory, (3) courses on the application of the integrative theory to a number of different classes of mental disorder, (4) a year of practicum during which the student therapist applies the integrative treatment to a substantial number of patients under supervision, and (5) a year-long internship-like experience during which the treatment will be applied to a much larger base of patients. Students would also attend a therapy-like group to explore feelings regarding the conduct of this therapy and a second case conference group to discuss their cases.     

Making Space for Every Body: Ending Sizeism in Psychotherapy and Training

Abstract

The importance of addressing weight bias as a social justice issue in psychotherapy and psychology education and training is introduced. The history of the development of fat studies is briefly reviewed. Current coverage of size and sizeism in psychology is critically examined and contrasted with the increasing adoption of the medical model of “obesity.” Fat shaming in the practice of mental health professionals is examined as a barrier to clients’ physical and mental health. Alternatives to medicalized weight management and fat shaming are introduced. Models that emphasize size acceptance and resist negative embodiment are encouraged. The potential for a future that makes space for every body is assessed.     

The Future of Training and Credentialing in Group Psychotherapy

High-quality group psychotherapy training is seen as more important than ever in the current health care environment. The training opportunities available at present are assessed. It is argued that there is a body of knowledge about generic group psychotherapy that can and should be taught, and that there are appropriate people to teach it. Credentialing is discussed, and it is suggested that the assessment of actual work in clinical situations must be emphasized if such efforts are to be meaningful.     

Definitional and Research Issues in the Common Factors Approach to Psychotherapy Integration: Misconceptions, Clarifications, and Proposals

This paper focuses on two common misconceptions of common factors in therapy. The first misconception entails the confusion between common factors and therapeutic factors, and thus the inappropriate and misleading use of the term therapeutic common factors in various situations. The second misconception is the mixing of commonalities of different kinds and levels in proposed lists and studies of common factors. These areas are discussed and clarified, and recommendations designed to facilitate conceptual and methodological improvements relative to each misconception are offered. The selection of best levels and kinds of common factors to be studied are further explored (i.e., the study of client change events and antecedent therapist behaviors across different therapies), and specific proposals for their research are outlined.     

The embodied analyst: from Freud and Reich to relationality

This paper presents the impact of clinical supervision on once-weekly psychoanalytically-informed training psychotherapy. The development of Oedipus complex theory is presented, culminating in Britton's work on the triangular space that opens up by working through the complex. The geometry of psychic space is described to highlight the importance of supervision, especially when training in therapy. The theme of spiders and cobwebs emerging from the clinical material provides a powerful metaphor for the tensions in psychic space. In the course of this training, the trainee therapist was at times less able to benefit fully from supervision, and thus the third position partially collapsed. Vignettes from anonymised clinical work are presented in the three ‘phases’ of this therapeutic process, illustrating the impact of the presence – and relative absence – of supervision.     

An Outsider's Perspective on Psychotherapy Integration

This article offers those who are identified with progress in psychotherapy integration an outsider's perspective on progress in the field. The author argues for a contextual study of psychotherapy and psychotherapy integration, noting that the social psychology of psychotherapy may be an overlooked dimension in the study of psychotherapy integration. He suggests that perceptions of progress in psychotherapy integration may be exaggerated due to the lack of such a perspective.     

An Overview of Directions in Psychotherapy Integration Research

In general, empirical research in psychotherapy integration has lagged behind the growing theoretical and clinical interest in the field. Even though many of the theoretically integrative treatment models currently available are based on empirical findings and clinical observations, the models themselves remain, for the most part, untested. Rigorous examination of integrative psychological theories and therapeutic programs is a necessary and useful way to increase our understanding of the process of psychotherapy and establish the efficacy and effectiveness of integrative therapies. The present article explores five different research areas in the field of psychotherapy integration, discussing several published studies in each area. The utility of this research for practicing clinicians is also discussed. Additional investigations in these areas and others are encouraged, with the goals of greater understanding of psychotherapy, as well as the further development and acceptance of integrative approaches.     

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.     

Does Every Good Behaviorist Deserve Favor? A Reply to Neil Jacobson

This is a response to Dr. NeilJacobson's article, An Outsider's Perspective on Psychotherapy Integration, which appears in this issue. It addresses the issue of the differences between eclecticism and psychotherapy integration as well as the possible advantages integration holds over a one-model therapy system. This article suggests that virtually all psychotherapy systems operate under an integrated three paradigm model, and offers some concrete examples of this explanation. It also suggests that the use of psychotherapy integration may lead to a better paradigm match between client and therapist, and ultimately to better outcome. This article concludes that psychotherapy integration possibly offers the best alternative in terms of reducing the biases of one's underlying treatment oaradiem.     

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.