Readiness to adaptively change under three conditions: Clinical,careers, and natural change situations

The Adaptive Change Model (ACM) was developed as an alternative form of the Transtheoretical Model of Change to address some of the criticisms of early operationalisation. Both models provide a framework for measuring the potentialities of change and to facilitate targeted behaviour change in general and clinical settings. In this research, the eight factors of the Adaptive Change Questionnaire (ACQ) operationalising the ACM were validated using confirmatory factor analysis, involving 238 respondents. The findings indicated a good fit between the model and data. A comparison of the mean scores of the factors of the ACM showed respondents seeking clinical therapy (n = 85) were lower on self‐rating of factors related to adaptive change than a group receiving career counselling (n = 88) and a non‐therapy group (n = 65). The ACQ factors correctly predicted the allocation of 79.3% of the clinical and non‐therapy respondents which confirmed previous research. The relevance of the findings for therapeutic interventions and future research are discussed.     

Her Body Speaks: The Experience of Dance Therapy for Women Survivors of Child Sexual Abuse

This qualitative, phenomenological study explores the experiences of dance therapy for 5 women who had been sexually abused as children. Using in‐depth, largely unstructured interviews, the women reflect on their dance therapy experiences and on their perceptions of the role of these experiences in their psychological healing. Analysis of these data revealed 6 common themes related to the women's sense of spontaneity, permission to play, struggle, freedom, intimate connection, and bodily reconnection. The implications of the findings are discussed in terms of the therapeutic nature of dance therapy and how this therapeutic modality facilitates change and healing in clients' lives.     

‘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.     

An exploration of the therapeutic process while using computerised cognitive behaviour therapy

Background: Modern technologies that offer an alternative to face‐to‐face therapy have gained ground in the NHS. Critics have argued that some of the important elements of the therapeutic change process necessarily require a human therapist. Yet, the traditional understanding of the change process in psychotherapy is challenged by evidence that some computerised cognitive behaviour therapy (cCBT) programs may be as effective as face‐to‐face therapy, suggesting that in certain cases the interaction between user and a cCBT product satisfies sufficient criteria for personal change without the need for actual human contact. Aim: This study used the cCBT package Blues Begone as a means of investigating the process by which a computer‐mediated program helped adults with mild depression help themselves. Method: Seven qualitative interviews were conducted with mildly depressed users who had completed Blues Begone in their own homes without any additional human help or support. Findings: Interpretive phenomenological analysis (IPA) was performed with four main themes emerging. These were: the meaningful relationship; shape from confusion; stimulation and empowerment. This study illustrates some of the ways that some depressed users make use of cCBT self help.     

Sharing My Music with You: The Musical Presentation as a Tool for Exploring,Examining and Enhancing Self‐Awareness in a Group Setting

Musical presentation (MP) is a diagnostic and therapeutic music therapy tool which focuses on the participant's emotional exploration and awareness‐insight development. Using this tool people present themselves through music of their choice and subsequently receive feedback from their peers. This study investigates MP as a tool for enhancing self‐awareness in the context of a voluntary activity that was integrated in courses for undergraduate students in order to demonstrate its possible uses. Open‐ended in‐depth interviews with 15 MP presenters and focus‐group interviews with 41 MP peers who listened to the presentations were conducted. The Johari Window, which is a cognitive psychological model used to help people better understand their interpersonal communication and relationships, served as a conceptual framework for this study. Qualitative analysis of the data showed that presenters' self‐awareness was enhanced through the use of both music and words. As an accessible and creative tool, the MP can be used as a way for people in both therapeutic and non‐therapeutic settings to present themselves via their music to a group and increase their self‐awareness.     

Understanding Pamina's recovery: An application of the hermeneutic single‐case efficacy design

This article reports an effectiveness case study of the individual systemic therapy of a 22‐year‐old Portuguese woman with a diagnosis of paranoid personality disorder, conducted in a university‐based clinic in Lisbon, Portugal. Data were analysed using the hermeneutic single‐case efficacy design, a non‐experimental interpretive approach that aims to determine whether change occurred, whether change was due to therapeutic strategies, and what in therapy caused the change. Results indicate that the treatment was effective and that de‐pathologising Pamina's condition and genogram‐based exploration techniques played a crucial role in her recovery.     

An exploration of the mechanisms of change following an integrated group intervention for stuttering,as perceived by school-aged children who stutter (CWS)

PurposeTo explore the process of change and role of resilience following an integrated group intervention for children who stutter (CWS).MethodUsing an exploratory multiple case study design, this research sought to identify the most significant changes perceived by seven participants following therapy, the mechanisms of change, and the role of resilience in the process of change. Quantitative measurements of resilience were combined with qualitative analysis of semi-structured interviews.ResultsThematic analysis of qualitative data showed that cognitive and emotional change was a key driver for therapeutic change, enabled by the shared experience of the group and a positive therapeutic environment. These changes were generalised into clients’ real-world experiences, facilitated by their support network. Quantitative data demonstrated a statistically reliable positive change in overall Resiliency scores for four participants and reduced impact of stuttering scores on OASES-S for all participants, maintained at 12 month follow-up.ConclusionsThis study demonstrates the importance of adopting an integrated approach in therapy for CWS, which incorporates Cognitive Behavioural Therapy (CBT) as a key component, to facilitate change and build resilience. These results are unique to this cohort of CWS and further investigation into the use of CBT and the process of change may be warranted.Educational ObjectivesThe reader will be able to (1) describe the integrated intervention used in this study (2) define the most significant change following therapy for the participants involved (3) summarise the key factors that facilitated change during the therapy process (as perceived by the participants).     

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.     

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.     

Diversity in practitioners' perspectives on the implementation of the evidence‐based Triple P—Positive Parenting Program

Evidence‐based programs (EBPs) have the potential to improve the well‐being of families and children, but do not necessarily produce the expected outcomes when implemented in real‐world settings. It thus appears essential to consider the factors that can impact the implementation process, especially those related to the practitioners who deliver these programs. This study aimed to identify and describe common patterns in practitioners' experience of the implementation of an EBP. To this end, six focus groups were conducted with 38 practitioners from the health, social and education sectors, 1 year after they had received training in the evidence‐based Triple P—Positive Parenting Program. An in‐depth analysis of the content of these interviews revealed a diversity in the practitioners' experience of the implementation of Triple P. Three distinct types of discourse regarding the implementation process, labelled ‘conviction’, ‘mastering’ and ‘estrangement’ discourse, were identified. Motivational theories were used to understand the interaction between the factors that appeared to be key elements differentiating the discourses in this typology (i.e., practitioners' attitudes, perceived organisational support, self‐efficacy and level of program use). This study highlights the dynamic nature of the implementation process, and shows that a negative initial position towards a new EBP can change over time, given the appropriate organisational conditions.     

A psychoanalytically informed hospitalization‐based treatment of personality disorders

This study presents a model of psychic change in personality disorders focusing on three dimensions: felt safety, mentalization and self‐object relations. Based upon this model a hospitalization‐based therapy program was created. Four scales to measure these three dimensions on the Object Relation Interview are discussed: the Felt Safety Scale, the Reflective Functioning Scale and the Bion Grid Scale and the Differentiation‐Relatedness Scale. A naturalistic symptom outcome study of the program showed a large effect on both symptoms and personality functioning. Furthermore, trajectory based on pre‐treatment patient characteristics (i.e., anaclitic versus introjective personality styles). Importantly, we also found a relation between symptomatic and personality change and change in felt safety and object relations. At 5‐year follow‐up, patients showed sustained improvement in symptomatic distress and further improvement in terms of personality and interpersonal functioning.     

Individual Determinants of Behavioral Intentions: What tells us that practitioners really want to change hiring strategies?

The current study investigated hiring managers' intentional readiness to change hiring procedures as a function of individual determinants, such as their self‐efficacy beliefs, causal attributions, and past behaviors. Hiring managers from three large organizations were recruited to participate and provide information about their current hiring processes and personal experiences. Results showed that self‐efficacy beliefs had a strong negative relationship with intentional readiness to change. Managers' past behavior, in terms of use of unstructured interviews and external attributions of failure, were negatively associated with intentional readiness to change, while use of unstructured interviews and external attribution of success were positively associated with intentional readiness to change. Furthermore, the interactive effect of causal attribution and use of selection methods played a significant role in explaining intentional readiness for change. The results indicated that recruiting managers who preferred using unstructured interviews and attributed failures to external causes were less willing to change hiring practices than those who made less use of unstructured interviews and explained their failure externally. Implications and limitations are discussed.     

The role of women's self‐injury support‐groups: a grounded theory

Research evidence suggests that services are struggling to adequately address the increasing incidence of self‐injury and the needs of women who self‐injure, while national self‐injury support‐groups across the UK appear to be growing in number. Despite their reported value, evidence regarding the role of self‐injury support‐groups in women's management of their self‐injury is lacking although government policy and official guidelines are advocating the incorporation of support‐groups into self‐injury services. Seven semi‐structured interviews were conducted and analysed using Grounded Theory to investigate the role of three UK self‐injury support‐groups in women's management of self‐injury and associated difficulties. Empowerment‐as‐process emerged as the core theme of self‐injury support‐groups, mediated through experiences of belonging, sharing, autonomy, positive feeling and change. Findings are discussed in relation to relevant theory and research, followed by critical evaluation and implications of the study. Copyright © 2006 John Wiley & Sons, Ltd.     

what helps and hinders workers in managing change

This research responds to calls for increased understanding of workers' experiences of their work and work contexts. Informed by positive psychology, this study focused on a seldom‐studied subset of working individuals who self‐identified as doing well with change affecting their work and on strategies that helped or hindered them in doing well, factors that would have helped, and their experiences of change within the context of volatile and changing work situations. Using the enhanced critical incident technique methodology, the authors extracted 790 incidents from 45 participant interviews. These data were organized into the following 10 categories: support from friends and family, support from colleagues, support from professionals, personal attitudes/traits/emotional set, self‐care, internal framework and boundaries, taking action, skill/role competence, management style and work environment, and personal life changes/issues. The implications of these categories for research, theory, practice, and organizations are discussed.     

You still feel different: the experience and meaning of women's self‐injury in the context of a lesbian or bisexual identity

This article reports an intensive qualitative study of the subjective experience and meaning of self‐injury for 16 women who identified as lesbian or bisexual and who had deliberately self‐injured on repeated occasions. In individual interviews, the women talked about their experiences of self‐injury and the role it played in their lives as lesbian or bisexual women. Interpretative Phenomenological Analysis (IPA) was used to elicit themes arising within their accounts. These highlighted a number of ways in which social and contextual factors contributed to the development of self‐injury. Although many of these factors seemed applicable to any woman who self‐injures, there were some aspects that were specific to the experience of lesbian and bisexual women. In addition, the women's accounts raised a number of important issues about the way in which mental health services respond to lesbian and bisexual women who self‐injure. It is argued that self‐injury can be understood as a coping response that arises within a social context characterized by abuse, invalidation, and the experience of being regarded as different or in some way unacceptable. These factors are especially salient in the lives of women, and they emerge particularly strongly as part of the experience of women who are developing a lesbian or bisexual identity. Copyright © 2004 John Wiley & Sons, Ltd.     

Engaging reluctant adolescents in family therapy: an exploratory study of in‐session processes of change

Informed by a trans‐theoretical model of the therapeutic alliance in conjoint family therapy, this exploratory study was the initial stage in a task analysis of critical shifts in adolescent engagement. Specifically, we compared sessions in which a resistant adolescent either did or did not shift from negative to positive engagement during the session. Two successful and two unsuccessful change events were selected from an archival data set based on SOFTA ratings of the therapeutic alliance. The results suggested that one parent element (support) and five therapist elements (structuring therapeutic conversations, fostering autonomy, building systemic awareness, rolling with resistance and understanding the adolescent's subjective experience) seemed critical for successfully facilitating adolescent engagement. The qualitative results were informed by the adolescent's self‐reported target complaints pretreatment, which suggested varying reasons for the teenagers’ active or passive disengagement. Implications for practice and recommendations for future research are offered to continue this line of inquiry.     

How individuals with self‐reported anxiety and depression experienced a combination of individual counselling with an adventurous outdoor experience: A qualitative evaluation

Background: Adventure therapy is a short‐term experiential psychotherapeutic approach that utilises adventurous activities and being in natural environments in order to facilitate therapeutic change in clients. The present paper examines how students with self‐reported anxiety and depression experienced participating in an innovative intervention that combined individual therapy with an adventurous outdoor experience. Clients participating in the Adventure Therapy Project received between 10–15 one‐to‐one counselling sessions prior to the outdoor experience, as well as ongoing counselling following it. Method: Interpretative Phenomenological Analysis was used in order to record and analyse the experiences of three male and three female students who presented at a major UK university student counselling service with self‐reported depression and anxiety. Findings: Twelve themes emerged which were categorised into four major domains: enhancing intrapersonal relationships; improving interpersonal relationships; providing an experiential outdoor venue for achieving therapeutic change; offering a secure, personal place for achieving inner healing. The intervention was perceived to improve the ways in which interviewees related towards themselves and other people. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing. Conclusions: Outdoor experiences offer an experiential venue for achieving personal change and, it appears enhance the therapeutic process. Prior and subsequent individual therapy increases the benefits of such experiences.     

Self‐managed learning groups in higher education: Students' perceptions of process and outcomes

Background. Self‐managed learning groups are increasingly used in higher education. There is a need for more systematic investigation of university students' perceptions of the processes and outcomes of this learning method. Aims. This study aimed to identify the domains of process issues that students perceive as relevant to their participation in self‐managed learning groups, and how these processes are perceived to influence group outcomes. Sample. Participants were undergraduate psychology students who were members of self‐managed learning groups. Method. The first study employed qualitative methods (namely, students' written accounts, interviews, and observation) to study learning groups (N =180 students) and identify the process domains. In the second study, first and second year students (N =207) used a questionnaire (based on the domains identified in Study 1) to evaluate the processes and outcomes of their learning groups. Results. Analysis of qualitative data (Study 1) identified seven process domains: task focus, staff support, process learning, environmental fit, managing differences, equity and responsibility, and collaboration and cooperation. Factor analysis of students' responses (Study 2) identified an underlying structure of two process factors: personal responsibility and collaborative climate, and staff support and environmental fit. Both process factors were associated with the self‐reported satisfaction and productivity of this group of students. Conclusions. University students' perceptions of the processes of self‐managed learning groups have a clear structure. These process factors are associated with perceived group outcomes in systematic and theoretically consistent ways.     

A qualitative review of perception of change for male perpetrators of domestic abuse following abuser schema therapy (AST)

Introduction: Domestic abuse is known to have detrimental effects on all members of the family, yet it is often difficult for victims to leave. It is therefore important to research available intervention programmes for perpetrators who want to change their behaviour. Intervention programmes for perpetrators are informed by different theoretical and philosophical approaches, such as pro‐feminism, psychopathology or biopsychosocial theories. However, there is little consensus to the most effective intervention and there is a paucity of qualitative research on the perspectives of the perpetrators who attend the available therapies. Aim: The aim of this research was to discover the perceptions of change of 18 male, heterosexual perpetrators with female partners who self referred to a community‐based therapy service providing abuser schema therapy (AST). Method: A qualitative methodology was adopted using semi‐structured interviews on completion of therapy, and at three, six, nine and 12 months follow‐up. A content analysis was conducted and data was coded and mapped against a priori variables. Findings: The findings indicated that the four highest rated variables were: (1) a reduction of anger, (2) an increase in communication and assertiveness skills, (3) an increase in ability to think prior to behaviour, and (4) responsibility for personal power. The findings are discussed in relation to the perceived changes for perpetrators. Conclusions: In conclusion, this study seeks to contribute to the development of future effective interventions to reduce aggression within the home.