Training in group-analytic psychotherapy in Europe

Group-analytic psychotherapy focuses on the making and maintaining of close, emotionally fulfilling relationships. Its practitioners attempt to fuse an individual and a whole-group perspective, and seek to provide the enabling conditions for freer communication between group members. The group-analytic approach is widely used in the United Kingdom, and many experiential groups on psychotherapy training courses are conducted on group-analytic lines. The Institute of Group Psychotherapy in London recognizes eight one-year courses in England and Scotland specifically oriented to group-analytic theory and methods. These courses provide an introduction to group psychotherapy to over 300 professionals of varied backgrounds every year. There are also two courses in the United Kingdom that provide a full training in group-analysis and group-analytic psychotherapy, and 11 courses on the continent of Europe. The number of courses is growing and there is now a European Group-Analytic Training Network providing formal links between them. Results of a postal survey indicate that few (10%) attenders at a one-year course have a negative response and that many (85%) recommend the course to colleagues. The efficiency and therefore reduced cost of group teaching and the incorporation of a group experience may be contributing factors to the increasing demand for this type of training.This paper is based on a presentation at an Open Session on Training in Group Psychotherapy: The Quest for a Viable Model at the American Group Psychotherapy Association Annual Meeting, Boston, February 1990. This paper represents the author's own views and is not an official statement of the Institute of Group Analysis [London]. However, members and staff of the Institute have made helpful contributions to the author in preparing it. He is especially grateful for the assistance of Mrs. Liesel Hearst (Chairperson, Overseas Training Sub-Committee, Institute of Group Analysis, London), Dr. Keith Hyde (Convenor, Manchester Course in Group Psychotherapy), Fr. Jim Christie (Convenor, Glasgow Course in Group Psychotherapy), and Dr. Vivienne Cohen (Chairperson, Training Committee, Institute of Group Analysis, London, in preparing this paper. The questionnaire study was conducted with the assistance of the Training Section of the North-Western Regional Health Authority.     

Universities are not a good place for psychotherapy and counselling training

This paper outlines eight aspects of institutional practice in university teaching that are at odds with the ethos of therapy: the linearity of university training has consequences for conceptual and cultural issues that may be antithetical to genuine therapeutic practice; certain notions about what reality is and what counts as truth may be reinforced by university trainings; academic knowledge in universities is standardized so as to sabotage therapeutic work; the university privileges a cognitive account; the university trains therapists in ways that are antithetical to the ethos of therapy; universities keep alive hierarchies that sit uneasily with the project of therapy; university training encourages the therapist to develop an identity that is anathema to many traditions in therapy; and compartmentalization of ethics in university-based trainings would run against the ethics of therapy.     

Die Verantwortung der Psychoanalyse für die Psychotherapie

Whether psychoanalysis can take over the responsibility for psychotherapy when it is not operating as a part of psychoanalysis but on its own is a question which has currently become significant again. The present paper gives an affirmative answer, but under certain limiting conditions only. Psychoanalysis can take responsibility for psychotherapy. It can base this on the fact that the definition of “depth psychological psychotherapy” binds psychotherapy—as it is usually called—to psychoanalysis. How this is possible in practice is determined during the training. The training at the Michael-Balint-Institute in Hamburg is presented which partly occurs jointly and partly separately, in this way representing the reality of the two separate fields linked to each other and yet independent. The common ground is constituted by the basic principles of psychoanalysis. As an example of this common ground, the seminar on the technique of diagnosis and treatment, which is part of the early curriculum, is discussed in detail. Later on in the training, the two curricula separate more and more, each taking over its own responsibility. Not only questions of the contents but also formal aspects have to be considered. There are good reasons for establishing an independent Institute for Psychotherapy which runs the necessary arrangements together with the Institute for Psychoanalysis, from which it derives, and also remains close to the latter. Finally, it is pointed out that all of this is only possible when respecting each other’s work. Independent psychotherapy is not less valuable than psychoanalysis, but simply something else.     

Broken Bounds: Contemporary reflections on the antisocial tendency

When embarking on research into the effectiveness of psychoanalytic psychotherapy in the NHS or the application of psychoanalytic principles, researchers come up against a number of hurdles: many clinicians still see empirical research as antithetical or disruptive to the practice of psychoanalytic psychotherapy; psychoanalytic psychotherapy has previously fared poorly in evidence-based policy guidelines and this can discourage ambition, and there are technical problems of research design, measurement and standardization. Nevertheless, in a political climate which stresses service evaluation, measurable outcomes and empirical evidence, psychoanalytic psychotherapy must participate to survive. There may be gains from conducting research beyond simply meeting the requirement to provide evidence of effectiveness. Research may be viewed by some clinicians as an unwelcome intruder but it may have the potential to offer triangulation, the perspective of the ‘third’, and so strengthen the foundations of clinical practice and the development of psychoanalytic thought.     

Developing clinical effectiveness in psychotherapy training: Action research

This study is an evaluation of a new approach to clinical training in Transactional Analysis using the methodology of action research. The evaluation focuses on the second year of training and placement‐based clinical practice at the Metanoia Institute, UK. The design of the training year was research‐based and used the concept of an ‘internship’ year. The design aimed to close the gaps between clinical practice, supervision and formal training; facilitate translation of theory into practice; and integrate findings from the ‘common factors’ research into effectiveness of psychotherapy. Training and supervision methods were linked and focused on emerging issues in clinical practice and the development of students’ capacity for critical reflection and a research attitude to practice. The evaluation was a naturalistic study which used quantitative and qualitative methodology within the action research framework to reflect on the impact of the training on the participants, the organisation and the clinical practice. The quantitative outcomes show that the project developed the effectiveness of students’ clinical practice and reflexivity. Qualitative analysis gives insight into the experiences of the participants and the emotional impact of the research process.     

Making a case for case studies in psychotherapy training: A small step towards establishing an empirical basis for psychotherapy training

The evidence debate in psychotherapy pays little attention to developing an evidence base for training practices. Understanding effective training requires an examination of what makes training work. This article examines the role of case studies in psychotherapy training. This has not been articulated explicitly or researched systematically in spite of its cardinal importance. An analysis of the role of case studies in psychotherapy training is presented. Reading, watching, or hearing about cases can offer novice psychotherapists access to a closed world; access to psychological theory in action; access to whole courses of therapy; access to different approaches; access to significant moments; access to the therapeutic relationship; access to a wide range of client types; access to working in different contexts; and the opportunity of identifying with therapists and clients. Writing or presenting cases offer students the opportunity of: learning to integrate information into a relevant whole; being in the ‘hot seat’; learning to give appropriate feedback; assessing the validity of interpretations, inferences, and interventions; adapting methods to suit the client; and learning to collaborate with other professionals. The paper presents directions for future research into psychotherapy training, specifically proposing an international survey of training practices at psychotherapy training institutions.     

Ethical and Legal Guidance for Mental Health Practitioners Who Wish to Conduct Research in a Private Practice Setting

Mental health practitioners, even when they have research training, rarely contribute to the scientific literature. One reason for this may be that they need help addressing the ethical and legal issues they encounter as they contemplate undertaking research in a clinical practice setting. To address that need, we offer several types of guidance for conducting research in a private practice setting in a way that meets high ethical and legal standards. We describe the situations in which ethical review of a research proposal by a federally registered institutional review board (IRB) is legally required, and identify alternate mechanisms that practitioners can use to obtain an ethical review when a formal IRB review is not required by law. We discuss legal and ethical requirements of conducting single-case studies in a practice setting. We provide a rationale, and free and inexpensive options, for obtaining a formal certificate of training in human subjects research. And we offer guidance for obtaining informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization from research participants. We conclude with a brief discussion of other legal and professional issues to consider when conducting research in private practice.     

‘A preparation for practice?’ Students experiences of counselling training within departments of higher education

The literature has identified a gap between the education and practice in the education and training for the practice based professions based within traditional Departments of Higher Education. In the education and training in counselling it is suggested that this gap is primarily between those who view practice as the rigorous application of formal ‘science’ and those who see it as more holistically embedded in ‘tacit knowledge’ and artistry of the practitioner. This paper reports on a small scale qualitative study (Scanlon, 1993) which investigated the experience of students undertaking Counsellor training courses within Departments of Higher Education. Analysis of interview data revealed three main categories of concern. The first categoy describes the adverse effects of the theory-practice gap on the students. The second catego y describes the importance of clinical supervision in acquiring practice skills and the third catego y describes the participants' concerns about the quality of outcome for such training, particularly in relation to the perceived lack of ngour in the assessment of clinical competence. In the light of these findings a number of suggestions about how the professional education and training of counsellors could be better integrated into a more ‘practice led’ curriculum model are discussed.     

Reversal theory and psychotherapy: A review

The present paper aims to review the emerging practice of structural phenomenological psychotherapy derived from the theory of psychological reversals and to provide some extensions of this practice. The paper does not provide a full account of reversal theory, which is available elsewhere (Apter, 1982; Apter et al., 1985). It does, however, provide an account of the way in which this theory can be applied to the practice of therapy. Throughout this paper, counselling and psychotherapy are regarded as synonymous.     

Researching the “therapeutic relationship” in psychoanalysis,counselling psychology and psychotherapy—a qualitative inquiry

This paper reports the methodology of a research project based on and including a review of almost 1000 texts and more than 20 years of learning and supervised practice as clinician and supervisor in the psychotherapeutic professions on the nature of the therapeutic relationship. Following a pilot study by five years, the findings were reported in a 165,000 word document which encompasses poetry, personal experience, many textual extracts of theory or therapeutic dialogue, other research reports, theoretical considerations, clinical reflections, syllabus constructions—a postmodernist assemblage which nonetheless attempts coherence, validity and reliability. The findings have also been tested in the field for example by: (a) providing the framework for at least one four-year psychotherapy training course from which the first students have recently graduated by external assessment and (b) an independent psychotherapy accreditation process by a case study submission. It is argued that clinical practice or supervision should be inseparable from research—Particularly qualitative research in psychology.     

Reflections on Contemporary Psychotherapy Practice, Research, and Training

We do not lack for criticism about psychotherapy practice, research, and training. Admittedly, there is much there that needs to change. But, thus far, what have we done right? What are some of the positive, affirming, constructive strides that have been made with regard to therapy practice, research, and training? In this paper, those questions are addressed. Ten broad-based themes about some aspects of psychotherapy are presented and discussed; while by no means exhaustive, each is considered to be quite robust and clearly reflective of some of the truly constructive facets now evident in the field.     

Examining the role and functions of self-development in healthcare therapy trainings: A review of the literature with a modest proposal for the use of learning agreements

Many healthcare trainings with a psychodynamic orientation encourage or require students to commit to a process of personal development, such as provided through attending individual psychotherapy and/or an experiential ‘as if therapy’ group. This paper reviews recent literature about training in psychodynamically oriented practices within counselling psychotherapy, psychiatry, the creative arts therapies and clinical psychology. The results indicate that the mandatory personal development dimension of therapy training needs urgent reassessment. Results of studies consistently call for further research about the direct benefits of personal development on students’ development of skills for therapy practice. There is minimal evidence to indicate what self-development through individual psychotherapy can specifically deliver in terms of eventual professional competence. To address some aspects of the current lacuna, this paper summarises the recommendations for training programmes available from the current research, and makes a modest proposal for the use of learning agreements, rather than only mandated hurdle requirements, to ensure that the incremental steps by which the student attains expected requirements is negotiated and agreed within regularised, and widely accepted university course procedures.     

Kenneth Gergen’s Social Constructionist Contributions to Counsellor Education

Kenneth Gergen??s seminal contributions to social constructionist thinking have substantial implications for the practice of counselling and psychotherapy, and thus for the training of practitioners as well. This article takes up the latter point, exploring the many deviations from traditional approaches to foundational counselling skills training that arise when educators are informed by constructionist philosophy. The article is written in the form of a dialogic exchange in recognition of Gergen??s emphasis on the relational aspect of knowing, with contributions from two educators accustomed to training graduate level practitioners in basic counselling and psychotherapy practice.     

Eye movement desensitization and reprocessing (EMDR): An overview

Eye movement desensitization and reprocessing (EMDR) is a recently developed psychotherapy procedure which has been reported to dramatically increase efficiency in the treatment of psychological disturbances rooted in traumatic memories. Following a review of the research on EMDR's efficacy, clinical considerations are addressed, including the client's experience and the potential for negative effects or treatment failure. Finally, the role of EMDR in clinical practice is discussed. Initial reports are encouraging, and further research is recommended. Clinicians who choose to use EMDR are urged to obtain formal training.     

Common impediments to good psychotherapy — or hell is other people

This paper discusses the thesis that the practice of psychotherapy, like other intense human relationships, involves a number of inherent difficulties that must be endured. These common impediments include 1) the identity and status of psychotherapy as a profession, 2) the requirement of a delicate balance in therapy between thought and emotion, 3) the necessity of a resolution to the patient's transferential rage while minimizing the therapist's tendency to avoid that rage, and 4) the therapist's desire and temptation to control and manipulate the patient. These four impediments are built-in barriers with which all therapists must live. Our task is to attack the more approachable, controllable problems in our impediments, such as limitations in our training models, frequent sell-out by psychotherapists to entrepreneurial profit-centered models of practice, and unclear guidelines about which patients should receive which psychotherapy and when.     

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.     

The Bodhi-Therapist

SUMMARY

This paper presents formulations and case studies that indicate the relevance of Buddhist meditation practice for the practice of psychotherapy. Samatha-vipassana meditation, the core of all Buddhist methods is described as a training in the cultivation of specific therapeutic talents that arise as concomitants of bodhicitta, awakened experience.     

A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.