‘The threat of the Other’: Using mixed quantitative and qualitative methods to elucidate racial and cultural dynamics in the counselling process

This paper examines the use of mixed quantitative and qualitative methods in the study of racial and cultural dynamics in the counselling process. The approach is illustrated by the author's own research which combined quantitative survey instruments with a blend of qualitative methods. Emphasis is given to complex racial and cultural phenomena arising from the qualitative methods of data collection and data analysis, particularly the pervasive experience of ‘threat of the Other’. These phenomena were seen to permeate the counselling interactions both explicitly and implicitly. The emerging racial dynamics are discussed with reference to theoretical concepts which stress the interrelationship between intrapsychic development and sociopolitical issues. The effectiveness of employing pluralistic methods in this field of enquiry is also evaluated.     

The implementation and adoptability of behavioral skills training in a university career center

We evaluated the extent to which staff at a university career center (a) already used, (b) could be taught to use, and (c) might continue to use behavioral skills training (BST) when teaching interview answers to college students. We used a nonconcurrent multiple baseline design across three staff‐student dyads to assess the extent to which staff implemented BST and students provided appropriate answers before and after training. Results showed that interview training at the career center typically consisted of few BST steps, but staff could be taught on how to implement BST. All staff rated BST as an acceptable and effective form of interview training, but only one indicated that he or she was likely to adopt BST at the career center.     

Investigating the dose-response relationship between motor imagery and motor recovery of upper-limb impairment and function in chronic stroke: A scoping review

The recovery of upper-limb impairment and dysfunction post-stroke is often incomplete owing to the limited time in therapy focused on upper-limb recovery and the severity of the impairment. In these cases, motor imagery (MI) may be used as a precursor to physical therapies to initiate rehabilitation early on when it would be otherwise impossible to engage in therapy, as well as to increase the dose of therapy when MI is used in adjunct to physical therapy. While previous reviews have shown MI to be effective as a therapeutic option, disparity in findings exists, with some studies suggesting MI is not an effective treatment for post-stroke impairment and dysfunction. One factor contributing to these findings is inconsistency in the dose of MI applied. To explore the relationship between MI dose and recovery, a scoping review of MI literature as a treatment for adult survivors of stroke with chronic upper-limb motor deficit was performed. Embase, Medline and CINHAL databases were searched for articles related to MI and stroke. Following a two-phase review process, 21 papers were included, and data related to treatment dose and measures of impairment and function were extracted. Effect sizes were calculated to investigate the effect of dosage on motor recovery. Findings showed a high degree of variability in dosage regimens across studies, with no clear pattern for the effect of dose on outcome. The present review highlights the gaps in MI literature, including variables that contribute to the dose-response relationship, that future studies should consider when implementing MI.     

Qualitative and quantitative measures of joint attention development in the first year of life: A scoping review

Joint attention (JA) is the purposeful coordination of an individual's focus of attention with that of another and begins to develop within the first year of life. Delayed, or atypically developing, JA is an early behavioural sign of many developmental disabilities and so assessing JA in infancy can improve our understanding of trajectories of typical and atypical development. This scoping review identified the most common methods for assessing JA in the first year of life. Methods of JA were divided into qualitative and quantitative categories. Out of an identified 13,898 articles, 106 were selected after a robust search of four databases. Frequent methods used were eye-tracking, electroencephalography, behavioural coding, and the Early Social Communication Scale (ECSC). These methods were used to assess JA in typically and atypically developing infants in the first year of life. This study provides a comprehensive review of the past and current state of measurement of JA in the literature, the strengths and limitations of the measures used, and the next steps to consider for researchers interested in investigating JA to strengthen this field going forwards.     

Developing countertransference awareness as a therapist in training: The role of containing contexts

The psychodynamic literature suggests that countertransference is an inevitable part of therapy and a significant feature of the client-therapist relationship. However, countertransference is also considered to be a ‘double-edged sword’: when it is reflected on by the therapist, it can offer valuable insights into the therapeutic relationship, but when it remains outside of awareness and therefore unmanaged it can result in the therapist unwittingly acting out in the therapeutic relationship and responding in counter-therapeutic ways. The purpose of this research was to explore the factors involved in the development of countertransference awareness in therapists and to construct a grounded theory of the process. Fifteen qualified therapists were recruited and interviewed, either face to face or via Skype, using a semi-structured interview schedule. The grounded theory constructed from the data suggests that during training participants initially experienced countertransference as threatening and overwhelming. When this experience was contained in supervision and therapy, the organisational context and by participants’ theoretical framework, they could reflect on their countertransferential responses and make sense of their experience, which then developed their self-awareness and other insights to the benefit of the therapeutic relationship. Conversely, a lack of containment in these domains resulted in participants acting out their countertransference and becoming either over or under available in the therapeutic relationship. The findings offer a useful process model on the role containing contexts play in the development of countertransference awareness for therapists in training.     

Pyramidal parent training using behavioral skills training: Training caregivers in the use of a differential reinforcement procedure

Six caregivers participated in a research study in which behavioral skills training (BST) was used within a pyramidal training model to train a differential reinforcement of an alternative behavior (DRA) procedure. Physical prompting was utilized to obtain correct responses across the identified alternative behavior. The caregivers were split into two tiers, comprised of three caregivers each. The experimenter trained tier‐one caregivers, who then trained tier‐two caregivers after meeting a predetermined mastery criterion. A multiple baseline design across participants research design was used to evaluate the effectiveness of correct implementation of the DRA procedure, demonstrating experimental control across participants. During baseline, caregivers did not implement DRA correctly. Following training, tier‐one and tier‐two caregivers demonstrated correct implementation of the DRA and prompting procedure. Intervention score was (M = 96%), from a baseline score of (M = 34.6%), for tier‐one participants. Intervention score was (M = 96.6%), from a baseline score of (M = 33%), for tier‐two participants. A follow‐up maintenance probe demonstrated correct implementation of the DRA procedure with prompting across both tiers of trained caregivers.     

Inter-professional learning: initial observations of the art psychotherapy tools used in the post-qualifying postgraduate training in counselling children and young people

ABSTRACT

Children and young people (C&YP) counselling training and art psychotherapy training lead to two distinctive psychological therapy approaches; one is informed by British Association for Counselling and Psychotherapy’s Competences for work with children and young people (4–18 years) [BACP. (2019a). Competences for work with children and young people (4–18 years). Retrieved from https://www.bacp.co.uk/media/5863/bacp-cyp-competence-framework.pdf], the other by Health and Care Professions Council’s Standards of Proficiency for Arts Therapists [HCPC. (2013). Standards of proficiency - Arts therapists. Retrieved from http://www.hpc-uk.org/publications/index.asp?id=39#publicationSearchResults]. In this article we outline the training methods utilised on the Postgraduate Diploma in Counselling C&YP at a British University and share initial observations of how creative and arts-based therapeutic tools form an important part of the curriculum delivery. The aim of this paper is also to outline the role of intentionality application in the use of creative interventions in therapeutic practice.     

Contemporary transgender health experience and health situation in prisons: A scoping review of extant published literature (2000–2019)

Abstract

Background: Many jurisdictions globally have no specific prison policy to guide prison management and prison staff in relation to the special needs of lesbian, gay, bisexual and transgender (LGBT) prisoners despite the United Nations for the Treatment of Prisoners Standard Minimum Rules and the updated 2017 Yogyakarta Principles on the Application of International Human Rights Law in relation to Sexual Orientation and Gender Identity. Within LGBT prison groups, transgender people represent a key special population with distinct needs and rights, with incarceration rates greater than that of the general population, and who experience unique vulnerabilities in prisons.

Aims/Method: A scoping review was conducted of extant information on the transgender prison situation, their unique health needs and outcomes in contemporary prison settings. Fifty-nine publications were charted and thematically analyzed.

Results: Five key themes emerged: Transgender definition and terminology used in prison publications; Prison housing and classification systems; Conduct of correctional staff toward incarcerated transgender people; Gender affirmation, health experiences and situational health risks of incarcerated transgender people; and Transgender access to gender-related healthcare in prison.

Conclusions: The review highlights the need for practical prison based measures in the form of increased advocacy, awareness raising, desensitization of high level prison management, prison staff and prison healthcare providers, and clinical and cultural competence institutional training on transgender patient care. The review underscores the need to uphold the existing international mandates to take measures to protect incarcerated transgender people from violence and stigmatization without restricting rights, and provide adequate gender sensitive and gender affirming healthcare, including hormone therapy and gender reassignment.     

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.     

The effectiveness of psychological skills training and behavioral interventions in sport using single-case designs: A meta regression analysis of the peer-reviewed studies

We used a novel meta regression analysis approach to examine the effectiveness of psychological skills training and behavioral interventions in sport assessed using single-case experimental designs (SCEDs). One hundred and twenty-one papers met the inclusion criteria applied to eight database searches and key sport psychology journals. Seventy-one studies reported sufficient detail for effect sizes to be calculated for the effects of psychological skills training on psychological, behavioral, and performance variables. The unconditional mean effect size for weighted (Δ = 2.40) and unweighted (Δ = 2.83) models suggested large improvements in psychological, behavioral, and performance outcomes associated with implementing cognitive-behavioral psychological skills training and behavioral interventions with a SCED. However, meta-regression analysis revealed important heterogeneities and sources of bias within this literature. First, studies using a group-based approach reported lower effect sizes compared to studies using single-case approaches. Second, the single-case studies, (over 90 per cent the effect sizes), revealed upwardly biased effect sizes arising from: (i) positive publication bias such that studies using lower numbers of baseline observations reported larger effects, while studies using larger numbers of baseline observations reported smaller – but still substantial – effects; (ii) not adopting a multiple baseline design; and (iii) not establishing procedural reliability. We recommend that future researchers using SCED’s should consider these methodological issues.     

The effects of clinical supervision on supervisees and patients in cognitive behavioral therapy: a systematic review

Clinical supervision is a central part of psychotherapist training but the empirical support for specific supervision theories or features is unclear. The aims of this study were to systematically review the empirical research literature regarding the effects of clinical supervision on therapists’ competences and clinical outcomes within Cognitive Behavior Therapy (CBT). A comprehensive database search resulted in 4103 identified publications. Of these, 133 were scrutinized and in the end 5 studies were included in the review for data synthesis. The five studies were heterogeneous in scope and quality and only one provided firm empirical support for the positive effects of clinical supervision on therapists’ competence. The remaining four studies suffered from methodological weaknesses, but provided some preliminary support that clinical supervision may be beneficiary for novice therapists. No study could show benefits from supervision for patients. The research literature suggests that clinical supervision may have some potential effects on novice therapists’ competence compared to no supervision but the effects on clinical outcomes are still unclear. While bug-in-the-eye live supervision may be more effective than standard delayed supervision, the effects of specific supervision models or features are also unclear. There is a continued need for high-quality empirical studies on the effects of clinical supervision in psychotherapy.     

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.