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.     

Integrating couples and family therapy into a community alcohol service: a pantheoretical approach

This paper discusses the contribution of family systems theory and therapy to mainstream alcohol treatment programmes. Systemic psychotherapy is integrated with group analytic psychotherapy in a couples and family therapy service within a community alcohol service (CAS) which uses the Prochaska and Diclemente model of stages of change. Problems and solutions in putting these complex ideas into practice are discussed, with specific reference to issues of engagement. An example of our work with a couple is offered to illustrate our weave of theory and practice.     

Private psychotherapy training in Italy: A systematic analysis

This paper examines the results of a systematic analysis, organised by the Italian Ministry of Education, University and Research, of private psychotherapy training in Italy. Since 1989, training in psychotherapy in Italy has been governed by a national law which recognises both public and private institutions. While the public system usually comprises approximately 150 students, the private system has grown significantly over time, registering thousands of students in hundreds of schools (for example, 19,123 students in 212 schools in 2011). Systematic analysis variables included geographical distribution, theoretical approaches, training methods, student and teacher characteristics, student’s personal psychotherapy, supervision and apprenticeships. Data were obtained from 92% of the schools. The primary issues discussed in this paper are as follows: the uneven geographical distribution of the schools; the disorderly amalgamation of traditional scientific paradigms; programmes which concentrate on theory and fail to meet international guidelines. One key issue is the excess supply with regard to demand, meaning that recently graduated psychotherapists (especially women) risk underemployment and financial hardship. Student enrolment is also increasingly problematic. This is the first paper to present an in-depth analysis of one European country’s situation in this field. The authors believe it will foster comparison and discussion internationally.     

Preconscious Foundations of Human Experience by Trigant Burrow

Abstract

Based upon observations indicating decreasing attractiveness of groups within and outside the clinical field, the present study aimed to determine attitudes toward, and expectations of, groups in a representative sample of 2512 German citizens. The survey also included questions specifically related to group psychotherapy and its acceptance. In addition, psychological characteristics of respondents (measures of narcissism, psychological impairment, and emotion regulation) and socio-demographic variables were assessed to examine their potential association with group-related attitudes. In total, the survey revealed a relatively positive picture of attitudes and expectations toward groups in general and psychotherapy groups in particular. Those with more open attitudes towards groups were comparatively less distressed, anxious, and depressed; they favored emotional reappraisal instead of suppression as the dominant strategy to regulate their emotions. Contrary to prediction, narcissism did not influence attitudes towards groups. The results are related to current discussions of the attractiveness of groups and to implications for the practice of group psychotherapy.     

Systematic Review of the Effects of Religion-Accommodative Psychotherapy for Depression and Anxiety

Integrating religion into psychotherapy may improve treatment for depression and anxiety. This review systematically examines clinical trials of religion-accommodative psychotherapy for depression or anxiety. Results indicate that integrating religion into psychotherapy does not lead to significantly more improvements in depression or anxiety than equivalent therapy without religious components. However, when compared with less stringent control groups, such as supportive psychotherapy, religion-accommodative therapy may be more effective, at least immediately post-treatment. Results from the 11 studies reviewed indicate that psychotherapy integrating religion is at least as effective for treating depression and anxiety as other forms of psychotherapy. Conclusions were limited by lack of power, comparable control groups, focus on anxiety, and treatment manuals.     

Experiences with the combination of communication training and dynamic group psychotherapy

Three psychotherapy groups consisting of altogether 37 patients took part in communication training after L. Sch?bisch and M. Sieme in preparation for group-centred dynamic psychotherapy. The results of pretherapy and post-therapy surveys with the MMPI were tested for quantitative changes using Posthoff and H. F. B?ttcher's gnoseologically based test. The findings suggest that this combination of methods has a high standard of efficiency, which is finally discussed.     

Saudi therapists' lived experience of self-awareness

Self-awareness and self-reflection in psychotherapeutic processes have been critical components for effective counselling and psychotherapy. However, little qualitative research in Saudi Arabia has been conducted that aims to explore the therapist's subjective experiences of the self in their professional work. Therefore, the purpose of this phenomenological study was to understand the therapist's self-awareness within psychotherapy, by focusing on the therapist's lived experience of self-awareness and exploring how therapists recognise themselves as an integral component of the therapeutic relationship. Semi-structured interviews were conducted with six experienced and accredited psychologists with at least three years of clinical experience, and the qualitative data were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the data; that is, development of the professional self, use of self, self-oriented, supervision and experience. This study provides an understanding of the therapist's self in psychotherapy, as it shows that self-awareness is important for therapists to manage their feelings, thoughts and behaviours in meeting with clients and that it is a valuable resource for a therapist to become aware of and reflect upon the process within oneself. This understanding is integrated into the training programmes in counselling psychology, especially in the areas of self-awareness and personal development.     

Videoconferencing versus face-to-face psychotherapy: Insights from patients and psychotherapists about comparability of therapeutic alliance,empathy and treatment characteristics

Objective

Videoconferencing psychotherapy (VCT) is an effective treatment option. Yet, it is unclear whether a similar therapeutic alliance as in conventional face-to-face psychotherapy (F2F) can be achieved, since previous studies yielded mixed results. Furthermore, surveys about the attitudes towards VCT amongst patients have been missing until now. The current study gathered opinions from patients and psychotherapists about the perceived comparability of VCT and F2F regarding contextual factors and treatment characteristics, focusing on therapeutic alliance and empathy.

Method

An online survey amongst patients (N = 189) and practitioners (N = 57) taking part in cognitive behavioural therapy was conducted after the first lockdown in Germany due to the COVID-19 pandemic and a resulting transition from F2F to VCT for most participants.

Results

While patients experienced therapeutic alliance and empathy as comparable, psychotherapists indicated advantages of F2F. Both groups indicated advantages of F2F for the therapy contents and expressed advantages of VCT for flexibility regarding location and time. More than half of the participants expressed a preference for a combination of analogue and digital therapy.

Conclusion

The perceived disadvantages of VCT can be addressed, for example, with training programmes for psychotherapists targeting communication in VCT and adapting established psychotherapy methods to a digital format to further improve VCT.     

Perceptions of psychotherapy trainees of psychotherapy research

Aims: The research‐practice gap and lack of engagement with research by trainees and qualified therapists is a widely discussed issue amongst psychotherapy researchers. The present study investigates the perceptions of psychotherapy trainees of psychotherapy research and explores what would encourage them to participate in research. Method: Two focus groups of 16 trainees in total were conducted at two separate psychotherapy training institutes to explore trainees’ attitudes and perceptions. Data was analysed using Braun and Clarke's (2006) thematic analysis. Results: Three superordinate themes emerged: negative perception of research; recognition of the importance of research; and what would be needed to facilitate engagement in research. Discussion: The results suggest that interest in and willingness to participate in research exists, however it is necessary for negative perceptions about research to be addressed and for researchers to design projects which are supportive of participants.     

Self-analysis and post-termination improvement after psychoanalysis and long-term psychotherapy

Long-term follow-up studies of long-term psychoanalytically oriented psychotherapy or psychoanalysis are extremely rare, and few have focused on the post-treatment process itself. In the Stockholm Outcome of Psychoanalysis and Psychotherapy project, one of the results was that patients in psychoanalysis continued to improve after termination to a higher degree than patients in long-term psychotherapy. In this study 20 patients selected from the project were interviewed on two occasions, one and two years after termination, in order to explore how they described their post-treatment processes. The interviews were studied qualitatively using a multiple case study design, and categories of different types of post-treatment development were created from these case studies. Results indicate that the variation within treatment groups is large, and that development may continue in several ways after termination. The most striking difference between psychoanalysis and psychotherapy was not, as hypothesized, in the self-analytic function, but in various self-supporting strategies described by former analysands but not by former psychotherapy patients. However, only self-analysis was significantly correlated with post-termination improvement across both treatments. Three patients improving after termination and three deteriorating are described in detail as illustrations. Some methodological constraints of the design limit the generalizeability of results.     

Does youth psychotherapy improve academically related outcomes? A meta-analysis

To better understand the impact of psychotherapy on youth academic performance, the authors located and examined 83 studies of youth psychotherapy that contained 102 treatment comparisons. Results revealed a d = 0.46 overall effect size, with a d = 0.50 effect size for mental health outcomes, and a d = 0.38 effect size for academically related outcomes. Academically related outcomes were further categorized into teacher-rated classroom behavior (d = 0.26), academic achievement (d = 0.36), environmentally related outcomes (d = 0.26), and self-reported academically related outcomes (d = 0.59). Each of these effect sizes differed significantly from zero, and the 4 academically related categories were homogeneous. Participant racial and ethnic diversity and age were explored as moderators. The results point to psychotherapy benefiting student academics, regardless of age. Ethnically diverse participant groups in the studies fared better academically than did nondiverse groups. Implications discussed include counseling psychologists maintaining a holistic view of youth and of working more closely with educators.     

Structural models of psychotherapy groups and their effect on inpatients with borderline personality disorders: Patients' perceptions

This research compares the way in which various group structural models affect self-understanding, interpersonal relationships and catharsis in hospitalized patients with borderline personality disorders. Each of the models is characterized by a different combination of group focus and leadership style. Three psychotherapy groups were chosen as paradigms: the dynamic psychotherapy group; the therapeutic games group, and psychodrama group. Sixty three inpatients with borderline personality disorders participated in the study. The one-way ANOVA yielded significant differences between the group models. Results of the post-hoc t-test showed that the dynamic and the games groups were perceived by the patients as more beneficial than psychodrama.     

Comparing competencies of a psychotherapist with those of a psychologist specialising in psychotherapy

This paper contributes to a recent call for dialogue between the different professional groups representing psychotherapy in Europe. At present, two core psychotherapy groups exist in Europe, namely the EAP, representing psychotherapy, and EFPA, representing psychologists specialising in psychotherapy. This article compares and contrasts two competency frameworks representative of these bodies, which capture the skills, knowledge, reasoning and values of the respective professions. The shared and divergent competencies are identified and discussed, followed by suggestions for potential changes in future European competency frameworks. By doing this, we not only respond to the recent call for dialogue but also promote collaboration and discussion between the professional groups representing psychotherapeutic practice both in Europe and beyond.     

The therapeutic community in the local community: Social networks between therapeutic community and supported housing

In this paper, the authors present a model for therapeutic community programmes for those with severe and enduring mental ill health, based on social networks. These programmes have given birth to a range of therapeutic community which are, in fact, an innovative form of group psychotherapy. These new model do not depend on communal living. Some are groupings of apartments, others day units. Work schemes also feature here. And yet, as the authors outline, various components need to be present if these are to be considered genuine therapeutic communities and not just supported housing schemes. Additionally, a certain kind of training and clinical supervision is needed for the staff.     

Voices from the Inaudible: The Patients Speak by Theodor Reik

Fifty-one inpatients, hospitalized on average for 21 days, were studied by means of discharge debriefing interviews. An unstructured, mandatory, and functionally heterogeneous psychotherapy group was compared with a structured, voluntary, and functionally homogeneous psychotherapy group. Statistical analysis of the patients' valuation of the group psychotherapy experiences and of their rankings of traditional group psychotherapy curative factors were performed. Results demonstrated that group psychotherapy was a highly valued component of the overall inpatient treatment. Structural modifications aimed at increasing the here and now, and interpersonal focus of the group meetings, such as the use of patient agendas and group rehashes, significantly affected the patients' group experiences. A comparison of both types of inpatient groups with an outpatient group psychotherapy sample suggests certain guidelines for the goal setting and conduct of inpatient group psychotherapy, recognizing the specific and heterogeneous needs and capacities of the patients treated.     

Self and external management compared with psychotherapy in the control of obesity

Seventy-four obese TOPS (Take Off Pounds Sensibly) members were assigned to one of five conditions: delayed treatment control, insight psychotherapy, self-management training plus external reinforcement, self-management training only, or external reinforcement only. The latter four groups met once per week for ten weeks and were seen at three and six months and followup. It was hypothesized that self-management plus external reinforcement would be superior to other conditions at both post-treatment and followup, and that this condition alone would produce continuing weight losses. Analysis of covariance on body weight, with pretreatment weight as covariate, indicated that self-management plus external reinforcement, self-management only, and external reinforcement only, did not differ in mean body weight at post-treatment. These three groups differed significantly from control and psychotherapy conditions, which did not differ from one another. Self-management plus external reinforcement produced better performance of techniques. At three and six month followup, differences between the four treatment conditions were no longer significant. Results are discussed in terms of evaluation of psychotherapy and behavior modification and durability of results.     

Therapist gender and the same-sex puberty age psychotherapy group

Puberty is considered to be the most difficult developmental period to conduct psychotherapy. Group psychotherapy has special appeal for pubescents because of the anxiety experienced in individual psychotherapy with adults, and the mutual identification and support experienced with groups of same-sex peers. Although pubescents readily form cohesive groups, the emotional stress for the group therapists is intense and many therapists are reluctant to take on such groups. Close attention to the principles of developmental ego psychology suggests that pubescent groups will be more effective if conducted by group therapists of the same sex as the patients.     

The public's perception of psychotherapy and counseling: Differential views on the effectiveness of psychologists,psychiatrists, and other providers

This study examined the public's perceptions relative to the effectiveness of psychotherapy and counseling, expectations of treatment efficacy for different psychotherapy and counseling providers (i.e., clinical psychologists, counseling psychologists, counselors, general medical practitioners, marital and family therapists, psychiatrists, self-help groups, and social workers), professional characteristics, and factors that may influence treatment utilization in an adult population. The sample viewed psychotherapy or counseling as moderately effective and perceived psychotherapy/counseling to be effective for 26 to 50 percent of all cases. The perceived amount of time necessary for noticeable improvement in psychotherapy or counseling was approximately four months, and the expected necessary length of treatment was approximately eight months. Participants stated they were moderately willing to seek psychotherapy or counseling if they were to experience a mental problem, and reported discernible differences among the eight psychotherapy/counseling providers in terms of treatment efficacy. Differences were also found in the relative perception of providers' personal/professional qualities and characteristics.     

Die Therapeutenvariable

Background

The objective of this study was to investigate the therapeutic attitude as a self-contained dimension of the therapeutic process.

Patients and methods

The psychotherapists’ beliefs and attitudes in therapeutic matters are measured according to the Therapeutic Attitude Scales (TASC) of the Therapeutic Attitude Questionnaire (ThAt) and were applied to investigate the therapist variable. The investigation concentrated on the therapist’s belief in the curative value of a number of ingredients of psychotherapy, on the therapist’s individual style of conducting psychotherapy and on basic assumptions about the nature of psychotherapy and the nature of the human mind. A total of 451 psychotherapists (81 psychodynamic psychotherapists, 208 psychoanalytic psychotherapists and 162 behaviour therapists) were investigated.

Results

There were highly significant differences between the three groups of therapists, a finding which is in line with the basic theory. Adaptation and insight of the assumed curative factors as well as supportiveness and neutrality of the technique factors, differentiate the groups highly significantly. The multivariate analysis underlines the importance of adaptation and insight to differentiate between all groups.

Conclusion

The results by and large confirm the general assumptions held on the differences between the groups. Thus the ThAt appears to be a valid instrument to grasp more subtle features of the therapist variable that may influence the outcome of psychotherapy.