Therapist orientation,supervisor match,and therapeutic interventions: Implications for session quality in a psychotherapy training PRN

Background: Theoretical orientation is a multifaceted construct that is integral to the process of psychotherapy and psychotherapy training. While some research has been conducted on personal identification with particular schools of psychotherapy, techniques used in psychotherapy sessions, and match between trainees and supervisors in training, there is insufficient information regarding how these may interact with one another. Aim: This study, conducted in a practice research network of trainee therapists, was designed to test whether these variables may be related to one another in predicting session quality. Method: The sample comprised 328 sessions from 26 clients and 11 therapists, with the clients completing session quality measures and therapists completing measures of technique immediately post‐session. Results: Using multilevel linear modelling, the data showed varied results. For behavioural therapy and person‐centred therapy, techniques and orientation were unrelated to session quality in the sample. However, process‐experiential, psychodynamic, and cognitive therapy techniques were all involved in interactions with therapist and/or supervisor orientations. Conclusions: These results suggest that the impact of specific psychotherapy techniques sometimes depends on the orientation of the therapist and/or supervisor. For instance, sessions high in cognitive therapy techniques were only associated with positive outcome when both the therapist and supervisor were highly cognitively oriented. Though preliminary, these results suggest that orientation may be an important variable to consider in training and supervision, especially in the context of other variables.     

Learning and difficult experiences in graduate training in clinical psychology: A qualitative study of Japanese trainees’ retrospective accounts

This study examined the experiences of Japanese clinical psychology trainees in their graduate school with the aim of identifying factors that might enhance or hinder their learning and professional development. We analyzed the interview data obtained from 17 clinical psychologists using grounded theory approach. Two major category groups were generated: Developing as a Clinician and Difficulties. The primary positive learning experiences in Developing as a Clinician were labeled “Hot Learning,” in which trainees acquired professional knowledge and skills through close interpersonal engagement with clients, peers, faculty, and supervisors. In contrast, Difficulties involved trainees’ negative experiences resulting in feelings of self-doubt and incompetence. These experiences occurred in close but sometimes conflicted interpersonal contexts, where trainees felt evaluated in a manner incommensurate with the support they received. We found that the quality of interpersonal relationships, which provided the context for optimal learning for trainees, was paramount to the definition of positive versus difficult learning experiences. Implications for therapist training, professional development and future research are discussed.     

Psychodynamic therapists' dilemmas in providing personal therapy to therapists in training: An exploratory study

Aim: This study explores dilemmas facing psychodynamic therapists who provide personal therapy to therapists in training. Method: Eight experienced psychodynamic psychotherapists were interviewed using a semi‐structured interview format during which they were asked about the importance of personal therapy, if they encountered any dilemmas and, if so, how they resolved those dilemmas. Their responses were analysed using a qualitative form of content analysis. Findings: Two categories of dilemma emerged: clinical and personal. Clinical dilemmas arose out of the mandatory requirement for therapy, boundaries, fitness to practice and the suitability of trainees. Personal dilemmas included pressure to model, sense of responsibility, therapeutic narcissism, countertransference reactions, over‐use of self and stressful involvement. The therapists' strategies for resolving the dilemmas are described. Conclusion: The results show participants considered personal therapy to be essential for trainees and thought it should be mandatory even though it led to difficulties in the therapy. Questions arose about the suitability of some trainees, the person of the therapist and stressful involvement. Further research into these important areas is recommended.     

Learning and Living Systemic: Exploring the Personal Effects of Family Therapy Training

Despite growing recognition that systemic family therapists need to be adept at personal reflection and managing the therapeutic relationship, little research has explored the effects of training beyond the development of skills. This article provides a report on a qualitative study focussed on the personal effects of family therapy training, with particular reference to the aspects of training that foster personal reflection and growth. Twenty three trainees from three training institutions were interviewed, utilizing the practices of grounded theory. Trainees reported a deepening relational awareness, which applied to both personal and professional domains and included shifts in perspectives on relationships with loved ones. Five aspects of training were identified as responsible: (1) personally challenging experiences with clients; (2) supervisors who live the paradigm; (3) the demystification of theory; (4) a safe supervisory space; and (5) the development of trusting peer relationships. Interns also described, in turn, how their personal development affected their clinical work, particularly in the development of compassion and empathy. This study serves to highlight training practices that support reflective practice in systemic family therapy.     

‘The bereaved therapist speaks’. An interpretative phenomenological analysis of humanistic therapists' experiences of a significant personal bereavement and its impact upon their therapeutic practice: An exploratory study

Aim: The aim of the research was to explore the under‐researched area of therapists' personal bereavement and its impact upon their therapeutic practice. Method: Data were collected via semi‐structured interviews with four humanistic therapists and were analysed using Interpretative Phenomenological Analysis (IPA). Findings: Four master and eight subordinate themes emerged from the rich data collected that exemplified both convergence with and divergence from the small body of extant literature on therapist bereavement and current thinking in thanatology. The findings suggest that bereavement is a unique experience that can affect the individual's personal and social identity and worldview. It can also be a transformative experience resulting in personal growth and a renewed sense of self and agency. In terms of professional practice, the findings suggest that the lived experience of the grieving process, mediated by supportive supervision, enabled participants to experience deeper levels of empathy and connectedness within their therapeutic relationships. Conclusion and implications: Bereavement is an experience that can profoundly impact upon therapists' personal identity and assumptive world. Such an experience can have an equally profound impact upon their therapeutic practice. There are therefore implications for students, trainers, therapists and supervisors particularly in terms of self‐care and the use of the ‘self’ in therapy. Further research needs to be undertaken in order to explore in greater depth the intersection between personal bereavement and therapists' evolving personal and professional identity development.     

The path towards a professional identity: An IPA study of Greek family therapy trainees

Objective: Contemporary psychotherapy research has focused mainly on practitioners' training and education. The impact of training on professional development and the application of therapeutic skills have been the primary foci of the empirical literature. The aim of this paper is to present the experiences of seven family therapy trainees regarding their personal paths toward the development of professional identity as they underwent training in systemic psychotherapy. Method: In‐depth interviews were conducted and analysed using Interpretative Phenomenological Analysis. Results & Conclusions: Seven themes were identified: The Quest, Developing by Relating, Learnings, Personification of Training, Use of Self, Self‐Care and Empowerment, and Reflecting on the Role of the Therapist. The findings are discussed with regard to the development of the ‘therapist as a person’, gaining acknowledgement and autonomy, and the development of a community of therapeutic practice.     

Women counsellors' experiences of personal therapy: A thematic analysis

Background: Following recent moves to relax the requirements for clinical mental health trainees to undergo personal therapy, this qualitative project explored the effects of personal therapy on volunteer counsellors. Method: Interviews were conducted with 19 volunteer counsellors at a women's community centre, and the data were analysed using thematic analysis. Findings: Emerging themes included the importance of personal therapy for trainee development, key elements of personal therapy and the idea that personal therapy is ‘a double‐edged sword’. Discussion: Allowing for evident methodological difficulties in evaluating the impact of personal therapy on trainees, this study suggests that close consideration should be given to the potentially adverse effects of reducing requirements for personal therapy in clinical trainings.     

The Soul of Supervision: Counselor Spirituality

Because spirituality training for counselors and supervisors is vital to counselor development, the authors examined the relationships between purpose in life, the integration of spirituality into supervision, and the supervisory working alliance among a sample of supervisors and trainees. Supervisors reported a greater sense of purpose and spiritual discussion during supervision than trainees. Trainees' personal sense of purpose was positively related to spiritual discussions with a supervisor and to an emphasis on client issues in supervision.     

Unheard Voices: The Experiences of Supervisors in Training

This paper seeks to expand on the supervision literature by exploring the experiences of five supervisors in training (SIT) as they navigate the transition from therapist to supervisor. Five key elements of the process of becoming a supervisor are highlighted; contracting, ethics, diversity, modalities, and troubleshooting. Each element is described in two parts: (1) information provided by current supervision literature and (2) by personal journal entries of SITs in an approved supervision course during their doctoral studies. The journal entries of the SITs describe the journey in forming their own supervision identity which included understanding how to include the five key elements in their own supervision with their supervisees. A postmodern approach was utilized to understand this process as well as shape the paper. The goal of this paper is to understand the experiences of supervisors who will shape the development of future therapists.     

Introduction to Group-Analytic Psychotherapy by S. H. Foulkes

This article will explore special leader issues that emerge in psychodynamically oriented therapy groups with adult children of alcoholics. Particular focus will be on countertransference feelings that get stirred up in group leaders and techniques for dealing with some of these special dilemmas. Specific issues include (a) assumption of sameness between the therapist and the patient (the therapist assuming that he or she “understands” because of having also grown up in an alcoholic family); (b) the “will to restore,” which may be destructive when the therapist, whose own self-esteem is dependent on the patient's progress in therapy, forces a “rush to recovery” on the patient; (c) other personal issues in the life of the therapist that may also resonate with experiences of the patient; (d) “countertransference goodness and availability” as it affects therapists' abilities to set reasonable limits on their patients, as well as reasonable expectations for themselves; and (e) special issues regarding therapist transparency and self-disclosure.     

“Not a little Mickey Mouse thing”: How experienced counselling psychologists describe the significance of personal therapy in clinical practice and training. Some results from an interpretative phenomenological analysis

The British Psychological Society's Division of Counselling Psychology currently specifies a mandatory period of personal therapy for trainees. However, evidence for the role of personal therapy in developing practitioner competence is sparse. This paper presents part of a wider ongoing interpretative phenomenological analysis exploring how counselling psychologists describe the meaning and significance of personal therapy in clinical practice and training. Detailed examination of a subset of data from this study suggests that personal therapy is valued as a vehicle for a genuine, often extremely intense relationship with the therapist, through which participants become able to establish authentic emotional contact with themselves and their clients. Whilst most participants felt that personal therapy should remain an obligatory part of the training curriculum, they were ambivalent about specifying its aims or evaluating its outcomes. Results are discussed in terms of the importance of establishing a sense of integrity and authenticity within the personal therapy experience and are tentatively situated within a possible theoretical framework drawing on current developmental literature.     

Outsider Witness Groups as a Means of Professional Growth in Family Therapy Training: An Exploratory Qualitative Study

This exploratory qualitative study examines the experiences and meanings associated with family therapy trainees’ participation in the narrative practice of Outsider Witness Groups (OWG). At the Barcai Institute in Tel Aviv, we incorporate OWGs into our live clinical supervision courses. In some sessions, we offer the families undergoing therapy the opportunity to listen to the reflections of the group of trainees regarding what they witnessed during the session. Twenty-nine family therapy trainees participated in the study in five focus group interviews. Analysis of the interviews yielded four core themes regarding the trainees’ experiences: (i) Exploring the stance of the therapist; (ii) The art of listening; (iii) Reflection on hierarchy and boundary setting; and (iv) Negotiating self-disclosure. The findings indicate that family therapy trainees stand to benefit significantly in their professional journey, development, and growth from integrating OWG practices into their training. OWG fosters the development of critical reflectivity in trainees, including the deconstruction of common and taken-for-granted assumptions. It also fosters practices related to family therapy, and perhaps also to therapy in general. The findings also suggest that taking part in OWGs during training may contribute to family therapy trainees’ development of critical reflectivity as a means of introducing a more critical and political approach to therapy and developing their own preferred stories as therapists.     

Recapturing the Person in the Therapist: An Exploration Of Personal Values, Commitments, and Beliefs

The authors encourage an approach to personal exploration that attempts to recapture the person in the therapist. Person in the therapist training is aimed at helping therapists discover or re-capture their own values, beliefs, and personal ethics. A personal approach to theory development and the practice of therapy is offered and discussed. Activities to recapture the person in the therapist focus on developing a personal theoretical orientation, exploring the values of family therapy theories, and exploring the values of the stance of the therapist in the therapy session. The authors offer their own personal beliefs throughout the article and encourage further development of these issues.Co-director of The Re-Authoring Center and a PhD student in Marriage and Family Therapy at Iowa State UniversityCo-director of The Re-Authoring Center and a PhD student in Marriage and Family Therapy at Iowa State University     

Therapist Response to Clients’ Partner Abuse: Implications for Training and Development of Marriage and Family Therapists

This qualitative study explored ecosystemic influences on therapists’ responses to partner abuse. Research questions focus on aspects of personal and professional development of attitudes and belief systems surrounding partner abuse. In-depth interviews with seven therapy trainees indicate that family of origin experiences, clinical experiences, and therapist developmental processes affect values, beliefs, and clinical reactivity to cases involving partner abuse. Implications for therapists’ self-work, clinical training, and the process of supervision are addressed.     

Trainee perspectives on their family therapy training

Although research into family therapy training is increasing it has so far mostly focused on the process of the teaching and acquisition of certain concepts and skills. In contrast, the experience of training as family therapists has rarely been investigated. This paper reports on the impact of family therapy training at one training institution in the UK on the personal, relational and professional identities of trainees. Six family therapy trainees were interviewed using semi‐structured interviews at regular intervals over a period of approximately twenty months. Interpretive phenomenological analysis (IPA) was employed to analyse the interviews. The results suggest that participants often found the experience of training as a family therapist overwhelming and de‐skilling, but that it nevertheless provoked a re‐evaluation of some of their established personal, relational and professional identities. In many cases these re‐evaluations seemed to have preceded a process of individuation, of assuming a different or more complex identity.     

Spirituality as a Dimension of Family Therapists' Clinical Training

From its psychoanalytic beginnings, therapy training has emphasized the crucial role the self of the therapist plays in the effectiveness of therapy. Attention initially focused on therapists' personal history and vulnerabilities and later included an exploration of their relationship style. Less emphasis has been placed on analyzing therapists' belief and meaning systems which inescapably influence their clinical conceptualizations, attitudes, and behaviors. This article defines spirituality as attributions of a personal nature which give meaning to life events, help transcend difficult experiences, maintain hopefulness, and lead to behaviors which honor connectedness and proposes a rationale for including the spiritual dimension in therapy and therapy training and steps graduate training programs and supervisors may take to raise therapists' spiritual understandings.     

Dialogical construction of the selves of trainees as competent researchers

There is a widespread perception among family therapy trainees and practitioners of research as an alien activity. This perception is both damaging and unnecessary. Exercises to enhance the relationship of trainees to research were conducted in stages. Concepts of dialogically constructed selves were introduced, and exercises explored the trainees' construction of ‘self as a systemic therapist’. The idea of an extensive repertoire of selves was proposed. During subsequent research training the fact that all trainees had successfully completed a collaborative research project was exploited. Pairs successfully conducted a dialogue in which they actively and imaginatively constructed their selves as researchers.     

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.     

Trainees Looking Through the Lens of a Supervisor: Remediation and Gatekeeping Responses to Hypothetical Problems of Professional Competency

This study investigated MFT trainees' perspectives of competency problems as they imagine themselves as supervisors. Trainees read seven vignettes and selected from 17 remediation responses (N = 21) originally designed for licensed supervisors (Russell, Beggs, Peterson, & Anderson, 2007). Consistent with the literature, respondents endorsed talking with the trainee as their first line of remediation and reserved dismissal for competencies related to dishonesty/fraud. Contrary to past research, trainees identified late case notes as a dismissible offense and were more lenient with untreated mental illness. Supervisors might consider orienting trainees to ethical decision making and remediation policies/strategies prior to their work in the field.