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.     

THE ABSTRACT SUBLIME: Life as information waiting to be rewritten

We report here on a series of interaction-intensive, interdisciplinary workshops to foster collaboration among those who teach, study, and engage with the public about scientific developments and social change—the New England Workshop on Science and Social Change. We include one line of thinking that fed into the workshops and present an analysis of how they contribute to participants developing their interest and skills in collaboration. Workshop evaluations suggest that people are moved to develop themselves as collaborators when they view an experience or training as transformative. Four R's—respect, risk, revelation, and re-engagement—point to the important conditions for interactions among researchers to be experienced as transformative. Three considerations lie behind the focus on the process side of the workshops, not the specific workshop topics: (1) how best to fill in for readers what they missed out on by not being there; (2) workshops and meetings are a ubiquitous part of the culture of science and technology studies (STS) so it is valuable to examine this aspect of our own culture with a view to promoting positive changes; and (3) in some scientific fields organized multi-person collaborative processes form a highly valorized aspect of the culture of science, so reflection on experiences of participation and collaboration in STS might inform our analyses of fields that emphasize collaboration and group processes. Indeed, the authors' own involvement in the workshops extends our own STS work on actor networks and ‘heterogeneous engineering’, that is, the mobilization of a variety of resources by diverse agents spanning different realms of social action.     

“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.     

The impact of psychiatric diagnosis and family system relationship on problems identified by families coping with a mentally ill member.

The purpose of this study was to explore how psychiatric diagnosis and family relationships relate to problems identified by participants in three one-day public family psychoeducation workshops for families with a member with a serious mental illness. Workshop participants generated lists of problems they had faced, which were coded into eleven categories. Logistic regression models predicting listing of categories were developed based on ill member (diagnosis, sex, treatment compliance) and family member (sex, age, relationship to the ill member) characteristics. For models predicting content category from ill member characteristics, only denial/noncompliance and interpersonal/social categories were significantly predictive as dependent variables. For models predicting content categories from family member characteristics, only the resources/benefits model was predictive. The significant findings, in conjunction with the important negative results, suggest implications for further development of family intervention models. Building on previous research, groups composed of families coping with more than a single diagnosis and including a variety of family member relationships have the potential to reach consensus on curriculum topics.     

Family therapy training: Current issues,future trends

This article extends the previous literature review of the family therapy training and supervision field (Liddle & Halpin, 1978) by organizing and discussing some of the dimensions most relevant to family therapy teachers. The five domains of focus include: (1) Personnel: who should teach and be taught family therapy? (2) Content and skills: what should be taught? (3) Methodology: how should the content and skills be taught? (4) Context: how do the setting and the training enterprise influence each other? (5) Evaluation: how should training be assessed? Finally, the article brings into focus several key aspects of family therapy training likely to have relevance for current and future trainers.     

Family therapy training—give the customers what they want

Family therapy training is an area of current interest and debate within the Association for Family Therapy. At a local level regional groups and branches have been promoting family therapy through a variety of sources and events (Bott, 1979; Haldane, 1980). The development of training has therefore been of a haphazard and ad hoc nature. More recently the Sub-Committee on Training for Family Therapy has addressed itself to establishing and co-ordinating formalized training programmes and to the attendant issues of course structure, content and accreditation.
The Workshop at Bangor looked at the rationale behind and organization involved in setting up introductory training in family therapy. Several introductory training schemes already in operation throughout the U.K. were described and the results of a recent consumer survey conducted in Northern Ireland were presented.     

Facilitating the highly bonded cohort: Should more be done to anticipate and reduce the potential for hyper-cohesiveness and deindividuation in therapy training cohorts in universities?

Successfully facilitating learning for small therapy training programmes requires a special understanding of the psychological work of group processes. Students in therapy training spend almost every class together over two or more years. In these student groups, or cohorts, individuals manage themselves within a unique interpersonal and intragroup dynamic. Course instructors must develop their capacity to work effectively with this specific learning milieu. At the same time, the particular dynamics of the cohort context might not be understood by university management where increasingly few cohort contexts exist for students. Consequently, phenomena arising from the specialised nature of the group environment may not be well understood outside of the expertise of the course. In the first part of the paper, the international literature about learning in cohorts is reviewed. In the second part, this reflection is further developed to explore facilitation of a group that has some features of what might be described as negative cohesiveness, or what is described in family theory as enmeshment. Some consideration as to how to anticipate and off-set potential difficulties for groups in therapy training courses is also contributed.     

Sequential analysis as a method of feedback for family therapy process

Abstract

The purpose of this study was to examine the relationship between therapist verbal behavior and family cooperation and resistance during the second session of family therapy with juvenile delinquents. Sequential analysis was used to investigate the impact of one therapist's behavior on family resistance and cooperation in a sample of 12 families. The results of the sequential analysis revealed that therapist “support” and “teach” behaviors were associated with significant increases in the likelihood of family cooperation. The study provides an example of how sequential analysis can be used to inform family therapists about the impact of their behavior on families.     

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.     

Family therapy for continuing professional education

This is a report on a program of family therapy instruction intended as a continuing professional education service to mental health personnel. The rapid expansion of the program since its inception in late 1971 is due to increasing demand from human service agencies in and around the Greater Philadelphia area. By the end of 1978 more than 550 had participated. Approximately 15% went on to higher levels of family therapy training available at the Department of Family Psychiatry of Eastern Pennsylvania Psychiatric Institute. Some characteristics of participants are described: most are master's level personnel representing a wide variety of human service agencies within a 100-mile radius of Philadelphia; most had a positive response to the training; most did not intend to become family therapists but wanted an exposure to theory and methods. Comments are included by selected category of how participants use what they learn.     

Family Secrecy in Family Therapy Practice: An Explorative Focus Group Study

The aim of this focus group study was to explore the experiences of family therapists working with family secrecy. Our study highlights that family secrets present important and compelling challenges for family therapists. Furthermore, our study reveals that there seem to be some basic strategies family therapists use in dealing with these challenges in therapy sessions. One basic strategy is that family therapists try to guard their position of being a trustworthy therapist for each family member by avoiding becoming stuck in family secrecy. Furthermore, therapists explore ways to guide the family toward the disclosure of the secret in order to alleviate the toxicity of the secrecy. This highlights the importance of the systemic model and how influential this perspective is in family therapy practice. Some participants, however, have in addition a second strategy they sometimes use: talking with the family about secrecy without aiming to disclose the secret. In the discussion section of the article we reflect on the possibility that in the strategic choices family therapists make conceptual issues might be involved. Furthermore, we stress the importance of further research.     

What is “Good” Technique? How to Teach it? Personal Reflections on Psychoanalytic Training

There is an intense interest in the interactional process across the varying psychoanalytic schools of thought. The analytic relationship itself, in all of its complexity, is the vehicle for our work. These advances raise the question of what we mean by technique these days, a question that has implications for analytic training and supervision. In this paper, the author reflects back on his analytic training experience, specifically at how two of his supervisors regarded technique, how it was taught, and the various ways in which it was communicated. In looking back at these supervisory experiences, the author examines how these teaching analysts embodied some of what they had to teach. The author shows what was mutative across these training experiences in terms of what was needed in order to grow—what facilitated his own development as an analyst and contributed towards the cultivation of his own style.     

Teaching preschool children to report suspicious packages to adults

Law enforcement agencies stress that public reporting of terror‐related crime is the predominant means for disrupting these actions. However, schools may be unprepared because the majority of the populace may not understand the threat of suspicious materials or what to do when they are found on school grounds. The purpose of this study was to systematically teach preschool children to identify and report suspicious packages across three experiments. In the first experiment, we used multiple exemplar training to teach children to identify the characteristics of safe and unsafe packages. In the second experiment, we taught participants to identify the locations where packages should be considered unsafe. Finally, in the third experiment, we used behavioral skills training to teach participants to avoid touching unsafe packages, leave the area where they were located, and report their discovery to an adult. Results suggest the participants quickly developed these skills. Implications for safety skills in young school children are discussed.     

participating in a couples therapy outcome study: Participants' views

Discovering that participants who received therapy in a research project and were being debriefed in a therapy outcome study considered those assessment sessions therapeutic, the authors conclude that participants: (a) are aware of the research context, (b) have some idea about how it affected the treatment they got, and (c) see positive outcomes for taking part in the study. Assessment and treatment were not separated in the minds of some participants, as they had been in the mind of the researchers.This study was supported in part by National Institute on Drug Abuse grant #1R 18DA 1069232001.     

Expecting to teach enhances motor learning and information processing during practice

Recent research has revealed that having learners study and practice a motor skill with the expectation of having to teach it enhances motor learning. However, the mechanisms underlying this effect remain unknown. We attempted to replicate this effect and elucidate the mechanisms underlying it. Thus, participants studied golf putting instructions and practiced putting either with the expectation of having to teach another participant how to putt or the expectation of being tested on their putting. During this acquisition phase, participants’ motivation, anxiety, and information processing (the duration they took preparing each putt) were indexed as possible mechanisms underlying a motor learning effect. One day and seven days after the acquisition phase, learning was assessed by testing all participants on their golf putting. Results revealed that expecting to teach enhanced motor learning, replicating the original finding. Moreover, expecting to teach increased the duration participants took preparing each putt, which was correlated with superior motor learning. Thus, results suggest expecting to teach enhances motor learning by increasing information processing during practice.     

Marriage and Family Therapy Students’ Views on Including Weight Bias Training into Their Clinical Programs

Discussions about diversity rarely focus on overweight, obesity, and bias about body size (i.e., weight bias). These discussions allow students to develop self-awareness about how their biases can affect their clinical work, as well as the challenges and subsequent bias clients may face in their everyday lives and from clinical providers. One consequence of the rising prevalence of overweight and obesity in the United States is the increase in the level of weight bias and discrimination towards individuals who are overweight, which has been documented among mental and healthcare professionals. Thus, it is imperative that training programs integrate weight bias as a part of diversity training. The authors will review weight bias in mental and healthcare professions, and describe several trainings focused on self-awareness about weight bias. The purpose of this study was to pilot and evaluate a training program for marriage and family therapy (MFT) students about developing self-awareness around weight bias and working with clients who are overweight. Following the program, focus groups were conducted to explore participants’ experiences, learning, and feedback on the content and delivery method. Focus Group methodology was used to guide the analysis process. Four themes emerged: training program feedback, challenges for the MFT field, self-of-therapist, and etiology of weight loss/gain. Implications for MFT training programs are discussed.     

Feeling of knowing and duration of unsuccessful memory search

Five experiments examined the impact of feeling of knowing on decisions to continue or to terminate the search of memory in question answering. First, two pairs of experiments respectively scrutinized knowledge about (1) ordinary facts and (2) national capitals. The first experiment of each pair extracted normative data: The participants indicated whether they had probably once known the answer to a question (once-knew-it scale), supplied the answer if they knew it, and either judged the likelihood of their recognizing the answer or made other pertinent metacognitive judgments. In these norming experiments, recognition ratings were highly correlated with once-knew-it responses, and both measures were highly predictive of performance. Thisindicated that both measures reflect feeling of knowing judgments. In the second experiment of each pair, different participants were timed as they indicated whether they knew the answer to the same questions. Responselatencies for responding "don't know" were strongly positively correlated with the once-knew-it judgments made by the norming participants. This relationship was corroborated by Experiment 5, which compared the crucial measures within participants. These outcomes suggest that, in this context, feeling of knowing judgments are predictive of how long people will search memory for requested information.     

Do Better Trainees Make Worse Family Therapists? A Followup Study of Client Families

This study was designed to evaluate the effects of training on family therapy outcome and to validate measures of cognitive/perceptual and executive skills. Followup data on family satisfaction were obtained from 176 individuals (73 families) treated by 12 trainee family therapists in their first or second year of training. The prediction that clients' scores on a scale of family satisfaction with therapy (FSS) would increase with training was not confirmed. Instead, there was a tendency for FSS scores to decrease with training. However, trainees' ratings of outcome did increase significantly as training progressed. Cognitive/perceptual and executive skill measures were not validated by the FSS, but negative associations indicated a tendency for trainees with high course-skills to receive poor FSS scores. The results suggest that trainees became more confident as they acquired technical skills, but that they put aside their nonspecific therapist skills as training progressed, to the dissatisfaction of families.     

"It's led me astray": How Cognitive Behavioural Therapists experience personal therapy in clinical practice

Personal therapy is considered to be an essential component of most psychotherapeutic training programmes. However, it remains peripheral to cognitive behavioural therapy (CBT) training courses. We present a subsection of results from a qualitative study that examines how CBT therapists use personal therapy in their clinical practice. Seven CBT therapists who have undergone personal therapy were interviewed. Participants were asked about how they used personal therapy in their clinical practice and their accounts were analysed using interpretative phenomenological analysis (IPA) to identify common themes. This article presents the results of the first master theme, “Personal therapy creates conflict”, which explores a paradox that arises between personal therapy and CBT clinical practice; participants suggest that personal therapy equips them with therapeutic tools that paradoxically hinder their capacity to practice a standardised protocol‐led CBT. Results show that participants found personal therapy created considerable internal conflict, where their use of technical evidence‐based treatment protocols as practitioners was experienced in tension with the relationally oriented therapy they had received as clients. We discuss results in the context of Gabriel Marcel's philosophical insights on the dehumanising effects of technology on human relationships. We conclude with a brief consideration of the current political climate that increasingly privileges short‐term technical solutions to psychological distress.     

EVALUATION OF BEHAVIORAL SKILLS TRAINING FOR TEACHING FUNCTIONAL ASSESSMENT AND TREATMENT SELECTION SKILLS TO PARENTS

Scant research has addressed the issue of teaching parents to conduct a functional assessment and design a treatment for problem behavior. The present study utilized behavioral skills training to teach parents how to conduct ABC recording, write a summary statement based on the data collected, and make appropriate treatment choices. Eight parents participated in one 3‐h class in which a trainer used instructions, modeling, rehearsal, and feedback to teach these three skill sets. Prior to class, during class, directly after class training, and 1 to 2 weeks following class, the participants viewed videos showing a problem behavior serving a different function in the context of a parent child interaction. The percentage of correct responding for each dependent variable (ABC recording, summary statement, and treatment choices) was calculated, and baseline and post‐treatment scores were compared via a multiple baseline across participants design. The results showed an increase in the percentage correct for most skills for most participants. These results show that it is possible to teach parents to conduct a functional assessment and choose proper treatment strategies. Copyright © 2012 John Wiley & Sons, Ltd.