Developing Metacompetence in Low Intensity Cognitive‐Behavioural Therapy (CBT) Interventions: Evaluating a Self‐Practice/Self‐Reflection Programme for Experienced Low Intensity CBT Practitioners

Self‐practice/self‐reflection (SP/SR) is a targeted training and professional development strategy in which clinicians practice cognitive‐behavioural therapy (CBT) techniques and processes on themselves and then working through a structured process of self‐reflection. Previous studies with CBT trainees and experienced mental health practitioners have found that SP/SR or experiencing CBT “from the inside out” has been perceived by participants as increasing competency in a number of important areas and increasing therapist flexibility and artistry. Low intensity (LI) practitioners are identified as a relatively new addition to mental health service delivery in the UK. These workers are differentiated from traditional mental health practitioners by a shorter training period, the delivery of a circumscribed number of CBT interventions, and a very high weekly patient load. This study, the first of its kind, reports outcomes from an SP/SR programme undertaken by seven experienced LI CBT practitioners. Participants used the following measures to track their experience of the programme: time spent on programme, personal‐ and therapy‐related belief rating, goals attained, and perceived skill rated for average and most difficult patients. Results showed a positive change in work‐related skill and behaviour change, particularly when working with the more difficult patients. The findings are consistent with those found in other groups of therapists (e.g., trainee CBT therapists and highly experienced CBT therapists), suggesting that SP/SR may be a valuable addition to LI intensity training and professional development. These findings are discussed in the context of the particular needs of LI practitioners.     

Enhancing Cognitive‐Behavioural Therapy (CBT) Skill Acquisition Through Experiential and Reflective Learning: A Commentary on Studies Examining the Impact of Self‐Practice and Self‐Reflection in CBT

Self‐practice and self‐reflection (SP/SR) is a targeted training tool that is intended to increase CBT competency in therapists. The four articles reviewed in this commentary examine the benefits of SP/SR with various types of therapists, and survey the significant obstacles faced in implementing this tool with clinicians. Collectively, these articles conclude that SP/SR is a valuable tool in improving CBT skill acquisition and preventing burnout, particularly with difficult patients, but that most therapists elect not to use it largely because of the time involved in engaging in it. In this commentary, I suggest that empirical studies with larger samples and controlled designs are needed to build on the wealth of qualitative data collected to date in order to assess the value added by SP/SR compared with other training methods, and in order to determine its impact on a range of therapeutic outcomes. I also suggest that future studies should examine the efficacy of required SP/SR engagement, isolate its critical ingredients, and assess if there are clients and therapists for whom SP/SR is comparably more effective.     

Invited Response to Commentaries: Self‐Practice/Self‐Reflection (SP/SR): Contexts,Challenges and Ways Forward

McGinn (2015) and Fernández‐Álvarez, Castañeiras, and Wyss (2015) make valuable suggestions in their commentaries on the three self‐practice/self‐reflection (SP/SR) articles in this issue of the Australian Psychologist. In our response, we use their commentaries as a springboard to highlight contextual influences and challenges for future SP/SR research, and suggest potential ways forward.     

Ecocultural effects on self‐concept. A study with young indigenous people from different sociodemographic contexts

This study explores self‐concept among indigenous young people from different ecocultural niches in Chiapas (Mexico) through a particular self‐concept task. Previous theory and research has described 3 cultural models linked with specific sociodemographic settings that foster particular psychologies. Our aim was to compare the results of the self‐concept test among indigenous groups from different sociodemographic settings in order to observed possible differences. We predicted that individuals from rural communities with little formal education (hypothesised to be Interdependent) would have self‐concepts with more social and less personal components than would those with an urban, highly educated (hypothesised to be Independent), and we expected a third group of highly educated young people living in an urban context but with a rural background (hypothesised to be autonomous‐related group) to value social and personal components equally. The results supported this hypothesis. Based on ecocultural theory, it is suggested that sociodemographic contexts affect the self‐concept.     

Revisioning Fordham's ‘Defences of the self’ in light of modern relational theory and contemporary neuroscience

This paper explores the evolution of Michael Fordham's ideas concerning ‘defences of the self’, including his application of this concept to a group of ‘difficult’ adult patients in his famous 1974 paper by the same name. After tracing the relevance of Fordham's ideas to my own discovery of a ‘self‐care system’ in the psychological material of early trauma patients (Kalsched 1996 ), I describe how Fordham's seminal notions might be revisioned in light of contemporary relational theory as well as early attachment theory and affective neuroscience. These revisionings involve an awareness that the severe woundings of early unremembered trauma are not transformable through interpretation but will inevitably be repeated in the transference, leading to mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome. A clinical example of one such mutual enactment between the author and his patient is provided. The paper concludes with reflections on the clinical implications of this difficult case and what it means to become a ‘real person’ to our patients. Finally, Jung's alchemical views on transference are shown to be useful analogies in our understanding of the necessary mutuality in the healing process with these patients.     

Self‐Control Moderates Decision‐Making Behavior When Minimizing Losses versus Maximizing Gains

We examined (1) whether people would be more responsive to the delayed consequences of their decisions when attempting to minimize losses than when attempting to maximize gains in a history‐dependent decision‐making task and (2) how trait self‐control would moderate such an effect. In two experiments, participants performed a dynamic decision‐making task where they chose one of two options on each trial. The increasing option always gave a smaller immediate reward but caused future rewards for both options to increase. The decreasing option always gave a larger immediate reward but caused future rewards for both options to decrease. In Experiment 1 where the two options had equivalent expected value in the long run, participants were more prone to select the increasing option, which yielded larger benefits on future trials, in the loss‐minimization condition than in the gain‐maximization condition. Trait self‐control moderated the effect of losses by enhancing the effect for low self‐control participants while attenuating it for high self‐control participants. In Experiment 2 where selecting the increasing option was suboptimal, low self‐control participants still attempted to reduce losses on future trials by selecting the increasing option more often than high self‐control participants. These results suggest that decision makers value delayed consequences of their actions more in a losses domain relative to a gains domain and low self‐control individuals are more susceptible to such an effect. Copyright © 2014 John Wiley & Sons, Ltd.     

The Effects of Negative Images on Young People's Willingness to Help Elderly People

We examined the effect of confronting young people with an image depicting them as unhelpful on their willingness to help elderly people. As expected, helpfulness increased when this image reflected the elderly's view of young people but decreased when it reflected objective information. Copyright © 2014 John Wiley & Sons, Ltd.