Online Cognitive Behavioural Therapy Training for Therapists: Outcomes,Acceptability, and Impact of Support

The objectives of the present study were to assess the effects of online cognitive behavioural therapy (CBT) training for therapists on measures of CBT knowledge, skills, confidence, and utilisation; to determine what differences might exist between a group supported by regular telephone contact and an independent group who undertook online training without additional support; and to determine the acceptability of CBT online training among rural and remote mental health professionals. Mental health practitioners were randomly allocated to a supported training group (six sessions of 15‐min support) or an independent group. They undertook a 12‐week online CBT training program. The two groups showed similar gains on an objective test of knowledge of CBT, and on self‐report measures of knowledge, skills, confidence levels, and utilisation of skills. However, the supported training group had a significantly higher program completion rate than the independent group. Participants evaluated the program favourably. The results suggest that online CBT training represents a promising and cost‐effective approach to training the mental health workforce, and may be particularly attractive for those who live in regional, rural, and remote communities. A challenge is to determine the most cost‐effective ways to enhance program completion rates and trainee skills.     

‘Learning from research’: Therapist perspectives on the benefits and challenges of participating in a longitudinal,systematic case‐study

Objectives: In psychotherapy research we have often neglected to examine the impact of research procedures on therapy process and outcome. Such information is extremely important in helping us evaluate the validity of our findings, increase relevance of research for practice, and choose appropriate methods for future projects. The aim of this paper is to share the experience of six person‐centered therapists, who participated in a longitudinal, systematic study, and present their reflections about the impact of research on therapy process, therapeutic engagement and professional development. Methods: The findings have emerged from semi‐structured interviews that took place after the first, sixth (middle) and last therapy session. In total 18 interviews were conducted. These data were part of a much larger research protocol that included a number of outcome and process measures. Results & Conclusions: The analysis of therapist narratives revealed important benefits for those participating in systematic case study research. The use of Brief Structured Recall methods and qualitative interviewing was an important factor in promoting therapist reflexivity and professional development. The importance of a strong research alliance and the active involvement of the client in the research process is discussed.     

To switch or not to switch: Inviting bilingual clients to switch languages in psychotherapy

In the present study, we used an audio-analog design to test whether exposing bilingual participants to a therapist who invited a bilingual client to switch languages in a psychotherapy session would have a positive effect on participants’ perceptions of the therapist. We also explored whether participants’ sense of belonging to their ethnic group and to the larger US culture would enhance or attenuate this effect. Sixty-three bilingual Latino/a university students listened to one of two recordings of a simulated psychotherapy session with a bilingual Latina therapist and client. In one recording, the therapist invited the client to switch from English to Spanish when the client had trouble expressing complicated feelings; in the other, the therapist did not invite the client to switch. When listening, participants were asked to imagine themselves in the role of client and to rate the credibility and multicultural competence of the therapist, and the emotional bond they would anticipate with her. Contrary to expectation, only participants who expressed a greater sense of belonging to US culture rated the therapist who invited the client to switch as being more multiculturally competent. We discuss how these findings contribute to the literature on language switching and bilingualism in psychotherapy.     

The pregnant therapist and the psychotic client: A phenomenological understanding of the impact of the therapist’s pregnancy on the therapeutic process

This original paper examines the underresearched area of therapist pregnancy. It explores the impact of psychosis as an additional complicating factor to the therapeutic process and the experience of one British counselling psychologist working in the National Health Service whilst pregnant. Five brief client summaries/clinical examples are presented to explore the common themes of anger, rejection, abandonment and envy that often emerge following the disclosure of a therapist’s pregnancy or the opposite reactions of over-protectiveness and an unwillingness to engage in therapy for fear of harming the therapist. Recommendations are made for further research within this neglected area and the need to incorporate the themes within training for therapists and training for supervisors.     

Client self-image,therapist acting,and the establishment of the therapeutic alliance in a training context

This study examined how clients’ self-image and perception of therapist’s behavior are related to the therapeutic alliance, as well as how these variables change in the psychotherapy process in trainee-led psychotherapy. A total of 164 participants (M = 28.9 years) who attended two semesters of treatment at the Psychology Clinic of Umeå University completed the Working Alliance Inventory (WAI) to evaluate their perception of their alliance with the therapist. They also completed two questionnaires based on the Structural Analysis of Social Behavior (SASB) model to give insight into their self-image patterns and to analyze their perceptions of the therapist’s behavior. The results show that a positive self-image and positive perceptions of the therapist’s actions increased significantly over the course of the therapy, with a corresponding decrease in negative patterns. The alliance scores show that the therapeutic alliance gains significance over time and that it is influenced more by the perception of the therapist’s behavior than by the self-image. The self-image becomes relevant after the mid part of therapy, underlining the role of the therapist in co-creating the treatment relationship. The implications of these results are discussed, and so are directions for future research in other trainee-led settings and samples.     

Response to “Turning Words and Twisting Truths”

SUMMARY

Too often, in discussions of psychotherapy, the techniques are given undue emphasis. Research suggests that the same techniques are differentially effective when used by equally trained and supervised therapists. Not only are some therapists more effective, irrespective of the type of therapy they practice, but some, because of their personal qualities, may actually harm those with whom they work. This research reflects the vast importance of the ubiquitous element in therapy, that of the “person” of the therapist. The question, then, follows, how may personhood be developed? This question is explored as it relates to both breadth and depth of life experience.     

D.H. Lawrence's The daughter-in-law: Transforming a family system

Abstract

D.H. Lawrence's play The daughter-in-law, written in 1912, explores underlying, implicit conflict within a family. Set in a small mining town in England, the family consists of Mrs. Gascoyne, her sons Luther and Joe, and her daughter-in-law, Minnie, Luther's wife. The central conflict is between Mrs. Gascoyne and Minnie, who challenges her mother-in-law's control over her sons, who also compete with each other for the love and recognition of their mother. Joe, the youngest son, perturbs the family system and acts as a mediator, functioning as a family therapist. He sets a process in motion through which the rigid family alliances are challenged and ultimately realigned. Mrs. Gascoyne's self-image as a perfect, self-sacrificing, self-righteous mother ultimately is transformed, and she accepts Minnie as a family member. Brandchaft's concept of “pathological accommodation” explicates how enmeshed family members can collide, and thereby stultify their personal development. As Joe plays his role of “family therapist,” the family dynamic changes. Through the process of rupture and repair, each family member begins to recognize the needs of the other, and thereby a path for differentiation, individuation, and autonomy becomes possible for them.     

A taste of reflecting practice

This article describes a training exercise in which students who are new to systemic practice but have some experience in therapeutic work in other modalities were invited to experience reflecting practice. The students were asked to follow a role‐played therapy session by offering reflections on the connections felt to a ‘family’ member. The students stood beside the ‘family member’, reflected on the problems and accounted for the connections felt in terms of particular resonances felt. The students thus experienced a therapeutic use of self congruent with the reflecting team approach and the therapeutic position adopted in reflecting practice.