Themes in Therapist Development During the First Three Months of Clinical Experience

The results of a qualitative research study designed to better understand the developmental processes active in beginning therapists during the first three months of clinical contact is reported. Thirteen beginning therapists were asked to complete a monthly log describing experiences impacting their clinical work and themselves as therapists during their first three months of client contact. Data analysis revealed that the primary developmental theme active during this period of time is the development of therapist confidence. Two additional themes, the development of an internal gauge on which to evaluate current experiences and the development of boundaries around the self as a professional, were also found to be active during this time. These additional themes support the development of therapist confidence. Implications for training and research are identified.     

Resistance and outcome expectations in cognitive‐behavioural therapy for generalised anxiety disorder

Greater client resistance has been consistently found to be negatively associated with outcome in psychotherapy. However, the pathways through which resistance impacts such outcomes are underexplored. Given that client outcome expectation (OE) has been identified as an important common factor in psychotherapy, the goals of the present study were to examine: (a) the impact of resistance on subsequent client and therapist OE (COE & TOE, respectively); and (b) whether COE and/or TOE mediate the relationship between resistance and outcome. These relationships were tested among 44 clients with severe generalised anxiety disorder treated with cognitive‐behavioural therapy in the context of a randomised controlled trial (Westra, Constantino, & Antony, 2016). Resistance was measured at a mid‐treatment session, and COE and TOE were assessed at baseline and immediately after the resistance session. Treatment outcome was measured via client‐rated worry severity at post‐treatment. As predicted, higher resistance was associated with lower subsequent COE and TOE; B = ?.73, p < .001 and B = ?.46, p < .001, respectively. In turn, lower post‐resistance COE predicted higher post‐treatment worry (B = ?.5, p < .001), indicating mediation. In contrast, TOE did not mediate the relationship between resistance and outcome (B = ?.02, p = .876). These results suggest that resistance can be demoralising to both clients and therapists. However, only lower client morale may be detrimental to therapy outcome. This study contributes to understanding outcome pathways through two common therapy processes.     

In Experiential Sessions, There Is No Therapist or Client: There Is a “Teacher” and a “Practitioner”

In virtually every kind of psychotherapy, therapist and client attend mainly to one another throughout almost the entire session. If each experiential session is to be successful in enabling the person to become the whole new person that the person can become, and to become free of the painful feeling in the painful situation, the radical alternative is for the experiential teacher–therapist and the person to attend mainly to the third thing that is the important center of attention for the person. An even more radical glimpse into the future includes the person having one's own sessions by oneself, complemented by skill-development sessions with the experiential teacher.     

Betrayal And Paranoia: The Psychotherapist's Function as an Intermediary

We present an approach to the problem of structuring a therapeutic alliance with patients presenting paranoid symptoms, using both psychoanalytical and cognitive techniques. Initially, we focused on one of the main aspects of the paranoid worldview: the fear of being betrayed and the tendency to betray. This is a defense maneuver, through which patients deny their passivity, and the impotence in the relationship with their own internal needs and with the significant people in the external world, including the therapist. In our experience to build up a working relationship, both a psychoanalytical interpretation of unconscious conflicts and the cognitive analysis of dysfunctional beliefs are needed. Often, in more serious cases, the role of nonqualified object must be accepted at the beginning, due to the patient's need to be in control of the situation. Only then can a therapeutic phase begin, in most cases, through an integrated approach that includes pharmacological, psychodynamic, and cognitive modalities.     

Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Therapist interventions in short-term dynamic psychotherapy: six expert treatments

This paper describes the profile of verbal response modes utilised in the expert application of Short-Term Dynamic Psychotherapy (STDP). One hundred and fifteen randomly selected segments from six treatments of STDP were analysed. Trained raters used a verbal response mode coding system to examine the individual speaking turns of an expert therapist. Based on the profile of therapist interventions reported, it was concluded that the actual conduct of this treatment in routine practice illustrates the empirically informed modifications to STDP technique integrated alongside the common characteristics of STDP based on the therapist (i) adopting an active stance, (ii) maintaining treatment focus using frequent confrontations and the ‘Triangle of Conflict’, and (iii) tailoring treatment to participant functioning using a combination of supportive and expressive interventions. Furthermore, specific differences in therapist activity were observed across treatment phases as well as between participants.     

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.