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Experiential learning for trainee therapists through a shame attack exercise
Abstract
Research on self-practice/self-reflection (SP/SR) programmes in training cognitive behavioural therapy (CBT) have shown promising outcomes over the past decade. To date, the SP/SR framework research has generally focused on entire programmes and has rarely assessed the utility of specific exercises as teaching tools. This study aimed to determine the utility of an exposure intervention known as a shame attack in helping to facilitate CBT training in a clinical psychology programe when delivered in a SP/SR framework. It also sought to examine the potential for the exercise to be used as a form of competency-based assessment. Forty-one student trainees engaged in self-directed shame attack exercises and provided written reflections on their experiences. The reflections were then studied via thematic analysis. The results indicate that the exercise provides an avenue for competency-based assessment of trainee therapists’ conceptual knowledge, formulation skills and intervention planning. It also promoted learning outcomes relating to a ‘deeper’ and more nuanced appreciation of CBT theory and practice. The shame attack exercise provided for personal development and the opportunity to experience typical client challenges with engaging in exposure interventions, which have the potential for enhancing empathy and cognitive behavioural skills.
Key learning aims
(1) To understand the usefulness of a shame attack exercise for training within a SP/SR framework.
(2) To examine the potential for using SP/SR as a form of competency-based training.
(3) To demonstrate the benefits of experiential learning through SP/SR in training CBT.
... However, research has otherwise elucidated clear and numerous benefits of the inclusion of SP/SR in CBT training. Participants who have engaged in this experiential learning strategy have reported greater empathic attunement with the client journey and a deeper understanding and belief in the CBT model (Bennett-Levy et al., 2001;Spendelow and Butler, 2016), increased self-awareness (Bennett-Levy et al., 2001;Scott et al., 2020;Spendelow and Butler, 2016), self-help skill acquisition (Spendelow and Butler, 2016), improved technical and interpersonal skills (Davis et al., 2015), greater confidence in their own therapeutic skills (Scott et al., 2020) and improved case conceptualisation skills (Collard and Clarke, 2020;Haarhoff et al., 2011). ...
... It has been noted in the research that there are important factors which may help in understanding how trainees might maximise these benefits from engaging in SP/SR (Bennett-Levy and Lee, 2014;Chaddock et al., 2014). One factor noted as being particularly important is the degree to which trainees are enabled to synthesise their personal and professional development (Chaddock et al., 2014;Chigwedere et al., 2021;Collard and Clarke, 2020). Bennett-Levy and Finlay-Jones (2018) built further upon the original DPR conceptualisation, outlining a model of Personal Practice (PP) which encapsulates the pertinence of this process. ...
... Bennett-Levy and Finlay-Jones (2018) term this process 'crossing the reflective bridge' p. 191); that is, a process of making sense of how what a therapist has learnt about their personal self is important to their professional self. It is suggested that this process is facilitated by using 'bridging questions', Whilst there is some research to support this notion (Chigwedere et al., 2021;Collard and Clarke, 2020), there is a paucity of research which contextualises this process adequately. Much of the research that examines the implementation of SP/SR during CBT training has accounted for participants' learning about the SP/SR process and about the practice of cognitive behavioural therapy, not what they have learned about the self. ...
Over the last two decades, self-practice/self-reflection (SP/SR) has been advocated as a useful experiential teaching method on CBT training programmes. As part of this, theoretical positions point to the importance of there being an explicit process of ‘bridging’ between what is learnt about the self (personal development) and the implications of this for clinical practice (professional development). However, exactly how participants experience this synthesis as part of their engagement in SP/SR has not yet been clarified. As such, the present study set out to explicate trainee CBT therapists’ experiences of this process, in order to further our understanding of how they synthesise their personal and professional development during training. Nineteen trainees took part in the study, each consenting to a 1000-word written summary of their learning from SP/SR being entered into the dataset and analysed using thematic analysis. The analysis identified five interconnected themes, illustrating how trainees had (i) identified self-schemas, (ii) increased their awareness of personal context, and (iii) conceptualised the role of the self in the therapeutic process; they had then achieved (iv) personal–professional development via experiential change methods, resulting in (v) perceived benefits for their clinical practice. SP/SR may therefore be a useful vehicle to enhance personal and professional development during training by helping trainees to understand and address the role of the self in cognitive behavioural psychotherapy. Tentative implications for CBT training and practice have been offered.
Key learning aims
(1) To summarise key theoretical positions and research outcomes underpinning the use of SP/SR as a CBT training method to enhance personal and professional development.
(2) To understand trainee experiences of synthesising personal and professional development from SP/SR during training.
(3) To consider implications for CBT training and ongoing professional practice.
... The research to date on the use of SP/SR as a training technique suggests that it is an effective training method, with studies supporting its use with novice therapists through to more experienced practitioners (Bennett-Levy and Lee, 2014;Bennett-Levy et al., 2001;Chigwedere et al., 2019;Collard and Clarke, 2020;Davis et al., 2015;Thwaites et al., 2014). Participants have typically reported a range of promising outcomes from this form of training. ...
... Participants have typically reported a range of promising outcomes from this form of training. Amongst the benefits reported have been an enhanced confidence with, and understanding of cognitive behavioural theory, an increased appreciation for cognitive behavioural strategies, and greater skill in the application of techniques, including greater flexibility and nuance in their application (Bennett-Levy, 2019; Chigwedere et al., 2019;Collard and Clarke, 2020;Collard and Clarke, 2022;Davis et al., 2015;McGillivray et al., 2015;Scott et al., 2021). Participants also tend to report improved interpersonal skills, allowing for a greater attunement with clients and increased empathy for their presenting difficulties Chigwedere et al., 2019;McGillivray et al., 2015;Thwaites et al., 2014). ...
... With the self-practice aspect of the SP/SR framework, trainees are required to practise formulation skills in relation to their own problems, to develop and apply interventions to these, and to then reflect upon what is learnt from these . While much of the SP/SR research has looked at outcomes from overall training programs, there have been a few studies that have focused on the learning outcomes from some specific exercises, including thought diaries, exposure tasks, and behavioural experiments (Bennett-Levy, 2003;Collard and Clarke, 2020;Collard and Clarke, 2022). These have shown that the SP/SR exercises can be used to target specific skills around formulation, intervention planning, and for reviewing intervention outcomes. ...
With the increased demand for psychological services, and particularly for cognitive behavioural therapy (CBT), it is vital that teaching programs offer effective training that produce skilled and competent clinicians. This paper reviews the limitations of traditional approaches to training within the field of psychology, in terms of the promotion of a breadth of declarative knowledge at the expense of a deep and nuanced understanding of cognitive behavioural theory and clinical competence. It also reviews issues with existing strategies for competency-based assessment of trainees learning CBT. To date, many of these appear to assess a range of competencies concurrently and to test trainees within complex environments. Such methods may fail to provide an opportunity for the assessment of specific areas of competence and/or confound the assessment itself. It may also result in the public being exposed to trainees who are yet to develop competence. Based on recent research in training methods within psychology at large, and in relation to CBT specifically, a model of competency-based training and assessment is presented to address these issues. This model extends the existing research on the use of the experiential self-practice/self-reflection (SP/SR) framework for training in CBT. It proposes that the use of discrete exercises within a SP/SR training program promotes a more in-depth and nuanced appreciation of cognitive behavioural knowledge and skills and increased clinical competence. Furthermore, such exercises are proposed to provide an avenue for assessing clinical competence in specific skills prior to the commencement of direct client services.
Key learning aims
• (1) To review literature on training for the development of clinical competence.
• (2) To review literature examining methods of assessing competence.
• (3) To propose the use of experiential training through a SP/SR framework as a method for providing both competency-based training and assessment.
... SP/SR may also provide a useful method for introducing competency-based assessment for trainees, that is a way to measure competency in a vocational skill. With psychological practice involving competencies in assessment, evidence-based treatment planning, the application of interventions, and evaluation of treatment outcome (von Treuer and Reynolds, 2017), it has been suggested that the SP/SR frameworks can provide an avenue for the early assessment of such skills in trainees (Collard and Clarke, 2020). The SP/SR provides trainees with a chance to practise and develop these skills on themselves prior to engaging in client work, and provides opportunity for external feedback to help with the development of such skills. ...
... Two exceptions to this include a paper by Bennett-Levy (2003) contrasting the benefits of SP/SR for automatic thought records and behavioural experiments and a study by Collard and Clark (2020) investigating the learning taken from trainees' engagement in an exposure intervention for social anxiety. While these studies helped to demonstrate the different types of learning that can be taken from thought records and behavioural experiments (Bennett-Levy, 2003) and the potential for improving trainees' appreciation for, understanding of, and application of exposure strategies for social anxiety (Collard and Clarke, 2020), there is still great scope for examining the potential learning trainees could take from other SP/SR exercises. ...
... For the qualitative analysis, a thematic analysis was conducted using a hybrid inductive-deductive model in line with recommendations by Fereday and Muir-Cochrane (2006) and Braun and Clarke (2006). For more information on this model, refer to Collard and Clarke (2020). With regard to the LFT exercise, previous literature on frustration intolerance (e.g. ...
Application of a self-practice self-reflection (SP/SR) framework to clinical training programmes for those learning cognitive behavioural therapy (CBT) have demonstrated positive outcomes. These programmes have typically resulted in reports of enhanced learning, improved clinical skills, heightened empathy, improved interpersonal skills, increased self-awareness, and self-development for those undertaking such training. However, the utility of specific activities within this framework for enhancing trainees’ learning still requires exploration. This study sought to explore the use of a low frustration tolerance (LFT) exercise to enhance trainee’s learning around issues relating to frustration and discomfort tolerance. It also further explored the possible application of SP/SR as a form of competency-based assessment. The study was based on 41 student trainees that engaged in a self-directed LFT exercise. Written reflections on these exercises were then thematically analysed. From a competency basis, the exercise provided an approach for observing the trainee’s competency with formulation skills, intervention planning, and self-reflective capacity. Participants reported both personal and professional development outcomes from the exercise. These included a ‘deepened’ understanding of cognitive behavioural principles related to their experiences, both in terms of principles relating to maintenance of dysfunction and to creating change. Increased self-awareness and learning outcomes relating to the development of interpersonal skills were also commonly reported by trainees.
Key learning aims
(1) To understand the usefulness of a behavioural experiment [a low frustration tolerance (LFT) exercise] for training within a SP/SR framework.
(2) To examine the potential for using SP/SR as a form of competency-based training.
(3) To demonstrate the benefits of experiential learning through SP/SR in training CBT.
... A sample size of 17 was deemed sufficient to compare findings from the original study, which used the EMDR Blind 2 Therapist protocol with participants from Northern Iraq (Bennett-Levy and Lee, 2014; Chigwedere et al., 2020;Collard and Clarke, 2020;Scott et al., 2021). A total of N = 24 was recruited for the study. ...
Objective
The COVID-19 pandemic has had a major impact on the delivery of psychological treatment. Due to social distancing requirements, the provision moved to videoconferencing psychotherapy (VCP). There is a paucity of empirical data supporting the efficacy of EMDR therapy as a VCP. This stage 1 pilot study tested an EMDR therapy scripted protocol, such as Virtual Blind 2 Therapist (VB2Tr), on frontline mental health workers as a VCP regarding fitness for purpose, distinctiveness, relevance, and efficiency.
Methods
A total of 24 participants were recruited for the study. The design included a one-session treatment intervention with pre, post, 1-month, and 6-month follow-up (FU) measurements. This treatment session used a “Blind 2 Therapist” EMDR therapy scripted protocol as videoconference psychotherapy that involves non-disclosure of traumatic memory. The research explored the treatment effect on the core characteristics of trauma memory, including subjective disturbance, belief systems, memory intensity (MI), vividness, and levels of emotionality. Additionally, the research explored participants’ experiences of adverse and benevolent childhood experiences (ACEs/BCEs) during their childhood.
Results
Regarding the four tests, namely, fitness for purpose, distinctiveness, relevance, and efficiency, results are favourably suggesting potential clinical benefits of using EMDR as videoconference psychotherapy. Although this is a proof-of-concept study showing positive results, no clinical population or control group was used. The purpose of the study is to explore the potential for scalability toward a larger clinical trial. The treatment intervention was achieved irrespective of either ACEs/BCEs during childhood.
Conclusion
The research tentatively supports the case for EMDR therapy as a credible treatment when used as video conference psychotherapy and in using the Blind 2 Therapist protocol. However, more research is needed to scale toward a clinical trial.
Clinical Trial Registration
Clinical Trial Registration: https://www.isrctn.com/ISRCTN12099530, identifier ISRCTN12099530.
Introduction
The study examined the qualitative impact and credibility of Self‐Practice/Self‐Reflection (SP/SR).
Methods
19 participants reflected on the self‐practice of cognitive‐behavioural therapy (CBT) techniques. Written reflections were analysed using inductive thematic analysis.
Results
Two super‐ordinate themes (1) Personal‐self and (2) Therapist‐self, with themes and sub‐themes emerged.
Conclusion
The themes found equivalents in existing goals of traditional therapists' training‐therapy. Though brief, SP/SR may be a credible alternative/adjunctive training therapy.
Anxiety disorders are the most common mental disorders, and are often chronic and disabling. Although exposure-based treatments are effective, a substantial number of individuals fail to fully remit or experience a return of symptoms after treatment. Understanding the critical processes underlying the development and treatment of anxiety disorders will help identify individuals at risk and optimize treatments. Aversive associative learning offers explanatory pathways through which fear and anxiety emerge, spread, persist, and resurge. This narrative review examines the advances made in our understanding of associative fear and avoidance learning in anxiety disorders. Overall, the extant literature supports a key role of aversive associative learning in the development and treatment of anxiety disorders. However, research is needed to target specific mechanisms such as extinction generalization and avoidance, the fragility of extinction, and moderating influences of individual differences pertinent to anxiety disorders (e.g., age, sex, depression). We discuss the need for more ecological valid and complex paradigms to model ambiguity and conflict as well as for clinical translation studies to optimize treatment.
As in all professions, the practice of psychologists is based on the acquisition and application of knowledge, skills, and behaviors that are often conceptualized as competencies. As students progress through their curricula, they might approach each individual unit as a discrete set of skills embedded in different coursework units. However, these discrete skills and competencies may not reflect the diverse, interrelated, and complex nature of the practice of psychology. This project sought to identify the key competencies required to practice psychology and to present these competencies in a model that demonstrates how melding these competencies together better reflects authentic, real-world practice. The methodology comprised two stages. Pre-existing data, including detailed postgraduate course content, graduate course evaluations, and destinations such as vocational outcomes, from two universities were distributed to eight Subject Matter Experts (SMEs) for consideration. During the first stage of the study, the eight SMEs engaged in a modified Delphi process designed to explore psychology competencies. The SME panel also answered several rounds of questions at first face-to-face, and later online. From these sessions, a draft psychology competency model was developed, including both competencies that are underpinned by the scientific-practitioner process, and meta- competencies. During the second stage of the study, practitioners and academics from various areas of psychology practice participated in a series of workshops and further refined the competency model. Future research is needed to validate the model. Elucidation of competencies in psychology is imperative and has ramifications for psychology regulation, training, and practice.
Low intensity CBT interventions are starting to be introduced into national healthcare systems (e.g. UK, Australia) to facilitate population-wide access to evidence-based psychological interventions. Good practitioner interpersonal skills are important to enhance the effectiveness of low intensity interventions. Self-Practice/Self-reflection (SP/SR) is an experiential training strategy with an evidence base that suggests its value in enhancing interpersonal skills. This study examines the impact of SP/SR on therapeutic empathy in a group of experienced low intensity practitioners in England. The results suggest a primary impact of SP/SR on practitioners' empathic stance/attitude. Other aspects of empathy (empathic attunement, empathic communication) are potentially responsive to SP/SR, but may require skilled reflective questioning and deliberate practice to translate attitude/stance to empathic attunement and communication skills.
A large amount of research has accumulated on the efficacy and effectiveness of cognitive-behavioral therapy (CBT) for anxiety disorders including posttraumatic stress disorder, obsessive-compulsive disorder, panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobia. The purpose of the current article is to provide an overview of two of the most commonly used CBT methods used to treat anxiety disorders (exposure and cognitive therapy) and to summarize and discuss the current empirical research regarding the usefulness of these techniques for each anxiety disorder. Additionally, we discuss the difficulties that arise when comparing active CBT treatments, and we suggest directions for future research. Overall, CBT appears to be both efficacious and effective in the treatment of anxiety disorders, but dismantling studies are needed to determine which specific treatment components lead to beneficial outcomes and which patients are most likely to benefit from these treatment components.
In this review we describe the intricate interrelationship among basic research, conceptualization of psychopathology, treatment development, treatment outcome research, and treatment mechanism research and how the interactions among these areas of study further our knowledge about psychopathology and its treatment. In describing the work of Edna Foa and her colleagues in anxiety disorders, we demonstrate how emotional processing theory of anxiety-related disorders and their treatment using exposure therapy have generated hypotheses about the psychopathology of posttraumatic stress disorder and obsessive-compulsive anxiety disorder that have informed the development and refinement of specific treatment protocols for these disorders: prolonged exposure and exposure and response (ritual) prevention. Further, we have shown that the next step after the development of theoretically driven treatment protocols is to evaluate their efficacy. Once evidence for a treatment's efficacy has accumulated, studies of the mechanisms involved in the reduction of the targeted psychopathology are conducted, which in turn inform the theory and further refine the treatments. We conclude our review with a discussion of how the knowledge derived from Foa and colleagues' programmatic research together with knowledge emerging from basic research on extinction learning can inform future research on the psychopathology of anxiety disorders and their treatments. Expected final online publication date for the Annual Review of Clinical Psychology Volume 12 is March 28, 2016. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
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.
Engaging and authoritative, this is the first self-experiential cognitive-behavioral therapy (CBT) workbook specifically designed to help therapists enhance their skills. Twelve carefully sequenced modules guide readers to identify, formulate, and address a professional or personal problem using CBT, and to reflect on the experience. Self Practice/self-reflection (SP/SR) is an evidence-based training strategy which enables therapists to build technical savvy in contemporary CBT interventions while deepening their self-awareness and therapeutic relationship skills. The book's large-size format makes it easy to use the innumerable reproducible worksheets and forms. Purchasers also get access to a Web page where they can download and print these reproducible materials.
Although exposure-based cognitive-behavioral therapy (CBT) has been recommended as the first line of treatment for anxiety disorders, it is rarely implemented by clinicians in practice. In part, issues with dissemination of this treatment can explain this occurrence; however, even clinicians who have received training in exposure-based CBT are not using it in practice. This chapter examines the therapist barriers to dissemination of exposure-based therapy and discusses approaches to overcome them.
The need for effective training methods for enhancing cognitive‐behavioural therapist competency is not only relevant to new therapists but also to experienced therapists looking to retain and further enhance their skills. Self‐practice/self‐reflection (SP/SR) is a self‐experiential cognitive‐behavioural therapy (CBT) training programme, which combines the experience of practicing CBT methods on oneself with structured reflection on the implications of the experience for clinical practice. In order to build on previous qualitative studies of SP/SR, which have mainly focused on trainee CBT therapists, the aim of the current study was to quantify the impact of SP/SR on the therapeutic skills of an experienced cohort of CBT therapists. Fourteen CBT therapists were recruited to participate in an SP/SR programme specifically adapted for experienced therapists. In the context of a quasi‐experimental design including multiple baselines within a single‐case methodology, therapists provided self‐ratings of technical cognitive therapy skill and interpersonal empathic skill at four critical time points: baseline, pre‐SP/SR and post‐SP/SR and follow‐up. Analysis of programme completers ( n = 7) indicated that SP/SR enhances both technical skill and interpersonal therapeutic skill. Further intention‐to‐treat group ( n = 14) analyses including both those who left the programme early ( n = 3) and those who partially completed the programme ( n = 4) added to the robustness of findings with respect to technical cognitive therapy skills but not interpersonal empathic skills. It was concluded that SP/SR, as a training and development programme, could offer an avenue to further therapeutic skill enhancement in already experienced CBT therapists. Copyright © 2014 John Wiley & Sons, Ltd.
Key Practitioner Message
It was possible to quantify the positive impact of a self‐practice/self‐reflection (SP/SR) training and development programme within a cohort of experienced cognitive‐behavioural (CBT) therapists.
Through SP/SR, experienced CBT therapists can further enhance their self‐perceived therapeutic skills in two key domains; technical cognitive therapy skills and interpersonal empathic skill.
Further SP/SR studies should aim to incorporate objective measurement of therapeutic skill, ideally from more than one rating source.
Although the study of psychotherapies has been favored over the study of psychotherapists, research investigating psychotherapists’ characteristics is nearly as old as psychotherapy research. Still, the literature is rather scarce when it comes to investigating psychotherapists’ attributes that may be
predict patients’ outcome in therapy. The paucity of research in this area is even more marked as far as the supervisor-trainee relation is concerned. The main objective of our study was to investigate supervisor characteristics (i.e. experience, unconditional self-acceptance, self-efficacy, allegiance) hypothesized to predict trainee outcome. A total of 33 trainees and 4 supervisors in Cognitive Behavior Therapy (CBT) entered the study. Results showed that experienced supervisors have better outcomes in conducting trainee personal development groups; also, the more allegiant they are, the better the results of their trainees. Unconditional self-acceptance and self-efficacy also seem to play an important role: the more supervisors accept themselves unconditionally and the more they believe in their ability to be efficient therapists, the better their trainees’ outcomes. Implications for psychotherapy research, practice and training are discussed.
In this article, the authors describe how they used a hybrid process of inductive and deductive thematic analysis to interpret raw data in a doctoral study on the role of performance feedback in the self-assessment of nursing practice. The methodological approach integrated data-driven codes with theory-driven ones based on the tenets of social phenomenology. The authors present a detailed exemplar of the staged process of data coding and identification of themes. This process demonstrates how analysis of the raw data from interview transcripts and organizational documents progressed toward the identification of overarching themes that captured the phenomenon of performance feedback as described by participants in the study.
Research over the past decade has shown that practising CBT methods on oneself and reflecting on the experience can help therapists enhance their therapeutic skills and also develop personally. Self-Practice/Self-Reflection (SP/SR) is a focused training strategy that gives therapists a structured experience of using CBT on themselves (SP) and reflecting on that experience (SR). It is ideally suited to enhancing the skills of therapists who have learned the basic techniques of CBT, and now wish to move towards developing therapeutic artistry by learning CBT ‘from the inside.’
This chapter (1) provides a basic description of SP/SR; (2) discusses the evidence-base supporting different methods of delivering SP/SR; (3) provides illustrative examples of tasks from SP/SR programs; and (4) discusses the important issue of ensuring safety and maximising benefit from the approach.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
Background:
Previous studies of self-practice/self-reflection (SP/SR) CBT training have found that trainees report significant benefits from practising CBT techniques on themselves (self-practice) and reflecting on their experience (self-reflection) as a formal part of their CBT training. However, not all trainees experience the same level of benefit from SP/SR and not all types of training course produce benefits to the same extent.
Aims:
This paper examines the question: What factors influence trainees' reported benefit from SP/SR? The aim was to develop a model to maximize the value of SP/SR training.
Method:
The authors used a grounded theory analysis of four SP/SR training courses, varying along several dimensions, to derive a model that could account for the data.
Results:
A model was derived comprising of seven elements: Two outcomes - "Experience of Benefit" and "Engagement with the Process" - that mutually influence one another; and five other influencing factors - "Course Structure and Requirements", "Expectation of Benefit", "Feeling of Safety with the Process", "Group Process", and "Available Personal Resources" - that mediate the impact on Engagement with the Process and Experience of Benefit from SP/SR.
Conclusions:
A model that provides guidance about the best ways to set up and develop SP/SR programs has been developed. This model may now be subject to empirical testing by trainers and researchers. Implications and recommendations for the design and development of future SP/SR programs are discussed.
Recent publications have suggested that practising cognitive therapy (CT) techniques on oneself may be
valuable in the development of cognitive therapists' clinical skills. The present study asks: Is this useful? If so, in
what ways? We report a qualitative study of the experience of trainees undertaking a CT training course, which
included an explicit self-practice (SP) and self-reflection (SR) component. Key features of the learning process were:
(i) experiencing cognitive techniques from the client's perspective, and (ii) reflecting on this experience that led to
(iii) a “deeper sense of knowing” of CT practices. The primary learning outcome was an enhancement of therapeutic
understandings, which trainees reported to be both professionally and personally useful. Professionally, they reported
deeper understanding of the therapist's role, the cognitive model and change processes. Personally, SP/SR led to
greater understanding of themselves, and to the perception of CT as a useful tool for personal change. The data also
suggested two other positive learning outcomes: an enhancement of therapist skills and therapist self-concept. We
conclude that SP/SR may be a valuable component in CT training. Guidelines and recommendations for inclusion of
SP/SR in training courses are discussed.
Experiential training and personal therapy have rich traditions in various therapies as strategies to enhance self-awareness and therapist skills. However, personal experiential work has not traditionally been part of cognitive therapy (CT) training. The purpose of the present study is to map the impact of personal experiential work on CT skills in a group of CT practitioners. Fourteen cognitive therapists undertook training courses utilizing a structured approach to self-practice of CT techniques, known as self-practice/self-reflection (SP/SR). Six therapists from one training group engaged in “co-therapy” sessions with a partner, while eight therapists from another training group practised CT techniques on their own. Both groups engaged in regular written reflections about their experience. Follow-up 1-5 months after the courses identified six areas of self-reported skill enhancement: Refinement of specific CT skills; Enriched communication of the conceptual framework of CT; Increased attention to the therapeutic relationship; Empathic attunement; Therapist self-reflection; and Therapeutic flexibility. The results suggested that SP/SR enhances the “professional artistry” of therapists, a finding consistent with literature suggesting that reflection is a key process in the development of therapist expertise. It is concluded that SP/SR represents a promising training strategy for cognitive therapists.
The study tested the hypothesis, derived from Teasdale and Barnard's (1993) Interacting Cognitive Subsystems (ICS) model, that two commonly used techniques in cog-nitive therapy, automatic thought records (ATRs) and behavioural experiments (BEs), would have their primary impact on different cognitive subsystems. Teasdale (1997a, b) has sug-gested that while ATRs tend to impact on a logic-based propositional information processing system, BEs impact on a more holistic implicational system, which has extensive links with emotion. Quantitative and qualitative data derived from three groups of participants undertaking cognitive therapy training courses, who practised ATRs and BEs on themselves, supported Teasdale's theory. Differences were found in participants' ratings of behaviour and belief change, with BEs being perceived as more powerful and compelling than ATRs, as predicted by the theory. There were also qualitative differences in participants' experi-ences of the two techniques, suggestive of different modes of processing. The data indicated the particular importance of the therapist's role in BEs. In order to provide a more compre-hensive account of ATRs and BEs, it was suggested that Teasdale's theory could profitably be extended to include the role of the therapist in promoting adaptive oscillation between the implicational and propositional modes.
CBT case conceptualization is considered to be a key competency. Prior to the publication in 2009 of Kuyken, Padesky and Dudley's book, little has been documented concerning methods for training conceptualization skills and the conceptualization process is usually perceived as predominantly an intellectual process. In this paper, the Declarative-Procedural-Reflective model of therapist skill acquisition provides a route to understanding how different kinds of knowledge systems can be integrated to enhance therapist skill acquisition.
Sixteen recent graduates of a postgraduate diploma in cognitive behaviour therapy worked independently through a self-practice/self-reflection workbook designed to lead them through a series of CBT interventions commonly used to elicit the information required for a CBT conceptualization.
The participants' self-reflections were thematically analyzed and uncovered the following inter-related themes: increased theoretical understanding of the CBT model, self-awareness, empathy, conceptualization of the therapeutic relationship, and adaptation of clinical interventions and practice.
A tentative conclusion reached, based on the self-reflections of the participants, was that targeted self-practice/self-reflection enhanced case conceptualization skill by consolidating the Declarative, Procedural and Reflective systems important in therapist skill acquisition.
The key proposition of this invited essay is that personal practice (PP), coupled with self-reflection, is central to the development of the most effective therapists. To date, the discussion about personal practice in therapist training and professional development has largely revolved around the value of personal therapy, subscribed to by some schools of psychotherapy but not by others. However, since the turn of the century a new landscape of personal practices for therapists has emerged. In particular, two forms of personal practice, meditation programs and self-practice/self-reflection (SP/SR) programs, have developed a growing evidence base. Here it is proposed that there is now a strong theoretical and empirical case to accord personal practice an explicit role in therapist training and professional development. The case rests on recent research suggesting that: (1) personal and interpersonal qualities of therapists play a key role in client outcomes; and (2) personal practice is the most effective way to achieve changes in therapists’ personal and interpersonal qualities. It is suggested that the research agenda needs to move beyond asking whether or not personal practice is effective towards a more sophisticated set of questions: what personal practice, facilitated by whom, is most effective with which practitioners, in what contexts, at what point in time? To make further progress, trainers and researchers need to be supported to include personal practices in therapist training and to undertake research to evaluate their impacts.
Posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) are commonly co-occurring disorders associated with more adverse consequences than PTSD alone. Prolonged exposure therapy (PE) is one of the most efficacious treatments for PTSD. However, among individuals with PTSD-SUD, 35–62% of individuals drop out of trauma-focused exposure treatments. Thus, it is important to identify predictors of PTSD treatment dropout among substance abusers with PTSD in order to gain information about adapting treatment strategies to enhance retention and outcomes. The current study explored pre-treatment predictors of early termination from PE treatment in a sample of 85 individuals receiving concurrent treatment for PTSD and a SUD in a residential treatment facility as part of a randomized controlled trial. The results indicated that less education and more anxiety sensitivity uniquely predicted PE treatment dropout. Demographic variables, PTSD severity, SUD severity, mental health comorbidities, and emotion regulation difficulties did not predict treatment dropout. These results suggest that adding pre-treatment interventions that address anxiety sensitivity, and promote social adjustment and cognitive flexibility, could possibly improve PE retention rates in clients with high anxiety or low education.
La profesion –formacion- docente es un tema crucial en los actuales debates educativos. La existencia de dos decretos y el desplazamiento del verdadero sentido del ser maestro reclaman de los analisis un ejercicio de comprension del orden discursivo oficial. La calidad es el sustrato de la sociedad de control. En este marco se agencia nuevas practicas de subjetivacion del maestro los cuales podriamos situar en la calidad, flexibilidad, adaptabilidad, eficiencia, eficacia. En cualquier caso, el esfuerzo por hacer del maestro un intelectual de la educacion fue borrado. La gran cuestion consiste en saber que discursos regula el saber del docente a la luz de la sociedad de control.
Levels of anxiety can not be maintained indefinitely, repeated exposure leads to decreased anxiety. This type of treatment is effective with phobias, post traumatic stress disorder, obsessive compulsive disorders, panic, generalized anxiety, and several other disorders. It's also been found to be effective in helping to treat substance abuse. Although exposure-based treatments have been extensively researched and reported in the literature, there is no single comprehensive treatment of exposure therapies. Writings tend to be limited to larger pieces on treating specific disorders or types of patients. A comprehensive book on the use of these treatments across patient disorders will be of great use to practitioners. The book is divided into three sections: Foundation, Applications, and Issues. Foundation chapters considers theoretical and assessment issues. Applications chapters will discuss research literature on each disorder having been proven to be successfully treated with exposure therapy. Issue chapters will discuss liability issues, false memory syndrome, and the use of computers and virtual reality in exposure therapy. *Covers the broad range of exposure therapies in one comprehensive source *Provides an integrated look at exposure therapy across anxiety disorders *Each such chapter will include a case study *Blends literature review and practice guidelines.
The use of self-practice and self-reflection has been proposed as an efficacious strategy in the training of therapists. It has been argued to enhance therapist skills, and a key factor in the development of expertise. This systematic literature review investigated the effect of self-practice and self-reflection on therapist skills development. Studies were identified through Medline, Academic Search Complete, PsychINFO, PsycARTICLES, Proquest, ISI, CINAHL, Cochrane, and Scopus databases. Additional studies were identified through lateral searches of relevant papers' reference lists and direct correspondence with authors of unpublished material. The selection criteria were studies that investigated the effect of self-practice and/or self-reflection on therapist skill development. There was no restriction on sample sizes, design of studies, dates of publication, or peer-reviewed papers. All studies were published in English. Ten studies were included in this review. A thematic analysis was undertaken to analyse qualitative data. Due to inconsistency in the variables investigated across the quantitative studies, quantitative results were not subject to a meta-analysis but simply reported. Finally, qualitative and quantitative data were juxtaposed in a meta-synthesis. The meta-synthesis revealed inconsistencies between the qualitative and quantitative literature and a gap in relation to declarative knowledge. Methodological limitations across studies are discussed and recommendations for future research provided.
The aim of the current study was to identify outcomes of a self-practice/self-reflection (SP/SR) exercise for trainee clinical psychologists.
Thirty-two trainees enrolled in their first year of a UK university doctoral clinical psychology training programme completed an online questionnaire following an eight-week exercise.
Findings indicated an endorsement of many previously reported benefits of exercise participation, but also the identification of negative outcomes. Thematic analysis of qualitative data revealed that outcomes could be grouped into two main thematic domains (individual task outcomes and task organization issues) along with several subordinate themes.
SP/SR is a useful tool in the development of trainee CBT therapist competences. There has been limited previous recognition of potential negative outcomes from this type of exercise. However, these can provide additional impetus for therapist skill development.
Despite the overwhelming evidence that the behavioral components of cognitive-behavior therapies (CBTs) are critical for patient improvement, particularly in the case of anxiety disorders, there remains a wide gap between science and practice in their consistent use. In particular, exposure therapy for anxiety is under-used, even among self-proclaimed cognitive-behavior therapists. Some have speculated that this under-use is related to therapist discomfort with and avoidance of the temporary increase in distress that patients often experience during exposure therapy, and the secondary distress that this may cause in therapists themselves. Recent studies have begun to examine therapist characteristics that are associated with the use of evidence-based psychotherapies, but this research has focused on evidence-based practice as a whole rather than on specific interventions such as exposure, and have not addressed therapist psychological variables. We examined the role of therapists׳ experiential avoidance in the hypothetical use of exposure-based interventions to treat fictional patients for whom exposure therapy is clearly indicated. A total of 172 therapists watched simulated therapy intake sessions and were asked to designate the percentage of time they would allot toward various therapeutic modalities, including exposure. Results suggested that participants exhibiting higher experiential avoidance tended to allot less time to exposure therapy for the fictional patient. Additional therapist personality factors, such as intuitive personality style and attitudes toward evidence-based treatments, were associated with self-reported use of exposure therapy as well.
Background
Self-practice/self-reflection is a valuable training strategy which involves therapists applying therapeutic techniques to themselves, and reflecting on the process. PurposeTo undertake a meta-synthesis of qualitative studies exploring therapists' experiences of self-practice/self-reflection in cognitive behavioural therapy (CBT). This would integrate, and interpret, the current literature in order to develop a new understanding, and contribute to the development of CBT training programmes. Methods
The meta-synthesis encompassed three distinct phases: undertaking a comprehensive and systematic literature search; critically appraising the papers; and synthesising the data using the meta-ethnographic method. ResultsThe literature search identified 378 papers, ten met the criteria for inclusion. After critical appraisal, all were included in the synthesis. The synthesis identified 14 constructs, which fell into three broad categories: experience of self-practice/self-reflection'; outcomes of self-practice/self-reflection'; and implications for training'. This synthesis found that self-practice allows therapists to put themselves into their clients' shoes, experiencing the benefits that therapy can bring but also the problems that clients can run in to. This experience increases therapists' empathy for their clients, allowing them to draw on their own experiences in therapy. As a result, therapists tend to feel both more confident in themselves and more competent as a therapist. The self-practice/self-reflection process was facilitated by reflective writing and working with others, particularly peers. Conclusions
Self-practice/self-reflection is a valuable training strategy in CBT, which has a range of beneficial outcomes. It can also be used as a means of continuing personal and professional development. Practitioner points Self-practice of CBT techniques, and reflecting on the process, can be a useful training strategy and helpful for ongoing development Therapists could consider developing a self-case' study, rather than using the exercises as one-off techniques, recording reflections in writing, and sharing reflections with peers. Self-practice/self-reflection can be particularly helpful for increasing empathy for clients, highlighting the difficulties they may encounter. 10.1111/(ISSN)2044-8341</doi
Current Theories on the Psychological Organization of Fear and AnxietyConclusions
References
Previous exposure therapy research has suggested potential differences in emotional processing at different points in treatment (Hayes, Hope, & Heimberg, 2008). For example, indicators of emotional processing may be more related to outcome during the later exposure sessions than during the initial session. This is consistent with a growing body of psychotherapy research highlighting the importance of timing and change processes across therapy. The current study examined whether the learning-but-not-benefiting hypothesis is observed in a group based intervention for clients with a range of anxiety disorders. It was hypothesized that activation and within session habituation during later, but not the initial exposure session, would be related to outcome, whereas activation and within session habituation during the first session would be related to dropout status. Results revealed that lower activation and less habituation during the first exposure was associated with increased treatment discontinuation. Second, lower peak and, to a lesser extent greater activation and habituation, during exposures were generally associated with better treatment outcomes. These findings highlight the importance of examining the complexities and timing of the exposure process.
Social anxiety disorder (SAD) is a common, distressing and persistent mental illness. Recent studies have identified a number of psychological factors that could explain the maintenance of the disorder. These factors are presented here as part of a comprehensive psychological maintenance model of SAD. This model assumes that social apprehension is associated with unrealistic social standards and a deficiency in selecting attainable social goals. When confronted with challenging social situations, individuals with SAD shift their attention toward their anxiety, view themselves negatively as a social object, overestimate the negative consequences of a social encounter, believe that they have little control over their emotional response, and view their social skills as inadequate to effectively cope with the social situation. In order to avoid social mishaps, individuals with SAD revert to maladaptive coping strategies, including avoidance and safety behaviors, followed by post-event rumination, which leads to further social apprehension in the future. Possible disorder-specific intervention strategies are discussed.
Developing cognitive therapist competency: teaching and supervision models. Frontiers of Cognitive Therapy
- C A Padesky
Padesky, C. A. (1996). Developing cognitive therapist competency: teaching and supervision models. Frontiers of Cognitive
Therapy. New York, USA: Guilford Press.