Exploring CBT therapists’ experience of feeling of safety within self-practice/self-reflection: an interpretative phenomenological analysis

Murray Mackenzie,James O’Mahony

doi:10.1017/s1754470x21000283

Abstract

Abstract Self-practice/self-reflection (SP/SR) is an experiential training strategy implemented to develop the skills of CBT therapists through the self-application of CBT techniques and subsequent reflection on the experience in relation to clinical practice. Outcome studies report significant personal and professional benefits from SP/SR but engagement studies suggest that CBT therapists’ experience is mixed. In order to inform the design and implementation of SP/SR within CBT, this study aims to explore CBT therapists’ experience of feeling of safety (FOS) within SP/SR. FOS has been identified as an important engagement factor. Three CBT therapists were interviewed using semi-structured interviews. The data, which took the form of verbatim transcripts, were subjected to interpretative phenomenological analysis. Four superordinate themes relating to participants’ experience of FOS within SP/SR emerged: FOS and its absence as embodied and non-verbal, role of the instructor, awareness of others and venturing beyond safety. Ensuing recommendations for instructors include proactive use of interventions within SP/SR which directly impact embodied FOS, monitoring the wellbeing and engagement of participants through awareness of physical cues and employment of measures designed to promote a sense of equality among group members. Areas of future research include exploration of factors which influence FOS, investigation of the effect on FOS of pre-existing relationships within the SP/SR group and review of interventions which are currently used by SP/SR instructors to promote FOS. Key learning aims (1) To explore the lived experience of FOS within SP/SR as experienced by CBT therapists. (2) To identify factors which influence CBT therapists’ experience of FOS within SP/SR. (3) To identify practical recommendations for use in SP/SR instruction which will promote participants’ FOS.

Highlights

Self-practice/self-reflection (SP/SR) has been increasingly utilised as a psychotherapeutic training intervention within cognitive behavioural therapy (CBT) since its development at the start of this century (Freeston et al, 2019)
SP/SR outcome studies tend to rely on therapist self-ratings rather than client appraisals of efficacy (BennettLevy, 2019) but there is evidence from psychotherapy research that increased therapist skill and understanding does lead to improved client outcomes (Sandell et al, 2006)
Another potential advantage of SP/SR is that it may be a form of personal practice which is preferred by trainees themselves (Chigwedere et al, 2020)

Summary

Introduction

Self-practice/self-reflection (SP/SR) has been increasingly utilised as a psychotherapeutic training intervention within cognitive behavioural therapy (CBT) since its development at the start of this century (Freeston et al, 2019). SP/SR outcome studies tend to rely on therapist self-ratings rather than client appraisals of efficacy (BennettLevy, 2019) but there is evidence from psychotherapy research that increased therapist skill and understanding does lead to improved client outcomes (Sandell et al, 2006). Another potential advantage of SP/SR is that it may be a form of personal practice which is preferred by trainees themselves (Chigwedere et al, 2020). A model of SP/SR engagement proposed by Bennett-Levy and Lee (2014) based on the authors’ qualitative research posits five key influencing factors: course structure and requirements, expectation of benefit, feeling of safety, group process, and available personal resources

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