Clinical Psychology Trainees Research Articles

Humanizing Pedophilia as Stigma Reduction: A Large-Scale Intervention Study

The stigmatization of people with pedophilic sexual interests is a topic of growing academic and professional consideration, owing to its potential role in moderating pedophiles’ emotional well-being, and motivation and engagement in child abuse prevention schemes. Thus, improving attitudes and reducing stigmatization toward this group is of paramount importance. Prior research has suggested that narrative humanization—presenting personal stories of self-identified non-offending pedophiles—could be one route to doing this. However, this work has only been conducted with students or trainee psychotherapists, meaning the public generalizability of this method is still unknown. In this study, we compared two stigma interventions to test whether narratives reduce stigma toward people with pedophilic interests more effectively than an informative alternative (scientific information about pedophilia). Using a longitudinal experimental design with a lack of non-intervention control (initial N = 950; final N = 539), we found that narratives had consistently positive effects on all measured aspects of stigmatization (dangerousness, intentionality), whereas an informative alternative had mixed results, and actually increased perceptions of pedophiles’ levels of deviance. These effects were still present four months after the initial presentation. We discuss these data in relation to ongoing debates about treating pedophilia as a public health issue requiring a broad societal approach to well-being and child abuse prevention.

Delix to synthesize psychedelic drugs

Delix Therapeutics has raised $70 million in series A financing to develop therapies inspired by psychedelics to treat neuropsychiatric and neurodegenerative diseases. The Boston-based start-up joins a list of more than a dozen drug companies developing psychedelic-based therapies for mental illnesses . CEO Mark Rus says Delix is part of a “psychedelic renaissance,” in which doctors, scientists, and biotech investors are hoping to repurpose recreational drugs into mainstream medicine. The magic mushroom–derived compound psilocybin, for instance, is emerging as a promising experimental therapy for major depressive disorder. But many clinical trials of psychedelics require trained psychotherapists to help guide patients through their drug-induced hallucinations. “We need new approaches,” Rus says. Delix aims to create psychedelic-inspired compounds that heal without hallucinations. The idea comes from David E. Olson, a neuroscientist and medicinal chemist at the University of California, Davis. In 2018, his lab published a study in animals showing that multiple

'I think it does just opens it up and … you're not hiding it anymore': Trainee clinical psychologists' experiences of self-disclosing mental health difficulties.

Self-disclosure of experiences of mental health difficulties is a complex process, particularly within the workplace. Research shows that a significant number of trainee clinical psychologists have lived experience of mental health difficulties and thus face the dilemma of whether to disclose and how to manage self-disclosure during doctoral training. Grounded theory methodology was used to explore trainee experiences of self-disclosure of mental health difficulties during training. Twelve trainee clinical psychologists from accredited doctoral programmes in the United Kingdom participated in semi-structured interviews about their experiences of disclosure. Six core categories emerged relating to 'motivations', 'enablers', 'barriers', 'features of disclosure', 'responses' and 'impact', each of which were comprised of several further sub-categories. The model that emerged is largely consistent with research on disclosure in healthcare professions and has implications for training programmes, supervisors and trainees when engaging in conversations about lived experience.

A changing climate for trainee research

A reflective account from a trainee clinical psychologist about the experience of undertaking research on clinical psychologists’ responses to the climate and ecological crises.

Motivation to lead in trainee clinical psychologists: service evaluation of a UK doctorate programme

PurposeThis paper aims to explore whether a United Kingdom (UK) clinical psychology training programme (the programme) was effective in producing graduates who are confident in leadership, within the context of the National Health Service and reflecting the British Psychological Society’s views of leadership.Design/methodology/approachMixed methods design surveys were administered to prospective-, current- and alumni trainee clinical psychologists on the programme, enquiring about their view of leadership, motivation to lead (MtL) and aspects of the course that are helpful and which need further development. Data collected from 92 individuals were analysed using content and thematic analysis (TA).FindingsFrom the TA, three themes were identified concerning the meaning of leadership as follows: professional identity, Improving the quality of services (team; organisations and wider context), professional skills. Overall, participants thought leadership was important to the role of a clinical psychologist, with prospective trainees reporting that the desire to develop as leaders influenced their decision to apply to the programme. Moreover, participants felt confident in leadership skills and that the training programme helped develop their leadership skills, with the alumni participants demonstrating a greater MtL. Placements, group study and specific modules were identified as contributing to the development of their leadership skills, but participants felt more teaching on leadership is needed. Recommendations have been suggested to improve the development of leadership skills on the programme.Research limitations/implicationsThe research was undertaken on a small cohort of trainees based in the UK.Practical implicationsParticipants were motivated to become clinical leaders but this motivation needed to be nurtured and developed particularly through structured placement and teaching experience.Originality/valueThis service evaluation is the only audit of the leadership of the programme and the findings will contribute to the existing body of reviews in this area.

Factors Affecting the Delivery and Acceptability of the ROWTATE Telehealth Vocational Rehabilitation Intervention for Traumatic Injury Survivors: A Mixed-Methods Study.

Background: Returning to work after traumatic injury can be problematic. We developed a vocational telerehabilitation (VR) intervention for trauma survivors, delivered by trained occupational therapists (OTs) and clinical psychologists (CPs), and explored factors affecting delivery and acceptability in a feasibility study. Methods: Surveys pre- (5 OTs, 2 CPs) and post-training (3 OTs, 1 CP); interviews pre- (5 OTs, 2 CPs) and post-intervention (4 trauma survivors, 4 OTs, 2 CPs). Mean survey scores for 14 theoretical domains identified telerehabilitation barriers (score ≤ 3.5) and facilitators (score ≥ 5). Interviews were transcribed and thematically analysed. Results: Surveys: pre-training, the only barrier was therapists’ intentions to use telerehabilitation (mean = 3.40 ± 0.23), post-training, 13/14 domains were facilitators. Interviews: barriers/facilitators included environmental context/resources (e.g., technology, patient engagement, privacy/disruptions, travel and access); beliefs about capabilities (e.g., building rapport, complex assessments, knowledge/confidence, third-party feedback and communication style); optimism (e.g., impossible assessments, novel working methods, perceived importance and patient/therapist reluctance) and social/professional role/identity (e.g., therapeutic methods). Training and experience of intervention delivery addressed some barriers and increased facilitators. The intervention was acceptable to trauma survivors and therapists. Conclusion: Despite training and experience in intervention delivery, some barriers remained. Providing some face-to-face delivery where necessary may address certain barriers, but strategies are required to address other barriers.

The Role of Personality in Early Alliance Formation in the Context of Clinical Supervision of Psychotherapists in Training

The literature suggests that working alliance is an important predictor of clinical supervision outcomes. However, little is known about the individual factors that influence the development and maintenance of the working alliance. This study aims to explore the role of supervisor and trainee personality traits in the development of early working alliances, as well as supervisor and trainee concordance rates in the context of clinical supervision. This study used the NEO-PI-3 measure to assess personality traits and the Working Alliance Inventory-Supervisor and Trainee Versions (WAI) measures to assess working alliance ratings. Results suggest that supervisors rate the strength of their alliances as significantly stronger than trainees (p < .05). While no trainee personality traits were found to predict their perception of the early alliance, the openness domain was found to be significantly associated to supervisor’s self-reported ratings of alliance. Implications of these findings are discussed.

End-of-placement failure rates among clinical psychology trainees:exceptional training and outstanding trainees or poor gate-keeping?

ABSTRACT Objectives: The objective of this multisite study was to examine failure rates across placements during clinical psychology training. Method: Placement supervisors from nine clinical psychology programmes used the Clinical Psychology Practicum Competencies Rating Scale (CΨPRS) to rate trainees’ competencies at the end of one of four placements (P1, P2, P3, P4). Results: Out of a total of 1449 placements, seventeen (1.17%) placements were failed, with fail-rates reducing as trainees progressed from P1 (2.45%) to P2 (0.77%), P3 (0.33%) and P4 (0.37%). CΨPRS norms used to identify competence as Much Below Standards generated similar fail-rates: 1.04% for all placements; 0.61% for P1; 1.28% for P2; 1.33% for P3; and 1.12% for P4. A larger subgroup (6.97% for all placements; 9.41% for P1; 4.34% for P2; 5.65% for P3 and 7.87% for P4) were also categorised as falling Somewhat Below Standards. The majority (88%) of these “Below Standards” placements received a pass grade from their supervisor. Conclusions: Supervisors tend to pass trainees who fail to meet competence thresholds on the CΨPRS. Placement supervisor assessments are essential but insufficient to ensure trainee competence, and supplemental assessments such as objective structured clinical examinations or competency assessment portfolios are important to complement supervisor assessments. KEY POINTS (1) The study reports end of placement failure rates for clinical psychology trainees across nine training institutions. (2) A number of trainees who received scores below competency thresholds were passed by their placement supervisors. (3) The study raises serious concerns about the sole reliance on placement supervisors’ assessments, and recommends additional independent assessments such as the use of standardised objective structured clinical examinations (OSCE) to ensure safe and competent practice among clinical psychology trainees.

Association study of six candidate genes with major depressive disorder in the North-Western population of Pakistan.

People around the world are currently affected by Major Depressive Disorder (MDD). Despite its many aspects, symptoms, manifestations and impacts, efforts have been made to identify the root causes of the disorder. In particular, genetic studies have concentrated on identifying candidate genes for MDD and exploring associations between these genes and some specific group of individuals. The aim of this research was to find out the association between single nucleotide polymorphisms in 6 candidate genes linked to the neurobiology of major depressive disorder in the North-Western population of Pakistan. We performed a case-control analysis, with 400 MDD and 232 controls. A trained psychiatrist or clinical psychologists evaluated the patients. Six polymorphisms were genotyped and tested for allele and genotype association with MDD. There were no statistical variations between MDD patients and healthy controls for genotypic and allelic distribution of all the polymorphisms observed. Thus, our analysis does not support the major role of these polymorphisms in contributing to MDD susceptibility, although it does not preclude minor impact. The statistically significant correlation between six polymorphisms and major depressive disorder in the studied population was not observed. There are inconsistencies in investigations around the world. Future research, including GWAS and association analysis on larger scale should be addressed for further validation and replication of the present findings.

Wake up psychology! Postgraduate psychology students need more sleep and insomnia education

ABSTRACT Objective Poor sleep can significantly impact mental health. Despite this, sleep education is absent from the curriculum of many psychology training programs. The current study examined the amount of sleep education delivered within postgraduate psychology programs in Australia. It also developed a new survey tool to capture postgraduate psychology students’ experience of sleep education. Method Two cross-sectional sleep education surveys were emailed to postgraduate psychology programs across Australia via the Heads of Department and Schools of Psychology Association. The first survey explored sleep education from postgraduate psychology program coordinators’ perspectives (n = 35; survey response rate = 73%), while the second custom-designed survey examined postgraduate psychology students’ perspectives (n = 152). Results Program coordinators reported a median of 2.00 hours (range 0-9) of didactic sleep education delivered within postgraduate psychology programs. Postgraduate students, however, reported receiving a median of only 1.00 hour (range 0-40) of sleep education, with 47% of students reporting no sleep education. Most students acknowledged already working with clients experiencing sleep disturbances (68%), yet they disclosed low confidence and self-efficacy to manage sleep disturbances in psychology practice. Despite delivering minimal sleep education, thematic analysis indicated that program coordinators viewed sleep education as an important topic for trainee psychologists. Program coordinators preferred sleep education to supplement the postgraduate curriculum, preferably online (63%), whereas students chose clinical supervision (61%). Conclusions Postgraduate psychology training programs deliver minimal sleep education to trainee psychologists in Australia. Enhanced integration of sleep education within the postgraduate psychology curriculum is required to improve mental health outcomes. Key Points What is already known about this topic: (1) Sleep disturbances commonly co-occur with mental health conditions, often with a bidirectional relationship. (2) Trainee clinical psychologists in the US receive limited sleep education, which may impact their ability to manage the sleep disturbances in clinical practice. (3) There are currently no Australian Psychology Accreditation Council training requirements in sleep and sleep disorders for postgraduate psychology programs, despite the bidirectional relationship between sleep and mental health. What this topic adds: (1) This is the first study to examine sleep education within postgraduate psychology programs in Australia. (2) We show that (1) a median of only two hours of didactic sleep education is delivered within postgraduate psychology programs, (2) almost half (47%) of postgraduate students received no sleep education during their training, (3) sleep issues were a common presenting complaint forpostgraduate students to address on placement, and (4) overall, graduate students reported low levels of confidence and self-efficacy to manage sleep disturbances in clinical practice. (3) Postgraduate psychology students in Australia need more sleep and insomnia education disturbances that commonly co-occur with mental health conditions.

Trainee life under COVID-19: A systemic case report.

The coronavirus disease 2019 (COVID‐19) pandemic has had implications for all of us. For those of us studying on clinical psychology doctorates, and similar psychotherapeutic training courses, this pandemic has led to some particular challenges. This article explores the experiences of a group of clinical psychology trainees, who are also completing intermediate systemic qualification, during the COVID‐19 pandemic using a systemic case study approach. We consider the challenges we faced in relation to systemic theory and the intervention we would have used if we were clients in a family therapy clinic. This enabled us to reflect on the importance of self‐reflexivity and self‐care during these challenging times.Practitioner points Using systemic thinking and ideas can help organisations make sense of how the system has had to adapt to working during a pandemic and can bring to light some of the challenges.During the pandemic and at other times of crisis, opportunities for students and staff to reflect together are likely to be beneficial.When working independently, as necessitated by the pandemic, finding ways to remain connected to our colleagues will be especially important.Providing opportunities for individuals to give feedback regarding their experiences and to influence organisational change will help individuals gain a sense of agency during a time when they are likely otherwise to feel disempowered.

Adapting to online group clinical supervision in a CAMHS during Covid-19: Reflecting on experiences and lessons learnt

Clinical supervision is a professional activity, facilitated through a collaborative process between supervisor and supervisee. Our supervision group, of one supervising clinical psychologist, a co-supervising trainee clinical psychologist, and five assistant psychologists, kept reflective journals on weekly online supervision sessions during the first Covid-19 lockdown. Group members’ reflections were combined, and several themes identified through an iterative process: Significance and Purpose of Supervision, Managing Online Distractions, Negotiating Communication, The Impact on Connection and Advantages of Technology. We aimed to capture the transition to online supervision and discuss themes and learning points from the reflections, which can be applied when adapting to online supervision.

Remarks on Using One-Way Mirror Supervision Method to Train Psychoanalytic Psychotherapists

The one-way mirror method of supervision is an excellent method to train psychotherapists. Its positive influences on training candidates and patients are well-documented in previous studies. Based on his personal experiences as an observer of psychoanalytic psychotherapy sessions from behind a mirror, the author recognized particular materials, dynamics and defenses both in the patients and the trainees, brought out by the one-way mirror setting. The advantages of this supervision method and the materials, defenses and dynamics that this setting instigated in patients and therapists are explored separately. The importance of the supervisory relationship in dealing with such issues is elaborated.

In with the outputs and out with the inputs: A need for better tracking and research on professional psychology practicum hours

ABSTRACT Objective Accreditation guidelines for professional psychology training have shifted from specifying educational inputs to emphasising attainment of core competency outputs. However, attention to both inputs and outputs are needed. Clinical practicum logs represent a neglected source of information to help guide training program development. The present article describes the development and preliminary data from a purpose‐built electronic web‐based log application for recording practicum activities. Method Participants were 76 university clinical psychology trainees who had completed at least 1,000-hr of practicum. Trainees recorded the time engaged in various practicum activities into the electronic log application. Results Trainees recorded practicum hours across 74 different placements. Most (43%) of the 72,494 entries were for activities supporting direct client work such as preparation and case notes. Direct client contact (37%) and supervision (20%) were next most frequent. On average, each trainee saw 78 clients for individual work and the average number of contacts was 3.69. The most frequent primary problems treated were anxiety disorders (28%) and depressive disorders (16%). Treatment of substance use disorders was rare (2%) as was work with older adults (2.6%), despite high needs in communities. Conclusions This descriptive study provides an example of an electronic log application and preliminary data from the application. The need to link such data to competency assessments is highlighted, as this will provide stronger evidence‐based decision making regarding minimum training standards. Further, by allowing real‐time monitoring of student progress, such applications can inform decisions about individual trainee's practicum progress and needs.

Do Athletes Have More of a Cognitive Profile with ADHD Criteria than Non-Athletes?

The current study investigates the possibility that athletes have more parallel ADHD symptoms than non-athletes. High-level youth sport athletes were compared with non-athletes in leisure time (i.e., sport) and in the school in ADHD symptoms. Athletes and students were evaluated by a trained psychotherapist using Adult ADHD Self-Report Scale (ASRS) on activities at school and during activities in leisure/sports time. They also filled in the Autism Spectrum Questionnaire (AQ) as a self-report assessment. Results showed significant differences in ASRS-scores for athletes in school and in their sport, with high scores in school and low scores in sport. No differences were found in AQ between the groups. The findings indicate that many athletes might display a cognitive profile of parallel of ADHD criteria. Future research needs to further investigate potential benefits of the cognitive profile in athletes and how they handle different contexts including sport and school settings.

A Live Video Program to Prevent Chronic Pain and Disability in At-Risk Adults With Acute Orthopedic Injuries (Toolkit for Optimal Recovery): Protocol for a Multisite Feasibility Study.

BackgroundDespite the pivotal role of psychosocial factors in pain and disability after orthopedic injury, there are no evidence-based preventive interventions targeting psychosocial factors in patients with acute orthopedic injuries. We developed the first mind-body intervention focused on optimizing recovery and improving pain and disability in patients with acute orthopedic injuries who exhibit high levels of catastrophic thinking about pain and/or pain anxiety (Toolkit for Optimal Recovery [TOR] after orthopedic injury). In a pilot single-site randomized controlled trial (RCT), the TOR met a priori set benchmarks for feasibility, acceptability, and satisfaction. The next step in developing TOR is to conduct a multisite feasibility RCT to set the stage for a scientifically rigorous hybrid efficacy-effectiveness trial.ObjectiveThe objective of this study is to conduct a rigorous multisite feasibility RCT of TOR to determine whether the intervention and study methodology meet a priori set benchmarks necessary for the successful implementation of a future multisite hybrid efficacy-effectiveness trial. In this paper, we describe the study design, manualized treatments, and specific strategies used to conduct this multisite feasibility RCT investigation.MethodsThis study will be conducted at 3 geographically diverse level 1 trauma centers, anonymized as sites A, B, and C. We will conduct a multisite feasibility RCT of TOR versus the minimally enhanced usual care (MEUC) control (60 patients per site; 30 per arm) targeting a priori set feasibility benchmarks. Adult patients with acute orthopedic injuries who endorse high pain catastrophizing or pain anxiety will be recruited approximately 1-2 months after injury or surgery (baseline). Participants randomized to the TOR will receive a 4-session mind-body treatment delivered via a secure live video by trained clinical psychologists. Participants randomized to the MEUC will receive an educational booklet. Primary outcomes include feasibility of recruitment, appropriateness, feasibility of data collection, acceptability of TOR (adherence to sessions), and treatment satisfaction across all sites. We will also collect data on secondary implementation outcomes, as well as pain severity, physical and emotional function, coping skills, and adverse events. Outcomes will be assessed at baseline, posttreatment, and at the 3-month follow-up.ResultsEnrollment for the RCT is estimated to begin in June 2021. The target date of completion of the feasibility RCT is April 2024. The institutional review board approval has been obtained (January 2020).ConclusionsThis investigation examines the multisite feasibility of TOR administered via live videoconferencing in adult patients with acute orthopedic injuries. If feasible, the next step is a multisite, hybrid efficacy-effectiveness trial of TOR versus MEUC. Preventive psychosocial interventions can provide a new way to improve patient and provider satisfaction and decrease suffering and health care costs among patients with orthopedic injuries who are at risk for chronic pain and disability.International Registered Report Identifier (IRRID)PRR1-10.2196/28155

Zoomed Out: Trainee Psychotherapist Perspectives on Online Clinical Work During the COVID-19 Pandemic

During lockdown in response to COVID-19, students in the Master of Psychotherapy at Auckland University of Technology were required to rapidly move their clinical work online. We surveyed these students about their experience of working clinically online. We used a mixed-methods approach and analysed qualitative data using grounded theory methods. Students found the move online challenging in terms of the technological challenges, lack of professional clinical space, and establishing and maintaining the therapeutic alliance. Students showed a strong preference for in-person (or, face-to-face) clinical work, along with scepticism about the efficacy of online therapy, though some acknowledged its convenience and others its currency and relevance. Most expressed a need for more specific training in online therapy. The literature finds equivalence between the effectiveness of in-person and online therapy. However, it acknowledges that online therapy can impose increased strain on clinicians and finds that clinician expectations directly impact their capacity to manage online clinical work.

Normativity, Marginality, and Deviance in a Psychiatric Placement: A Parallel Process

This article explores links between normativity, marginality, and deviance via the experiences of the author, a trainee psychotherapist on a psychiatric placement in an American mental health emergency services unit. Drawing on her own experience as a woman of Sri Lankan heritage living in postcolonial Great Britain, she weaves together themes of identity, power, and marginalization, asking questions about the lived experience of those who are positioned as deviant by normative society. She uses the work of social and political theorists to illustrate how such themes are integrated at a wider group level. Two distinct forms of writing are used as a self-reflexive mechanism offering both personal revelation and critical analysis: the autoethnographical and the theoretical as a method of intersubjective textual speculation on that which lies in and outside of awareness. The author holds the view that there are gains to be made when we place psychotherapeutic concerns back into the world in which we live.

Division of Clinical Psychology Conference 2021; ‘Doing what matters: Value-driven clinical psychology in action’

Caragh Maher,Trainee Clinical Psychologist, shares her review of this year’s DCP conference, hosted virtually.

Opportunities and challenges of an older adult placement during Covid: Reflections from a supervisor and trainee clinical psychologist

Despite the importance of placements to clinical psychology training, the Covid-19 pandemic has made offering placements challenging. In this article, the experience of providing an older adult placement from trainee and supervisor perspectives are outlined, with opportunities and learning discussed.