Novice Therapists Research Articles

The First Year of Practice: An Investigation of the Professional Learning and Development of Promising Novice Physical Therapists

The goal in studying expertise is not merely to describe ways in which experts excel but also to understand how experts develop in order to better facilitate the development of novices. The study of novice progression helps us to understand what successful versus unsuccessful learning looks like. This understanding is critical, as autonomous practice places increased demands for advanced clinical judgments and the ability to assume professional responsibilities. The purpose of this study was to explore the experiences, learning, and development of promising novice therapists throughout their first year of practice in the United States. A longitudinal, multiple-site qualitative case study method was used for within-case and across-case analysis. A purposive sample of 11 promising new graduates from 4 physical therapist education programs participated. Investigators followed the graduates throughout their first year of practice. Data sources included: (1) semistructured interviews conducted at baseline and every 3 months thereafter for 1 year, (2) reflective journals completed at regular intervals, and (3) review of academic and clinical education records and résumés. Four themes emerged: (1) the clinical environment influenced the novice physical therapists' performance, (2) participants learned through experience and social interaction and learning was primarily directed toward self, (3) growing confidence was directly related to developing communication skills, and (4) therapists were engaged in professional identity formation and role transitions. The findings suggest there are common experiences and themes that emerge as novice physical therapists develop. Although research has been conducted on expertise in physical therapy, few longitudinal investigations have explored the development of therapists across transitions from graduate to novice to expert practitioner. This study explored and described the learning and development of graduates during their first year of practice.

Poetry as self-supervision for mental health professionals: The use of poetry to process and understand clinical work

There is a growing body of literature suggesting that “self-supervision” is an option when other means of supervision are not present or are insufficient. Writing poetry in response to sessions can be a valuable form of self-supervision in and of itself as well as a supplement to conventional supervision or a positive self-care outlet for the seasoned professional or novice therapist. The development and awareness of metaphor and meaning as a path toward better empathy for a client as well as more skilled responsiveness are outcomes from a personal use of poetry responding to clinical work. Examples of responsive poetry and the methodology of such will be shared in the context of the current literature on expressive methods in conventional supervision and self-supervision.

Limited clinical reasoning skills used by novice physiotherapists when involved in the assessment and management of patients with shoulder problems: a qualitative study

The aim of this study was to explore the clinical reasoning process used by novice physical therapists in specific patient problems. Nine physical therapists in the UK with limited experience of managing musculoskeletal problems were included. Semi-structured interviews were conducted on how novice physical therapists would assess and manage a patient with a shoulder problem; interviews were transcribed and analyzed using framework analysis. To be included as a final theme at least 50% of participants had to mention that theme. A large number of items (n=93) were excluded as fewer than 50% of participants referred to each item. Included items related to seven main themes: history (16), physical exam (13), investigations (1), diagnostic reasoning (1), clinical reasoning process (diagnostic pathway) (3), clinical reasoning process (management pathway) (5) and treatment options (1). Items mostly related to information gathering, although there was some use of hypothetico-deductive clinical reasoning there appeared to be limited understanding of the clinical implications of data gathered, and clinical reasoning through use of pattern recognition was minimal. Major weaknesses were apparent in the clinical reasoning skills of these novice therapists compared to previous reports of expert clinical reasoning, indicating areas for development in the education of student and junior physical therapists.

Therapist Feelings of Incompetence and Suboptimal Processes in Psychotherapy

This study focused on novice therapists’ feelings of incompetence (FOI). FOI are moments where therapists’ beliefs in their abilities, judgment, and/or effectiveness is diminished, reduced, or challenged internally. In order to get at the subtleties of this internal and subjective process, ten novice therapists were interviewed for approximately 90 min using a semi-structured interview protocol. The interviews were analyzed by two researchers using procedures adapted from grounded theory methodology with the aim of developing thick descriptions and a conceptual structure. Findings indicate that novice therapists struggle with FOI, which vary in nature and intensity, and that FOI are multiply determined and complex. Implications for supervision and for psychotherapy process are discussed.

The Development of the Scale about Novice Therapists' Difficulty Experienced in Counseling

The Development of the Scale about Novice Therapists' Difficulty Experienced in Counseling

Motivational Change in an Inpatient Anorexia Nervosa Population and Implications for Treatment

The relationship between motivation and recovery in anorexia nervosa has received increased attention in the research literature although few controlled investigations of increasing motivation in this population exist. Three questions were therefore examined in an inpatient anorexia nervosa population: (i) does baseline motivation predict change in eating pathology; (ii) does change in motivation predict change in eating pathology; and (iii) can we increase motivation to recover in this group? Inpatients (n=47) in a specialist weight disorder unit with a mean age of 21.85 years (SD=5.37) were randomly allocated to receive four sessions of motivational interviewing with a novice therapist in addition to treatment as usual (n=22) or treatment as usual alone (n=25). Assessment of eating pathology and motivation to recover was conducted on three occasions: at admission (baseline), and at 2- and 6 week follow up. Eating pathology was assessed using the Eating Disorder Examination and self-reported motivation was assessed using the Anorexia Nervosa Stages of Change Questionnaire and six Likert scales. Higher baseline motivation across five of the seven measures predicted significant decreases in eating pathology, and increased Anorexia Nervosa Stages of Change Questionnaire scores between baseline and 2 week follow up predicted significant improvement in eating pathology between baseline and 6 week follow up. Significantly more patients were lost to follow up from the treatment as usual compared to the motivational interviewing group. More patients in the motivational interviewing condition moved from low readiness to change at baseline to high readiness to change at 2 and 6 week follow up. Motivation is an important predictor of change in anorexia nervosa and preliminary evidence is provided that motivation can be improved in this population. Further investigations, however, of ways of improving motivation in this population need to be conducted, along with the impact of motivational changes on treatment outcome.

A virtual human agent for assessing bias in novice therapists.

Monitoring the psychological and physiological activity of persons interacting with virtual humans poses exacting measurement challenges. Three experiments are reported in this paper. In these experiments we made use of Virtual Human Agent technology to assess persons' psychological and physiological responses to Virtual Standardized Patients. The first experiment provided support for the usability of the Virtual Standardized Patients through the use of a virtual character emulating an adolescent male with conduct disorder. In the second experiment we further developed the technology and aimed at assessing whether novice mental health clinicians could conduct an interview with a virtual character that emulates an adolescent female who has recently been physically traumatized. The third experiment looked at the usability of Virtual Standardized Patients for eliciting psychophysiological responses following exposure to virtual humans representing different ethnicities.

When Novice Therapists Meet Their First Patients: Reflections and Questions on Training in CBT

Hougaard et al.(2008) report a case series on a mixed individual and group treatment for social phobia, suggesting that the treatment is efficacious. As a group who has just embarked on a similar training program, we comment on their endeavor from the teacher/student perspective with an eye towards pedagogy in training students to conduct CBT. Thoughts and questions regarding the treatment, the patients, the therapists, and the outcomes are raised in order to highlight the potential that exists in such training models.

Outpatient Psychiatry: A Beginner's Guideby Thomas E. Steele; New York, W. W. Norton Company, 2007, 176 pages, $24.95 softcover

Back to table of contents Previous article Next article Book ReviewFull AccessOutpatient Psychiatry: A Beginner's GuideWilliam Meehan M.D.William Meehan M.D.Search for more papers by this authorPublished Online:1 Sep 2008https://doi.org/10.1176/ps.2008.59.9.1069AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Thomas Steele has been training psychiatry residents in an outpatient setting for over 25 years at the Medical University of South Carolina. He states that he has long wished for a single text addressing the needs of the neophyte outpatient psychiatrist, and thus he has written Outpatient Psychiatry: A Beginner's Guide . The book provides an overview of several topics in outpatient psychiatry, including psychodynamic psychotherapy, cognitive-behavioral therapy (CBT), brief psychotherapy, supportive psychotherapy, psychotherapy with the prescription of psychotropic medication, psychotherapy research, and issues common to various therapies. Given the topics covered, A Beginners Guide to Psychotherapy might have been a more accurate subtitle. At 169 pages, the author does not attempt to cover each topic in depth but introduces the most salient points for a novice therapist. Steele understands that most psychiatry residents are initially somewhat uncomfortable with psychotherapy, and therefore he writes the book from a reassuring and hopeful perspective. Both eloquent and humorous, Steele makes the usually dense topic of psychotherapy relatively accessible. As a third-year resident I found that the book consolidated my knowledge about psychotherapy and provided some pearls of wisdom that I had not come across in previous reading. Steele is at his best when he draws on his experience to distill information into a form that is useful and practical for residents. He is less effective when he attempts to summarize large quantities of information, thereby making material so diluted as to be of little utility. Fortunately, the majority of the book is written from the former perspective.Steele's least useful chapter summarizes CBT; he becomes lost in the details of CBT techniques that cannot be adequately described in the pages allotted. In contrast, the chapter on psychodynamic therapy is excellent. In particular, Steele's summary of Strupp's psychotherapeutic lessons provides a useful framework for a resident who may initially need a relatively concrete set of goals for the psychotherapy patient. The chapter about psychotherapy research provides a lens that is particularly useful for the beginner psychiatrist. Steele begins with a succinct history of psychotherapy research and describes some of the unique challenges of psychotherapy studies. Steele also provides a useful review of basic clinical statistics. Given that the psychiatric literature is replete with large placebo effects, Steele explains that these placebo rates do not demonstrate the psychiatric benefits of sugar pills. Instead the placebo effects likely reflect "regular contact with a concerned professional who takes an interest in the patient's symptoms, side effects, and progress," a placebo effect that is inherent in clinical trials and particularly germane to psychiatric studies. Steele also distinguishes between what Gabbard calls efficacy and effectiveness in psychiatric research. Efficacy reflects research on highly selected, well-defined patient populations. However, efficacy may bear little resemblance to the effectiveness demonstrated in studies of treatment of patients with multiple diagnoses in common clinical practice. Overall, Outpatient Psychiatry is a worthwhile text for beginning psychiatrists hoping for a practical and insightful overview of selected psychotherapeutic techniques and psychiatric paradigms. Dr. Meehan is a psychiatrist at the University of Massachusetts Medical School, Worcester. FiguresReferencesCited byDetailsCited ByNone Volume 59Issue 9 September, 2008Pages 1069-1069PSYCHIATRIC SERVICES September 2008 Volume 59 Number 9 Metrics PDF download History Published online 1 September 2008 Published in print 1 September 2008

Outpatient Psychiatry: A Beginner's Guide

Back to table of contents Previous article Next article Book ReviewFull AccessOutpatient Psychiatry: A Beginner's GuideWilliam Meehan M.D.William Meehan M.D.Search for more papers by this authorPublished Online:1 Sep 2008https://doi.org/10.1176/ps.2008.59.9.1069AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Thomas Steele has been training psychiatry residents in an outpatient setting for over 25 years at the Medical University of South Carolina. He states that he has long wished for a single text addressing the needs of the neophyte outpatient psychiatrist, and thus he has written Outpatient Psychiatry: A Beginner's Guide . The book provides an overview of several topics in outpatient psychiatry, including psychodynamic psychotherapy, cognitive-behavioral therapy (CBT), brief psychotherapy, supportive psychotherapy, psychotherapy with the prescription of psychotropic medication, psychotherapy research, and issues common to various therapies. Given the topics covered, A Beginners Guide to Psychotherapy might have been a more accurate subtitle. At 169 pages, the author does not attempt to cover each topic in depth but introduces the most salient points for a novice therapist. Steele understands that most psychiatry residents are initially somewhat uncomfortable with psychotherapy, and therefore he writes the book from a reassuring and hopeful perspective. Both eloquent and humorous, Steele makes the usually dense topic of psychotherapy relatively accessible. As a third-year resident I found that the book consolidated my knowledge about psychotherapy and provided some pearls of wisdom that I had not come across in previous reading. Steele is at his best when he draws on his experience to distill information into a form that is useful and practical for residents. He is less effective when he attempts to summarize large quantities of information, thereby making material so diluted as to be of little utility. Fortunately, the majority of the book is written from the former perspective.Steele's least useful chapter summarizes CBT; he becomes lost in the details of CBT techniques that cannot be adequately described in the pages allotted. In contrast, the chapter on psychodynamic therapy is excellent. In particular, Steele's summary of Strupp's psychotherapeutic lessons provides a useful framework for a resident who may initially need a relatively concrete set of goals for the psychotherapy patient. The chapter about psychotherapy research provides a lens that is particularly useful for the beginner psychiatrist. Steele begins with a succinct history of psychotherapy research and describes some of the unique challenges of psychotherapy studies. Steele also provides a useful review of basic clinical statistics. Given that the psychiatric literature is replete with large placebo effects, Steele explains that these placebo rates do not demonstrate the psychiatric benefits of sugar pills. Instead the placebo effects likely reflect "regular contact with a concerned professional who takes an interest in the patient's symptoms, side effects, and progress," a placebo effect that is inherent in clinical trials and particularly germane to psychiatric studies. Steele also distinguishes between what Gabbard calls efficacy and effectiveness in psychiatric research. Efficacy reflects research on highly selected, well-defined patient populations. However, efficacy may bear little resemblance to the effectiveness demonstrated in studies of treatment of patients with multiple diagnoses in common clinical practice. Overall, Outpatient Psychiatry is a worthwhile text for beginning psychiatrists hoping for a practical and insightful overview of selected psychotherapeutic techniques and psychiatric paradigms. Dr. Meehan is a psychiatrist at the University of Massachusetts Medical School, Worcester. FiguresReferencesCited byDetailsCited ByNone Volume 59Issue 9 September, 2008Pages 1069-1069PSYCHIATRIC SERVICES September 2008 Volume 59 Number 9 Metrics PDF download History Published online 1 September 2008 Published in print 1 September 2008

Dialectical Behavior Therapy in Private Practice

Manualized therapies continue to gain in popularity among therapists. These “newer” therapies have a growing body of evidence documenting their effectiveness in treating mental illness. These burgeoning efficacy data and the typically limited number of treatment sessions have not escaped third-party payers. In fact, insurance pressure has contributed to the momentum enjoyed recently by therapies such as interpersonal therapy (IPT), cognitive-behavioral therapy (CBT), and dialectical behavior therapy (DBT). Dialectical behavior therapy is the brainchild of Marsha Linehan, who created it to treat patients with borderline personality disorder. The central idea is that such patients have competing dialects that cause significant emotional stress. As a means of coping, these patients often engage in self-harm as a maladaptive means of regulating emotions. Traditional DBT requires significant resources as patients undergo both individual and group therapy during a course of treatment. The group component is psychoeducational and primarily didactic in nature. Several core modules of skill sets focusing on emotion regulation, distress tolerance, and mindfulness are presented to the patients. During individual sessions, parasuicidal behaviors are normally the primary target. Additionally, patients are coached in the application of skills taught during the group sessions with emphasis on practice to obtain skill mastery. Typically, a team of therapists skilled in DBT are required to coordinate both the group and individual sessions. These logistical challenges can restrict the practice of DBT to academic centers where educational or research subsidies are provided. Dialectical Behavior Therapy in Private Practice challenges the above assertions. The book provides an argument that DBT is not beyond the reach of a solo practitioner. Breaking with tradition, the author suggests that DBT can be used in a more piecemeal approach where limited resources require such an adaptation. Moreover, extensive research is presented that documents DBT's efficacy well beyond its original target of patients with borderline personality disorder. The book is designated for both seasoned as well as novice DBT therapists. In the first 2 chapters, the theoretical underpinnings of DBT are compared with other psychotherapy frameworks and evidence for the DBT approach is presented. Chapter 3 examines the possible psychological and neurobiological factors underlying a patient's emotional sensitivity. DBT's central thesis that emotional sensitivity (high emotional arousal, delayed return to baseline, and hypervigilance to threats) leads to maladaptive avoidance and escape behaviors is developed in the next chapter. This is followed by a chapter that establishes the goal of DBT as balancing acceptance of emotional problems and pain with specific skill strategies to change them. The author then illustrates the generalizability of DBT by applying it to various mental disorders outside of the traditional personality disorders. The final 2 chapters focus on the nuts and bolts of the specific skill sets patients need to master in DBT. Thomas Marra is obviously quite versed in the practice of DBT and has developed an exhaustive list of mnemonics aimed at assisting both clinicians and patients in remembering the specific skills. Typical patient dialects as well as excerpts of therapy sessions illustrating key conflicts are utilized to demonstrate how DBT can be used to understand a wide array of patients. These vignettes make the theory and practical skills much more understandable for the reader. Furthermore, the extensive citations to authority and research studies examining DBT across the mental health spectrum make the book a valuable addition to a reference library. However, these citations and instructional comments render the text quite dense and thus not appropriate for patients or individuals who want a brief introduction to DBT. Perhaps one of the greatest assets of the book is that Dr. Marra has included a CD-ROM with PowerPoint presentations for all of the key modules, which are turnkey for those interested in implementing a group therapy component. This CD-ROM also provides worksheets and handouts for individual therapy sessions aimed at skill building. Although the PowerPoint slides appear “homemade,” lacking slick graphics or animation, and carry an admonition that they cannot be changed or adapted by the purchaser, for the novice therapist they serve as an invaluable starting point. The countless hours of preparation they save make it possible to initiate a DBT program with only minimal additional outlay in terms of materials and are well worth the price of the text.

Integrative Treatment for Borderline Personality Disorder

Integrative Treatment for Borderline Personality Disorder

An Update on the South Carolina Trauma Initiative

An Update on the South Carolina Trauma Initiative

Confessions of a novice rational-emotive therapist

Many therapists who subscribe to RET are converts from other approaches. Few master’s or doctoral training programs exclusively teach RET and many do not place any emphasis on it at all. Thus, many otherwise experienced therapists are novices when it comes to integrating RET techniques into their professional repertoire of interventions. And as novices, they experience many of the doubts and obstacles in trying something new. I am such a novice. My formal training in RET consists solely of a Five Day Intensive Practicum (Weinrach, 1977) conducted by Ellis and his staff in 1976 since neither my master’s nor doctoral programs paid much attention to this approach. It has taken me 4 years to feel secure enough to call myself a Rational Therapist. My reluctance was not a philosophical one. Philosophically, I’ve been there for a long time. But I have found it difficult to integrate various RET interventions into my counseling style and feel comfortable at the same time. The discomfort I experienced is similar to what my counselor-trainees experience during their first few years after training with me and my colleagues. It takes a while for a therapist to develop an internally consistent style apart from the role models experienced while in training. Many of the obstacles that I have encountered are probably rather common and especially so for those whose training has been limited to a Five Day Intensive Practicum in RET or less. Those with more formal training have probably dealt with these and similar issues within

Developing One's Own Voice as a Therapist: A Dialogic Approach to Therapist Education

In this learning model for novice therapists, students study a well-known therapist and converse about their ideas and practices in the “voice” of that therapist with other students within a series of reflecting processes. Students dialogue about this approach in the presence of other students who listen as if they were a client, acting in the role of a film character. This learning model is described in detail, with a discussion of the therapy approaches that have contributed to its development. Drawing on Bakhtin (1984), a “lens” for understanding this model is advanced, highlighting how the learning model facilitates a movement from authoritarian to internally persuasive discourse. This shift fosters a more dialogic awareness on the part of students, contributing to the development of their distinctive voices as therapists.

It Takes More Than Training To Become a Psychotherapist

It Takes More Than Training To Become a Psychotherapist

Essential Skills for Novice Structural Family Therapists: A Delphi Study of Experienced Practitioners’ Perspectives

The considerable number of essential skills identified in the literature creates a challenge for family therapist instructors and supervisors who must develop a coherent curriculum for clinical training and supervision. This study used a modified Delphi method to obtain a consensus from experienced structural family therapists concerning the most essential skills needed by novice structural family therapists. The therapists concluded that relational skills are of primary importance to establish a therapeutic relationship that would facilitate the structural interventions. A critical component of the relational factor was the ability of the novice therapist to provide a vision of hope to clients and establish expectancy for change. The study provides an added dimension to understanding the essential training needs of novice structural family therapists from the practitioner’s perspective and brings research in essential skills for novice therapists closer to actual clinical practice. Implications for further research and clinical training are discussed.

Clinical Reasoning during Community Health Home Visits: Expert and Novice Differences

Very little is known about the differences between novice and expert clinical reasoning in community health practice. This article presents the findings of a study of the clinical reasoning of five expert and five novice community health occupational therapists (CHOTs) during the conducting of home visits. A head-mounted video camera was used to record the visits, followed by the participants reporting their clinical reasoning verbally using a video-assisted debriefing method. The transcripts from these verbal reports were analysed quantitatively and qualitatively. The quantitative results demonstrated many differences between experts and novices in terms of the amounts and types of clinical reasoning used. For example, the novices used more procedural reasoning whereas the experts used more conditional reasoning and mixes of different reasoning types. The qualitative results demonstrated that the experts used a free-flowing conversational approach when reasoning during home visits whereas the novices depended on external structures such as assessment forms to guide the process. Given their experience and familiarity with the process, the experts were confident and clear in their reasoning whereas the novices were more awkward and self-conscious. The experts handled sensitive issues whereas the novices seemed to avoid them. The study findings may provide insights for student and novice therapists concerning expert CHOTs' practice and promote reflection in general on the attainment of expertise in clinical practice.

Exploring Physical Therapy Clinical Decision Making for Children with Spastic Diplegia: Survey of Pediatric Practice

The purpose of this special interest report is to describe the outcomes of a research round table discussion regarding the physical therapy management of mobility for children with spastic diplegia. Sixty-two pediatric physical therapists and physical therapists assistants participated in focus groups during the Research Round Table at the American Physical Therapy Association (APTA) 1999 Combined Sections Meeting. A case description of a child with spastic diplegia and guiding questions were used to facilitate discussion. Common practices in patient management across the child's life-span emerged from the discussion. Practices in examination, evaluation and prognosis, and intervention differed depending on the age and function of the child and the family's needs. In general, therapists reported that younger children receive examinations that include standardized tests of development and ongoing intervention with a frequency of one to five times per week. In contrast, older children receive therapy services on an episodic basis that address their specific needs. The elements of patient management served as a useful framework for exploring decision making. The information compiled from this project needs to be validated through systematic inquiry. Therapists may, however, use the practices reported here to reflect on their clinical decision making and to identify questions for further exploration. This descriptive document is the first step in the development of a guideline for evidence-based practice. The development of such a clinical guideline could serve as an education tool for novice therapists, a program evaluation tool to ensure quality care, and a foundation for future research to promote evidence-based practice.

Progressing Therapeutic Intervention in Patients with Neuromuscular Disorders

As patients with neuromuscular disorders improve, therapists continually and intentionally advance the level of difficulty of therapeutic interventions (exercises and activities). Optimal patient performance, related to ongoing intentional progression, could result in optimal functional outcomes. This paper describes a conceptual framework with parameters that can be used to adjust or progress interventions. The parameters of progression are grouped into 3 categories and include those related to: (1) motor learning: variability in practice, practicing components of movement, task attention, feedback, environmental progression;(2) characteristics of the movement or task: amplitude, velocity, amount of work, endurance, regional; as well as (3) others: developmental sequence, supportive device, assistance given. The parameters overlap in clinical application. Students and novice therapists in particularly may find the framework useful in helping them organize therapy, while experienced therapists may gain ideas to optimally challenge patients to perform at higher functional levels.