Therapist Students Research Articles

Experiences of People with Aphasia Receiving Enhanced Community-Based Speech-Language Pathology Provided by Speech-Language Pathology Students

Introduction: Treatment intensity for people with aphasia (PWA) is a significant factor in enhancing recovery. Personal factors such as fatigue, physical endurance, and motivation as well as clinician availability have been described as barriers to increased intensity. The use of student therapists has been shown to assist with addressing service gaps. Methods: The aim of the study was to explore the experiences of PWA who received enhanced community-based treatment delivered by speech-language pathology (SLP) students. Enhanced community-based treatment was defined as three or more treatment sessions per week targeting communication. Semi-structured interviews were conducted with 10 PWA living in New Zealand. Interview data were analysed with reflexive thematic analysis. Results: Two themes and six sub-themes were developed. Theme 1 related to intensity and included more treatment is better than less (sub-theme 1), there’s a “right time” for more intensive treatment (sub-theme 2), the hard work is worth the effort (sub-theme 3). Theme 2 related to working with SLP students; it didn’t feel like they were students (sub-theme 4), we just got on so well (sub-theme 5), and they listened to what I wanted (sub-theme 6). Conclusions: The findings confirm that PWA value access to more intensive treatment and desire involvement in decisions about flexible treatment schedules. PWA have positive experiences when treatment is provided by SLP students. Implications for clinical practice and future research directions are discussed.

The Role of Social Support in Concussion Rehabilitation: A Prospective Mixed Methods Study of Canadian University Athletes’ Return to Sport

Context: Social support is an important consideration during athletes’ rehabilitation following a concussion. Yet, its influence during the return-to-sport (RTS) strategy has been underexplored. Design: Concussed athletes’ experiences with social support during RTS were explored prospectively using an explanatory sequential mixed methods design. Methods: University rugby, basketball, and track and field athletes (N = 8) from a single Canadian institution, 19–23 years of age (mean = 20.63, SD = 1.51), completed concentric circles maps, the Perceived Available Support in Sport Questionnaire, and 2 semistructured interviews during their RTS. We analyzed concentric circles maps and questionnaire data descriptively and interview data using codebook thematic analysis. Results: Athletes identified 16 different social support agents. The 5 most important agents during RTS were athletic therapists, student therapists, head coaches, significant others, and teammates/friends. Significant others provided the most emotional (mean = 2.82, SD = 1.85) and esteem (mean = 2.63, SD = 1.85) support, and the athletic therapist (mean = 1.82, SD = 1.35) and head coaches (mean = 0.93, SD = 1.19) provided the most informational and tangible support. We generated 4 themes from athletes’ interviews: social support behaviors, contextual factors, concussion and RTS factors, and psychological readiness factors. Conclusions: The number of social support agents present, frequency of support types, and demonstration of support behaviors decreased across the concussion RTS strategy. Contextual (ie, toughness), concussion (ie, visibility), and RTS (ie, prognosis uncertainty) factors influenced athletes’ perceptions of social support agents’ support behaviors. Results add to our limited understanding of athletes’ social support during RTS following a concussion and suggest exploring the integration of behavior-specific (eg, checking in, providing reassurance, and demonstrating compassion) social support strategies to promote concussion rehabilitation and readiness to RTS.

Transference and client attachment to therapist in psychodynamic psychotherapy.

Although there are theorized connections between client transference and their attachment to their therapists (Bowlby, 1969/1982), limited empirical research exists examining their association over the course of psychotherapy. We thus examined the association between positive and negative transference and client attachment to therapist across the course of open-ended psychodynamic psychotherapy for 49 cases with doctoral student therapists and adult community clients who had at least 32 sessions. Using a Bayesian multilevel structural equation model framework, results indicated that client secure attachment increased and avoidant-fearful attachment decreased across the course of psychotherapy. For clients with higher preoccupied-merger attachment at the beginning of therapy, therapists perceived more fluctuation in negative transference over time than for clients with other attachment styles. Implications for research, practice, and therapist training are offered. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Retraction of Gupta et al. (2018).

Reports the retraction of "Client laughter in psychodynamic psychotherapy: Not a laughing matter" by Shudarshana Gupta, Clara E. Hill and Dennis M. Kivlighan Jr. (Journal of Counseling Psychology, 2018[Jul], Vol 65[4], 463-473). The following article is being retracted (https://doi.org/10.1037/cou0000272). This retraction is at the request of coauthors Kivlighan and Hill after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Gupta was not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2018-33326-005.) We studied 814 client laughter events nested within 330 sessions nested within 33 clients nested within 16 therapists at one community clinic in which doctoral student therapists provided psychodynamic psychotherapy to adult community clients. Each laughter event in Sessions 1 to 5 and 16 to 20 was rated for cheerfulness, politeness, reflectiveness, contemptuousness, and nervousness. Across all clients, there was an average of about one laughter even per session. The average laughter event lasted 3.5 seconds, and was characterized primarily by politeness and reflectiveness. Overall amount of client laughter and the characteristics of client laughter did not change across sessions. Most of the variance in the laughter characteristics was at the session level, with less variance attributable to clients and therapists. When client attachment avoidance was high, laughter was less cheerful and more contemptuous. When client attachment anxiety was high, laughter was more nervous. Sessions with more reflective laughter were evaluated more positively by clients, and therapists whose clients had more reflective laughter had more positive client session evaluations. Furthermore, within a therapist's caseload, clients with the most nervous and contemptuous laughter evaluated sessions most positively. Implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Student therapists' experiences of learning using a machine client: A proof‐of‐concept exploration of an emotionally responsive interactive client (ERIC)

AbstractBackgroundThe use of artificial intelligence (AI) is increasing in many areas of healthcare, including mental healthcare. The automated nature of such technologies has the potential to be developed to work with large numbers of people. This paper examines the way that student therapists experience using an interactive text‐based machine client as a training tool.MethodologyChatbot technology has been used to develop an emotionally responsive interactive client (ERIC). This introduces individuals to concepts of person‐centred therapy (empathy, congruence and unconditional positive regard) by using a series of pre‐programmed scenarios. Twenty‐eight student therapists evaluated ERIC's potential as a learning tool. Individuals were recruited from one university from a postgraduate and an undergraduate counselling programme.FindingsFeedback was generally positive, with all reporting that they enjoyed engaging with ERIC as a learning method. ERIC helped individuals consider their understanding of counselling skills in a non‐judgemental environment. Participants felt the scenarios were realistic and engaging, with many reporting that they felt they were engaging with a real client/person due to ERIC's ability to express emotions.DiscussionERIC is at the proof‐of‐concept phase. From the feedback presented here, it is evident that it can be a useful learning tool. Further development of ERIC with feedback from a larger sample is, however, required. ERIC is currently a text‐based client, and further development would like to see the intervention be voice‐activated to enhance the experience. ERIC can be further enhanced and adapted to be a useful learning platform for student therapists, as well as for students in other (healthcare‐related) disciplines, whereby a client or patient is required.

Retraction of Cuttler et al. (2019).

Reports the retraction of "Productive silence is golden: Predicting changes in client collaboration from process during silence and client attachment style in psychodynamic psychotherapy" by Ethan Cuttler, Clara E. Hill, Shakeena King and Dennis M. Kivlighan Jr. (Psychotherapy, 2019[Dec], Vol 56[4], 568-576) https://doi .org/10.1037/pst0000260. This retraction is at the request of coauthors Hill and Kivlighan after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Coauthors Cuttler and King were not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2019-75736-005.) We investigated the process and outcome of the first silence event for each of 86 clients and 26 doctoral student therapists in individual psychodynamic psychotherapy. Antecedent client collaboration and client attachments styles did not predict type of client or therapist behavior during silence events. Client collaboration increased from before to after silence events if therapists were productive (mostly invitational) and if clients were productive (mostly emotional and expressive) during silence events. Furthermore, subsequent client collaboration was higher when productive therapist silence occurred with clients who were lower rather than higher in attachment anxiety. In contrast, subsequent client collaboration was higher when productive client silence occurred with clients who were higher rather than lower in attachment anxiety. These results suggest that type of silence and client attachment styles are important factors in the immediate outcomes of silence events. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Applied behavior analysis interventions for autism spectrum disorders

Applied behavior analysis (ABA) has been considered the gold standard intervention for individuals diagnosed with autism spectrum disorder (ASD) for over 60 years. ABA, as a therapeutic intervention, dates to the 1960s and first appeared in studies conducted by Ole Ivar Lovaas. ABA gained the attention of many practitioners in 1987 when Lovaas reported children who received 40 hours or more of ABA treatment per week had significantly better outcomes than children who received 10 hours or less of ABA treatment per week after 2 or more years of intervention (Lovaas, 1987). Lovaas and his team of trained student therapists used interventions informed by behaviorism to target self‐stimulatory behaviors, play skills, and expressive language skills among other targeted goals and found that 47% of children in the experimental group achieved a normal score for intellectual and educational functions compared to 2% of children in the control group (Lovaas, 1987).

Retraction of Keum et al. (2021).

Reports the retraction of "Do therapists improve in their ability to assess clients' satisfaction? A truth and bias model" by Brian TaeHyuk Keum, Katherine Morales Dixon, Dennis M. Kivlighan Jr., Clara E. Hill and Charles J. Gelso (Journal of Counseling Psychology, 2021[Oct], Vol 68[5], 608-620). The following article (https://doi.org/10.1037/cou0000525) is being retracted. This retraction is at the request of coauthors Kivlighan, Hill, and Gelso after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. Keum and Dixon were not responsible for obtaining and verifying participant consent but agreed to the retraction of this article. (The following abstract of the original article appeared in record 2020-51285-001.) We used the truth and bias model to examine changes in tracking accuracy and under/overestimation (directional bias) on therapists' judgments about clients' satisfaction. We examined 3 factors of clinical experience that could moderate accuracy: (a) overall level of acquaintanceship with a client, operationalized as treatment length (i.e., less or more time seeing a client), (b) time point in therapy with a specific client, operationalized as session number (i.e., earlier or later in treatment with a client), and (c) order (1st client seen, 2nd client seen . . . last client seen across two years of training in a psychology clinic) in which clients were seen. We conducted a three-level hierarchical linear modeling using data on 6054 sessions, nested in 284 adult clients, nested in 41 doctoral student therapists providing open-ended psychodynamic individual psychotherapy. We found that therapists were able to accurately track client-rated session evaluations with less underestimation (i.e., lower tendency to estimate that clients were less satisfied than they actually were) as they gained experience (both treatment length and client order). Furthermore, therapists exhibited greater tracking accuracy gains over the span of shorter treatments and when working with clients earlier in their clinical training. In longer treatments and with clients seen later in training, tracking accuracy was stable and consistent. Implications for research and practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Socioeconomic dynamics in an American psychoanalytic psychotherapy training clinic: an exploratory qualitative analysis of doctoral education and practice

It is understudied how a patient’s or psychotherapist’s socioeconomic status (SES) might influence psychotherapeutic treatments. This project addressed this gap in research by investigating how doctoral therapists-in-training understood the impact of SES in their psychotherapeutic work. Reflexive thematic analysis with a phenomenological approach was used to analyze conversations with doctoral student therapists at a university clinic. Specific themes emerged concerning therapist self-worth, addressing patient SES, self-disclosing about one’s SES, and working through SES fantasies. It was found that therapists-in-training routinely avoided conversations with patients related to SES. These findings suggest that doctoral training is not adequately preparing psychoanalytic psychotherapists to work with patients in lower SES positions. Limitations of the study and suggestions for future research are explored.

Student-led occupational performance coaching in a university setting

Introduction: University students are at a high risk for mental health difficulties. Occupational performance coaching is an action-oriented and strengths-based approach that can help clients set and accomplish personally valued goals. We carried out a pilot project to evaluate a tele-rehabilitation occupational performance coaching service for university students within an occupational therapy fieldwork placement. Method: A pretest post-test design was used. Severity of symptoms of depression, anxiety and stress and goal achievement were measured before and after the intervention and semi-structured interviews were carried out with student clients and student therapists. Development of student therapist competencies were noted. Results: Thirty-five student clients enrolled in occupational performance coaching and participated in 1–6 sessions. They identified academic, health, social and vocational goals. Through occupational performance coaching, clients made important progress on their goals. Following occupational performance coaching, clients demonstrated statistically significant improvement in anxiety and depression. The occupational therapy students attained competencies comparable in number and level to those achieved in more traditional placements. Conclusion: Occupational performance coaching is a potentially valuable addition to student mental health services. Such a service can be provided by supervised fieldwork students.

Mental Health Literacy and Confidence in a Sample of Student Athletic Therapists

Intercollegiate student-athletes appear to be a high-risk population with respect to mental health. Student athletic therapists are one of the groups with whom these athletes may be comfortable disclosing concerns. The current study investigated the relationship between mental health literacy and mental health referral efficacy in a sample of intercollegiate student therapists. One hundred and eleven student athletic therapists (81 female, 29 male, 1 nondiscloure) competed a revised version of the multicomponent mental health literacy measure and a four-item measure of mental health referral efficacy. T tests revealed statistically significant differences in mental health literacy by gender and personal history, and a multiple linear regression revealed a significant model predicting referral efficacy from mental health literacy. There are several implications of these results, particularly when working with a high-risk population of student-athletes.

A training program to increase collaboration between interpreter and therapists in psychotherapy with resettled refugees.

Drawing from the framework of community-academic partnerships, we describe the development and implementation of a training module to increase collaboration between interpreters and therapists in interpreter-mediated psychotherapy with refugees. Beginning with community engagement with local agencies and leaders to identify barriers to accessing psychotherapy services in the resettled refugee populations, this project involved multiple layers of collaboration to include multiple perspectives. The program was funded by a local community foundation and was implemented in three phases. In the first phase we identified key community partners and stakeholders with first-hand knowledge of the needs of refugee populations. Phase two involved a two-day workshop for student therapists from different disciplines and interpreters working in the field. Phase three included a follow up to re-assess challenges in the field and refine our training. The need to build early collaboration between therapists and interpreters was highlighted throughout the development and implementation of the project. We discuss the project’s impact, challenges encountered, and implications of lessons learned in developing community-engaged partnerships for graduate programs as a way of promoting social justice in practitioner training.

A review of occupational therapy services within an acute public tertiary hospital in KwaZulu-Natal, South Africa

INTRODUCTION: The provision of occupational therapy services in providing a minimum essential service in public health institutions in South Africa are currently guided by a quality control measure by the National Department of Health. AIM: To review the occupational therapy services in an acute, public tertiary hospital from 2015-2019 and to compare this with the expectations of these services in a tertiary hospital to identify potential gaps in service delivery. METHOD: A single site, retrospective quantitative audit from 2015-2019 was completed at one tertiary hospital. Patient-related and occupational therapy service data were included. 18579 patient entries were captured. The analysis included descriptive and inferential statistics of mean, standard deviations, frequency tables, percentages, and ANOVA. RESULTS: Findings indicated a consistent decline in the mean values of, the number of therapists attending to patients, number of patients, assistive devices issued, total time of patient units and consultations, total time spent on ward rounds, clinics, and meeting attendance. The number of student therapists attending to patients, splints, pressure garments and issued wheelchairs showed an increase in trend across the reviewed years. CONCLUSION: Inadequate human resources and budget systems are potential gaps in occupational therapy service delivery in an acute public tertiary hospital.

The within-client alliance-outcome relationship: A response surface analysis.

The authors examined how stability/change in working alliance predicted subsequent symptoms, and how stability/change in symptoms predicted subsequent alliance in a sample of 188 adult clients with 44 doctoral student therapists over the course of 893 eight-session time periods of individual psychodynamic psychotherapy. Clients completed the Working Alliance Inventory-Short Revised (WAI-SR; Hatcher & Gillaspy, 2006) after every session and the Outcome Questionnaire-45 (OQ; Lambert et al., 1996) before intake and every eighth session. The authors used multilevel polynomial regression and response surface analyses to examine within-client effects. The authors found that change in the alliance across an eight-session period did not have an immediate temporal effect on symptoms, but when alliance was stable and stronger compared to other periods, subsequent symptoms were lower. Similarly, change in symptoms across an eight-session period did not have an immediate temporal effect on alliance, but when symptoms were stable and lower compared to other periods, subsequent alliance was stronger. These results suggest that sustained improvements in the alliance contribute to subsequent symptom improvements, and vice versa. The authors conclude that it is important to work to improve and maintain improvements in the working alliance and symptoms. Limitations and future directions are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Preparing student therapists to work with Black mental health: Attending to the social and institutional organization of “culture” in Canadian counsellor education.

Preparing student therapists to work with Black mental health: Attending to the social and institutional organization of “culture” in Canadian counsellor education.

Using the Weaving Thoughts Peer Supervision Method to Generate a Nested Mentalization Frame: The DHCC Experience

ABSTRACT The Weaving Thoughts (WT) peer group process is a method for eliciting insight that is used by analytic groups in Europe. The process involves the presentation of a therapy session to a group of colleagues who know nothing about the case and share their reactions and associations after the presentation of the session. This paper offers an account of the use of the WT group process at a university-run school-based community clinic, the Derner Hempstead Child Clinic. Through the use of the WT group process the directors and supervisors of the clinic were able to create a nested mentalization frame that was experienced as supportive by student therapists, faculty supervisors and administrators.

A strong alliance is not enough: Item-level variation in an alliance measure moderates the alliance strength and client outcome relationship.

[Retraction notice: A retraction for this article was reported in Vol 70(4) of Journal of Counseling Psychology (see record 2023-89440-002). The following article (https://doi .org/10.1037/cou0000629) is being retracted. This retraction is at the request of coauthors Kivlighan and Hill after the results of an investigation by the University of Maryland Institutional Review Board (IRB). The IRB found that the study included data from between one and four therapy clients of the Maryland Psychotherapy Clinic and Research Laboratory (MPCRL) who either had not been asked to provide consent or had withdrawn consent for their data to be included in the research. An was not responsible for obtaining and verifying participant consent but agreed to the retraction of this article.] This study investigated within-client effects of session-to-session working alliance (WA) strength (mean of client's and therapists' ratings of Working Alliance Inventory [WAI] items for a session; WAI-M) and intra-individual variance of working alliance (WAI-IIV; variation in how the same individual responds to different items in the WAI for a session) of therapist and client on overall client functioning. Specifically, we explored how the strength and intra-individual variance for therapist and client working alliance at a previous session (Time t-1) would relate to overall client functioning at a current session (Time t). We also explored whether the effect of WA-M on overall client functioning would be different at different levels of WAI-IIV. The dynamic structural equation modeling (Asparouhov et al., 2018) was used to analyze longitudinal data from 4,489 sessions at a university clinic where 17 doctoral student therapists provided low-cost, open-ended, individual psychodynamic psychotherapy to 135 adult community clients. We found that client-rated WAI-M and WAI-IIV had positive within-client main effects on next-session client functioning when controlling for autoregressive effects. Findings on WAI-M by WAI-IIV interaction effects revealed that the relationship between WAI-M at a previous session and client functioning at a current session was significant only when WAI-IIV was low (i.e., high intra-individual consistency across WAI items). Therapists' WAI-M, WAI-IIV, and interaction of WAI-M and WAI-IIV did not predict the next session client functioning significantly. Limitations and implications of the present research are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Retracted Article: Advice-giving in final sessions of therapist-terminated psychodynamic psychotherapy: is it advised?

ABSTRACT We studied the outcomes of 95 advice events nested within 52 adult clients nested within 23 doctoral student therapists in the final session of individual psychodynamic psychotherapy when therapists had initiated the termination. In 77% of the final sessions, therapists gave at least one piece of advice. Advice was focused on future therapy work (45%), changes in self or self-reflection (42%), or relationships (12%). On average, client collaboration decreased after advice and clients verbalized a moderate intent to act. Clients whose therapists provided more explicit advice had higher subsequent collaboration, and advice that was more directive was associated with lower intent to act. Implications for practice and research are provided.

Antecedents and consequences of open and closed questions in intake sessions of psychodynamic psychotherapy

ABSTRACT Objective: To investigate whether there are different antecedents and consequences of different types of therapist questions as this has implications for conducting psychotherapy and for training therapists. Method: We examined the antecedents and consequences of questions for 88 clients working with 33 doctoral student therapists in psychodynamic psychotherapy. Questions were coded into open questions for thoughts (OQT), open questions for feelings (OQF), closed questions for facts (CQF), and closed questions other (CQO). The antecedents and consequences were assessed in terms of self-referring pronouns (SRP), self-referring emotion words (SRE), and number of words. Results: In terms of antecedents, when clients were using a high number of SRP, therapists were more likely to ask OQT and CQO than CQF. When clients were using a high number of SRE, therapists were more likely to ask OQF than CQF. In terms of consequences, clients spoke less after CQF than the other three skills, used fewer SRP after CQF than after CQO, and used more SRE after OQF than CQF. Conclusions: CQO were more similar in terms of antecedents and consequences to OQT and OQF than to CQF.

Facilitating exploration in psychodynamic psychotherapy: Therapist skills and client attachment style.

We examined how much 62 adult community clients working with 26 doctoral student therapists in the 10th session of individual, open-ended, psychodynamic psychotherapy engaged in affective and cognitive-behavioral exploration preceding and following four different therapist skills (restatement, reflection of feelings, open question for thoughts, open question for feelings). Overall, therapists used more skills focused on thoughts than feelings. At the between-therapists level, therapists tended to use more skills focused on affect when antecedent client affective exploration was high. An increase in affective exploration was associated with skills focused on feelings, however, clients low in attachment anxiety showed a decrease in affective exploration in response to paraphrases (i.e., restatements and reflections of feelings). Open questions for feelings were associated with an increase in cognitive-behavioral exploration, especially for clients low in attachment anxiety. Implications for practice and research are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).