Clinical Psychology Trainees Research Articles

LSD modulates music-induced imagery via changes in parahippocampal connectivity

Psychedelic drugs such as lysergic acid diethylamide (LSD) were used extensively in psychiatry in the past and their therapeutic potential is beginning to be re-examined today. Psychedelic psychotherapy typically involves a patient lying with their eyes-closed during peak drug effects, while listening to music and being supervised by trained psychotherapists. In this context, music is considered to be a key element in the therapeutic model; working in synergy with the drug to evoke therapeutically meaningful thoughts, emotions and imagery. The underlying mechanisms involved in this process have, however, never been formally investigated. Here we studied the interaction between LSD and music-listening on eyes-closed imagery by means of a placebo-controlled, functional magnetic resonance imaging (fMRI) study. Twelve healthy volunteers received intravenously administered LSD (75µg) and, on a separate occasion, placebo, before being scanned under eyes-closed resting conditions with and without music-listening. The parahippocampal cortex (PHC) has previously been linked with (1) music-evoked emotion, (2) the action of psychedelics, and (3) mental imagery. Imaging analyses therefore focused on changes in the connectivity profile of this particular structure. Results revealed increased PHC–visual cortex (VC) functional connectivity and PHC to VC information flow in the interaction between music and LSD. This latter result correlated positively with ratings of enhanced eyes-closed visual imagery, including imagery of an autobiographical nature. These findings suggest a plausible mechanism by which LSD works in combination with music listening to enhance certain subjective experiences that may be useful in a therapeutic context.

Concepts of Mental Disorders in Trainee Clinical Psychologists.

The models of mental disorders held by all mental health professionals are implicit in their attitudes and inform all aspects of theory and practice. The present study aims to explore the attitudes of trainee clinical psychologists towards mental disorders by building on a study conducted by Harland et al. () with psychiatrists. In so doing, the present study contributes to an evidence base that can inform the development of clinical training programs and multidisciplinary working. The Maudsley Attitude Questionnaire was administered in an online survey of trainee clinical psychologists (n = 289). Analyses of variance revealed main effects of model, and of diagnostic category, and a significant interaction effect between model and diagnostic category. Principal component analysis revealed a biological-psychosocial continuum and cognitive/behavioural and psychodynamic/spiritual dimensions. Comparisons with Harland et al.'s () psychiatrists revealed large differences, particularly in biological and social constructionist model endorsement. Results suggest that the attitudes of psychologists and psychiatrists continue to sit at opposite ends of a biological-psychosocial continuum. However, an area of consensus regarding psychotherapeutic models was indicated. Training courses can be reassured that strong opinions tended to reflect the evidence base. Future research with similarly large representative samples from different disciplines would allow findings of the current study to be better contextualized. Copyright © 2016 John Wiley & Sons, Ltd. The models of mental disorders held by clinical psychologists are implicit in their attitudes and inform all aspects of theory and practice. We found that trainee clinical psychologists continue to favour psychosocial over biological understandings of mental disorders, giving the cognitive, behavioural and psychodynamic models equal value overall, and stronger attitudes were supported by the evidence base. We found that trainee clinical psychologists organized their attitudes around a biological-psychosocial continuum and cognitive/behavioural and psychodynamic/spiritual dimensions. These findings may be useful for those involved in developing clinical training programs and multidisciplinary working because they provide an insight into the attitudes of emerging clinical psychologists.

The use of outcome and sessional measures in clinical psychology training

This article is the first in a set of three looking at the use of outcome and sessional measures in clinical psychology. This collaborative project between the three Yorkshire clinical psychology programmes aims to explore current practice and then establish a system by which all trainee clinical psychologists on the three programmes. It is hoped that this information will be used to expand the new practice research network to include measures applicable across clinical specialities.

Psychology people in profile: Dr Anne Abey

Dr Anne Abey is a qualified consultant clinical neuropsychologist, and is currently Head of Physical Health Psychology Services in Lincolnshire. She supervised me as a trainee clinical psychologist on placement earlier this year. I was inspired by her passion and enthusiasm for this field, and felt that her knowledge of this upcoming area of work would be interesting and useful for other psychology graduates to hear about.

Entering the therapists's world: Experiences of psychotherapists in India

Introduction The arena of therapist's perspectives and experiences has been inadequately represented in psychotherapy research. Along their professional journey, practitioners often have a myriad of experiences in the therapeutic process that influence their therapeutic interactions. Aim The present study aims to discuss the personal and clinical experiences of trained psychotherapists that influence their choice of the profession and psychotherapy practice. Methods Snowball sampling technique was used to recruit 10 trained psychotherapists for the purpose of the study. Audio-recorded interviews were held individually with each of the participant using a semi-structured interview schedule developed for the study. The interview schedule was reviewed by 2 experts with more than 10years of experience in psychotherapy. Qualitative data was subjected to thematic analysis. Results All psychotherapists identified an integral relationship between their individual belief systems and psychotherapy practice. Role of training, influence of mentors, significant experiences with family members and peers, significant childhood experiences, client characteristics, therapists' emotional responses to clients and the therapist's own beliefs about mechanisms of change were important factors in the psychotherapy process and were seen as significant internal experiences that underlie the psychotherapy process.

Developing a CORE system for use in the training of clinical psychologists

This is the second of three linked papers. It reflects on the process of setting up a centralised system for recording routine sessional and outcome data for trainee clinical psychologists across Yorkshire. Comments are included from two trainers involved in setting this up (GL and JH) and also a colleague from CORE IMS (JM) involved in developing the system used.

P.3.038 The brain-derived neurotrophic factor gene variant Val66Met and personality predict stressful life events

Psychedelic drugs such as lysergic acid diethylamide (LSD) were used extensively in psychiatry in the past and their therapeutic potential is beginning to be re-examined today. Psychedelic psychotherapy typically involves a patient lying with their eyes-closed during peak drug effects, while listening to music and being supervised by trained psychotherapists. In this context, music is considered to be a key element in the therapeutic model; working in synergy with the drug to evoke therapeutically meaningful thoughts, emotions and imagery. The underlying mechanisms involved in this process have, however, never been formally investigated. Here we studied the interaction between LSD and music-listening on eyes-closed imagery by means of a placebo-controlled, functional magnetic resonance imaging (fMRI) study. Twelve healthy volunteers received intravenously administered LSD (75 µg) and, on a separate occasion, placebo, before being scanned under eyes-closed resting conditions with and without music-listening. The parahippocampal cortex (PHC) has previously been linked with (1) music-evoked emotion, (2) the action of psychedelics, and (3) mental imagery. Imaging analyses therefore focused on changes in the connectivity profile of this particular structure. Results revealed increased PHC–visual cortex (VC) functional connectivity and PHC to VC information flow in the interaction between music and LSD. This latter result correlated positively with ratings of enhanced eyes-closed visual imagery, including imagery of an autobiographical nature. These findings suggest a plausible mechanism by which LSD works in combination with music listening to enhance certain subjective experiences that may be useful in a therapeutic context.

Training novice clinical psychologist trainees to implement effective CBT for anxiety disorders: training model and clinic outcomes

AbstractThe need for development of effective models of training and superivision for trainee clinical psychologists to build CBT competencies and to implement high-quality CBT is frequently highlighted. Effectiveness of trainee therapist outcomes working within different models of training, supervision and services is also important to establish. This paper reports on the development and outcome effectiveness of a model of training and supervision aimed at increasing CBT clinical skills and competence of trainee clinical psychologists offering CBT for anxiety disorders in an anxiety disorders clinic (ADC) in inner-city London. Details of the training and supervision model are provided, which was conducted over a period of 3 months, with ongoing weekly supervision throughout the intervention period. Pre- and post-intervention data were analysed from service users who attended the ADC over a 2-year period. Over the 2-year period, 10 trainees treated 57 clients. Data from completer and intention-to-treat samples indicated that scores on four outcome measures improved significantly: at post-therapy, 75% of service users who completed the intervention showed reliable and clinically significant recovery or improvement. When supported by appropriate training and supervision, as outlined in this training model, initially inexperienced trainee psychologists can achieve outcomes comparable to those obtained in other secondary-care settings with qualified therapists.

There is more to CST than the manual

In this article we will explore the notion that there is more to CST than the manual by contrasting two CST groups that we facilitated in a six-month period: ‘Friends’ (moderate to severe dementia) and ‘The Hopefuls’ (mild dementia). We will look at different applications of CST theory to practice, the adaptability of the manual, and the importance of supervision in the process of running the groups. Finally, we will discuss the qualitative and quantitative effects of being in the group and look at CST in the broader context of group work with people with dementia.This article is written from a first person perspective. The use of ‘we’ relates to myself, an Assistant Psychologist, together with a co-facilitator, either a trainee clinical psychologist or a support worker.

A prospective study of therapist facilitative interpersonal skills as a predictor of treatment outcome.

This study examined whether therapists' facilitative interpersonal skills (FIS) would prospectively predict the outcomes of therapies that occurred more than one year later. Therapists were 44 clinical psychology trainees who completed the FIS performance task and a self-reported measure of social skills in the initial weeks of their training. In the FIS task, prospective therapists were presented with a standard set of videos portraying clients in therapy. Verbal responses to these therapeutic simulations were recorded and then rated by trained coders. More than one year later, the therapists began providing psychotherapy to clients in a psychology clinic. Clients completed a symptom measure before each therapy session. Using multilevel modeling, it was found that therapist FIS significantly predicted client symptom change. That is, higher FIS therapists were more effective than lower FIS therapists. However, subsequent analyses showed that this FIS effect was not uniform across all therapy durations; specifically, higher FIS therapists were more effective than lower FIS therapists over shorter durations (e.g., ≤8 sessions) but did not differ from lower FIS therapists in effectiveness for the small percentage of therapies that were longer-term (e.g., >16 sessions). Therapists' interpersonal characteristics may influence client progress in therapy.

Clinical Psychologists’ Experiences of Accessing Personal Therapy during Training: A Narrative Analysis

The objectives of this study were to explore the experiences of trainee clinical psychologists who utilised therapy whilst training, and its role in their personal and professional development. Ten clinical psychologists were recruited, and asked to share their story of accessing personal therapy during training. Data were analysed using narrative analysis, which led to the development of four chapters: Chapter one explores the context of being a trainee clinical psychologist whilst experiencing therapy, including stressors encountered during training. In chapter two, participants discuss the stigma they felt in accessing personal therapy. Through chapter three, participants describe the journey of therapy itself, including difficult emotions they experienced and events such as ‘the ending’. Finally, chapter four details the personal and professional impact of their therapy journey. It is concluded that personal therapy can provide both personal and professional support to trainee clinical psychologists. However, some barriers may affect individuals seeking such support. The clinical and professional implications of these findings are discussed, in addition to recommendations for future research.

Assessment and follow-up of suicidal ideation when screening for depression in hospitalized coronary heart disease patients – development of a protocol

Rationale, aims and objectives: Depression is common in coronary heart disease (CHD) patients and routine depression screening is often performed in research settings and recommended for clinical practice. Many depression screening instruments contain an item assessing suicidal ideation. A positive answer for suicidal ideation requires timely follow-up evaluation by trained clinicians; however, the process of transferal of this information is not without its problems. We aimed to develop and implement a step-by-step action protocol for the timely follow-up evaluation of positive screenings for suicidal ideation in hospitalized CHD patients who complete a depression screening in a research study.Method: The protocol was developed by a team of psychiatrists and psychologists as part of a two-site prospective cohort study which includes 1265 hospitalized CHD patients with and without co-morbid depression. Patients were presented with two depression screening instruments as part of the baseline assessment, the Patient Health Questionnaire (PHQ-9) and the Hospital Anxiety and Depression Scale (HADS). All participants underwent a standardized computer based evaluation for clinical depression, anxiety and post-traumatic stress disorder using the Composite International Diagnostic Interview (CIDI). The protocol was adapted continuously with the aims to optimize information transfer between study team and clinic staff and to initiate potentially required care.Results: The protocol was adapted to site-specific exigencies, resulting in a stepped approach of handling suicidal ideation, starting with suicidality assessment in a depression screening questionnaire. In case of positive screening, a detailed procedure for following-up on suicidal ideation was developed, including guidelines for various eventualities. In case of insufficient or doubtful distance from suicidal intent as assessed by clinical psychologists in training, psychiatric consultation was initiated. Conclusions:Implementation of a protocol to follow-up on a positive suicidality screening in a research setting at two coronary care hospital sites was a logistical challenge, but proved feasible and acceptable to patients and staff.

The Hierarchical Clustering of Clinical Psychology Practicum Competencies: A Multisite Study of Supervisor Ratings

Competency evaluation rating forms are widely used to assess a range of global and specific psychology practitioner competencies during and at the end of clinical placements. Surprisingly, there is little research examining the dimensional structure or the hierarchical clustering of items on these ratings. The current, multisite study examined supervisor ratings of clinical psychology trainees (N = 204) on the Clinical Psychology Practicum Competencies Rating Scale (CΨPRS). Based on the proximity criterion chosen, hierarchical clustering yielded either nine clusters or four super clusters: Good Practitioner Attributes and Conduct, Scientist Practitioner and Professional Management, Assessment and Intervention, and Psychological Testing. The study also tracked the developmental trajectory of competency attainment. CΨPRS ratings differentiated groups between early but not between later stages of training. Measurement issues and implications for training and practice are discussed.

COMPARING SCHOOL AND CLINICAL PSYCHOLOGY INTERNSHIP APPLICANT CHARACTERISTICS

The ratio of internship applicants to internship positions listed in the online directory of the Association of Psychology Postdoctoral and Internship Centers (APPIC) is estimated at 1.23:1. In , approximately 14% of all students who participated in the match were not placed. Although the internship crisis impacts students in clinical, counseling, and school psychology programs, school psychology applicants are least successful in matching to APPIC‐member and American Psychological Association (APA)‐accredited internship programs. Of the APA‐accredited internships that feature one of more child rotations, school psychology applicants are not permitted to apply to 51.21% of them. The purpose of the current study was to examine the pre‐internship experiences and qualifications of school and clinical psychology trainees applying to at least one child‐focused, APA‐accredited internship. Results showed that clinical students accumulated significantly more intervention hours with adults than children. School psychology students wrote significantly more integrated assessment reports. The implications of these findings in light of the ongoing internship crisis for school psychology trainees, doctoral training programs, and internship programs are discussed.

The buds and shoots of what I’ve grown to become: the development of reflective practice in Trainee Clinical Psychologists

Within literature regarding Personal Professional Development (PPD) in Clinical Psychology training, personal and professional development are largely conceptualised as separate processes. Yet models of reflective practice would suggest that an awareness of the personal self is necessary for effective clinical work. This study explored newly qualified Clinical Psychologists’ (CPs) experiences of PPD, and in particular their identities, during their clinical psychology doctoral training. The main research question was ‘How do newly qualified CPs experience their personal and professional identities during doctoral training?’ Seven newly qualified CPs were interviewed regarding their experiences of their personal and professional identities during training. A qualitative research design was employed and Interpretative Phenomenological Analysis was used to analyse the data. Three superordinate themes were identified: Enhancing awareness of self and others; Taking risks and managing uncertainty; Developing self-acceptance. Within these results there was a strong message of an inextricable link between personal and professional identities. Enhancing awareness of self was understood as a personal process within PPD and an important aspect of reflective practice, thus it is proposed that PPD is an effective tool for training reflective practitioners. Within PPD, learning to manage uncertainty and take risks within relationships was seen to contribute to reflective practice, as CPs may be more able to attend to process issues within the therapeutic context. Furthermore, greater self-awareness seemed to help trainees find a balance between self-development and self-acceptance. Maintaining a stable and accepting sense of self may contribute to a CP’s professional development and personal wellbeing.

Working in the present moment: The impact of mindfulness on trainee psychotherapists’ experience of relational depth

AbstractAimTo explore the lived experience and impact of a brief mindfulness meditation training intervention on trainee psychological therapists, in particular their experiences of relational depth, the cultivation of therapeutic qualities and their use of the self in the therapeutic relationship.MethodInterpretative phenomenological analysis was used to investigate participants’ lived experience of mindfulness. Fifteen participants completed an eight‐week MBSR/MBCT mindfulness training, contextualised for therapists, and eight were interviewed four months later.FindingsParticipants experienced a range of positive outcomes and meaningful effects at both a personal and professional level, with mindfulness appearing to facilitate ‘being versus doing’ qualities and the potential for enhanced relational depth.DiscussionThe findings indicate the potential of mindfulness as a complementary clinical training and were suggestive of a process model, where ‘therapist intrapersonal attunement’ facilitates ‘therapist‐client interpersonal attunement’ that in turn promotes ‘client self‐attunement’, in a ‘co‐created co‐meditation space’.

Academic education in addictology (addiction science) in the Czech Republic: Analysis of the (pre-1989) historical origins

Background In the Czech Republic, education in addiction science consists of a distinctive and interconnected system of non-medical healthcare education on the Bachelor's (Bc) and Master's (MA) levels, followed by a doctoral study programme (PhD). Addictology (addiction science) as a new term is defined as a distinct and independent field of scientific inquiry on addictive behaviours and the risk environment of substance use, aiming at scientific and professional excellence relevant to society. Aims This case study seeks to identify, describe and explain important events in shaping the historical context of the Czech education and research programmes in addictology. Design The historical review is based on qualitative content analysis of central written documents. Results In the 19th century Czech territory, problematic alcohol use was addressed through self-help activities in the second half of the nineteenth century. During the 1950s and 1960s, a new generation of Czech psychiatrists emerged with an interest in alcohol treatment and in research of hallucinogenic drugs. A patient education bulletin Apolinářský zápisník [Apolinar Diary] was launched in 1951 and was later also used for education of treatment professionals in connection with other self-help and quasi-self-help activities. The monographs Alkoholism (1957) and Toxicomany (1973) conceptualised the core of abstinence-oriented historical traditions and developments. A separation of approaches to legal and illegal drugs can be observed in the 1970s. In 1967, a new and intensive training model was introduced for psychiatrists and psychotherapists, leading into specialisation in psychotherapy and addiction. Because of the Iron Curtain, Czech practitioners had to develop their own concept of addiction and ideas on training psychotherapists so they could not be labelled western or anti-state, or be subject to intense state control. Conclusions The final profile of the study programmes is the outcome of a long-term process that commenced in the 1950s but with roots in the interwar years, when addictology in the Czech Republic reflected traditional healthcare-oriented models of training and education. In this context the historical development in Czecholovakia and later Czech Relpublic can be characterized as a combination of early interest in self-help activities followed by the development of specialized treatment programmes both affected by a futher 40 years behind the “iron curtain” and intensively confrontated with harm and risk reducation interventions after the Velvet revolution.

Impact of psychotherapist expectations on client outcomes.

Recent investigations have implicated client expectations of psychotherapy as a strong predictor of premature termination; however, there is reason to believe psychotherapist expectations may also impact client outcomes. This study sought to address this gap in the literature by examining the association of psychotherapists' expectations to clients' psychotherapy outcomes, including termination status. Participants were 54 current and recent trainee psychotherapists at a Southern public university, who completed delay discounting measures to assess their expectations of the effectiveness of psychotherapy. Data were also drawn from 300 adult clients who had received at least 2 sessions of individual psychotherapy from the participating psychotherapists of this study, and had previously completed the Outcome Questionnaire 45.2 prior to each individual therapy session. Psychotherapists were found to hold significantly higher expectations for client improvement than anticipated, based on existing literature, and these high expectations were found to be positively correlated with clinically significant change in clients. Moreover, psychotherapists' expectations were found to explain 7.3% of the explainable variance in whether or not clients experienced clinically significant change during psychotherapy. Implications for improving client retention and treatment outcome are discussed.

Ethical dilemmas experienced by clinical psychology trainee therapists.

Ethical dilemmas are inevitable during psychotherapeutic interactions, and these complexities and challenges may be magnified during the training phase. The experience of ethical dilemmas in the arena of therapy and the methods of resolving these dilemmas were examined among 35 clinical psychologists in training, through an anonymous and confidential online survey. The trainees' responses to four open-ended questions on any one ethical dilemma encountered during therapy were analysed, using thematic content analysis. The results highlighted that the salient ethical dilemmas related to confidentiality and boundary issues. The trainees also raised ethical questions regarding therapist competence, the beneficence and non-maleficence of therapeutic actions, and client autonomy. Fifty-seven per cent of the trainees reported that the dilemmas were resolved adequately, the prominent methods of resolution being supervision or consultation and guidance from professional ethical guidelines. The trainees felt that the professional codes had certain limitations as far as the effective resolution of ethical dilemmas was concerned. The findings indicate the need to strengthen training and supervision methodologies and professional ethics codes for psychotherapists and counsellors in India.

Attitudes toward Substance Abuse Clients: An Empirical Study of Clinical Psychology Trainees

Despite the high prevalence of substance use disorder (SUD) and its frequent comorbidity with mental illness, individuals with SUD are less likely to receive effective SUD treatment from mental health practitioners than SUD counselors. Limited competence and interest in treating this clinical population are likely influenced by a lack of formal training in SUD treatment. Using a factorial survey-vignette design that included three clinical vignettes and a supplementary survey instrument, we investigated whether clinical psychology doctoral students differ in their level of negative emotional reactions toward clients with SUD versus major depressive disorder (MDD); whether they differ in their attributions for SUD versus MDD; and how their negative emotional reactions and attributions impact their interest in pursuing SUD clinical work. Participants were 155 clinical psychology graduate-level doctoral students (72% female). Participants endorsed more negative emotional reactions toward clients with SUD than toward clients with MDD. They were also more likely to identify poor willpower as the cause for SUD than for MDD. More than a third reported interest in working with SUD populations. Highest levels of interest were associated with prior professional and personal experience with SUD, four to six years of clinical experience, and postmodern theoretical orientation.