Clinical Psychology Trainees Research Articles

Two service evaluations of LEAPlets – An early years programme for children in foster care and adoption, based on the BUSS® (Building Underdeveloped Sensorimotor Systems) Model

BUSS® is a relationally based intervention, bringing an appreciation of the role nurture, touch and movement play in the development of bodily regulation in early childhood. Following a neurosequential understanding of development ( Perry and Hambrick, 2008 ), BUSS® works to support foster carers and adoptive parents in understanding both the disruptive impact of trauma on the development of their child’s foundation sensorimotor systems and the critical role they can play in ameliorating this disruption. Good bodily regulation offers children a platform upon which relationships, emotional regulation and learning can grow ( Lloyd, 2023 ). LEAPlets is a group for children and their parents and carers, based on the BUSS® Model. It aims to build attachment relationships, supporting parents and carers in understanding and rebuilding their child’s foundation sensorimotor systems. This paper brings together two service evaluation projects of LEAPlets carried out by clinical psychologists in training. The first evaluation is of LEAPlets as a school readiness programme for children in foster care in Leeds. The second evaluation is the LEAPlets group in One Adoption West Yorkshire (OAWY) for new adoptive parents and their newly adopted children. While more research is needed, both studies showed improvements for the children in bodily and emotional regulation, communication and relationships, as well as positive changes in skill development, understanding of their child, and relationships for foster carers and adoptive parents. Models like LEAPlets, which address both the relational and sensorimotor consequences of early trauma, may usefully form part of early intervention programmes for care-experienced children. Training to run LEAPlets groups has been developed, and groups are now running in England, Wales and the Republic of Ireland. This will be explored and discussed, with reference to school readiness, impact on foster carers and supporting adoptive families early in their life together.

Potential promises and perils of artificial intelligence in psychotherapy -The AI Psychotherapist (APT).

Since the release of ChatGPT, popular demand has driven the use of social chatbots as pseudo-AI psychotherapists. With time, it is inevitable that these technologies will be deployed in some form as dedicated psychotherapy interventions. Here, we attempt to forecast the implications for psychotherapy including the unique benefits to distributive justice as well as concerns for the quality of the therapy and its societal impact. An AI psychotherapist (APT) has the potential to provide engaging clinical interactions given its capacity for highly realistic interaction as well as its high level cognitive and emotional capabilities. Moreover, it can potentially address financial and workforce limitations on access to therapy. However, an APT may cause significant iatrogenic harm if released without adequate quality control and oversight by trained psychotherapists. If not appropriately designed and regulated, APTs have potential to mislead and reinforce maladaptive coping behaviours. Given societal drivers and possible benefits, these technologies will inevitably be deployed; thus, it is incumbent upon us as a professional body to consider their regulation.

Effect of older adult health and age on psychology doctoral trainees’ expectations of clinical work with older adult clients

ABSTRACT This experimental, repeated-measures study investigated the effects of client health and client age on doctoral psychology students’ clinical expectations for their work with older adult clients. Doctoral clinical and counseling psychology trainees (N = 223) completed measures assessing clinical expectations for three older adult clients of varying health status (healthy, recent Alzheimer’s Disease (AD) diagnosis, heart disease) who all presented with depressive symptoms. Trainees were randomly assigned to the 71-year-old or 81-year-old condition. Trainees perceived a depressed client with a recent AD diagnosis as a less appropriate candidate for therapy, less motivated and less responsible for therapy, and less able to develop a therapeutic relationship. Additional health-based differences in prognosis, comfort, and competence were moderated by client age. Although age did have a small effect, the health of the older adult client had a stronger influence on trainees’ clinical expectations for work with older adults. Cognitive health concerns were perceived as a greater barrier to clinical work with older adults than were physical health concerns. Health biases for clinical work with older adults could impact the quality of mental healthcare provided.

Existing policies and procedures for training needs among clinical psychology trainees: An institutional policy review.

Existing policies and procedures for training needs among clinical psychology trainees: An institutional policy review.

How many Trainee Clinical Psychologists (TCPs) in the UK self-report lived mental health experience (LMHE)?

Lived mental health experience’ (LMHE) describes direct impact of a mental health problem and/or being a mental health carer. LMHE among Trainee Clinical Psychologists (TCP) is rarely investigated despite encountering challenges throughout training. The current study aimed to estimate point, period, and lifetime prevalence of LMHE among TCPs. UK-based TCPs (N=301) completed an online survey. Results found 39.9% identified as a mental health carer at some point in life (current for 21.2%; historical for 32.8%) with 38.5% acquiring mental health carer responsibilities before training, and 6.6% since training commenced. Additionally, 44.9% and 45.2% respectively reported experiencing a diagnosed or undiagnosed mental health problem at some point in life (current for 55.8%; historical for 63.6%). Moreover, 86.4% reported a mental health problem prior to training, and 11.2% since training started. TCPs are likely to experience a mental health problem or identify as a mental health carer at some point in their life either before or during their doctoral training. This is the first study to estimate point, period and lifetime prevalence of self-reported lived mental health experience among UK based TCPs. Although just an estimate, dissemination of prevalence rates to DClinPsy course staff and employing trusts may be useful to prompt development of supportive resources and adaptations for TCPS with LMHE. This may also facilitate normalisation of LMHE within this population and combat stigma.

Evaluation of a reflective practice group for social care managers

Registered Managers in care settings have complex and varied roles, including supporting the staff and those they serve in care homes and domiciliary services. A Department of Health white paper acknowledged that often registered managers do not receive adequate training and support to fulfil this vital role (Department of Health, 2012). In 2020 in response to the pressures of the covid pandemic the UK government set up 41 county-wide mental health hubs offering psychological support to health and social care staff. This hub offered co-produced bi-monthly training days for registered managers for a period of a year, of which a reflective practice group using the Heads and Hearts model was a key element (Kurtz, 2022; Kurtz, 2020). This model provides groups with structure and purpose in looking at the emotional impact of the work, and thinking through practice dilemmas, both in terms of client care and management of staff. Participants’ experiences of the group were explored using semi-structured interviews conducted by a trainee clinical psychologist and senior assistant psychologist in the service and was analysed using thematic analysis. Three superordinate themes were identified: Peer support and collaboration, reflexivity and thinking differently, and confidence in making changes. The frame of reflective practice, including the size and stability of the group, were identified as important factors in the participants’ experiences of the group. Suggestions for future research and practice are also discussed.

‘I’m really glad I did do it and that on balance the extra work was worth it’: A COM-B framework of final year trainees experiences of attaining secondary accreditation in Cognitive Behavioural Therapy on a clinical psychology programme in the UK

Clinical Psychology trainees undertaking the specialised Cognitive Behavioural Therapy (CBT) pathway develop robust CBT competencies and gain secondary accreditation with the British Association for Cognitive and Behavioural Psychotherapy upon qualification from doctoral training. This paper outlines final year trainees’ reflections on their experience of undertaking the pathway. A COM-B model of behaviour change was adopted to consider the process of implementation and avenues for development. Overall, trainees reported being pleased to have left the doctorate with well-honed competencies in CBT. The trainees reported varied opportunities to develop skills, a significant increase in their capability, referred to multiple forms of intrinsic and extrinsic motivations and reported commitment to sustainable behaviour change. Issues relating to working with complexity and across the lifespan were highlighted as areas for further consideration.

BEST FOR CAN – bringing empirically supported treatments to children and adolescents after child abuse and neglect: update to the study protocol

ABSTRACT Background: The implementation trial BESTFORCAN aims to evaluate the dissemination of Trauma-Focused Behavioural Therapy (TF-CBT) for children and adolescents in Germany with posttraumatic stress symptoms (PTSS) after child abuse and neglect (CAN) with a focus on supervision. Objective: This update to the study protocol outlines changes made due to practical reasons in the course of the ongoing trial while maintaining methodological quality. Method: The amendments to the original study protocol comprise (1) a more refined operationalisation of the primary outcome sufficiently adherent TF-CBT therapy (SATT), (2) changes in the study sites and (3) additional inclusion of one post-gradual psychotherapy training institute. Discussion: The adaptions to the original study protocol ensured high methodological quality through the transparent presentation of protocol modification: ensuring the recruitment of participating psychotherapists in training by including a further post-gradual training institute as well as an adaption of the measurement of SATT with high external validity. The objectives, diagnostic set, and secondary outcomes remained unimpaired by the amendment. Therefore, we expect the trial to provide evidence for the effect of model-specific trauma-focused supervision on the implementation outcomes of TF-CBT as compared to supervision as usual. Trial registration: German Clinical Trials Register identifier: DRKS00020516..

Trainee tips for conducting a clinical trial during the Clinical Psychology Doctorate

The research component of doctoral training in clinical psychology can evoke a range of emotions, from excitement to apprehension, often influenced by prior experience and the nature of the research undertaken. This article shares reflections on conducting a feasibility randomised controlled trial (RCT) as part of a clinical psychology thesis, offering practical advice to ease the process for trainee clinical psychologists considering a clinical trial for their doctoral research. Key insights include the importance of selecting experienced supervisors, starting early, deciding between a feasibility or full-scale trial, determining recruitment sources, staying organised, building positive relationships with researchers and participants, and choosing a topic of genuine interest. Conducting a clinical trial during clinical psychology training, despite its challenges, can provide invaluable experience and skills, fostering a deeper understanding of clinical research methodologies and their practical applications.

Acceptability, feasibility, and preliminary evaluation of an animated VR game for reducing mental health stigma in health-care students and trainees: a mixed-method study

PurposeThis study aims to pilot-test the acceptability, feasibility, preliminary efficacy and user experience of an animated virtual reality (VR) game (“Goliath: Playing with Reality”) aimed at reducing stigma related to psychosis and schizophrenia among health-care students and trainees.Design/methodology/approachA mixed-methods design was used. Sixteen trainee clinical psychologists with experience working with service users with psychosis/schizophrenia engaged with the VR game using a headset and controllers, and completed measures before and after. Quantitative measures assessing intervention acceptability, appropriateness and feasibility were collected and analysed descriptively. These were complemented by qualitative feedback on user experience, analysed through content analysis. Pre- and post-intervention mental health stigma-related measures were also collected and analysed inferentially.FindingsMost participants found the VR game acceptable, appropriate and feasible for reducing mental health stigma. Although there were no significant changes in stigma-related measures, participants were impressed by the immersive storytelling and the symbolic portrayal of psychosis. Participants also valued the educational aspect, empathised with people living with psychosis/schizophrenia and experienced a range of emotional reactions. However, participants noted usability concerns, and suggestions for improvement were made.Originality/valueThis is one of the first studies to show the potential of “Goliath: Playing with Reality” as a mental health educational intervention for health-care students and trainees. Drawing on narrative theory and immersive-interactive storytelling techniques, the VR game provides experiences that can foster narrative engagement and emotional connection, potentially enhancing its effectiveness in mental health stigma reduction efforts.

'It Is Good to See the Person As a Whole Person and… Continue to Improve Our Psychologically Informed Working': A Thematic Analysis of Clinical Psychology Trainee Placements in Homelessness Settings.

The National Framework for Inclusion Health identified the need for collaborative action between the NHS and third sector health to improve access and outcomes for Inclusion Health groups. Clinical psychology trainee placements in homelessness settings could be a valuable pathway to improving access to psychological support for people experiencing homelessness and the provision of clinical services, which is key to developing the workforceand a catalyst for the future recruitment of clinical psychologists in the third sector. A qualitative evaluation was conducted using semistructured interviews to explore the perspectives of clinical psychology trainees, supervisors, staff in homelessness settings and a peer mentor. Twenty-two participants were recruited from two universities and six services across the South East, including 11 clinical psychology trainees, six supervisors, four placement staffand one peer mentor. Placement staff described the value of a psychological approach but identified some challenges to be overcome. Induction was identified as the key to success. Supervisors recognised the breadth and depth added to trainees'knowledge and skills alongside significant challenges. Trainees valued the opportunities to work in homelessness settings and develop their understanding of the role. The peer mentor identified collaborative working as especially important. Clinical psychology trainee placements are a necessary programme to fulfil the NHS vision for Inclusion Health. These placements equip the health and social care workforce to create excellent and sustainable provisions to improve the physical and mental health of people experiencing homelessness whilst also providing much-needed psychological support for staff. Psychologically Informed Environments Through Staff Training: Staff training and support within these placements contribute to the development of psychologically informed environments. This not only leads to better outcomes for both staff and clients but also aligns with the objectives of the National Framework for Inclusion Health, fostering sustainable provision for the health needs of people experiencing homelessness (PEH). Enhanced Therapeutic Adaptability: Trainees gain invaluable experience in adapting therapy to meet the diverse needs of clients, benefiting both trainees and clients alike. This adaptability fosters more effective therapeutic relationships and contributes to the improvement of inclusion health provision in the long term. Tailored Therapy for Timely Intervention: Clinical psychology trainee placements in homelessness settings offer therapy that bypasses long waiting times for interventions, crucial for individuals experiencing homelessness. This flexible approach caters to the unpredictable engagement levels of PEH, ensuring timely support aligning with the Health and Care Act 2022 to improve overall health and address health disparities through primary care networks.

Tracking trainee development: preliminary validation of a tool designed to evaluate clinical psychology competencies over time

ABSTRACT Objective Competency-based assessment on placement ideally involves evaluation of a trainee performing clinical skills using fit-for-purpose tools that are simple for clinical supervisors to use and informative to the trainee. The current study examined the potential utility of a new tool, the Psychology Competency Evaluation Tool – Summative (PsyCET-S), designed to assess the attainment of professional competencies in clinical psychology trainees. Method Twelve experts tested the inter-rater reliability of the vignette ordering, before the tool was used to assess performance of clinical psychology trainees on placement by both supervisors and trainees. Ninety-nine placement reviews of 45 trainees at different stages of training were analysed. Results Strong inter-rater reliability in the rank ordering of vignettes within each domain indicated their ability to capture competence development. Supervisor and trainee ratings showed a gradual increase in competence from early to later stages of training in all domains, with performance plateauing for the final placement. Evidence of both the leniency bias and halo effect were evident, with supervisors appearing more lenient than the trainees themselves. Conclusion The PsyCET-S encourages supervisors to evaluate the development of professional competencies in their trainees in a way that can optimise trainee learning and future practice as a Psychologist.

Clinical Psychologists’ Experiences of “Community Service” in South Africa: Community-Based Service Learning and Primary Healthcare

Many South African master’s degree programmes in Clinical Psychology integrate community psychology training modules into the first year (M1) of the coursework. Such modules often incorporate community-based service learning (CBSL) to equip trainees for work in primary healthcare settings. After completing their M1 year, trainees complete a year’s internship (M2) in a psychiatric setting, followed by a mandatory third year of “community service”, before being able to register for independent practice. This raises questions about the preparation of trainees for this additional year, including its links with CBSL and the provision of primary healthcare. The aim of this study was to investigate the clinical psychologists’ experiences of and settings for community service, and resonances with and contrasts to CBSL. The data were collected through an online survey accessing reflections of trainee clinical psychologists from five South African universities (n = 12), who had recently completed, or were currently completing, their community service. The data were analysed by template analysis. The resonances in the findings seem to be linked to the trainees’ relational and attitudinal skills and concepts related to community psychology, refined and applied during their M1 year. The contrasts in the themes illustrate the predominance of traditional clinical placements during community service, with their associated demands linked to dominant clinical practice. In conclusion, this study indicates that community service settings for clinical psychologists are seldom well linked to primary healthcare or based in community settings. Recommendations are made for CBSL in the M1 year and for expanding the settings of community service more widely into primary healthcare.

'School-based screen-and-treat': An effective blueprint for expediating access to care in children experiencing PTSD following disasters.

While 5%-10% of children exposed to natural disasters develop PTSD, few children access support. This paper reports on the proactive 'screen-and-treat' approach deployed following devastating floods in Queensland, Australia, in 2011 and presents results for children in the Lockyer Valley (the most impacted community). Open treatment study (2011-2012) within a government-funded post-disaster service response. One hundred and fifty children (7-12 years) completed pencil-and-paper screening (PTSD, anxiety and depression) at school. Eighty children endorsing either clinical levels of PTSD, or moderate levels of PTSD and clinical levels of either anxiety or depression, and their parents, completed a structured diagnostic interview. Forty-eight children were offered a free trauma-focused CBT intervention. The parents of 19 children accepted this offer. Most clinicians were clinical psychology trainees from local universities. All measures were repeated at post-treatment, 6- and 12-month follow-up. Note: The term 'parents' is used to refer to the wide variety of people serving as a child's primary caregiver. Pre-treatment, all children met diagnostic criteria for full (N = 17) or sub-clinical PTSD. By post-treatment, 10.5% met criteria for PTSD, with 0% meeting criteria at the 12-month follow-up. The incidence of anxiety and depressive disorders also reduced significantly. There were no differences in outcomes for children seen by trainees compared to experienced clinicians. A school-based screen-and-treat approach offers potential as a means of identifying and treating children following natural disaster exposure. However, engagement of families at the outset, and when offering intervention was challenging. Postgraduate trainees represent an effective potential workforce in a post-disaster environment.

Case Conceptualization in Clinical Practice and Training.

Case conceptualization is central to the success of the therapeutic process. However, integrative case conceptualization research has lagged behind research on integrating therapeutic intervention techniques. A successful case conceptualization provides (a) a dynamic, context-sensitive, yet parsimonious model of the client's functioning; (b) relevant treatment targets and associated assessment procedures; and (c) a treatment plan including intervention phases and potential obstacles. Success in case conceptualization is a core clinical competency goal for trainees in clinical psychology and a career-long learning goal even for expert clinicians. Emerging technological trends and the formation of adversarial collaborative teams may assist research on the utility of well-constructed case conceptualizations.

Online psychotherapy as a first clinical experience during the Covid-19 pandemic: A new generation of psychotherapists in the digital age

The temporary closure of the Outpatient Psychotherapy Clinic at the Sigmund Freud Private University in Vienna during the Covid-19 pandemic demanded an immediate and unexpected reaction to assure further psychotherapeutic services. Both psychotherapists and patients were forced into a rapid transition to online psychotherapy. While Covid-19 research has comprehensively described challenges of online psychotherapies, we were interested in learning specifically how early stage psychotherapists-in-training, who started their clinical work with patients exclusively in the online setting, experienced this unprecedented clinical situation.Sixteen in-depth interviews were conducted with psychotherapists in training. The data were analyzed using a thematic analysis. The analysis revealed how psychotherapists in training were able to cultivate a set of early-training resources and competencies in the online therapy setting without evidence-based guidelines from supervisors and the institution. This study highlighted the necessity of incorporating specific and novel educational input that is necessary for achieving specific online skills in the early training phase. Recognizing that the therapeutic landscape has undergone an irreversible transformation, the data suggest that distinct techniques are necessary to equip early-training psychotherapists for the now commonly practiced alternation between online setting and in-person setting in psychotherapeutic processes.

Straddling two homes: Our evolving identities as first-generation migrant clinical psychology trainees in the UK

PHOTO CREDIT: Paul BuliaThis article draws on the experiences of clinical psychology training in the United Kingdom as discussed by three trainee clinical psychologists who identify as first-generation migrants. We reflect on the difficulties that accompany migration in the context of the Doctorate of Clinical Psychology (DClinPsy) and offer recommendations for aspiring clinical psychologists, fellow trainees, training courses, colleagues, and supervisors.

Exploring subgroups of acceptance prediction for e-mental health among psychotherapists-in-training: a latent class analysis.

Research of E-Mental Health (EMH) interventions remains a much-studied topic, as does its acceptance in different professional groups as psychotherapists-in-training (PiT). Acceptance among clinicians may vary and depend on several factors, including the characteristics of different EMH services and applications. Therefore, the aims of this study were to investigate the factors that predict acceptance of EMH among a sample of PiT using a latent class analysis. The study will 1) determine how many acceptance prediction classes can be distinguished and 2) describe classes and differences between classes based on their characteristics. A secondary analysis of a cross-sectional online survey was conducted. N = 216 PiT (88.4% female) participated. In the study, participants were asked to rate their acceptance of EMH, as operationalized by the Unified Theory of Acceptance and Use of Technology (UTAUT) model, along with its predictors, perceived barriers, perceived advantages and additional facilitators. Indicator variables for the LCA were eight items measuring the UTAUT-predictors. Best model fit emerged for a two-class solution; the first class showed high levels on all UTAUT-predictors, the second class revealed moderate levels on the UTAUT-predictors. This study was able to show that two classes of individuals can be identified based on the UTAUT-predictors. Differences between the classes regarding Performance Expectancy and Effort Expectancy were found. Interestingly, the two classes differed in theoretical orientation but not in age or gender. Latent class analysis could help to identify subgroups and possible starting points to foster acceptance of EMH.

Discrimination-Sensitive Psychotherapy: How High Is The Privilege Awareness Among Psychotherapists?

Discrimination can have a negative impact on mental health and thus can play a crucial role in the context of psychotherapy. This paper outlines the potentials and the relevance of an (intersectional) privilege awareness of psychotherapists for a discrimination-sensitive psychotherapy. The aim of this study was to assess the privilege awareness of psychotherapists in Germany for the first time as well as its thematization in the training of psychotherapists. In addition, the connection between belonging to a marginalized group and the privilege awareness was investigated. 270 psychotherapists (in training) based in Germany participated in an online survey (2022). Privilege awareness was assessed with an adapted version of the Awareness of Privilege and Oppression Scale-2, translated into German, regarding the following axes of discrimination: heterosexism, classism, and racism. Three self-written items additionally surveyed the thematization of discrimination and privilege in psychotherapy training. The relationship between belonging to a marginalized group and privilege awareness was examined using linear regression analysis. Nearly 65% (N=270) of participants felt unprepared or somewhat unprepared to deal with patients' experiences of discrimination, with approximately 40% (N=270) indicating that discrimination was not addressed in training. Privilege was addressed much less frequently. Belonging to a marginalized group was associated with higher privilege awareness (B=0,47, 95%-confidence interval: 0,27-0,67, F(2, 267)=15,41, p<0,001). There is a need to include the impact of discrimination and privilege on mental health and the therapeutic relationship as an integral part of psychotherapy training to enhance its quality as well as the quality of future psychotherapies.

Feeling the Joy of Life in the Body

The article aims to present how Bioenergetic Analysis exercises can be applied in a playful way in Child Psychotherapy. There are specificities in handling body work with children, which are: a) the understanding that patients are still in the process of ego development; b) plasticity of armor formation in this phase; c) the intention to strengthen more adaptive defense systems. As an initial theoretical review, the pioneering initiatives of body psychotherapies on child clinical psychology are discussed and a proposal for the use of bioenergetic exercises is launched, following the assumptions for the energetic mobilization of the armor rings in children, in the bottom-up sense. Finally, this article justifies the importance of training psychotherapists for specific care with children as a way of promoting health and rescuing Reich’s intention to prevent neuroses.