Clinical Psychology Trainees Research Articles

Workforce challenges in digital health implementation: How are clinical psychology training programmes developing digital competences?

ObjectivesDigital practice in psychological services is a rapidly expanding and innovative area which is supporting continuation of clinical provision during the COVID-19 pandemic. Training the workforce to deliver safe and effective online psychological provision is key to service success and relies on accurate mapping of competences and current training needs. This paper discusses the initial stage for developing the first digital mental health competence framework for applied psychology in the UK. It reports on the digital training currently provided nationally and barriers/facilitators to acquiring these competencies.MethodsEighteen of the thirty UK Clinical Psychology Doctoral training programmes completed a 16-item survey. This mapped current digital health teaching and skills acquisition for trainee Clinical Psychologists throughout their 3-year pre-registration training. Furthermore, potential barriers and facilitators to developing these digital skills for both trainee and qualified Clinical Psychologists were investigated.ResultsThe quantitative analysis highlighted the majority of respondents viewed developing digital mental health competencies with importance, but were not integrating this into teaching or clinical placements activity. The qualitative, inductive content analysis revealed seven key themes influencing the development of digital mental health skills, with the majority of respondents identifying with two themes; the need for practice guidelines (50% of respondents) and opportunities for digital mental health experience.ConclusionsThe findings suggest the need for a greater focus on developing the digital health knowledge, skills, and confidence across trainee and qualified Clinical Psychologists. Strategic analysis indicated the need to develop a framework for digital mental health competences across the curriculum and placement experience. Easily accessible learning packages may support the implementation of training nationally.

Workplace bullying from the perspectives of trainee clinical psychologists

Purpose Research has identified that workplace bullying is a significant problem within health care, with health-care trainees at particular risk. The purpose of this study is to explore the experiences of workplace bullying from the perspectives of trainee clinical psychologists. Design/methodology/approach A total of 14 trainee clinical psychologists recruited from British universities participated in semi-structured telephone interviews. Qualitative data was analysed using thematic analysis. Findings The analysis generated four main themes: workplace bullying “activating threat responses”, the process of trainee clinical psychologists “making sense of bullying”, “difficulties navigating power within the system” when experiencing and reporting bullying and “finding safety and support” within and outside of work contexts. Originality/value To the best of the authors’ knowledge, this is the first known study of workplace bullying specifically within clinical psychology. The research has implications for guidance for training institutions and professional bodies associated with trainee mental health professionals.

Inter-professional education in a child mental health-care context: children’s nursing and clinical psychology students learning together

PurposePrevious research has explored inter-professional education (IPE) in mental health contexts, for example, between mental health nurses and clinical psychologists (CPs). However, little research has explored IPE with children’s nurses (CNs) and CPs, who often work together in a range of in-patient and community mental health settings. Indeed, a significant proportion of CNs’ work involves identifying and responding to the mental health needs of children, young people and families; equally, CPs work directly into child teams, and their consultancy work requires awareness of other professional roles. However, knowledge and understanding of roles, and true collaborative working, appears to be limited. This study aimed to address these limitations.Design/methodology/approachA project was designed to bring together these two groups in an educational context, to explore ways in which collaborative working may enable effective mental health-care delivery. A total of 17 children’s nursing students and 15 clinical psychology trainees participated in a 3-day workshop, including experiential and clinical vignette work. Workshops were evaluated at three time points, using a questionnaire.FindingsThe workshops were effective in improving knowledge, skills and understanding of roles. Teamwork and discussions were helpful in modifying attitudes and perceptions. However, “defensiveness” was an important theme, demonstrating somewhat fixed beliefs about roles in relation to child mental health care.Originality/valueFew studies have explored IPE in child mental health contexts, especially in the pre-qualification arena.

Experiences of psychotherapists working with refugees in Germany: a qualitative study

BackgroundDespite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group. Although substantial efforts in understanding the complexity of cross-cultural psychotherapy – which in the context of this study we use to refer to therapy with client and therapist of different cultural backgrounds – have been made, there remains a dearth of research exploring barriers for effective cross-cultural psychotherapy. This study aimed at narrowing this gap in knowledge by exploring major challenges encountered by psychotherapists in cross-cultural psychotherapy and strategies which have proven useful in overcoming such challenges.MethodsWe employed a qualitative study design, conducting semi-structured in-depth interviews with 10 purposely selected psychotherapists working with refugees in Germany. Respondents were from varying theoretical background and had varying levels of experience. Data were analyzed using a thematic approach, following a mix of deductive and inductive coding.ResultsRespondents reported three main challenges in their cross-cultural practice: different or unrealistic expectations of clients towards what psychotherapy would offer them; challenges grounded in different illness explanatory models; and communication challenges. In dealing with these challenges, respondents recommended psychoeducation to overcome issues related to problematic expectations towards psychotherapy; “imagining the real”, identifying “counter magic” and other client-appropriate resources to deal with issues related to clients’ foreign illness attributions; and translators in dealing with communication barriers, though the latter not univocally.ConclusionsResults show that psychotherapy with refugees can be very successful, at least from the psychotherapist perspective, but also poses significant challenges. Our findings underline the importance of developing, testing, and institutionalizing structured and structural approaches to training psychotherapists in cross-cultural therapy at scale, to accommodate the rising mental health care need of refugees as a client group.

Development and validation of the trainee rated impact of involvement index (TRIple-I) in clinical psychology training

PurposePrevious research suggests that service user and carer involvement (SUCI) in clinical psychology training may have an impact. The purpose of this study was to develop a validated questionnaire to enable trainee clinical psychologists to rate this.Design/methodology/approachA collaborative project was carried out with service users and carers and trainee clinical psychologists. The principles of questionnaire design were followed. The authors developed and validated a trainee self-report questionnaire, based on focus groups and relevant literature indicating potential impacts of involvement on practice. A draft 60-item version was piloted with 15 trainee clinical psychologists. Then, 133 trainees from 22 UK clinical psychology courses completed it (estimated response rate of 13.2%). The sample was representative of UK trainees in gender and ethnicity, but slightly older.FindingsThe principal component analysis produced a 36-item questionnaire with four factors: human communication, carer perspectives, empathy and challenging/changing. The questionnaire showed good internal consistency and test-retest reliability. Stakeholder consultation suggested face and content validity and there was some indication of construct validity.Originality/valueThe project has resulted in a usable co-produced questionnaire, which is now available to clinical psychology courses to assess the self-reported impact of SUCI in training, and which may also be used in future research.

Attitudes towards CBT in trainee clinical psychologists

PurposeThis paper aims to address how one Doctorate in Clinical Psychology (DClinPsy) programme contributes to the shaping of attitudes of its trainee clinical psychologists (TCPs) towards cognitive behavioural therapy (CBT).Design/methodology/approachA total of 28 TCPs completed an online, mixed-methods questionnaire relating to their attitudes towards CBT, what factors had influenced their attitude and how competent they felt in applying CBT to clinical practice.FindingsThe majority of respondents reported a positive attitude towards CBT. There was a statistically significant positive change at an individual level in TCPs’ views of CBT between the point at which they applied for the DClinPsy and the present day. Thematic analysis of qualitative data identified influential factors on the development of TCP attitudes towards CBT. The vast majority of TCPs reported that they felt competent applying CBT in their clinical practice.Research limitations/implicationsOverall, the DClinPsy has a positive effect on TCPs’ attitudes towards CBT. However, the influence of placements has a more mixed effect on attitudes. A small sample size reduced the reliability of these conclusions. Recommendations for further evaluation have been made.Originality/valueThis paper evaluates the effect of a DClinPsy programme on TCPs’ attitudes towards CBT. The value is that it establishes which components of the course have different effects on trainee attitudes.

Reflections from a Mindfulness Based Cognitive Therapy (MBCT) group in a Recovery College setting: Working across primary and secondary care

The article describes an innovative and flexible approach to running a mindfulness group, open to primary and secondary care services. The group was run by a clinical psychologist and a trainee clinical psychologist, reflections on the process and outcomes are provided.

349 - Cognitive-Behavioral Therapy for Caregiving Relatives of People with Dementia: Three-Year Follow-Up of a Randomized Controlled Trial

Background:Even if cognitive-behavioral therapy (CBT) for caregiving relatives of people with dementia (PwD) has been found to be effective across various outcome measures, investigations into the long-term effects of these interventions remain scarce. Therefore, the purpose of the present study was the evaluation of a CBT intervention for caregiving relatives of PwD three years after intervention onset.Method:273 caregivers were randomly assigned to receive the intervention (IG) or usual care (CG). IG participants received over 6 month twelve 50-min sessions of individual CBT by trained psychotherapists. Symptoms of depression (CES-D), physical health symptoms (GBB-24), challenging behavior (BEHAVE-AD), quality of life (WHOQOL-BREF), utilization of psychosocial resources (RES), burden of care, coping with the care situation, and emotional well-being (visual analogue scales) were assessed three years after baseline. Data were analyzed using generalized ANCOVA.Results:164 participants (IG: n = 83, CG: n = 81; 60% of the baseline sample) participated in the three-year follow-up. Based on changes in the caregiving situation at three-year follow-up, we divided the sample into three subgroups: “still caring at home” (n = 52), “nursing home placement of the care recipient” (n = 29), “bereaved caregivers” (n = 83). Positive effects were found in the subgroup of caregivers “still caring at home” (on burden of care, coping with challenging behavior, social relationships QoL-domain) and “bereaved caregivers” (on overall QoL and physical health QoL-domain) compared to the CG. However, IG participants who decided for “nursing home placement of the care recipient” had poorer outcomes on a few measures (overall QoL, psychological health, emotional well-being, utilization of resources related to well-being).Discussion:It is impressive that CBT for caregiving relatives yielded positive effects in caregivers still caring at home and bereaved caregivers investigating long-term effects three years after baseline. Many challenges arise over the course of the different caregiving trajectories with changes in the caregiving situation being probably particularly influential. We will provide some ideas on how effects could be further sustained and discuss the need for further investigating the impact of changes in the caregiving situation.

Drivers and Self Ego States in Social Cognitive TA: a research on drivers as protective strategies

The work presents a synthesis of a set of studies of a correlational research conducted by Scilligo and co-workers on drivers and their relationship with the developmental Self-integration. Drivers are examined in the light of their historical development in TA. A definition is adopted that sees the drivers as normative protective strategies that can acquire dysfunctional connotations both when they are absent and when they are present in a rigid and “out of context” way. Self-integration is defined in term of self-perception of Self Ego state according to Social Cognitive TA. Subjects (N= 700) were adults, mostly university students and trainees in clinical psychology. The five drivers (Hurry Up, Please Me, Try Hard, Be Strong, Be Perfect) were measured with the Espero self-report questionnaire (Scilligo, 2005) and Self Ego States were measured with the Anint self-report questionnaire based on SASB (Benjamin, 1974, 2000; Scilligo & Benjamin, 1993, Scilligo 2005) by which 12 prototypical Ego states are operationally defined according to SCTA (Scilligo, 2009; De Luca e Tosi, 2011). Different studies were conducted for men and women, concerning Ego states for three levels of each of the five drivers. Results show, for all the drivers, that an average level of the driver is related with Self Ego State profiles indicating good integration both for men and women. High level of the driver is related with less integration of Self, except for Be Strong and Be Perfect in men, which result is associated to a functional profile of Ego states. Low level of the drivers is related to less integration of Ego states except for Be Strong in women, and for Hurry Up both for men and women. Results support the hypothesis of a non-linear relationship between drivers and Self-integration, with better levels of integration in subjects with average levels of drivers.

The treatment of young-onset dementia within older people’s services: Reflections of a trainee clinical psychologist

This paper presents reflections upon working with individuals diagnosed with young-onset dementia in the context of older people’s services. Paul Gilbert’s compassion-focused therapy is proposed as a useful approach towards improving service provision for these individuals and their unique needs.

“I’m Like A Chameleon”: An Exploration of the Experiences of Mexican American Women Who Are Group Psychotherapists-in-Training

ABSTRACT The purpose of this study was to explore the tasks, challenges, and perspectives of group-therapy leadership among Mexican American women who are psychotherapists-in-training. The literature regarding counselor and psychotherapist development suggests that culture and gender interact and shape group leadership, along with the group leader’s effectiveness, behavior, and style. This study sought to answer the following research questions: (1) What are the experiences of group leadership of Mexican American women who are psychotherapists-in-training (PITs)? (2) What tasks and challenges do Mexican American women PITs encounter as group psychotherapy leaders? Results suggest that Mexican American women group PITs encounter obstacles to group leadership associated with their cultural and professional identities. However, consistent with Anzaldúa's borderlands theory, the Mexican American women group PITs in this study straddle two cultures and competing demands while also turning obstacles into sources of empowerment and strength. Implications for training and supervision of Mexican American women group PITs are discussed.

Addressing the unmet needs of BAME trainees through a system of mentoring

This article discusses the unmet needs of BAME clinical psychology trainees in the UK. Mentoring is offered as a possible strategy aimed at providing BAME trainees with a safe space to explore their personal and professional identity.

Film as an educational tool to train psychotherapists.

Starting with Freud who wrote about Dostoyevsky, Michelangelo, and da Vinci, therapists have acknowledged that the humanities and arts contain great sources of insight into human nature. In this paper, I argue for the need to incorporate insights acquired by artists into the training of psychotherapists. Specifically, I present and describe a graduate-level seminar I teach that uses cinema as a tool to train mental health practitioners. Films are used to expose students to a range of universal human issues; we discuss film characters' conflicts, motivations, sources of suffering, and attempts to cope. Further efforts should be devoted to search for ways to use art to inform and enrich the practice, training, and teaching of psychotherapDirected by Robert Redford and produced in the United Statesy.

Metacognitive Therapy versus Cognitive Behaviour Therapy in Adults with Major Depression: A Parallel Single-Blind Randomised Trial

In the last forty years therapy outcomes for depression have remained the same with approximately 50% of patients responding to treatments. Advances are urgently required. We hypothesised that a recent treatment, metacognitive therapy (MCT), might be more effective, by targeting mental control processes that directly contribute to depression. We assessed the clinical efficacy of MCT compared to current best psychotherapy practice, CBT, in adults with major depressive disorder. A parallel randomized single-blind trial was conducted in a primary care outpatient setting. This trial is registered with the ISCRTN registry, number ISRCTN82799488. In total 174 adults aged 18 years or older meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for major depressive disorder were eligible and consented to take part. 85 were randomly allocated to MCT and 89 to CBT. Randomisation was performed independently following pre-treatment assessment and was stratified for severity of depression (low < 20 vs high > =20) on the Hamilton Depression Rating Scale (HDRS) and on sex (male/female). Assessors and trial statisticians were blind to treatment allocation. Each treatment arm consisted of up to 24 sessions of up to 60 minutes each, delivered by trained clinical psychologists. The co-primary outcome measures were assessor rated symptom severity on the HDRS and self-reported symptom severity on the Beck Depression Inventory II (BDI-II) at post treatment. Secondary outcomes were scores six months post treatment on these measures and a range of symptom and mechanism variables. A key trial design feature was that each treatment was implemented to maximize individual patient benefit; hence time under therapy and number of sessions delivered could vary. Treated groups in the trial were very similar on most baseline characteristics. Data were analyzed on the basis of intention to treat (ITT). No differences were found on the HDRS at post treatment or follow-up (−0.95 [−2.88 to 0.98], p = 0.336; and −1.61 [−3.65 to 0.43], p = 0.122), but floor effects on this outcome were high. However, a significant difference favouring MCT was found on the BDI-II at post treatment (−5.49 [95% CI −8.90 to −2.08], p = 0.002), which was maintained at six-month follow-up (−4.64 [−8.21 to −1.06], p = 0.011). Following MCT 74% of patients compared with 52% in CBT met formal criteria for recovery on the BDI-II at post treatment (odds-ratio=2.42 [1.20 to 4.92], p = 0.014). At follow-up the proportions were 74% compared to 56% recovery (odds-ratio=2.19 [1.05 to 4.54], p = 0.036). Significant differences favouring MCT, also maintained over time, were observed for most secondary outcomes. The results were robust against controlling for time under therapy and when outcomes were assessed at a common 90 day mid-term time-point. Limitations of the study include the use of only two therapists where one treated 69% of patients, possible allegiance effects as the study was conducted in an established CBT clinic and the chief investigator is the originator of MCT and group differences in time under therapy. Never the less evidence from this study suggests that MCT had considerable beneficial effects in treating depression that may exceed CBT.

Learning to “live upside down”: Experiencing the true and false self in psychotherapy training

The emergence of the true self is often a significant part of training to become a psychotherapist. Yet the challenge this presents, particularly in relation to the movement between a true and false self has been largely unacknowledged. This study aimed to explore UK trainee psychotherapists’ first-hand experiences of this, to understand how the phenomenon is experienced, and to explore the impact on trainees’ development. Qualitative semi-structured interviews were conducted with five trainee integrative psychotherapists who identified with this struggle. Interpretative phenomenological analysis illuminated two superordinate themes: The tensions of psychotherapy training and “dropping the shackles”: The journey to self-acceptance. Findings highlight the many challenges of the psychotherapy trainee, illustrating how a conflicting need to be ‘true’ alongside an impossible prospect of letting go of adaptations induces shame and judgments. Findings also highlighted the liberating processes of letting go of old constraints, through a journey of self-acceptance and awareness.

Early phase child and adolescent psychiatry response after mass trauma: Lessons learned from the Easter Sunday attack in Sri Lanka.

Sri Lanka is a South-Asian nation with a multi-ethnic population. A 26-year-old armed conflict ended in 2009 and the relative stability over the last decade was unexpectedly disrupted by the Easter Sunday Bombings of Catholic Churches and luxury hotels in 2019. More than 250 were killed and most of the deaths were reported from the St. Sebastian's Church in Negombo in the District of Gampaha. This article describes how mental health services of the District of Gampaha, with a population of 2.3 million and only one child and adolescent psychiatrist responded to the psychological trauma in children. The child and adolescent psychiatry response to the mass trauma was a collaboration between health, educational and voluntary organisations. The psychological support was provided at affected villages, schools and hospital settings. Medical and non-medical personnel were able to refer affected children directly to the child and adolescent psychiatrist. Children who had developed psychological consequences of trauma were provided with evidence-based psychotherapies and psychopharmacology where necessary. In addition, health staff members and teachers were trained to provide psychological support and a booklet was prepared in the local language based on trauma-focused cognitive behaviour therapy. Psychoeducation about the psychological response to trauma was provided through electronic, printed and social media. The limited number of trained psychotherapists and experts in child mental health were a major barrier to implement effective management strategies. Due to the severe shortage of child mental health experts, practical low-cost methodologies were employed to provide an early response to trauma. Traditional ways of mental health service provision were modified to be implemented via non-experts.

Effects of the Mindful Self‐Compassion programme on clinical and health psychology trainees' well‐being: A pilot study

BackgroundClinical and health psychologists are often exposed to occupational hazards, such as burnout and compassion fatigue, which originate from emotional demands at work. Mindful Self‐Compassion (MSC) training has been demonstrated to be useful in increasing well‐being and enhancing mental health. Although the use of the MSC programme in educational contexts has been suggested, an evaluation of its efficacy as a method to improve the competencies of trainees in clinical psychology has yet to be performed.MethodsOur study used a sample of 61 adults (88.5% women) attending postgraduate courses in clinical and health psychology who participated in an 8‐week MSC programme. Their levels of self‐compassion, mindfulness, well‐being, anxiety and depression symptoms were assessed before and after the intervention. Based on the participants' adherence to the MSC programme, two groups were created, that is, high (n = 30) versus low (n = 31) adherence.ResultsThe participants in the high‐adherence group benefitted from the MSC programme because they increased their self‐compassion, mindfulness and psychological well‐being scores. The extent to which the participants reported to have been committed to the MSC practice was associated with changes in self‐compassion, mindfulness and psychological well‐being. Furthermore, the changes in self‐compassion were significantly correlated with changes in mindfulness and psychological well‐being.ConclusionThe MSC programme offers a promising way to develop professional competencies and enhance the well‐being of trainees in clinical psychology.

Clinical psychology trainees' self versus supervisor assessments of practitioner competencies

BackgroundAlthough accurate self‐assessment is essential for professional development, little is known about psychology trainees' abilities to self‐assess. The present study enhances our understanding of the influence of clinical psychology training on self‐assessment and competence development, by systematically examining self‐assessment capacity among postgraduate trainees vis‐a‐vis supervisors' assessments of trainee competence across multiple domains of competency.MethodsSelf‐ and supervisor‐assessment ratings were measured by the Clinical Psychology Practicum Competencies Rating Scale, which assessed trainees across global and specific psychology practitioner competencies. Assessments were in relation to trainees' end‐of‐placement evaluation, and included 35 trainee‐supervisor dyads.ResultsResults indicated that trainees are reasonably accurate in their self‐evaluations, although they tended to underrate their performance. Assessments by both trainees and supervisors suggest that functional competencies develop more slowly than foundational competencies. Clinical experience and reflective practice were unrelated to self‐assessment accuracy, although the use of observational techniques in supervision increased trainee and supervisor agreement concerning assessments.ConclusionsResults support the developmental model of competence attainment, offer preliminary support for the reliability of trainee self‐assessments, and demonstrate the importance of observation‐based supervision for fostering accurate self‐assessment.

The Importance of Mentoring Relationships Independent of Supervision for Clinical Psychology Trainees

The Importance of Mentoring Relationships Independent of Supervision for Clinical Psychology Trainees

Testing the effectiveness of a weight bias educational intervention among clinical psychology trainees

AbstractWeight bias is a neglected issue in the health professions, including mental health training programs. Even though mental health professionals exhibit many of the same weight biases that are seen at the societal level and among other health professionals, mental health programs rarely provide training on weight bias, weight diversity, or critical weight science. No study to date has tested the effectiveness of a weight bias reduction intervention in a mental health setting. The purpose of this study was to examine the efficacy of a weight bias seminar informed by the attribution‐value model of prejudice. Using a pretest‐posttest design, 45 clinical psychology trainees completed measures of weight controllability beliefs, anti‐fat attitudes, and attitudes toward fat clients 1 week before and 1 week after the weight bias seminar. After the weight bias seminar, participants reported weaker weight controllability beliefs, anti‐fat attitudes, and negative client attitudes. Furthermore, weight controllability beliefs mediated the effect of the weight bias seminar on participants’ general anti‐fat attitudes and client‐specific attitudes. Thus, this study identifies weight controllability beliefs as a potential mechanism underlying the efficacy of educational weight bias interventions in mental health training programs. Future weight bias educational interventions may benefit from application of the attribution‐value model of prejudice.