Psychotherapy Training Research Articles

Difficult to reach mentally ill people and their psychotherapeutic supply. Chances for psychotherapy training in reducing barriers to outpatient psychotherapy for hard-to-reach clients

ZusammenfassungDer vorliegende Artikel widmet sich der mangelnden ambulanten psychotherapeutischen Versorgung von hard to reach Klient:innen. Basierend auf einer systematischen Datenbankrecherche werden zentrale strukturelle und professionsspezifische Zugangsbarrieren zur ambulanten Psychotherapie aufgezeigt. Der Fokus soll jedoch nicht auf diesen liegen, sondern vielmehr auf den Möglichkeiten des Abbaus dieser durch eine sich verändernde Psychotherapieausbildung innerhalb Deutschlands und Österreichs. Es werden sechs zentrale Handlungsmöglichkeiten vorgestellt, die bei Berücksichtigung innerhalb der Psychotherapieausbildung zur Verringerung und zum Abbau der Zugangsbarrieren beitragen können und folglich ein Entgegentreten von systematischer Ungleichheit hinsichtlich Versorgungsrealitäten bedeuten.

How do counselling trainees describe group process and does this change over time?

AbstractPersonal development groups or “group processes” are used in most counselling and psychotherapy trainings, but little is understood about how trainees change in their experience and descriptions of them over time. This study collected qualitative surveys (N = 70) from two groups of master's students (N = 35), at the mid‐ and end point of their first year of counselling training, to find out whether their descriptions of group process changed. We used content analysis to study the most common words and phrases used by trainee counsellors to describe group process and to monitor how positive, neutral and negative their descriptions were over time. We found a significant difference in the vocabulary and the ratio of positive to negative descriptions of group process at the midpoint of term, depending on the group the trainees were assigned to, with a levelling out of vocabulary words and positive and negative descriptions over time, converging towards a 70%–80% positive point at the end of term. Our results indicate that process groups need time to develop trainees above a positive threshold, by balancing group bonding against an ability to challenge and learn from difference, because individuals and groups start at different points in relation to their readiness and capacity for personal development. Further research should explore facilitation and trainee variables, as well as the impact of process groups on students' well‐being, because, while most of our students positively described the process, an important minority of students described negative experiences that were unresolved at the end of the study.

Psychotherapy training via a task‐based assessment of the multicultural orientation framework: A pilot study

AbstractThis pilot study involved the development and initial testing of an applied Multicultural Orientation Performance Task (MCO‐PT) and coding system. The MCO‐PT was comprised of seven brief video simulations of cultural exchanges. Seventy‐four graduate students recorded responses and then completed measures of desirable responding and multicultural competence. Research assistants coded the videos on three dimensions: cultural humility, cultural opportunities and cultural comfort (ICCs 0.61–0.97). Exploratory factor analysis yielded three factors that corresponded with the MCO constructs (alphas 0.77–0.97). Cultural opportunities were positively correlated with multicultural competence, and none of the subscales were associated with social desirability.

The art and science behind socratic questioning and guided discovery: a research review

Socratic questioning is used to enhance the process of guided discovery in psychotherapy sessions. Objective: Socratic questioning and guided discovery are defined, and assorted clinical examples are provided. Methods: The limited research on the impact of Socratic questioning is reviewed and integrated with 30 + years of clinical experience. Results: The scant research suggests that Socratic questioning significantly reduces depression from one session to the next, particularly for patients with a pessimistic cognitive bias, but there is no research on patient improvements at the end of psychotherapy. Conclusion: Socratic questions and guided discovery can facilitate sensitivity to issues related to diversity and can be useful in psychotherapy training. The Socratic approach relies on an integration of the research evidence, ancient philosophy, and contemporary cognitive therapy.

Psychiatry residents’ perceptions of competence acquisition, training programe compliance and clinical supervision in the Spanish psychiatry training system

IntroductionThere are differences in the training curricula of medical specialists in different countries. The opinion of the doctors in training on how they acquire competencies and carry them out is of great importance. In our case, we asked ourselves what were the perceived shortcomings in psychiatric training.ObjectivesThe main objective of the study is to describe the opinion of psychiatry residents in Spain on the acquisition of competencies, compliance with the training programme and quality of clinical supervision.MethodsThis is a descriptive, cross-sectional, mixed (quantitative and qualitative) study. Based on previous bibliography and the ministerial order of the official training programme, an online survey was prepared, which was disseminated telematically through the residents’ representatives of the National Commission of the Speciality of Psychiatry of the National Council of Health Sciences Specialities.ResultsA total of 109 responses were obtained, with representation from all the Autonomous Communities of Spain. Graph I shows the opinion of the psychiatry residents as to which competencies they feel are less developed at present, with the competencies related to psychotherapy standing out in first place with great importance. In terms of compliance with the training programme, the parameter most in line with what was established was the average number of shifts, with an average of 4.26 shifts per month. However, 11.7% of residents do not take compensatory rest after on-call duty as required by law. Moreover, the rotation times established by the BOE are not complied with in 38.5% of the hospitals. With regard to the rotations that the residents feel should increase their rotation time, the child and adolescent psychiatry and dual pathology rotations stand out (graph II). Finally, with regard to the supervision process, only 22.90% of first-year residents are always supervised in person during their rotations (graph III).Image:Image 2:Image 3:ConclusionsOur study reflects the belief on the part of the resident physicians that further training in psychotherapy (45.7%), psychogeriatrics (10.6%) and dual pathology (8.5%) would be necessary. The fact that only 11.7% of the participants stated that they did not take compensatory rest after on-call duty seems to us to be an improvement over what was initially expected. There are other less reassuring data, such as the fact that only 22.9% of first-year residents report having continuous supervision. We consider that the results found follow the trends observed in studies carried out in residents from other countries. We stress the need to carry out a greater number of studies with a broad population base in which to find the failures that psychiatry residents themselves perceive in their training.Disclosure of InterestNone Declared

Relevance of Group Training for Psychiatrists: an Experiential-Strategic model.

IntroductionThere are many stressors that lead to burn out and decrease the quality of life of health professionals as a whole and it occurs also to trainee psychiatrists.Training programs rarely include specific interest in the personal self of students even if they begin to deal with severe human suffering.Authors present a model of experiential group training in psychiatry that is centred on the person/trainee at the very most.ObjectivesThe aim is to focus on unsolved emotional needs of students to allow them to achieve the capacity of relationship with patients. It is not a mere application of empathy but a truth overcoming, for trainees, of major risks of collusion due to reflection of individual conflicts into the patients and/or due to the encounter with strong emotion during clinical training.MethodsThe model is Experiential because it is the space for personal expression and it is Strategic because it is born inside the strategic group training in psychotherapy (Battuello et al. Psichiatria e Psicoterapia 2022; 41, 2, 65-82).The conductor of the group carries on her/his skin the experience of own training group, to be brought into the trainees’ one.This is an original approach because the epistemology of the model came directly from the experience.The group is led by a psychotherapist that plays an active part inside the process instead of being only a facilitator.The main focus is to allow students to express themselves that includes various steps such as: tuning with their own experiences/emotions, freedom of expressing them to the group, active listening to the other and response to the same other even when feelings don’t resonate but instead are divergent.This phase is related to the conductor’s participation that is totally immersed into the group bringing personal feelings, stories and emotions to create an undifferentiated space, free from hierarchical roles.During a second period, students can access a more mature relational capacity that carries the group to a phase of individuation of the self that also engages professional issues.ResultsStudents in the group question themselves: it is the root of every health professional that has to explore and overcome personal relational issues. Only after the expressiveness phase, as authors name this part of the training, an individuation phase is truly possible that leads to the definition of the professional.ConclusionsThe training group is necessary for students to explore the wider range of emotions, expressing personal ones, accepting others’, experiencing the tolerance to their frustration, and emerging as professional, that is, in few words, professional of the relationship, the key and the basement of the psychiatrist.The training in mental health should include, at first, the taking care of the person/student as it is proposed by authors inside the group model.Disclosure of InterestNone Declared

Oppression is not "culture": The need to center systemic and structural determinants to address anti-Black racism and racial trauma in psychotherapy.

Psychology, and the United States more broadly, finds itself at yet another reckoning point with White supremacy and anti-Black racism. The American Psychological Association has even recently apologized for psychology's role in upholding systemic racism and White supremacy, and articulated expectations for psychology's role in dismantling systemic racism and White supremacy throughout psychology. Yet, the norms of White supremacy pervade our professional and individual consciousness, resulting in our radical movements toward a "culturally responsive psychotherapy" seeking to adapt to, and ultimately becoming quashed by, the very oppressive systems it seeks to upend. In this article, I argue first that to address anti-Black racism and racial trauma in psychotherapy, it is imperative to move beyond notions of "culture" and "identity" to a structural competency model of psychotherapy and psychotherapy training. Structural competency and examples of its integration are briefly discussed. I then offer and expand upon two additional recommendations: That we must learn about and incorporate the incredible work of Black, Indigenous, and people of color scholars who have offered robust guidance in how to engage in healing racial trauma in individual and family psychotherapy; and, that to ethically engage in and develop an antiracist psychotherapy equipped to heal racial trauma, we must individually and collectively engage in our own conscientization and radical racial healing. Throughout, I emphasize the importance of prioritizing the work of scholars of color, whose work I seek here to integrate and build upon, but do so as a low socioeconomic status-origin, White woman with disabilities scholar situated at complex axes of both privilege and oppression. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Fighting for Psychotherapy by Psychiatrists: Join Us!

Fighting for Psychotherapy by Psychiatrists: Join Us!

Early detection and intervention of psychosis in children and adolescents in Zurich, Switzerland: Clinical Data from 2017-2022

IntroductionThe construct of a clinical high-risk (CHR) state of psychosis has been established to describe potentially prodromal symptoms which typically appear during adolescence and young adulthood. This is a very sensitive developmental period and the clinical high risk (CHR) is associated with increased functional impairment. To address the specialities in the care for this patient population a specialized outpatient care unit for early intervention in psychosis at the Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, of the University Zürich (CAPS) is established. The interdisciplinary team (psychiatrists and psychologists) supports children and adolescents with psychotic disorders or at clinical high risk for developing psychosis. The early intervention service offers specialized assessment, treatment and case management for minors with a first psychosis or CHR-state in an outpatient or inpatient setting as well as by day clinic care.ObjectivesThe evaluation main objective was to get a better understanding about this vulnerable patient group. Therefore we analysed the clinical data about CHR-state, comorbid diagnosis, treatment, medication and hospitalisation of the patients who entered the service for early intervention in psychosis.MethodsParticipants who entered the service for early intervention in psychosis were followed up in the years 2017-2021 and descriptive analysis was used to summarize the data. For the evaluation of the risk construct the participants have been classified in “no increased risk”, “CHR” or “early onset psychosis” (EOP). Additionally, ICD diagnosis, demographics and treatment (medication, psychotherapy, treatment setting) were assessed. Therapy was either psychotherapy and/or group training called DBT2P (Dialectical behavioral group training for adolescents, to prevent psychiatric disorders). Additionally, the use of a smartphone application “Robin Z”(add-on treatment tool to support the patients between the sessions) was assessed.ResultsIn the last five years we saw 300 patients (112 female, mean age 15.7) who sought the care unit for early intervention. The evaluation of the risk showed that 44 patients had no increased risk, 205 were classified with a CHR and 51 fulfilled the criteria of an early onset psychosis (18.5%). Most of the patients showed comorbid diagnosis, mainly depressive disorders (42%). The data about the treatment will be analyzed for the congress.ConclusionsDespite clinical implications, there is little data about early detection and early intervention in psychosis for children and adolescent. Therefore, the evaluation of the clinical data of the CAPS is of clinical importance and expected to add essential information in the fields of prevention and early intervention in psychosis.Disclosure of InterestNone Declared

Combining remote work and training: the experience of participating in the first Virtual EPA Gaining Experience Programme

AbstractEach year the European Psychiatric Association offers early career psychiatrists the opportunity to take part in the Gaining Experience programme, a scholarship that funds short observership placements (between 2 and 8 weeks) overseas in different psychiatric institutions across Europe to ECPs who have completed their psychiatric training. However, since COVID-19 was declared by the WHO as a worldwide emergency on 11th March 2020, it was no longer possible to provide offline overseas observerships. Therefore, the Gaining Experience programme changed its format in 2020-2021 and became virtual. It was in this context, that an Ukranian early career psychiatrist was going to participate in the virtual Gaining Experience programme at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London (United Kingdom) from December 2021. The observership placement had a particular academic focus, the essence of which was investigating psychotherapy training among ECPs in Ukraine, and to examine how it is included in psychiatry training. The sharing of this example of virtual observership shows that it is possible and feasible high-quality and affordable distance learning for ECPs. This training format can be useful not only during quarantine restrictions, but also in conditions of limited travel opportunities.Disclosure of InterestNone Declared

Psychedelics Legislation Gains Momentum

Psychedelics Legislation Gains Momentum

Mental Illness-Its Causes, Symptoms, Diagnosis, Treatment (Medical and Psychotherapy), Maintenance and Rehabilitation-A Treatment Program

Mental health is one area of medicine that is demonized, stigmatized, discriminated against, disrespected and poorly funded. It is time to treat mental health like all other branches of medicine. This review article addresses the problems of mental health care, how it should be done, and is needed to improve the care. The process of mental health care from intake to discharge at a clinic/hospital is explained. Arrangements that should be met with the patient before discharged from the clinic/hospital and programs are discussed. Pharmacotherapy, psychotherapy, and social skills training are explained in detail. Symptoms for most mental disorders are mentioned. Programs are presented that can be used for the rehabilitation of the mentally ill. It is emphasized that social skills training should include a cookery class that could be useful to the mentally ill patient when the social skills training is done and there is community re-entry. Educating the community about mental health is necessary to improve the treatment and respect of the mentally ill among community members. The assisted living program mentioned in this article can be modified as suggested and implemented on a global basis. The assisted living program is mentioned because it is unique in housing only mentally ill individuals. Life style changes are necessary for many individuals with mental disorders. It is suggested that such changes necessary can be achieved through social skills training and psychotherapy or religious indoctrination. There are also behavior cycles and change cycles that can be used. Menus are included in this review to ensure healthy eating and can be used in the psychiatric hospital/clinic and assisted living facilities. Cultural differences in the preparation of meals should be respected. The programs and services that are to be made available to individuals with mental disorders as mentioned in this review is recommended for use in all countries of the world-developed and .......

“That is just your stuff”: The potential use and abuse of congruence in counselling and psychotherapy practice and training

AbstractThis piece discusses the potential use and misuse of congruence within counselling training and practice. A definition of congruence is provided, and how deliberate misuse of congruence could result from two separate emotional communications (bullying and gaslighting) is discussed. Current representations and misrepresentations of congruence in counselling and psychotherapy have been highlighted. A new term of “Intentional Congruence Misuse” was coined to explain this position (not to be confused with incongruence). “Intentional Congruence Misuse” is the deliberate bullying of another individual using terms related to congruence. A discussion has been provided to emphasise the evident implications for counselling, psychotherapy practice and training. The author acknowledges that this opinion piece will be from a biased perspective. Still, it does not aim to detract from others who have found their therapy and counselling training beneficial.

A Psychoanalytic Institute's Response to Existential threats: A Case Study of Organizational Self-Inquiry and External Consultation.

The term institute is used inclusively here to refer to different organizational structures such as psychoanalytic societies and centers. Those organizations have primary tasks such as providing education and training in psychoanalysis and psychoanalytic psychotherapy. Existential threats covers a range of factors, both internal and external to an organization, that may seriously impair or destroy its capacity to carry out its primary tasks and to survive as a functioning entity. Perceptions and responses relating to those threats are dynamic processes within the organization that shift and evolve over time. This case study explores one institute's use of organizational self-inquiry and external consultation to strengthen its capacity to perceive, make meaning of, and respond adaptively to those threats. The qualitative research for this case study is based on a series of semistructured individual interviews with a representative sample of participants in the consultation, close attention to the intersubjective experiences of interviewees and interviewers, and careful thematic analysis of the interview data. Interviewees shared their understanding of what led up to the consultation, their experience of the consultation, and their perception of its immediate and ongoing impact. Many interviewees felt that the consultation helped strengthen the institute's organizational capacity for resilience and innovation, expressed the desire for additional consultation to ensure the institute's survival and ongoing health, recommended that the institute include the study of organizational dynamics in its curriculum, and thought it should develop its internal capacity for organizational self-inquiry.

Reflective practice and psychotherapy case experience of Specialty Doctors and Associate Specialists (SAS) working in psychiatry: UK-wide survey.

To survey nationwide opportunities for Balint-type and reflective support group participation and psychotherapy training among doctors classified as Specialty Doctors and Associate Specialists in psychiatry ('SAS psychiatrists') and the professional benefits and barriers to access. Approximately 9% of SAS psychiatrists responded, from all UK regions. A minority reported participating in a Balint-type group (27.3%) or reflective practice/support group (30.9%), and only 6.5% were not interested in participating. Although 44.8% planned to see a psychotherapy case, most reported barriers, particularly time constraints, job plans and lack of support. The 22.1% who reported already gaining psychotherapy case experience reported many benefits, including becoming a better listener (84.8%), more empathetic (81.2%), enjoying work more (78.8%) and overall becoming a better psychiatrist (90.9%). The reported interest in Balint group and psychotherapy training opportunities exceeded existing provision; psychotherapy case experience benefited professional development and self-reported clinical capabilities. Healthcare trusts and boards need to consider more actively supporting SAS psychotherapy training and reflective practice.

Withdrawal ruptures in adolescents with borderline personality disorder psychotherapy are marked by increased speech pauses-can minimal responses be automatically detected?

Alliance ruptures of the withdrawal type are prevalent in adolescents with borderline personality disorder (BPD). Longer speech pauses are negatively perceived by these patients. Safran and Muran's rupture model is promising but its application is very work intensive. This workload makes research costly and limits clinical usage. We hypothesised that pauses can be used to automatically detect one of the markers of the rupture model i.e. the minimal response marker. Additionally, the association of withdrawal ruptures with pauses was investigated. A total of 516 ruptures occurring in 242 psychotherapy sessions collected in 22 psychotherapies of adolescent patients with BPD and subthreshold BPD were investigated. Trained observers detected ruptures based on video and audio recordings. In contrast, pauses were automatically marked in the audio-recordings of the psychotherapy sessions and automatic speaker diarisation was used to determine the speaker-switching patterns in which the pauses occur. A random forest classifier detected time frames in which ruptures with the minimal response marker occurred based on the quantity of pauses. Performance was very good with an area under the ROC curve of 0.89. Pauses which were both preceded and followed by therapist speech were the most important predictors for minimal response ruptures. Research costs can be reduced by using machine learning techniques instead of manual rating for rupture detection. In combination with other video and audio derived features like movement analysis or automatic facial emotion detection, more complete rupture detection might be possible in the future. These innovative machine learning techniques help to narrow down the mechanisms of change of psychotherapy, here specifically of the therapeutic alliance. They might also be used to technologically augment psychotherapy training and supervision.

The effectiveness of short-term intensive psychodynamic therapy on emotional self-awareness, empathy and self-compassion in psychotherapy trainees

Background and Aim: Paying attention to the mental state of psychotherapy trainees plays an essential role in preparing students to enter the field of therapy. Therefore, this research was conducted with the aim of determining the effectiveness of short-term intensive psychodynamic therapy on emotional self-awareness, empathy and self-compassion in psychotherapy trainees. Methods: It was a semi-experimental research with a pre-test-post-test design with two experimental and control groups and a two-month follow-up. The statistical population of the research consisted of all the psychotherapist trainees in Tehran in 2021, who were selected by the available sampling method, 30 people and randomly replaced in two groups of 15 people. Data collection was done with emotional self-awareness questionnaire (Rifi et al., 2008), empathy questionnaire (Mehrabian and Epstein, 1972) and self-compassion questionnaire (Neff, 2003). For each of the experimental groups, an intervention program was held in the form of weekly meetings. In addition to descriptive statistics, data analysis was performed with mixed analysis of variance and Bonferroni's post hoc test. Results: The results showed that in the post-test period, between the mean scores of emotional self-awareness (p<0.01), empathy (p<0.01) and self-compassion (p<0.01) of the experimental group in the intervention sessions compared to the control group. Statistically, the difference is significant. The effectiveness of short-term intensive psychodynamic therapy was stable over time in the subjects of the experimental groups. Conclusion: Based on the results of the research, conducting psychological interventions for the preparation of psychotherapy trainees is very important and can be a basis for raising awareness and correctly applying these interventions in psychotherapy trainees.

Psychotherapy training in Turkey: Experience of early career psychiatrists

Psychotherapy training in Turkey: Experience of early career psychiatrists

Reliability of the Reflective Essay Marking Scale (REMS): a scale for marking of students’ reflective essays

Abstract Personal practice (PP) is widely practised and a requirement across major psychology and psychotherapy organizations and modalities. However, one of the challenges for training institutions is how to assess the quality of such PP. The Reflective Essay Marking Scale (REMS) was developed to improve standardization of marking reflective essays in cognitive behavioural psychotherapy (CBT) training. A small sample of 16 expert CBT participants recruited by email used the REMS to rate two mock reflective essays in a within-subjects design. The internal consistency of REMS was acceptable (Cronbach’s α=.73) with excellent inter-rater reliability. Across the raters, it sufficiently differentiated quality (t12=4.91; p<.0001). Although these are the results of a preliminary and very small study with a small sample using mock essays, the REMS may be a useful scale, allowing CBT courses to account for students’ reflective work in a standardized way. A larger validation study is required in the future. Key learning aims (1) To improve the thinking about what raters should focus on when rating the reflective essays of trainee therapists. (2) To describe the development of the scale and how its reliability was tested. (3) To improve the transparency and objectivity in assessing and rating reflective practice.

Effectiveness of positive psychotherapy training on thought control and emotional adjustment of 17-15-year-old female students recovered from the Corona Pandemic (Covid-19)

Background and Aim: The purpose of the present study is to determine the effectiveness of psychological education in positive mania on the control of thought and emotional adjustment of 15-17-year-old female students who have recovered from the first peak of the Corona Pandemic (Covid-19) in Zabul city. Methods: The present study was applied research with quasi-experimental type and pre-test, post-test with a control group. The statistical population was all secondary school female students of Zabul city, and using multi-stage cluster sampling method, 32 students recovered from the first peak of the corona pandemic were selected and divided into two experimental groups. (16 people) and the control group (16 people) were randomly selected. The pre-test was conducted in all groups and positive psychotherapy trainings were given to the experimental group. The post-test was conducted in all groups. In the pre-test and post-test Wells and Davis Thought Control Questionnaires (TCQ, Rabiot et al. 's emotional compatibility (EAM) were implemented. One-way univariate analysis of covariance and multivariate one-way analysis of covariance or Mancova test were used to analyze the data. Results: In general, the results of the data analysis showed that positive psychotherapy training did not affect the increase in thought control of 15-17-year-old female students who recovered from the first peak of the Corona pandemic. This training had an effect on the emotional adjustment of students. The emotional adjustment of subjects who were trained in positive psychotherapy was significantly improved compared to the control group. Conclusion: It can be concluded that positive psychotherapy can improve students' thought control and emotional adjustment, so it is suggested to use it in counseling and treatment.