Psychotherapy Training Research Articles

Gendered capital in psychotherapy: A thematic analysis of patients' experiences of the therapists' gender

Gendered capital in psychotherapy: A thematic analysis of patients' experiences of the therapists' gender

Models of practice and training in psychotherapy: cross-national perspectives from Italy and Canada.

Internationally, there is ongoing concern about accessibility to mental health care and training. The goal of this study was to explore commonalities and differences within models of clinical psychology and psychotherapy in Ontario, Canada, and Lombardia, Italy, respectively, to inform improvements to the accessibility of mental health care and training. Using key informant sampling, we recruited ten students and professionals in Italy and Canada who study or work in psychology for semi-structured interviews. We analyzed the interview content using an inductive approach for thematic analysis within countries and meta-theme analysis across countries. The findings indicated three cross-national meta-themes: the need to integrate evidence with practice, the limited accessibility of training for students and treatment for patients, and the importance of the quality of training programs. Despite some differences regarding the amount of scientific training, personal therapy for trainees, and the prominence of cultural diversity training, Canadian and Italian psychology professionals and students shared experiences of psychotherapy practice and clinical psychology training. The three cross-national meta-themes indicate which issues in training and practice may be relevant worldwide and where to focus resources. The findings can inform international collaborations regarding training model structures that may increase access to psychology training and may increase consensus on professional recognition standards to improve mobility for professionals. These changes could reduce barriers to mental healthcare services for patients.

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.

Connecting in a remote world: Psychotherapy & counselling students’ experiences of remote teaching and learning

ABSTRACT In 2017 Scholl et al. highlighted a growing trend towards online courses in Psychotherapy & Counselling training. With the emergence of the Coronavirus (COVID-19) pandemic, this growth has accelerated, with more training now taking place in an online setting. This study explored students’ experiences of remote learning on a Psychotherapy & Counselling training, with a particular focus on engagement and interaction in an online setting. A Thematic Analysis was carried out on the data and the central organising theme of Connection emerged. Three sub-themes were identified including, ‘Connection to Self’, ‘Connection to Others’ and ‘Connection to Lecturers’. Findings indicate that connection can be nurtured online through intentional and considered instruction. Findings also suggest that students miss the personal connections that face-to-face teaching affords with a preference for a blended approach to learning. The results are used to make specific recommendations for Counselling & Psychotherapy educators.

Engaging Minds: Toward Developing Psychoanalytic Candidates

ABSTRACT The future and vibrancy of psychoanalysis rests on increasing the accessibility to training for early career clinicians. By recognizing and addressing the numerous barriers to the immersive experience of psychoanalytic training, we can foster strong candidate groups. This paper recounts one institute’s process of creating multiple points of access and substantive mentorship for new clinicians, aiming to nurture involvement over time with institute members and its professional offerings. Valuing both individual developmental trajectories and attracting diverse applicants across disciplines while attending to the significant obstacles many potential trainees face, generated increased interest and matriculation in both psychotherapy and psychoanalytic training programs.

The > Uncommon < Factor in Psychotherapy and the Role of Negative Skills: Why and How Psychoanalysis Offers an Important Contribution for Mental Health Practice Today

Psychoanalysis brings some specific aspects of treatment technique to the field of mental health practice today, such as highlighting the dynamics within therapeutic relationship (especially regarding emotional and unconscious elements), the role of defense mechanisms etc. Moreover, by means of taking a particular therapeutic stance, psychoanalysis offers some shared mental space for patients. The present paper argues that this stance is characterized by the capacity to “not act”, that is: by passive receptivity. To view this as some specific “negative skill” in psychotherapy in general means to align common elements of effective psychotherapy with the capacity to explore the uncommon, unfamiliar or unforeseen in particular psychotherapeutic processes. The paper sketches how this can be employed in psychotherapy training as well as in psychotherapy integration.

Improved self‐ and relational regulation: The relationship with the client changes the therapist

AbstractObjectivesSeveral contemporary models of psychotherapy demand psychotherapists and counsellors to navigate an intensely personal involvement with clients. This study considers how this personal involvement impacts the clinician as a person.DesignWe interviewed practitioners about how working with clients in a one‐on‐one therapeutic setting changed them.MethodsA grounded theory analysis of interviews with behavioural and cognitive therapists (N = 14; 9 women, 5 men) was carried out.ResultsWorking with clients may improve practitioners' self‐regulation by generating a clearer view of themselves, providing strategies for effective living and facilitating self‐compassion. These changes are often either clinical work's unavoidable effects or gains from accidental exposure to clients' contents. Clinical work may also improve practitioners' relationships by demonstrating the value of and providing strategies for managing one's input in crucial relationships and non‐judgemental acceptance. Improved relational regulation often occurs as unavoidable learning or results from intentional emulation. Both self‐regulation and relational regulation may contribute to clinical competency. Professionals can also unintentionally reproduce client quirks and accidentally learn practical tips. Possible implications are discussed.ConclusionClients' influence on counsellors and psychotherapists deserves attention in psychotherapy research, training and supervision.

Challenges Faced by Family Caregivers of Patients with Spinal Cord Injury

Background: Spinal Cord Injury (SCI) presents significant challenges not only to the individuals directly affected but also to their family caregivers. The sudden onset of SCI demands immediate adaptation to new caregiving roles, inducing physical, financial, emotional, and psychological strains on caregivers. Understanding these dynamics is crucial for developing supportive interventions that can alleviate the burdens faced by caregivers and improve the quality of care for SCI individuals. Objective: This study aimed to explore the experiences of family caregivers of individuals with SCI, focusing on the challenges they face, the roles they assume, the strains encountered, and the coping strategies they employ. Methods: A qualitative exploratory study was conducted among family caregivers of individuals with SCI at the Punjab Institute of Neurosciences, Lahore. Purposive sampling was used to select participants who were engaged in caregiving for at least 10 hours per week. Data were collected through semi-structured interviews, utilizing a specifically designed interview question grid. Demographic data were analyzed using SPSS software, while thematic analysis of interview data was conducted using NVivo 12 software. The study adhered to ethical standards, including obtaining informed consent from all participants. Results: The study comprised an equal distribution of male and female participants, with a majority engaged in caregiving for nine to twelve hours per week. Four main themes emerged: the initial challenge of becoming a caregiver, the multifaceted roles of caregiving, the strains of caregiving, and the coping strategies adopted. Caregivers reported significant physical strain, financial burdens, emotional and psychological stress, and relied on a combination of spiritual beliefs, optimism, and social support to navigate their caregiving responsibilities. The study also highlighted the importance of psychotherapy and comprehensive caregiving training sessions for caregivers. Conclusion: Family caregivers of individuals with SCI face substantial challenges that impact their physical, financial, emotional, and psychological well-being. Supportive interventions, including psychotherapy, comprehensive training, and the establishment of support groups, are essential to aid caregivers in managing the complexities of their roles effectively. Further research is needed to quantify these challenges and evaluate the effectiveness of proposed interventions.

Process-focused psychotherapy training is evidence-based psychotherapy training: Commentary on Westra and Di Bartolomeo (2024).

Westra and Di Bartolomeo (2024) made a strong case for psychotherapy training to focus more on psychotherapy process rather than content (e.g., manuals). Their recommendations are consistent with the preponderance of the evidence that finds that psychotherapy process variables (and psychotherapist variables related to the process, such as empathy) account for most of the variance in psychotherapy outcomes. Despite the overwhelming evidence, the Great Psychotherapy Debate (Wampold & Imel, 2015) rages on. In this commentary, I emphasize and strive to extend Westra and Di Bartolomeo's recommendations. I describe how and when we might time the training of process monitoring to be most effective in the context of trainee development, and how such process monitoring may be useful both generally, as well as for cultural responsiveness. I begin, however, by addressing the substantial barriers we face in the integration of process-based training approaches given the prevailing avoidance of process. As the authors note, despite the proliferation of psychotherapy models and manuals, client outcomes have not improved in kind. If the field of psychotherapy is to make progress in helping to address the ongoing mental health crisis, it will necessitate that we finally heed the scientific evidence and orient our practice and our training (as Westra & Di Bartolomeo, 2024, recommend) to the process of psychotherapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The influence of deliberate practice on skill performance in therapeutic practice: A systematic review of early studies

Objective Deliberate practice (DP) is recommended as a new approach to facilitate the acquisition of discrete therapeutic skills, however, its implementation and effectiveness in psychotherapy remains unclear. Method A systematic search on DP for therapeutic skills among psychotherapy trainees and psychotherapists yielded eleven studies for inclusion. Nine were randomized controlled studies (RCTs), including seven unique RCTs, and two were within-group studies. Results Risk of bias was assessed as “high” for one RCT, “some concerns” for the remaining RCTs, and “serious” for within-group studies. All RCTs found the DP group performed better than the control group. All studies involved efforts to improve performance based on learning objectives and iterative practice but varied in the source of expert guidance and feedback. The included studies provide limited insight into best practice for delivering DP. Conclusion The results highlight the paucity of research in this field; however they offer insight into current applications of DP and provide preliminary empirical support DP for as a model for promoting the development of discrete therapeutic skills. Given the rapid dissemination of DP publications and manuals in psychotherapy, future research is strongly encouraged.

A refreshing and necessary start: Commentary on Westra and Di Bartolomeo (2024).

Westra and Di Bartolomeo (2024) make a compelling case for integrating "process acuity" skills into routine clinical training. The authors have done the field a service by articulating the need for novel and process-science-informed psychotherapy training and practice. This brief commentary echoes the authors' observations about the status quo of clinical training and expands upon what else will need to be considered to fully realize the goals of their proposal. Specifically, research on negative process signals has outpaced research on the optimal responses to such process signals. Further, process-outcome associations and the relevance of other technical mechanisms vary by the therapist/trainee (and dyad), which will require enhanced training personalization and precision. Future work on implementation will require elucidating responsive clinical strategies based on the accumulation of more sophisticated and contextualized process-outcome and training research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Positum MGS Coaching Protocol in the Framework of Positive Group Psychotherapy Training for Specialists Working with Groups of Children and Adults Affected by War, Disasters and Refugee Crises: a Case Study

War brings destruction in the broader sense, forcing millions to flee their homes, and resulting in an increased burden of depression, anxiety, PTSD and other mental and behavioral disorders. This burden grows even more in the framework of pandemics and natural disasters, as social and protection services experience crisis of resources. Providing one-to-one mental health care is no longer feasible for masses of refugee and internally displaced children and adults who need support, and, as a result, the need to have increasing numbers of mental health specialists who intervene in groups becomes more and more emergent. The paper reviews the Positum MGS approach to work with groups of children and adults in refugee settings, and not only, suggests the ‘Positum MGS coaching protocol’ within the framework of group Positive Psychotherapy (PPT after Peseschkian, since 1977)TM. Empirically supported and demonstrated by a case in the paper, the protocol being applied by a Positum MGS trainer or team of trainers, during an in-person training of 4-5 days, helps trainees greatly in learning to use psychosocial transcultural games and related techniques as resilience-building tools with groups of children, adolescents or adults. Either in the position of PPT trainers, psychotherapists, consultants or students, the participants in a Positum MGS core training and coaching or PPT training at basic or master levels with a focus of working with groups, can be supported through the suggested coaching protocol and questions in line with the 5-stage consultation of PPT.

Psychologists' experiences with telepsychology during the COVID-19 pandemic in South Africa.

During the COVID-19 pandemic, South African psychologists started to use telepsychology to continue providing services. However, diverse factors may influence psychologists' decisions regarding the use of telepsychology. To investigate South African psychologists' experiences with using telepsychology during the COVID-19 pandemic. Health Professions Council of South Africa (HPCSA)-registered psychologists practising in South Africa. A quantitative, cross-sectional study was conducted. Psychologists were invited to complete an online survey on the REDCap platform. Convenience sampling was used for respondent selection (n = 179). The study explored demographic variables, telepsychology use, changes in psychotherapy format, guidelines, ethical considerations, training, socio-economic factors, and individual patient and psychotherapist factors. Descriptive statistics, including categorical variables (frequencies and percentages) and numerical variables (medians and percentiles) were utilised for the data analysis. A bivariate analysis with backward selection was subsequently used, and significant variables were integrated into the logistic regression model. Most respondents (84.8%) used telepsychology, with 72.8% considering it a positive experience. Private psychologists used electronic means for delivering services significantly more than public sector psychologists. The public sector psychologists had more challenges relating to changes in the therapeutic format, additional training requirements and technology access. During the COVID-19 pandemic, psychologists turned to telepsychology as a valuable tool for providing services while navigating the unique challenges it presented. This study provides insights into the utility of telepsychology in the South African context during COVID-19. It underscores the experiences, importance of guidelines, and needs regarding training and technology access among psychologists.

Time for a Change? A Review of Transactional Analysis Psychotherapy Training and Examinations With Consideration to Adopting a More Inclusive and Nondiscriminatory Approach

This essay reviews current training, examination, and assessment structures and processes in transactional analysis (TA) following on from the research article by Baker and Widdowson, which concluded that more research and a deeper understanding of neurodiversity is necessary in order to consider appropriate support for trainees and qualified practitioners in TA. Additional evidence drawn from live research at the 2021 online United Kingdom Association for Transactional Analysis (UKATA) Conference is considered by the author alongside the experience of her supervisees and colleagues as well as her own experience as a Provisional Teaching and Supervising Transactional Analyst (PTSTA), written examination coordinator, and written and oral examination evaluator.

Psychotherapy training in postgraduate psychiatry training in Nigeria - Are we doing enough?

Nigeria, with an estimated 40 million people living with mental disorders, faces a critical shortage of psychiatrists to address the significant burden. Despite psychotherapy being integral to psychiatric training, it lacks structure, consistency and adequate supervision. This is alarming, particularly given the substantial demand for specialized psychotherapeutic support among those with mental illness. A cross-sectional study utilised an online survey targeting early career psychiatrists recruited from the Early Career Psychiatrists section of the Association of Psychiatrists in Nigeria. The questionnaire was distributed to 252 early career psychiatrists across Nigeria, with a 42.9% response rate, of which 50% were male, with 73.2% trainees and 26.8% early career psychiatrists. While 52.8% had received some psychotherapy training, only 2.8% were qualified psychotherapists. Notably, only 27.6% of those with psychotherapy training had over 100 hours of training. Factors such as receiving psychotherapy training during postgraduate training and having supervised psychotherapy training were found significant for having independent psychotherapy training. There is little emphasis on psychotherapy training in the postgraduate training in Nigeria. Those who had full training in psychotherapy were self-sponsored. Structured, supervised and mandatory psychotherapy within psychiatry training curriculum is recommended.

Open notes in psychotherapy: An exploratory mixed methods survey of psychotherapy students in Switzerland.

In a growing number of countries, patients are offered access to their full online clinical records, including the narrative reports written by clinicians (the latter, referred to as "open notes"). Even in countries with mature patient online record access, access to psychotherapy notes is not mandatory. To date, no research has explored the views of psychotherapy trainees about open notes. This study aimed to explore the opinions of psychotherapy trainees in Switzerland about patients' access to psychotherapists' free-text summaries. We administered a web-based mixed methods survey to 201 psychotherapy trainees to explore their familiarity with and opinions about the impact on patients and psychotherapy practice of offering patients online access to their psychotherapy notes. Descriptive statistics were used to analyze the 42-item survey, and qualitative descriptive analysis was employed to examine written responses to four open-ended questions. Seventy-two (35.8%) trainees completed the survey. Quantitative results revealed mixed views about open notes. 75% agreed that, in general open notes were a good idea, and 94.1% agreed that education about open notes should be part of psychotherapy training. When considering impact on patients and psychotherapy, four themes emerged: (a) negative impact on therapy; (b) positive impact on therapy; (c) impact on patients; and (d) documentation. Students identified concerns related to increase in workload, harm to the psychotherapeutic relationship, and compromised quality of records. They also identified many potential benefits including better patient communication and informed consent processes. In describing impact on different therapy types, students believed that open notes might have differential impact depending on the psychotherapy approaches. Sharing psychotherapy notes is not routine but is likely to expand. This mixed methods study provides timely insights into the views of psychotherapy trainees regarding the impact of open notes on patient care and psychotherapy practice.

Seeing Your Stories: Visualization for Narrative Medicine.

Importance: Narrative medicine (NM), in which patient stories play a crucial role in their diagnosis and treatment, can potentially support a more holistic approach to patient care than traditional scientific ones. However, there are some challenges in the implementation of narrative medicine, for example, differences in understanding illnesses between physicians and patients and physicians' increased workloads and overloaded schedules. This paper first presents a review to explore previous visualization research for narrative medicine to bridge the gap between visualization researchers and narrative medicine experts and explore further visualization opportunities. Highlights: The review is conducted from 2 perspectives: (a) the contexts and domains in which visualization has been explored for narrative medicine and (b) the forms and solutions applied in these studies. Four applied domains are defined, including understanding patients from narrative records, medical communication, medical conversation training in education, and psychotherapy and emotional wellness enhancement. Conclusions: A future work framework illustrates some opportunities for future research, including groups of specific directions and future points for the 4 domains and 3 technological exploration opportunities (combination of narrative and medical data visualization, task-audience-based visual storytelling, and user-centered interactive visualization). Specifically, 3 directions of future work in medical communication (asynchronous online physician-patient communication, synchronous face-to-face medical conversation, and medical knowledge dissemination) were concluded.

Analysis of implementation processes in a hybrid effectiveness-implementation trial of interpersonal psychotherapy (IPT) for major depressive disorder in prisons: Training, supervision, and recommendations.

There are 10 million admissions to U.S. prisons and jails each year. More than half of those admitted have mental health problems. The goal of this article is to inform: (1) implementation of evidence-based mental health treatments in prisons and jails, an important effort that needs more evidence to guide it; (2) psychotherapy and interpersonal psychotherapy (IPT) training efforts, especially in low-resource settings. A randomized hybrid effectiveness-implementation trial of group IPT for major depressive disorder (MDD) in state prisons found that IPT increased rates of MDD remission and lowered posttraumatic stress disorder symptoms relative to prison treatment as usual. The trial used prison counselors, only some of whom had prior psychotherapy training/experience, to deliver IPT. IPT treatment adherence was high (96%), but trial training and supervision were too costly to be scalable outside the trial. The current article reports results from a planned qualitative analysis of 460 structured implementation and supervision documents in that trial to describe training and supervision processes and lessons learned, inform training recommendations, and facilitate future work to optimize training and supervision for under-resourced settings. Themes identified in implementation and supervision process notes reflected: work on psychotherapy basics (reflective listening, focusing on emotions, open-ended questions, specific experiences), IPT case conceptualization (forming a conceptualization, what is and is not therapeutic work, structure and limit setting, structure vs. flexibility), IPT techniques (enhancing social support, role plays, communication analysis), psychotherapy processes (alliance repair, managing group processes), and managing difficult situations (avoidance, specific clients, challenging work settings). Counselors were receptive to feedback; some relied on study supervisors for support in managing stressful prison working conditions. Findings can be used to make future training and supervision more efficient. Based on our results, we recommend that initial and refresher training focus on IPT case conceptualization, steps for addressing each IPT problem area, and reflective listening. We also recommend supervision through at least counselors' first two rounds of groups. More low-cost, scalable training methods are needed to get mental health treatment to individuals who need it most, who are often served in challenging, low-resource settings such as prisons. This is a mental health access and equity issue. The trial was registered at clinicaltrials.gov (NCT01685294).

The Quality of Supervision Questionnaire – associations between quality, person and context variables

Abstract Only a few instruments can monitor the quality of individual supervision sessions. Therefore, the first objective was to develop a brief Quality of Supervision Questionnaire (QSQ). The second objective was to examine person and context variables associated with more effective supervision sessions. Two online samples of n=374 psychotherapy trainees and n=136 supervisors were used to develop the QSQ using exploratory factor analysis, validity and reliability analyses, and tests for measurement invariance. In addition, correlations between the QSQ and person and context variables were examined. The final QSQ included 12 items and three factors (Effectiveness, Procedural Knowledge, Relationship). The supervisee version had good reliability (α=.83 to .88) and correlated moderately to strongly with convergent measures (r=.37 to .68). The supervisor version was partially invariant to the supervisee version, displayed weak to good convergent validity (r=.27 to .51) and mixed reliabilities (α=.67 to .81). Regarding person variables, higher session quality was positively associated with supervisee self-efficacy (r=.16) and being a supervisor (vs supervisee, d=0.33 to 0.56). Regarding context variables, there were significant effects for supervisors in cognitive behaviour therapy (vs psychodynamic therapy; in terms of Procedural Knowledge, d=0.86) and for competence feedback (vs no feedback; d=0.47 to 0.68), but not for individual (vs group-based) sessions. Overall, the QSQ is a valid and reliable self-report questionnaire. We discuss the conceptual overlap between supervision scales. Key learning aims As a result of reading this paper, readers will: (1) Be aware of the Quality of Supervision Questionnaire (QSQ), which is a brief self-report scale assessing the quality of individual supervision sessions with 12 items and three subscales: Effectiveness, Procedural Knowledge, and Relationship. (2) Learn that there are no significant differences in the quality of supervision between sessions in individual and group formats. Compared with psychodynamic supervisors, supervisors in cognitive behaviour therapy report more procedural knowledge (i.e. what exactly to do and how to do it) in their sessions. (3) Understand that supervisees evaluate sessions that included competence feedback as qualitatively better than supervisees who did not receive competence feedback.

Psychotherapist perceptions of engagement-building behaviours with youth clients across developmental levels.

Building a positive therapeutic relationship is a challenging, yet critical, first step in conducting youth psychotherapy. A number of studies in the youth treatment literature have indicated that a positive therapeutic alliance is related to increased treatment attendance, participation, and outcome. Some research has examined therapist behaviours for engaging therapy clients; however, developmental differences in alliance formation have had limited exploration. The current study surveyed clinicians about their use of specific engagement strategies and the developmental stage of their youth clients. It was hypothesised that participants would differentially rate the importance of different aspects of therapeutic engagement based upon a youth client's developmental stage and that these would correspond with differences in specific engagement strategies. A total of 64 clinicians with experience treating youth completed the study. The participants completed a questionnaire administered online that asked them to rate the importance of developmental differences to forming a therapeutic relationship and provide example client behaviours from their clinical experience for each developmental stage. Results showed clinicians felt the relative importance of collaboration, advocacy, and trustworthiness increased with age. These differences were also evidenced in the specific strategies clinicians endorsed in relation to each engagement factor across developmental stages. This program of research will eventually aid in the development of new guidelines for engaging clients in youth psychotherapy. In addition, the results may be used to enhance psychotherapy training for those working with children and adolescents.