Irish clinical and counselling psychologists' experiences and views of mandatory personal therapy during training: A polarisation of ethical concerns

Although there have been some recent changes in Ireland, the practice of mandating personal therapy during training has traditionally differed between counselling and clinical psychologists. Irish psychologists (n = 258: 170 clinical, 88 counselling) took part in a survey study of experiences and views regarding this practice. Counselling psychologists reported higher rates of lifetime and current attendance at personal therapy compared to clinical psychologists, and nearly all had experienced mandated personal therapy compared to a minority of the clinical group. However, the clinical psychologists had a high rate of attendance at personal therapy compared to that reported for their British peers, indicating a high regard for personal therapy amongst Irish clinicians despite the absence of a training mandate. Five factors were found to be independent predictors of agreement with mandating personal therapy during training—lifetime experience of personal therapy, being a counselling psychologist, experience of mandated therapy, being more recently qualified, and longer attendance at personal therapy. Thematic analysis of the psychologists' open responses regarding mandated therapy indicated that the majority believed that personal therapy was an important part of ethical, effective practice, and valuable in enhancing self‐awareness and learning from the client experience. Ethical concerns about a mandate were polarised between the two psychology specialisms, more counselling psychologists emphasising the dangers and questionable efficacy of psychologists practising psychotherapy without personal therapy experience, and more clinical psychologists questioning the efficacy and ethics of imposing a mandate on trainees. Recommendations are made regarding this issue for trainers of both specialisms.     

A survey of influences on the practice of psychotherapists and clinical psychologists in training in the UK

A questionnaire survey of 95 qualified psychotherapists of various therapeutic orientations and 69 psychologists in clinical training was carried out to investigate the main influences on their clinical practice, using the Questionnaire of Influencing Factors on Clinical Practice in Psychotherapies (QuIF‐CliPP). For the qualified group the most highly rated factors were current supervision, client characteristics, client feedback, psychological formulation, intuition/judgement, professional training and post‐qualification training. For the trainees, those rated highest were current supervision, past supervision, client characteristics, client feedback, psychological formulation and professional training. Evidence based factors such as treatment manuals and evidence based guidelines were rated relatively low for both groups, although the cognitive behaviour therapists rated them significantly higher than the other groups. Personal therapy was rated highly by the psychodynamic, psychoanalytic, person centred and eclectic therapists but not by CB therapists. The implications of these findings for the application of evidence based practice and the need to evaluated supervision, personal therapy and training are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Development of a global curriculum for professional psychology: implications of the Combined-Integrated model of doctoral training

This article considers the development of a global training curriculum and qualification in professional psychology, with particular emphasis on the Combined-Integrated (C-I) model. The C-I model exposes professional psychology trainees to two or more of the practice areas (i.e., clinical, counseling, school/educational). The authors argue that the C-I approach is one that is well suited to the development of a global training curriculum due to its emphasis on broadly training psychologists as well as its respect for diversity and integration of various theoretical and professional orientations. A survey of training programs in 16 countries/regions on six continents found significant variation in training, minimal qualifications, and roles of the professional psychologist. The authors recommend that an international group of psychologists develop a regionally flexible, but common, training curriculum and qualification that would include a five- to six-year competency-based qualification. Ways in which the C-I training model may serve to integrate and globalize professional psychology are discussed.     

Psychologist Impairment: What Is It,How Can It Be Prevented,and What Can Be Done to Address It?

Research indicates that psychologists self-report a variety of problems related to their personal and professional functioning, such as depression, substance abuse, and burnout. These difficulties not only lead to psychologist distress, but can also result in impairment and have a negative effect on patient care. This review of the psychologist impairment literature provides information on the historical movement toward colleague assistance, rates of impairment, identifying distress and impairment, intervening with an impaired colleague, barriers to treatment, and preventing impairment. It is suggested that, through education of psychologists and graduate trainees, impairment may be prevented or its effects minimized.     

Implementing a Virtual Community of Practice for Family Physician Training: A Mixed-Methods Case Study

Background

GP training in Australia can be professionally isolating, with trainees spread across large geographic areas, leading to problems with rural workforce retention. Virtual communities of practice (VCoPs) may provide a way of improving knowledge sharing and thus reducing professional isolation.

Objective

The goal of our study was to review the usefulness of a 7-step framework for implementing a VCoP for general practitioner (GP) training and then evaluated the usefulness of the resulting VCoP in facilitating knowledge sharing and reducing professional isolation.

Methods

The case was set in an Australian general practice training region involving 55 first-term trainees (GPT1s), from January to July 2012. ConnectGPR was a secure, online community site that included standard community options such as discussion forums, blogs, newsletter broadcasts, webchats, and photo sharing. A mixed-methods case study methodology was used. Results are presented and interpreted for each step of the VCoP 7-step framework and then in terms of the outcomes of knowledge sharing and overcoming isolation.

Results

Step 1, Facilitation: Regular, personal facilitation by a group of GP trainers with a co-ordinating facilitator was an important factor in the success of ConnectGPR. Step 2, Champion and Support: Leadership and stakeholder engagement were vital. Further benefits are possible if the site is recognized as contributing to training time. Step 3, Clear Goals: Clear goals of facilitating knowledge sharing and improving connectedness helped to keep the site discussions focused. Step 4, A Broad Church: The ConnectGPR community was too narrow, focusing only on first-term trainees (GPT1s). Ideally there should be more involvement of senior trainees, trainers, and specialists. Step 5, A Supportive Environment: Facilitators maintained community standards and encouraged participation. Step 6, Measurement Benchmarking and Feedback: Site activity was primarily driven by centrally generated newsletter feedback. Viewing comments by other participants helped users benchmark their own knowledge, particularly around applying guidelines. Step 7, Technology and Community: All the community tools were useful, but chat was limited and users suggested webinars in future. A larger user base and more training may also be helpful. Time is a common barrier. Trust can be built online, which may have benefit for trainees that cannot attend face-to-face workshops. Knowledge sharing and isolation outcomes: 28/34 (82%) of the eligible GPT1s enrolled on ConnectGPR. Trainees shared knowledge through online chat, forums, and shared photos. In terms of knowledge needs, GPT1s rated their need for cardiovascular knowledge more highly than supervisors. Isolation was a common theme among interview respondents, and ConnectGPR users felt more supported in their general practice (13/14, 92.9%).

Conclusions

The 7-step framework for implementation of an online community was useful. Overcoming isolation and improving connectedness through an online knowledge sharing community shows promise in GP training. Time and technology are barriers that may be overcome by training, technology, and valuable content. In a VCoP, trust can be built online. This has implications for course delivery, particularly in regional areas. VCoPs may also have a specific role assisting overseas trained doctors to interpret their medical knowledge in a new context.     

How can we know what we don’t know? An exploration of professionals’ engagement with complicated grief

ObjectiveResearch has shown that complicated grief has the potential to adversely affect bereaved individuals, and in this context, understanding how mental health professionals engage with it in practice is of relevance. Gaining an understanding of professionals’ knowledge, attitudes, skills and training in relation to complicated grief could provide insights that will inform their training and professional development. The aim of this study was to consider professionals’ engagement with complicated grief, as represented by self-reported knowledge, attitudes, skills and training.MethodsThe study used a three-phase mixed methods design (systematic review, qualitative interviews, and a quantitative survey) with empirical data being collected from psychologists, psychiatrists and counselor/psychotherapists.ResultsAnalysis yielded 15 integrated findings across the three phases, which were grouped into two clusters: the first highlighted tension between professionals’ reported confidence and competence and the second explored the parameters and contribution of research and training in this area.ConclusionProfessionals’ perception of their competence to work with complicated grief seems overstated and research and professional practice are not aligned.Practice implicationsThese findings are positioned to inform empirically supported training that addresses identified deficits in professionals’ knowledge, attitudes and skills. It is important therefore that training is reflective of the needs of different professional groups.     

Utilization of personal therapy by psychotherapists: a practice-friendly review and a new study

This article offers both a practice-friendly review of research on therapists' personal therapy and a new study of personal psychotherapy among 3,995 psychologists, counselors, social workers, psychiatrists, and nurses in 6 English-speaking countries. The prevalence of personal therapy as it relates to professional discipline, theoretical orientation, gender, and career level are studied. Findings showed that 87% of the overall sample embarked on personal therapy at least once: 94% of analytic/psychodynamic therapists, 91% of humanistic therapists, 73% of cognitive-behavioral therapists, 82% of the novice therapists to 89% of senior therapists. Both the existing research and this new study demonstrate the extraordinary commonality of personal therapy among psychotherapists, and encourage further use for professional training, clinical practice, and therapist self-care.     

Clinical empathy in GP-training: Experiences and needs among Dutch GP-trainees. “Empathy as an element of personal growth”

ObjectiveClinical empathy has been described as a key component of effective person-centeredness in patient-physician communication. Yet little is known about general practitioner (GP) trainees’ experiences and opinions regarding clinical empathy, empathy-education and the development of empathic skills. This study aimed to explore trainees’ experiences with clinical empathy during GP training.MethodsThis study used focus group interviews. GP trainees at two Dutch universities were approached by e-mail. Focus groups were conducted between April and November 2018. Six focus groups were conducted: two with starting trainees, two with trainees at the end of their first year and two with trainees at the end of their 3 years’ training. Two experienced qualitative researchers analyzed the focus groups. During the thematic analysis the differences and similarities between the various stages of education were taken into account and a framework for the identified themes and subthemes was developed.ResultsThirty-five GP trainees took part. Four main themes could be identified. Starting trainees experienced frictions regarding the influence of personal affective reactions on their medical competencies. Trainees at the end of their first year indicated that they reached a balance between empathic involvement and their responsibility to carry out relevant medical tasks, such as following GP guidelines. Trainees at the end of their three years’ training recognized the mutual relationship between the development of the behavioral part of clinical empathy and personal growth. All trainees stated that their needs concerning education changed during their GP training and proposed changes to the curriculum.ConclusionsGP trainees face various obstacles in developing empathic skills and behavior. Particularly they mention handling personal affective reactions. Trainees express a clear wish for clinical empathy, in its theoretical as well as its skill and emotional aspects, to play a central role in the curriculum.Practice implicationsMore explicit attention to be paid to empathy by embedding theoretical education, explicit attention to skill training and assessment of empathic behavior by patients and supervisors     

Distress and burnout among genetic service providers

PurposeTo determine the nature, sources, prevalence, and consequences of distress and burnout among genetics professionals.MethodsMailed survey of randomly selected clinical geneticists (MDs), genetic counselors, and genetic nurses.ResultsTwo hundred and fourteen providers completed the survey (55% response rate). Eight discrete sources of distress were identified forming a valid 28-item scale (α = 0.89). The greatest sources of distress were compassion stress, the burden of professional responsibility, negative patient regard, and concerns about informational bias. Genetic counselors were significantly more likely to experience personal values conflicts, burden of professional responsibility, and concerns about informational bias than MDs or nurses. Burnout scores were lower among those practicing more than 20 years and nurses. Distress scores were positively correlated with burnout and professional dissatisfaction (P < 0.0001). Eighteen percent of respondents think about leaving patient care, and burnout was the most significant predictor. Predictors of burnout included greater distress, fewer years in practice, working in university-based settings, being a genetic counselor or an MD, and deriving less meaning from patient care.ConclusionsGenetic service providers experience various types of distress that may be risk factors for burnout and professional dissatisfaction. Interventions to reduce distress and burnout are needed for both trainees and practitioners.     

A reflective practice intervention for professional development,reduced stress and improved patient care—A qualitative developmental evaluation

Objective

Professional capabilities, such as empathy and patient-centeredness, decline during medical education. Reflective practice is advocated for teaching these capabilities. The Clinical Reflection Training (CRT) is a reflective practice intervention using the professional dilemmas faced by medical students during clinical practice. The aim of this study was to evaluate students’ perceptions of the helpfulness of the CRT and its effects on their medical education.

Methods

Eighteen semi-structured interviews were conducted with medical students who had participated in the CRT. Content analysis was used to analyze the interview data.

Results

Medical students did not feel adequately prepared to manage the difficult personal and interpersonal problems frequently encountered in clinical practice. They reported that the CRT reduces stress, improves patient care and serves as a tool for professional development.

Conclusion

The CRT may be a useful tool for developing professionalism during medical education, reducing stress and enhancing the quality of patient care.

Practice implications

Providing students with reflective practice training that draws on their current personal clinical problems in order to improve their clinical work may be a productive investment in personal professional development, physician health, and quality improvement.     

Self‐reflection and self‐practice in training of Cognitive Behaviour Therapy: an overview

The present paper deals with a developing training element in cognitive behaviour therapy (CBT), the self‐practice of therapeutic techniques and the self‐exploration of the person of the therapist. Initially, the current status of this training element in CBT is discussed, and a short note on its terminology is presented. Then an overview of the most important objectives of self‐practice and self‐reflection in CBT, and the concepts and methods of practice of this element is given. The concepts focus on two major aims, the self‐exploration of the person of the therapist within and beyond his or her therapeutic practice, and the self‐application of therapeutic techniques (= self‐practice). In the second part of the paper empirical studies related to the outcome of self‐reflection and self‐practice on the development of the therapist and her or his therapeutic practice are reviewed. The few empirical studies show that trainees experience in their own view substantial professional and personal gains from this training tool, with the professional impact being more important than the personal one. The most important outcomes evaluated by subjective data from the trainees are improvements in self‐insight and self‐awareness and a better understanding of the therapist's role and the therapeutic change process. Additionally, a better understanding of CBT methods and of general therapeutic skills, such as empathy and role‐taking‐competencies, are reported by the trainees. The paper comes to the conclusion that self‐exploration and self‐practice are important components of CBT training. Consequences and recommendations for its integration into training courses for CBT are discussed as well as the necessity for more research in this area. Copyright © 2002 John Wiley & Sons, Ltd.     

Reflective practice and its role in facilitating creative responses to dilemmas within clinical communication - a qualitative analysis

Background

Good communication is a major factor in delivering high quality in care. Research indicates that current communication skills training alone might not sufficiently enable students to find context-specific creative solutions to individual complex personal and interpersonal challenges in the clinical context. This study explores medical students’ experiences with real communication dilemmas in a facilitated group setting. The aims were to gain a better understanding of whether and, if so, how reflective practice can enhance students’ ability to find creative individual solutions in difficult communication situations and to identify factors within the reflective setting that foster their creative competency.

Methods

Thematic content analysis was used to perform a secondary analysis of semi-structured interview data from a qualitative evaluation of a group reflective practice training for final-year medical students. The categories that arose from the iterative deductive-inductive approach were analyzed in light of current scientific understandings of creativity.

Results

Reflection on real difficult clinical communication situations appears to increase medical students’ ability to handle such situations creatively. Although group reflection on clinical dilemmas involving personal aspects can stir up emotions, participating students stated they had learned a cognitive process tool that enhanced their communicative competence in clinical practice. They also described changes in personal attitudes: they felt more able to persevere and to tolerate ambiguity, described themselves more open and self-efficient in such complex clinical communication situations and thus more motivated. Furthermore, they reported on factors that were essential in this process, such as reflection on current and real challenges, a group format with a trainer.

Conclusions

Reflective practice providing a cognitive process tool and using real clinical challenges and trainer support in communication education may provide learners with the skills and attitudes to develop creativity in practice. Implementing reflection training in clinical communication education may increase students’ overall communicative competency.

     

We Are All More Nearly the Same

[Clin Psychol Sci Prac 18: 12–16, 2011] The analysis of program differences by Sayette, Norcross, and Dimoff (2011) was based on a small group (N = 8) of professional programs that was too small to have been used as the basis of any conclusions and was not representative of professional programs in general. More importantly, the highlighting of the distinctiveness of some training models places an undue emphasis on differences between models and ignores the essential similarities between approaches to training clinical psychologists. The spirit of the Boulder model of training was to be inclusive and to allow programs to develop their unique ways of training, with substantial but differing emphases on both science and practice.     

Training faculty to facilitate communication skills training: development and evaluation of a workshop

OBJECTIVE: To develop a workshop for training faculty to facilitate small group role play sessions for a communication skills training program and assess the impact of that workshop on the trainees' self-efficacy about facilitation skills. METHODS: A multi-specialty group of 33 attending physicians at a Comprehensive Cancer Center were trained in a Facilitating Communication Skills Training workshop in order to prepare them to facilitate small group role play with fellows and residents. The workshop curriculum was based on theory and literature on teaching communication skills. RESULTS: The workshop had a significant effect on participants' self-efficacy in facilitating communication skills training. At least 75% of participants reported feeling comfortable facilitating communication skills training small groups. CONCLUSION: This facilitation workshop was successful in providing participants with confidence to successfully facilitate small group role play sessions in communication skills training. PRACTICE IMPLICATIONS: In order to evaluate the effectiveness of communication skills training programs, it is important to have trained facilitators who adhere to a set of facilitation guidelines. Workshops on facilitation skills provide the background and practice time necessary as a first step in the training process.     

Impact of mindfulness-based cognitive therapy on counseling self-efficacy: A randomized controlled crossover trial

ObjectiveTo investigate the impact of a structured eight-week mindfulness-based cognitive therapy (MBCT) program on counseling self-efficacy among counseling trainees.MethodsUndergraduate counseling trainees were randomized to an MBCT group (n = 25) or a waitlist control group (n = 25) with a crossover trial design. Psychological measurements regarding mindfulness, empathy, self-compassion, psychological distress, counseling self-efficacy as well as neuro-physiological measures including frontal midline theta activity, respiration rate, and skin conductance were taken at baseline (T1), after intervention (T2), and six-month follow-up (T3).ResultsMindfulness training could make significant positive changes in empathy, self-compassion, stress reduction, and counseling self-efficacy with this being backed up by both psychological and neuro-physiological evidence at T2. However, such differences between the two groups had greatly subsided after crossover in which carry-over effect and marked improvement were noted in the study and control group, respectively, at T3. In addition, mindfulness was the most significant determinant that contributed to counseling self-efficacy, followed by psychological distress reduction and self-compassion according to the regression models.ConclusionIntegrating mindfulness into counseling training is beneficial for helping profession trainees.Practice implicationIncorporating mindfulness into counseling training can enhance the necessary “being mode” qualities in counseling and address self-care issues during training.     

Factors influencing levels of research activity in clinical psychologists: a new model

There are concerns in the USA and UK about low levels of research activity amongst clinical psychologists emerging from doctoral level training. The authors explore existing evidence and theory pertaining to this phenomenon. Three relevant theoretical strands are identified, along with related empirical studies and commentaries in practitioner journals. These different sources are integrated to suggest a more complete model of factors influencing clinical psychologists' research intentions, and in turn research activity itself: vocational preferences, research training experienced during qualifying training, practice context, value placed on expected outcomes of doing research, perceived norms for clinical psychologists in relation to doing research, research self‐efficacy, professional identity and, most tentatively, sex role identity. Our new model points to training interventions, either pre‐ or post‐qualification, that may increase the likelihood of clinical psychologists carrying out clinical research that will contribute to their profession's knowledge base, beyond their time in qualifying training. Copyright © 2006 John Wiley & Sons, Ltd.     

An evaluation of the facilitator training to implement ‘Taking charge of my life and health’, a peer-led group program to promote self-care and patient empowerment in Veteran participants

ObjectiveWe developed a peer-led group program for Veterans called Taking Charge of My Life and Health (TCMLH) that emphasizes patient education, goal setting, shared decision making, and whole person care. Our aim was to conduct an evaluation of a facilitator training course to deliver TCMLH in VA sites.MethodsRepeated measures ANOVA models were used to examine change over three timepoints (pre-test, post-test, and two-month follow-up) in outcomes of attitudes, knowledge, skills, and self-efficacy related to patient empowerment, skills acquisition, self-care strategies, and curriculum facilitation. Qualitative data analysis of participant feedback was used to identify potential training adaptations and barriers to TCMLH delivery.ResultsOur sample comprised 70 trainees who completed all three assessments. Participants reported high levels of training satisfaction, quality, and utility, and sustained improvements in knowledge of Whole Health, self-efficacy for group facilitation, and self-efficacy for using Whole Health concepts and tools. Implementation barriers included challenges related to group management and site logistics.ConclusionThe facilitator training course improved knowledge and self-efficacy associated with successful peer-led program delivery and identified opportunities to improve the training course and TCMLH dissemination.Practice Implications: Findings provide insights on the design and implementation of training models to support peer-led programs.     

A Balint-inspired reflective forum in oncology for medical residents: Main themes during seven years

Objective

Reflection groups for clinicians, often called Balint groups, are a way of refining professional competence in health care. This study presents a model for reflective practice in a group setting and describes the kinds of troublesome cases that medical residents are concerned about.

Methods

From 2005 to 2012 a Balint-inspired reflective forum has been a part of the academic seminar program for physicians in training in a Department of Oncology at a Swedish university. The present study is focused on all 63 cases presented in the forum.

Results

The cases were categorized into three kinds of challenges: Communication challenges in the patient–physician relationship, Communication challenges in organizational matters, and Communication challenges with close relatives of the patient.

Conclusion

The study tells us something about the vulnerability of being a medical resident and the identified challenges have bearings on medical education curricula as well as on how the training of junior physicians is organized.

Practice implications

The cases are contextual and multifaceted, and a forum of this kind might therefore be regarded as a potential way to develop professional competence and to refine communication in clinical practice. A structured evaluation of the forum would be valuable.     

GROUP SUPERVISION OF INDIVIDUAL CASES IN THE TRAINING OF COUNSELLORS AND PSYCHOTHERAPISTS: TOWARDS A GROUP‐ANALYTIC MODEL?

ABSTRACT The process through which individual psychodynamic practitioners learn how to learn from practice is central to their future professional development and second only to having had a 'good enough' experience of personal therapy. To facilitate this learning process many trainees, particularly those working within organizations, might be offered the opportunity to join a supervision group. The aim of this article is to explore some group dynamic issues that might enable greater understanding of this learning opportunity. Literature from the general field of professional education will be integrated with more specific psychodynamic and group-analytic psychotherapy sources. Implications for the place of analytically informed cooperative inquiry groups in continuing professional development will also be briefly discussed.     

Reconsidering action research as a guiding metaphor for professional psychology

Action research is proposed as a more appropriate guiding metaphor for inquiry in professional psychology than applied research as traditionally conceived and practiced. Institutional, social, and ideological factors that affect the research practices of psychologists are considered in the context of contemporary knowledge production. The history of action research and its justification with a pragmatist epistemology are given. Its value in promoting a culture of inquiry based on collaborative norms and the reciprocity of theory and practice is argued. Specific characteristics of action research are explained and illustrated with examples from diverse areas of professional psychology. Implications for professional knowledge, research, training, and practice are discussed. © 1996 John Wiley & Sons, Inc.