The acquisition of psychotherapeutic skill: an empirical study

The acquisition of psychotherapy skillfulness is an important aspect of training programs in psychiatry and clinical psychology. Psychotherapy supervision is employed to teach and monitor the development of these clinical skills. The Supervisor Report (SR) is a questionnaire designed to systematically assess therapeutic behaviors and global psychotherapeutic skillfulness of therapists conducting psychodynamic psychotherapy. SRs were employed to examine changes in trainees' skillfulness over the course of training. T-tests were applied to evaluate differences between the average scores of trainees in the first half of their training compared to the last half of their training. Comparisons of the scores for Psychotherapeutic Techniques and assessments of Global Skillfulness were in the predicted direction: Trainees in the advanced portion of their training were rated as more skillful than at the beginning. This study provides some evidence that psychotherapy skillfulness is acquired over time in training.     

Relationship of cognitive style and theoretical orientation to psychology interns' preferences for supervision.

This study (N ?=?106) investigated the effects of cognitive style and theoretical orientation on psychology interns' judgments about the type of supervision they find most beneficial. Preferences for task-oriented and relationship-oriented supervision have been hypothesized to indicate lower and higher levels of professional development, respectively. This study, however, found that trainees' cognitive styles and the behavioral emphasis of their theoretical orientations were also significantly related to their preferences for these two types of supervisory environments. Individual-difference variables in addition to developmental level may need to figure more prominently in future models of psychotherapist training and supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Individual psychotherapy with head-injured adults: Clinical notes for the practitioner.

Head injury is a relatively common phenomenon that often results in the need for psychotherapeutic attention. We review deficits in cognitive and psychological functioning after head injury in adults as they pertain to the psychotherapist. Clinical issues that often arise in treating this population are discussed, as are adjuncts to the therapeutic process. Specifically addressed are the importance of family and marital interventions with head trauma patients and issues concerning sexuality. The importance of an extended referral network to those conducting psychotherapy with head-injured adults is emphasized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Activation of self-observation: A core process among the psychotherapies.

Activation of self-observation is proposed as a core psychotherapy process. Self-observation entails an active scan of one's inner landscape (intentions, expectations, feelings, cognitions, and behaviors), the ability to introspect on one's own thoughts, and the realization of the relation of self to one's social and cultural environment. This process is collaboratively employed by psychotherapist and client within all psychotherapy orientations to help clients learn about their own functioning, change maladaptive responses, and generate new responses for the future. This article addresses (a) defining and distinguishing features of self-observation, (b) self-observation within the psychotherapeutic encounter, (c) ways in which psychotherapists accelerate this process, and (d) the implications of self-observation as a core psychotherapeutic process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An eclectic model of supervision: A developmental sequence of beginning psychotherapy students.

Suggests a supervision model that uses both individual and group formats and incorporates 3 foci: facilitation of personal growth and awareness, acquisition of practical skills, and mastery of cognitive and theoretical knowledge. The initial experiences and needs of beginning psychotherapy students are used to illustrate this model. The trainees' needs are divided into 3 stages: role definition, skill acquisition, and practice solidification and evaluation. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

True and false self in the development of the psychotherapist.

Explored the psychotherapist's struggle to achieve a position of security, using interviews with 15 doctoral students in clinical psychology who described their experiences of learning to do psychotherapy and the development of their identities as psychotherapists. Areas of experience within the psychotherapy training context and also in Ss' personal lives were considered. During the course of their training, Ss were seen to develop self-protective competencies, which are conceptualized in terms of the theory of the true self and the false self developed by D. W. Winnicott (1965). The psychotherapist false self is linked to commonly used terms such as professional identity and identity as a psychotherapist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical dilemmas in contemporary psychotherapy: The search for clinical wisdom.

Examines the concept of the clinical dilemma in the contemporary practice of psychotherapy. The notion of "dilemma management" by the psychotherapist is viewed as a ubiquitous phenomenon in the psychotherapeutic process. Dilemmas in a range of areas of clinical practice are discussed. These include (1) differing treatment modalities, such as insight-oriented psychotherapy, behavior therapy, marital and family therapy, and group therapy; (2) systemic issues such as spousal codependency and family homeostasis; (3) transference and countertransference; (4) therapeutic neutrality and management of the therapeutic boundary; and (5) psychological assessment and psychiatric diagnosis. Finally, observations are made about the interpersonal process of dilemma management in psychotherapy that models for patients an effective way of approaching the pervasive conflicts and dilemmas in their own lives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bias in psychotherapist ratings of client transference and insight.

The psychology literature at large considers rater bias to be a substantial source of error in observer ratings. Yet, it is typically ignored by psychotherapy researchers using participant (psychotherapist/client) ratings. In particular, interrater variability, or differences between raters' overall tendency to rate others favorably or unfavorably, has been a largely ignored source of error in studies that use psychotherapists and/or clients as raters. Ignoring rater bias can have serious consequences for statistical power and for interpretation of research findings. Rater bias may be a particular problem in psychotherapy research, as psychotherapists are often asked to rate subjective variables that require much rater inference. Consequently, we examined the extent to which rater bias is a factor in psychotherapist ratings of client transference and insight, by comparing psychotherapist variance from these ratings to psychotherapist variance in ratings of client-perceived emotional intelligence, using Hierarchical Linear Modeling. Results suggest that bias may be a substantial source of error in psychotherapist process and relationship ratings, accounting for, on average, 38% of the total variance in scores, and 30% after accounting for perceived emotional intelligence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The training psychotherapist in a therapeutic community.

Discusses the impact of a therapeutic community on the training psychotherapist and indicates potential difficulties in working with psychotic patients in a setting that demands personal vulnerability and that may reawaken the therapist's yearnings for communal participation and belonging. The psychotherapist may develop a communal transference as a result of his/her repressed communal object-hunger. The "mad psychotherapist" "Dr. Doctor," and the "nag therapist" characterize defensive postures taken by psychotherapists dealing with the stress of treating psychotic patients in a therapeutic community. As a result of their communal participation, therapists have the opportunity to work through this transference which then enhances their psychotherapeutic efforts. The psychotherapist further matures when toward the end of training, he/she confronts the social reality of the patients' continued hospitalization. The therapist's role in assisting the social rehabilitation of his/her patients is discussed. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supervision: Its contributions to treatment efficacy.

The efficacy of supervision in training of psychotherapists is discussed in relation to (a) trainees' attitudes, beliefs, and skills, (b) trainee's performance in the therapist role, (c) interactional process events in supervision and psychotherapy, and, (d) client change. Although investigations to date suggest the potential of supervision for teaching advanced skills of psychotherapy, few studies exist that examine directly the relation of therapist performance and client change to supervision. There are virtually no studies that compare the efficacy of supervision to other training methods. If supervision is to remain an integral part of training, then standardized training manuals, analogous to those in psychotherapy, need to be developed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of Psychological Help Seeking in Clinical and Counseling Psychology Graduate Students.

Psychologists are often called upon to provide supervision, mentorship, and training to graduate student therapists-in-training. In these roles, psychologists may influence whether graduate students enter personal therapy during their training. This study investigated variables (including perceived faculty attitudes about students in personal therapy) that predict psychotherapy help seeking in clinical and counseling psychology graduate students (N = 262). The findings indicated that confidentiality issues, general attitudes about therapy, and perceptions of the importance of personal therapy for professional development were important predictors of graduate student help seeking. The implications for faculty, supervisors, and mentors of therapists-in-training are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The residential therapeutic caring community.

The residential therapeutic caring community (RTCC) for adolescents combines psychotherapeutic principles of the professional model and self-help concept of the therapeutic community by using the collective resources of members to mobilize peer pressure. The RTCC is a safe, structured, supportive treatment environment that employs a confrontation, teaching, interpretative, and reasoning approach and uses the psychotherapeutic principles of reality therapy and existential thought. In the RTCC, the staff serve as mentors and role models, and they demonstrate their concern by maintaining high expectations for immediate improved behavior. The personal qualities necessary for a psychotherapist working in an RTCC are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Humanistic analysis in groups.

Presents a personal and professional journey taken by the author during the past 15 yrs aimed at developing a theoretical and clinical framework for integrating the humanistic functioning of the group psychotherapist within a psychodynamic process. Personally, it represents a struggle to become a flexible, creative, giving, authentic, and emotionally alive psychotherapist. This means an ongoing process of working through the emotional issues of the past and present that inhibit appropriate expression within the psychotherapy encounter. To achieve the desired goal professionally, it was necessary to borrow meaningful aspects of 2 approaches to psychotherapy: the active psychoanalysis of S. Ferenczi (1919, 1920) and the humanistic tradition of client-centered psychotherapy, exemplified by C. Rogers (1942, 1951). Humanistic analysis is the attempt to integrate these approaches into a contemporary form of combined therapy in which action, empathy, and responsiveness are compatible with uncovering understanding and the development of insight. A long-term intensive experience with a seriously disturbed individual whose therapy dictated a flexible and creative approach is used to illustrate this approach. (47 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirical search for psychotherapists' gender competence in psychotherapy.

Over the past half century, psychotherapy research has demonstrated that psychotherapy outcomes do not vary based on clients’ gender (Clarkin & Levy, 2004; Garfield, 1994; Wierzbicki & Pekarik, 1993). However, most studies assumed that all psychotherapists are equally competent to treat men and women, thus potentially missing essential information about variations in psychotherapy outcomes. In fact, there is a paucity of studies that have examined if psychotherapists’ gender competence truly exists. We propose that psychotherapists’ gender competence should be defined as the psychotherapist’s ability to achieve positive psychotherapy outcomes with either female or male clients. This study examined the relationship between clients’ gender and psychotherapy outcomes and if psychotherapists varied in their abilities to produce positive psychotherapy outcomes for female and male clients. The sample included 93 male and 229 female clients treated by 31 psychotherapists. Consistent with previous research, the results demonstrated that clients’ gender was not related to psychotherapy outcomes. However, compared to other psychotherapists, some psychotherapists were better at treating men, whereas others were better at treating women. The results of this study demonstrate that psychotherapists’ gender competence exists and relates directly to the psychotherapy outcomes (i.e., psychological well-being) of clients. Implications for psychotherapy practice, training, and research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supervising international students: Relationship between acculturation, supervisor multicultural competence, cultural discussions, and supervision satisfaction.

The purpose of this study was twofold: (a) to explore the relationship between international trainees' acculturation level and cultural discussion on supervision satisfaction and (b) to examine the mediating effect of cultural discussions on the relationship between perceived supervisor multicultural competence and trainee satisfaction with supervision. One hundred and four international students from several clinical programs who have received clinical supervision participated in the study. Results revealed that students who had lower acculturation levels but greater cultural discussion showed more satisfaction with supervision. Furthermore, cultural discussion partially mediated the relationship between the perceived supervisor cultural competence and satisfaction with supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical competence in psychotherapy termination.

The termination of an active psychotherapy relationship can be a very complex process. It calls for a blending of clinical, practical, and ethical factors that become the foundation for the required level of reasonable professional conduct in this area. Competence in termination requires that the psychotherapist first have a strong foundation in ethics and second understand how to apply the ethical principles and standards in unique and varied clinical settings. In this article, we highlight the necessary foundational competence in ethical knowledge and link this knowledge to practical steps as a general guide for functional competence in psychotherapy termination. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethical issues in the supervision of psychotherapy.

Supervision is the accepted training model for the teaching and learning of psychotherapeutic skills. Although standards of ethical behavior between a psychotherapist and client have been established, specific guidelines for ethical behavior between a supervisor and trainee have not been delineated. Given the importance of the supervisory relationship in the development of competent psychotherapists, the relatively powerless and dependent position of the trainee, and the potential occurrence of therapylike experiences in supervision, the development of guidelines outlining the rights of trainees and responsibilities of supervisors is indicated. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quasi-literary elements in psychotherapy.

Describes a quasi-literary aptitude with words, life-stories, and treatment sequences as a major component in the work and formation of the psychotherapist. Spelling out and systematizing therapists' often intuitive mastery of these skills is a necessary step toward better training. This quasi-literary adjunct of psychotherapeutic work is illustrated from the work of many contributors. It is argued that therapists can be trained in these skills as in the elements of a craft. Trainees in psychotherapy can be taught how to recognize the appropriate contexts for developing a climactic ending, a climactic beginning, or a theme with variations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The In-Session Self-Awareness of Therapist-Trainees: Hindering or Helpful?

Although therapist self-awareness has been hailed as a critical component of psychotherapy, recent evidence suggests that therapists' in-session self-awareness may hinder rather than help the therapeutic process. The authors examined the in-session self-awareness of therapists in training (trainees) in relation to their interpersonal involvement and the reactions of volunteer student clients (volunteer clients). Trainee in-session self-awareness variables predicted over 50% of the variance in their interpersonal involvement and the volunteer clients' perceptions of the therapeutic alliance. Contrary to previous research, trainees' level of in-session self-awareness was generally helpful rather than hindering from both the trainee and student-client perspectives. Potentially hindering aspects of in-session self-awareness did emerge, however, in that trainees' increasing efforts to manage their self-awareness were related to decreased trainee involvement and lower volunteer client ratings of the therapeutic alliance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)