The role of personal therapy for therapists: a review

Mental health in Austrian psychotherapists during the COVID-19 pandemic

Although the impact of the COVID-19 pandemic on mental health has been reported in different communities, little is known about the mental health of psychotherapists during the COVID-19 pandemic. This study aimed to assess mental health during the COVID-19 pandemic in Austrian psychotherapists and compare it with the general population. A total of n = 513 psychotherapists (80.5% women; mean age: 53.06 ± 9.94 years) took part in an online survey conducted from April to June 2022. At the same time, a representative sample (N = 1,031) of the Austrian general population was surveyed online. Indicators of mental health were mental wellbeing (WHO-5), depression (PHQ-2), anxiety (GAD-2), insomnia (ISI-2), and stress (PSS-10). The general population sample was matched according to age and gender with the psychotherapist's data using propensity scores, yielding a final sample of n = 513 (80.5% women; mean age: 52.33 ± 13.39 years). Psychotherapists showed lower odds for exceeding cut-offs for clinically relevant depressive, anxiety, insomnia and stress symptoms (0.34-0.58) compared to the general population. Further studies should elucidate the protective factors underlying these findings.

[Effects of Personal Therapy during psychotherapy training - A Systematic Review]

BACKGROUND

Self-experiential work/personal therapy as part of psychotherapeutic training is often under critical discussion. In the German system, self-experiential work will remain an established part of training in psychosocial medical specialties and will continue to be part of the future curriculum in psychotherapy and in practical training subsequent to the study.

OBJECTIVES

Identification of different impacts of self-experiential work on psychotherapy trainees.

MATERIAL AND METHOD

Systematic literature review of studies between 2005 and 2020. Literature search via electronic databases, prior literature search and searches through reference lists of previous research. Selection via previously determined inclusion and exclusion criteria.

RESULTS

Thirteen studies were selected for this review. Results were summarised related to 7 outcome variables which mostly displayed positive impacts of self experience related to interpersonal skills, self-perception, knowledge and understanding of therapeutic work, well-being and relief. Satisfaction and the acceptance of the subjective importance of personal therapy for increasing competence were more common than reports about intensive emotions and stress.

CONCLUSION

Self-experiential work is highly valued by psychotherapy trainees and is therefore correctly considered as an obligatory part of training. Nonetheless, it should be evaluated regularly. For further research, self-reports, the most commonly used method, should be combined with objective measures, representativeness of samples should be enhanced and long-term effects should be investigated.

The COVID-19 era: How therapists can diminish burnout symptoms through self-care

COVID-19 is a frightening, stress-inducing, and unchartered territory for all. It is suggested that stress, loneliness, and the emotional toll of the pandemic will result in increased numbers of those who will seek psychological intervention, need support, and guidance on how to cope with a time period that none of us were prepared for. Psychologists, in general, are trained in and know how to help others. They are less effective in taking care of themselves, so that they can be their best in helping others. The article, which aims to heighten clinicians' awareness of the need for self-care, especially now in the post-pandemic era, describes the demanding nature of psychotherapy and the initial resistance by therapists to engage in self-care, and outlines the consequences of neglecting to care for themselves. We covered the demanding nature of psychotherapy and its grinding trajectory, the loneliness and isolation felt by clinicians in private practice, the professional hazards faced by those caring for others, and the creative and insightful ways that mental health practitioners can care for themselves for the good of their clients, their families, and obviously, themselves.

Are you sitting (un)comfortably? Action-based supervision and supervisory drift

Action-based methods such as behavioural experiments, role-play and (by extension) ‘chairwork’ are powerful techniques recommended in core supervisory texts for cognitive behavioural therapy (CBT). Despite this, experiential methods are seldom used by supervisors, suggesting that supervision often drifts from a ‘doing process’ to a ‘talking process’. A number of factors contribute to this divergence from best practice, including limited confidence and a lack of familiarity with experiential procedures amongst supervisors. To address this, the current paper presents a variety of action-based techniques for enhancing supervisees’ technical, perceptual, interpersonal, reflective and personal competencies. Behavioural experiments, empty-chair, multi-chair and role-playing exercises for maintaining treatment fidelity, enhancing empathic attunement, repairing therapeutic ruptures, resolving impasses and working through negative countertransference are described, amongst others. Further research is needed to establish the nature and extent of supervisory drift, as well as the efficacy of action-based methods.

Key learning aims

As a result of reading this paper, readers should:(1)

Personal Therapy and Self-Care in the Making of Psychologists

Psychologists are skilled in assessing, researching, and treating patients' distress, but frequently experience difficulty in applying these talents to themselves. The authors offer 13 research-supported and theoretically neutral self-care strategies catered to psychologists and those in training: valuing the person of the psychologist, refocusing on the rewards, recognizing the hazards, minding the body, nurturing relationships, setting boundaries, restructuring cognitions, sustaining healthy escapes, maintaining mindfulness, creating a flourishing environment, cultivating spirituality and mission, fostering creativity and growth, and profiting from personal therapy. The latter deserves special emphasis in the making of health care psychologists. These strategies are recommended both during training and throughout the career span. Recommendations are offered for enhancing and publicizing systems of self-care throughout the profession.

Why therapists should walk the talk: The theoretical and empirical case for personal practice in therapist training and professional development

The key proposition of this invited essay is that personal practice (PP), coupled with self-reflection, is central to the development of the most effective therapists. To date, the discussion about personal practice in therapist training and professional development has largely revolved around the value of personal therapy, subscribed to by some schools of psychotherapy but not by others. However, since the turn of the century a new landscape of personal practices for therapists has emerged. In particular, two forms of personal practice, meditation programs and self-practice/self-reflection (SP/SR) programs, have developed a growing evidence base. Here it is proposed that there is now a strong theoretical and empirical case to accord personal practice an explicit role in therapist training and professional development. The case rests on recent research suggesting that: (1) personal and interpersonal qualities of therapists play a key role in client outcomes; and (2) personal practice is the most effective way to achieve changes in therapists' personal and interpersonal qualities. It is suggested that the research agenda needs to move beyond asking whether or not personal practice is effective towards a more sophisticated set of questions: what personal practice, facilitated by whom, is most effective with which practitioners, in what contexts, at what point in time? To make further progress, trainers and researchers need to be supported to include personal practices in therapist training and to undertake research to evaluate their impacts.

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.

Personal psychotherapy in psychiatric training: study of four London training schemes

Aims and Method

We carried out a web-based survey to establish the proportion of London psychiatry senior house officers who undertake personal psychotherapy. Demographics, training characteristics and psychotherapy experience were examined using descriptive statistics. Predictors of personal psychotherapy status were examined using logistic regression.

Results

The majority of trainees who undertook personal psychotherapy included training as a reason for doing so. of the participants, 16% had undergone personal psychotherapy and of the remainder, 73% reported that they would consider it in the future. Ethnicity was the only predictor of psychotherapy status, with White British trainees nearly four times more likely to pursue it.

Clinical Implications

Personal psychotherapy appeared to have relevance to training from both a pastoral and a learning perspective. If training schemes wish to support this practice they will need to address difficulties trainees may face in accessing therapy. Trainees might also be encouraged to think about the effect of cultural factors on their attitudes towards psychological therapies.

The Self-focused Practice Questionnaire (SfPQ): Preliminary Psychometric Properties of a Measure of Therapist Self-focused Practice

Background: Therapist self-practice, in its various forms, is common across therapeutic modalities, but a measure of its impact on participants does not yet exist. Aims: This paper describes the development and reliability testing of the ‘Self-focused Practice Questionnaire’ (SfPQ), a measure of self-perceived impact of one's self-focused practice. Method: Exploratory factor analysis (EFA), internal consistency and reliability were assessed in a convenience sample of 112 trainee therapists. Results: Five factors, rating impacts on therapist Personal-self (Awareness of Developmental experiences, Experience of Personal Change and Felt-sense/Self-awareness), and Therapist-self (Internalization of the Model, and Development of Empathy) were identified, with good internal consistency and acceptable to good test–retest reliability. Conclusions: Though more work is needed, these preliminary results support the SfPQ's reliability and validity. The SfPQ is an important measure, which may enhance routine rating of self-focused practice in training institutions.

Personal Therapy in Psychiatry Residency Training: A National Survey of Canadian Psychiatry Residents

OBJECTIVE

The authors collected nationally representative data on Canadian residents' experiences with and perspectives on personal psychotherapy in their psychiatric training.

METHODS

A 43-item questionnaire was distributed electronically to all current psychiatry residents in Canada (N = 839).

RESULTS

Four hundred residents from every program across Canada returned the survey (response rate 47.7%). The prevalence of personal therapy at any time was 55.3%, with 42.8% receiving personal therapy during residency. Of residents who undertook personal psychotherapy, 59.3% engaged in weekly therapy, 74.1% received psychodynamic psychotherapy, and 81.5% participated in long-term therapy (>1 year). Personal growth, self-understanding, and professional development were the most common reasons for engaging in personal therapy; however, one-third of residents did so to alleviate symptoms of depression, anxiety, or other mental health concerns. Time was the most important factor impeding residents from personal therapy; only 8.8% found stigma to act as a barrier. The vast majority of residents rated their experience with personal therapy as having a positive or very positive impact on their personal life (84.8%) and overall development as psychiatrists (81.8%). For 64% of respondents, personal therapy had an important or very important role in psychiatry residency training. Residents who received personal therapy rated themselves as better able to understand what happens moment by moment during therapy sessions, detect and deal with patients' emotional reactions, and constructively use their personal reactions to patients.

CONCLUSION

Interest in personal therapy remains strong among psychiatry trainees in Canada. Residents who engaged in psychotherapy endorsed greater confidence in psychotherapy and rated their psychotherapy skills more favorably than those who had never been in the patient role, supporting the view of personal therapy as an important adjunct to psychotherapy training during residency.

Stories of the Accused: A Phenomenological Inquiry of MFTs and Accusations of Unprofessional Conduct

Interviews were conducted with 10 MFTs (six females and four males) who had received a formal accusation of unprofessional conduct and went before state licensure boards in three different states. Accusations included dual relationships, financial fraud/errors, receiving DUIs, sexual misconduct, and emotionally harming a client. Utilizing Moustakas' (1994, Phenomenological research methods, Thousand Oaks, CA: Sage) transcendental phenomenology, five essential themes emerged: (a) The experience of being formally accused of unprofessional conduct is life-changing, (b) state MFT licensing boards are more punitive than rehabilitative, (c) obtaining support is vital, (d) making accusations creates stigma, (e) therapists were unprepared to handle accusations of unprofessional conduct. Clinical implications include the importance of supervision, personal therapy, and strategies for prevention and rehabilitation with this population.

The professionalization and training of psychologists: The place of clinical wisdom

OBJECTIVE

The current study examines how clinical wisdom develops and how it both is and can be influenced by professional training processes. In this way, the project is studying the intersection of developmental and systemic processes related to clinical wisdom.

METHOD

Researchers analyzed the interviews of psychologists practicing in the USA and Canada who were nominated for their clinical wisdom by their peers. These interviews explored how graduate training and professionalization were thought to influence the development of clinical wisdom and were subjected to an adapted grounded theory analysis.

RESULTS

The findings described both professional and personal disincentives toward developing wisdom, including the dangers of isolation. Therapists reported concerns about educational systems that rewarded quick answers instead of thoughtful questioning in processes of admittance, training, and accreditation. Findings emphasized the importance of teaching multiple psychotherapy orientations, critical self- and professional-reflection skills, and openly supporting graduate students' curiosities and continued professional engagement.

CONCLUSIONS

Recommended principles for training are put forward for the development and evaluation of psychotherapy training programs that aim to foster clinical wisdom. These principles complement training models focused upon clinical competence by helping trainees to develop a foundation for clinical wisdom.

The gap between science and practice: how therapists make their clinical decisions

Recent surveys have found that many patients are not receiving empirically supported treatments and that therapists may not update their knowledge of research. Studies have found that therapists prefer to use their clinical experience rather than research findings to improve their practice, although cognitive behavioral (CB) practitioners have been found to use research more frequently than therapists of other theoretical orientations. The organization in which therapists work has been shown to impact attitudes toward working practices, but studies have not examined whether workplace requirements to use research affect therapists' practice. Studies to date have mainly been conducted in North America. These findings may not be generalizable to the United Kingdom where there is a National Health Service (NHS), which requires the use of empirically supported treatments. The first part of this study aimed to investigate which factors were influential in therapists' choice of theoretical orientation and to see whether CB practitioners differed from other therapists in the factors that influenced their choice of theoretical orientation. The second part tested whether therapists' theoretical orientation or their workplace influenced the frequency with which they used research in their clinical decision-making. The final part investigated whether being a CB practitioner or working in the NHS was associated with having a favorable attitude toward research. An online survey was sent to 4,144 psychological therapists in England; 736 therapists responded (18.5%). Therapists reported that research had little influence over their choice of theoretical orientation and clinical decision-making compared to other factors, specifically clinical experience and supervision. CB practitioners and NHS therapists, regardless of their orientation, were significantly more likely to use research than other therapists and were more likely to have a positive attitude toward research.

Self-practice and self-reflection in cognitive behaviour therapy training: what factors influence trainees' engagement and experience of benefit?

BACKGROUND

Previous studies of self-practice/self-reflection (SP/SR) CBT training have found that trainees report significant benefits from practising CBT techniques on themselves (self-practice) and reflecting on their experience (self-reflection) as a formal part of their CBT training. However, not all trainees experience the same level of benefit from SP/SR and not all types of training course produce benefits to the same extent.

AIMS

This paper examines the question: What factors influence trainees' reported benefit from SP/SR? The aim was to develop a model to maximize the value of SP/SR training.

METHOD

The authors used a grounded theory analysis of four SP/SR training courses, varying along several dimensions, to derive a model that could account for the data.

RESULTS

A model was derived comprising of seven elements: Two outcomes - "Experience of Benefit" and "Engagement with the Process" - that mutually influence one another; and five other influencing factors - "Course Structure and Requirements", "Expectation of Benefit", "Feeling of Safety with the Process", "Group Process", and "Available Personal Resources" - that mediate the impact on Engagement with the Process and Experience of Benefit from SP/SR.

CONCLUSIONS

A model that provides guidance about the best ways to set up and develop SP/SR programs has been developed. This model may now be subject to empirical testing by trainers and researchers. Implications and recommendations for the design and development of future SP/SR programs are discussed.