Learning to Practice Compassionate Care: Medical Students Discuss Their Most Memorable Lessons

Compassion in interactions between physicians and patients can have a therapeutic effect independent of the technical medical treatment provided. However, training physicians to effectively communicate compassion is challenging. This study explores how medical students experienced training focused on interacting with patients by examining students’ reports of particularly memorable lessons. Six focus groups were conducted with medical students (total n = 48) in their fourth year of training. We report on responses from students to the question, “What was the most memorable lesson you have learned about interacting with patients?” Students discussed lessons aimed at patient-centered physical navigation, interpersonal navigation, and perspective taking. Concerns were raised that navigation techniques felt inauthentic and that perspective taking was too time consuming to be sustainable in actual practice. While perspective-taking exercises should motivate medical students to treat every patient with dignity by demonstrating the complexity of others’ lives, if students assume that full understanding is a prerequisite to delivery of compassionate care, they may dismiss explicit techniques of patient-centered care as inauthentic and perceive compassion and efficiency as mutually exclusive.

Building a doctor, one skill at a time: Rethinking clinical training through a new skills-based feedback modality

The Accreditation Council for Graduate Medical Education milestones and entrustable professional activities (EPAs) are important assessment approaches but may lack specificity for learners seeking improvement through daily feedback. As in other professions, clinicians grow best when they engage in deliberate practice of well-defined skills in familiar contexts. This growth is augmented by specific, actionable coaching from supervisors. This article proposes a new feedback modality called microskills, which are derived from the psychology, negotiation, and business literature, and are unique in their ability to elicit targeted feedback for trainee development. These microskills are grounded in both clinical and situational contexts, thereby mirroring learners' cognitive schemas and allowing for more natural skill selection and adoption. When taken as a whole, microskills are granular actions that map to larger milestones, competencies, and EPAs. This article outlines the theoretical justification for this new skills-based feedback modality, the methodology behind the creation of clinical microskills, and provides a worked example of microskills for a pediatric resident on a hospital medicine rotation. Ultimately, microskills have the potential to complement milestones and EPAs and inform feedback that is specific, actionable, and relevant to medical learners.

Positive Psychological Coaching Tools and Techniques: A Systematic Review and Classification

Positive psychological coaching (PPC) has emerged as a popular "paradigm" for practitioners interested in the professional development of people. A recent review consolidated the literature on PPC and produced a 5-phase positive psychological coaching model aimed at facilitating professional growth. However, little is known about practically operationalizing each phase of the coaching process (i.e., how to facilitate each phase and which underlying tools and techniques could be employed to do so). As such, the purpose of this systematic review was to address this limitation by (a) determining which coaching tools and techniques are proposed within the coaching literature and (b) classifying the identified tools and techniques into the respective phases of PPC model. The investigation used a two-step approach by conducting a systematic literature review (to identify various PPC tools/techniques) followed by an iterative heuristic classification process (to assign these PPC tools/techniques to a known PPC model). The systematic literature review resulted in 24 peer-reviewed publications on positive psychological coaching, providing 117 different coaching tools that could be condensed into 18 overarching coaching techniques. The iterative classification process showed that most techniques and tools are useful in at least two phases. Interestingly, experts still vary in opinion on the timing and application of these specific techniques and tools within the positive psychological coaching process. This study provides researchers and practitioners with practical guidelines to facilitate a positive psychological coaching process.

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.

The effects of the psychodrama in instilling empathy and self-awareness: A pilot study

This pilot study investigated the effects of psychodrama on the counseling skills (mainly empathy) and on increasing the self-awareness of 23 counseling undergraduate students. Participants attended 12 psychodrama sessions over 3 months. Data were gathered by using the Empathic Tendency Scale and a personal information form. The study used the mixed method research design, which combines qualitative and quantitative methods. The quantitative aspect of the study involved the use of pretest-posttest experimental and control group design with random assignment, while the qualitative aspect utilized the methods of case study, observation, and interview. The quantitative and qualitative results showed that psychodrama increased students' empathy, counseling skills, and self-awareness.

Helping Skills Training for Undergraduate Students

We examined the effectiveness of the Hill model of helping skills training for 191 undergraduate students in six sections of a semester-long course. Students completed self-report, performance, and nonverbal measures at the beginning; they conducted one 20-min helping session at the beginning and another toward the end of the semester; and they completed self-efficacy measures at the end of the semester. Students’ helping skills improved over the course of the semester, as evidenced by higher helper- and volunteer client–rated session quality, reduced proportion of words spoken in sessions, increased proportion of exploration skills used in sessions, and increased self-efficacy for using helping skills. Self-reported empathy predicted four of the five helping skills criteria at the beginning-of-semester assessment. Facilitative interpersonal skills predicted end-of-semester self-efficacy in helping skills when controlling for retrospective prelevels and instructor effects. Implications for training and research are presented.

“An Unspoken Level of Comfort”

This study examined 36 Black therapists’ experiences working with Black clients in hospital, school, college, and community counseling settings. Findings of this interpretative phenomenological analysis suggest these therapists most often feel a distinct sense of solidarity with their Black clients, as evidenced by having a better understanding of the context of Black clients’ lives, creating easier and faster therapeutic connections with Black clients, and feeling especially committed to these clients’ well-being. Participants also acknowledged the potential pitfalls and having insufficient boundaries and acknowledged the limitations of their formal training in learning to work with Black clients. How participant responses differed according to years of experience, practice setting, and gender are also explored. This study also suggests implications to increase the quality of training provided to therapist trainees of African descent.

Training Undergraduate Students to Use Insight Skills

We briefly review the literature on helping skills training. We then provide a rationale for the current series of studies, given methodological problems and a lack of focus on teaching insight skills in the previous literature. Next, we provide an overview of the rationale, methods, and analyses used in common across three studies conducted to teach insight skills (immediacy, challenges, and interpretation, respectively) to undergraduate students in helping skills courses.

Therapeutic Change

In this rejoinder, the authors respond to the comments, feedback, and suggestions offered by Hatcher, Miville, and Nutt. The authors clarify a possible point of confusion, reaffirm their contention that the crux of sound psychology practice rests on therapists’ ability to facilitate change with their clients, and acknowledge both the progressive development that characterizes the process of becoming a competent counselor and the problem of assuming advanced training alone can compensate for the limitations inherent in the microskills-only approach to training. Next, the authors address the issue of complexity, including their intention to balance the need to provide a coherent, accessible model that does not fall prey to oversimplification. Finally, the authors note key similarities to and differences from the competency benchmarks and invite their colleagues to join them in the rigorous testing needed to validate their model of counseling competence.

Microskills, Trainee Competence, and Therapy Outcomes

This article represents an invited reaction to the series of articles critiquing the microskills approach predominant in most counseling training programs as well as the new model of counseling competence presented in this issue. The authors note that the microskills approach has been a useful and well-researched framework in the field, although they were generally in agreement with the conclusions drawn regarding this approach. These authors suggest that the authors of the series of articles address how their new model intersects with the competency benchmarks model as well as provide feedback concerning the social justice applications of the model.

Counseling Competence

Working from their proposed model of counseling competence, the authors address critical implications and applications of the model. First, they present a 10-parameter juxtaposition of the model of counseling competence and the microskills training model, including points of comparision and contrast. Second, they discuss implications of the model for practice, including guidelines for teaching and an application exercise. Third, they discuss implications of the model for research, including improvements over design flaws and the limited focus that has typified research on microskills training.

Training in Counseling Psychology

This Major Contribution, consisting of four articles, critically evaluates the status of training in counseling psychology, especially at the entry level, and offers a model for moving the field forward. In this first article, we provide a rationale for the contribution, laying the foundation for the subsequent three articles. Specifically, we ask the questions, Do training programs in counseling psychology produce the desired results? and Is the prevailing paradigm of training effective in developing counselor competence? Then we report on the research showing a disappointing relationship among training, experience, and expertise. We conclude by inviting the profession to engage in honest self-reflection about the status and future direction of training in counseling psychology.