While a significant amount of research illustrates the positive effects of therapists’ use of mindfulness, few studies have addressed whether therapists’ mindfulness actually improves psychotherapy outcomes. Additionally, no existing research has examined whether therapists’ use of a mindfulness exercise immediately before meeting with a client could also have a positive impact on the following session. The purpose of this study was to test whether engaging in a centering exercise 5-10 minutes before a session could have a positive impact on therapy, in particular on the therapists’ ability to remain present in session. Results indicated that the trainee therapists did not report changes in mindfulness after the brief mindfulness training program. Results also indicated that completing the centering exercise before a session did not appear to impact client ratings of therapeutic presence and session outcomes. The results suggest that more intensive training in mindfulness may be necessary to impact psychotherapy outcomes.

Background: Although exposure is considered an active ingredient in evidence-based treatments (EBTs) for anxiety, it is infrequently used in routine clinical care settings. Therapist-level barriers to the use of exposure include inadequate training and negative beliefs about exposure. Prior efforts to train therapists in exposure therapy have resulted in knowledge but not behavior change. This study employed a novel training strategy, experiential learning, designed to improve the translation of knowledge into clinical practice. This study’s aims were to assess the feasibility and acceptability of experiential training (ET), as well as to conduct exploratory inferential analyses examining knowledge, attitudes, and use of exposure following training. Methods: Participants included 28 therapists working in routine clinical care settings. They were randomized to one of two conditions to learn about exposure therapy: training as usual (TAU) or ET (i.e., undergoing a one-session treatment for fear of spiders). Both workshops lasted one day, and participants were expected to attend weekly consultation calls for three months after training. Qualitative interviews were conducted at the end of the consultation call period. Results: The ET was feasible and acceptable to participants. Qualitative interviews suggested that participants, including those who were fearful of spiders, had a positive response to the training and found it to be useful. Quantitative analyses found that there was a significantly greater increase in the number of exposures used following ET than TAU at 1-month follow up. Both conditions demonstrated significant increases in knowledge, attitudes toward exposures, and self-efficacy following the training. Conclusions: The findings suggest that, consistent with previous research, a one-day training resulted in significant improvements in therapist-level factors that may affect the use of exposure. In addition, there is initial evidence that ET resulted in greater use of exposure after training, which applied more broadly, could increase the number of clients receiving an EBT for anxiety. The results provide promising evidence for the utility and acceptability of ET as a strategy to increase the use of EBTs in clinical practice. / Psychology

Patirtinė grupė yra pagrindinis būsimų grupės terapeutų rengimo būdas. Terapinio ir mokymosi kontekstų joje susidūrimas sukuria savitą įvairių patirčių susipynimą, kuris šiame darbe įvardinamas kaip dalyvių patirties daugialypiškumas. Šis patirtinės grupės bruožas yra itin mažai tyrinėtas. Šiame darbe, remiantis ilgalaikės patirtinės grupės dalyvių patirtimi, atskleidžiama, kaip reiškiasi patirtinės grupės daugialypiškumas, kokią įtaką jis daro grupės dinamikai. Tyrime dalyvavo visi (I etape – 8, II etape – 5) Humanistinės ir Egzistencinės psichologijos instituto (Lietuva) Grupinės terapijos programos tos pačios grupės dalyviai. Programa vyko dviem etapais: I etape patirtinę grupę pakaitomis vedė skirtingi patyrę grupės terapeutai, II – patirtinę grupę pakaitomis vedė patys dalyviai. Patirtinės grupės darbas buvo aptariamas drauge su ją stebėjusiais supervizorias. Kiekviename etape buvo atlikta po 2 pusiau-struktūruotus interviu. Interviu tekstai buvo analizuojami taikant indukcinę teminę analizę ir interpretuojami remiantis I. D. Yalom grupių teorijos ir praktikos samprata. Tyrimo rezultatai atskleidė, kad būsimųjų grupės terapeutų patirties daugialypiškumas patirtinėje grupėje atsispindi jų santykyje su patirtine grupe, programos struktūra ir tarpasmeniniuose santykiuose. Jis veikia grupės dinamiką: lėtina grupės telkimąsi, apsunkina tikslų vaidmenų grupėje atlikimą, ir atskleidžia mokymosi motyvacijos ir kolegiškų santykių svarbą grupės sutelktumui kurti. / Participation in an experiential group is the main method of training prospective group therapists. The encounter of therapeutic and learning contexts in an experiential group creates a distinctive twine of various experiences that is called experience diversity in this study. This experiential group feature was little researched. The study reveals how experiential group diversity presents itself in experiences of participants in a long-term experiential group, and what influence it makes on group dynamics. All participants at the Institute of Humanistic and Existential Psychology (Birštonas, Lithuania) group therapy program (stage I–8, stage II–5) took part in the study. The program consisted of two stages: an experiential group was guided by experienced group therapists in stage I, the experiential group was guided by participants themselves in stage II. The work in experiential group was discussed with supervisors. Participants were interviewed four times: two semi-structured interviews were performed in each stage. Interview texts were analyzed applying inductive thematic analysis and interpreted according to I. D. Yalow’s conception of group therapy and practice. Study results revealed that prospective group therapists’ experience diversity in the experiential group is reflected in interpersonal relationships, participant relationship to the experiential group and program structure. It slows down group cohesion, influences the perception of roles, and reveals the... [to full text]

Patirtinė grupė yra pagrindinis būsimų grupės terapeutų rengimo būdas. Terapinio ir mokymosi kontekstų joje susidūrimas sukuria savitą įvairių patirčių susipynimą, kuris šiame darbe įvardinamas kaip dalyvių patirties daugialypiškumas. Šis patirtinės grupės bruožas yra itin mažai tyrinėtas. Šiame darbe, remiantis ilgalaikės patirtinės grupės dalyvių patirtimi, atskleidžiama, kaip reiškiasi patirtinės grupės daugialypiškumas, kokią įtaką jis daro grupės dinamikai. Tyrime dalyvavo visi (I etape – 8, II etape – 5) Humanistinės ir Egzistencinės psichologijos instituto (Lietuva) Grupinės terapijos programos tos pačios grupės dalyviai. Programa vyko dviem etapais: I etape patirtinę grupę pakaitomis vedė skirtingi patyrę grupės terapeutai, II – patirtinę grupę pakaitomis vedė patys dalyviai. Patirtinės grupės darbas buvo aptariamas drauge su ją stebėjusiais supervizorias. Kiekviename etape buvo atlikta po 2 pusiau-struktūruotus interviu. Interviu tekstai buvo analizuojami taikant indukcinę teminę analizę ir interpretuojami remiantis I. D. Yalom grupių teorijos ir praktikos samprata. Tyrimo rezultatai atskleidė, kad būsimųjų grupės terapeutų patirties daugialypiškumas patirtinėje grupėje atsispindi jų santykyje su patirtine grupe, programos struktūra ir tarpasmeniniuose santykiuose. Jis veikia grupės dinamiką: lėtina grupės telkimąsi, apsunkina tikslų vaidmenų grupėje atlikimą, ir atskleidžia mokymosi motyvacijos ir kolegiškų santykių svarbą grupės sutelktumui kurti. / Participation in an experiential group is the main method of training prospective group therapists. The encounter of therapeutic and learning contexts in an experiential group creates a distinctive twine of various experiences that is called experience diversity in this study. This experiential group feature was little researched. The study reveals how experiential group diversity presents itself in experiences of participants in a long-term experiential group, and what influence it makes on group dynamics. All participants at the Institute of Humanistic and Existential Psychology (Birštonas, Lithuania) group therapy program (stage I–8, stage II–5) took part in the study. The program consisted of two stages: an experiential group was guided by experienced group therapists in stage I, the experiential group was guided by participants themselves in stage II. The work in experiential group was discussed with supervisors. Participants were interviewed four times: two semi-structured interviews were performed in each stage. Interview texts were analyzed applying inductive thematic analysis and interpreted according to I. D. Yalow’s conception of group therapy and practice. Study results revealed that prospective group therapists’ experience diversity in the experiential group is reflected in interpersonal relationships, participant relationship to the experiential group and program structure. It slows down group cohesion, influences the perception of roles, and reveals the... [to full text]

The purpose of this study was to explore whether and in what ways an intensive eight-week Mindfulness-Based Symptom Management (MBSM) program might shape the therapeutic experiences of therapists. I used a hermeneutic phenomenological approach to interview and develop in-depth descriptions of four therapists’ experiences in relation to mindfulness and their therapeutic practices. The data collection consisted of: (1) a telephone screening interview; (2) pre-mindfulness training interview; (3) post-mindfulness training interview; (4) field notes based on my observations, subjective experiences, and beginning analyses; (5) and member-checks to verify the accuracy of my interpretations of participants’ interview responses. The results pointed to several common themes indicating the changes therapists described after participating in the mindfulness program. Themes denoting the reported changes were organized into three categories: (1) personal relationship with mindfulness; (2) relationship between mindfulness and therapeutic experiences; and (3) mindfulness-oriented interventions performed in therapy. The findings indicated that mindfulness training is associated with the enhancement of important relational attitudes and skills of therapists, including more acceptance of where clients are at, more presence in therapy, increased capacity to listen, openness and curiosity, and more compassion and empathy. In addition, mindfulness training may be linked to improved reflexive abilities, which has implications for more intentional and ethical decision-making in therapy. Further, the findings also indicated that mindfulness training may be linked to improvements in emotion regulation by decreasing stress, increasing feelings of relaxation and calmness, improving awareness of negative emotional and cognitive states as well as the ability to interrupt these negative cycles. As such, this study pointed to several potential benefits for the inclusion of mindfulness training in therapists’ self-care practices as well as in therapist education.

The purpose of this study was to explore whether and in what ways an intensive eight-week Mindfulness-Based Symptom Management (MBSM) program might shape the therapeutic experiences of therapists. I used a hermeneutic phenomenological approach to interview and develop in-depth descriptions of four therapists’ experiences in relation to mindfulness and their therapeutic practices. The data collection consisted of: (1) a telephone screening interview; (2) pre-mindfulness training interview; (3) post-mindfulness training interview; (4) field notes based on my observations, subjective experiences, and beginning analyses; (5) and member-checks to verify the accuracy of my interpretations of participants’ interview responses. The results pointed to several common themes indicating the changes therapists described after participating in the mindfulness program. Themes denoting the reported changes were organized into three categories: (1) personal relationship with mindfulness; (2) relationship between mindfulness and therapeutic experiences; and (3) mindfulness-oriented interventions performed in therapy. The findings indicated that mindfulness training is associated with the enhancement of important relational attitudes and skills of therapists, including more acceptance of where clients are at, more presence in therapy, increased capacity to listen, openness and curiosity, and more compassion and empathy. In addition, mindfulness training may be linked to improved reflexive abilities, which has implications for more intentional and ethical decision-making in therapy. Further, the findings also indicated that mindfulness training may be linked to improvements in emotion regulation by decreasing stress, increasing feelings of relaxation and calmness, improving awareness of negative emotional and cognitive states as well as the ability to interrupt these negative cycles. As such, this study pointed to several potential benefits for the inclusion of mindfulness training in therapists’ self-care practices as well as in therapist education.

While a significant amount of research illustrates the overall positive effects of therapists' general use of mindfulness, very few studies have addressed whether therapists' use of mindfulness translates to improved psychotherapy outcomes. The present study utilized a randomized-controlled design to test whether a brief mindfulness training program and pre-session mindfulness practice could have a positive impact on therapy; in particular, we hypothesized that mindfulness training and practice would improve ratings on therapeutic presence as rated by clients and therapists and session effectiveness as rated by clients. The present study also examined whether clients' subjective ratings of therapy outcome and therapists' theoretical orientation impacted outcome measures after therapists completed mindfulness training. The 20 participating therapists were randomly assigned to either the mindfulness training (MT) group or control group according to a computer generated randomization list. Results indicated that clients did not significantly improve on outcome measures after completing the mindfulness training. Clients' subjective ratings on a psychotherapy outcome measure did predict changes in their ratings of therapeutic presence. This finding may have important implications for future research examining client characteristics that may moderate the relationship between therapeutic presence and session outcomes. Limitations of the present study and future directions are discussed.

The client-therapist relationship has long been recognized as an important element in psychotherapy, and research has demonstrated its robust association with positive outcomes. This study examined the feasibility and preliminary efficacy of training therapists in strategies for improving therapeutic relationships with clients. The strategies were compiled from the empirical literature, drawing on the work of Hilsenroth and Cromer (2007), Castonguay (1996), and Safran and Muran (2000). The study employed a manipulated training design that has the benefit of addressing naturalistic effectiveness questions, while adhering to the rigorous scientific standards of controlled efficacy research (Hayes, 2002). Participants were 57 therapists working at five community mental health clinics who were randomly assigned to the brief alliance training workshop (in which they participated prior to starting treatment with a new client) or to a delayed-training control condition. Outcomes assessed included therapists' self-reported use of alliance strategies in session 1, therapist-rated alliance quality after session 1, and early client engagement. Engagement was operationalized in several ways: number of sessions attended in the first four weeks, planned session frequency (e.g., weekly, monthly), attendance rate (i.e., percent of scheduled sessions attended), and treatment status at the end of four weeks (e.g., therapist and client had next session scheduled, client had terminated unilaterally). Counter to hypotheses, one-way ANOVAs and chi-square analyses revealed no statistically significant differences between the training and the delayed-training conditions on the primary outcomes. However, effect size estimates suggested that clinicians in the training condition reported better alliances with their clients than clinicians who had yet to receive the training (d = 0.40, 95% CI [-0.13, 0.93], small to medium effect). Furthermore, therapists' use of alliance strategies taught in the workshop was significantly correlated with alliance quality. In addition to the preliminary efficacy findings, the study generated important information about the feasibility of conducting psychotherapy research in naturalistic settings, as well as recommendations for future studies. The manipulated training design holds promise for collaborations between researchers and clinicians seeking to bridge science and practice.

Listening is a fundamental and deceptively complicated component of talk therapy that has received very little specific research attention. The work of Carl Rogers and others promotes the importance of empathic listening to create safety and process client experiences, and several models identify its importance in processing and regulating client emotions (especially in couple therapy, where empathic listening can disrupt rigid conflict cycles and model coregulation skills). Much of the dysregulation and resistance we see in therapy may be related to a perceived lack of safety caused by persistent conflict or previous trauma, explained by the unconscious processes of the autonomic nervous system and polyvagal theory. Polyvagal research also supports the relationship between empathic listening and emotional safety: demonstration of genuine interest, care, acceptance, and validation are perceived as evidence of safety that encourage emotional connection. These behaviors are accessible to novice therapists who are still learning specific models and interventions. This study seeks to illustrate this relationship by conducting a task analysis on empathic listening behaviors by therapists in training in a therapy-as-usual environment. Observation of emotional inquiries in therapy leading to increased perceptions of safety demonstrate that empathic listening requires a sustained balancing of safety-promoting and exploratory behaviors. Therapist directiveness, possibly rooted in anxiety, was a common observation across segments where client safety was not achieved. Our observations also highlight the importance of therapist attunement, or neuroception, to determine whether to use safety-promoting behaviors or exploratory questioning. It is my hope that this research can lend illustration and clarity to the theoretical underpinnings of empathic listening to guide therapist interventions and training.

Empirically supported treatments (ESTs) now exist for a variety of psychological disorders; however, few individuals have access to these treatments and even fewer receive them in well delivered form. This has been termed the research-practice gap. It is likely that a combination of factors contribute to individuals not receiving good quality ESTs. One major reason is the limited availability of effective training in these treatments. Although many therapists wish to learn such treatments, they seldom have the opportunity as training relies on scarce expert resources and is costly. Furthermore, relatively little is known about the effectiveness of this method or how best to train clinicians: despite having evidence-based treatments, there are no evidence-based trainings. This dissertation examined one example of an EST - enhanced cognitive behavior therapy for eating disorders (CBT-E) - with the overarching aim of evaluating both existing, and commonly accepted, training methods, as well as, newly developed more scalable ones. How best to train clinicians in CBT for eating disorders has not been investigated previously. The Kirkpatrick training evaluation framework was adopted to guide the studies. Chapter One provided an overview of the research-practice gap with a particular emphasis on the obstacles faced in training therapists. Chapter Two reviewed the literature on training in ESTs and highlighted gaps in the research evidence and areas for improvement in future studies. An important conclusion was that, although studies varied in design and the precise form and content of the training investigated, results were mostly consistent in indicating that knowledge and skills tended to improve following training. However, the outcome measures used to assess training were often poorly described with unknown psychometric properties. Perhaps most importantly the lack of clearly defined competence cut-points made interpretation difficult. In addition, much of the training investigated had limitations in terms of scalability. Chapters Three, Four and Five, aimed to overcome some of these difficulties and provided a series of studies investigating training in CBT-E. Chapter Three employed qualitative methods to investigate trainees' reaction to conventional workshop and more scalable web-based training and found that although trainees enjoyed training, they had a variety of reasons for not planning to implement the treatment as learned. Chapters Four and Five evaluated the impact of different forms of training on knowledge and skill acquisition respectively. Training in CBT-E was associated with increases in knowledge especially when paired with supervision or scalable guidance, which proved feasible and acceptable to clinician trainees. The results for skill acquisition were less clear, but the new scalable online training was associated with therapists achieving competence. Finally Chapter Six discussed the broader implications of the work and highlighted areas for future research.