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Experiential learning for trainee therapists through a shame attack exercise

Published online by Cambridge University Press:  23 November 2020

James Collard Open the ORCID record for James Collard [Opens in a new window]  and
Michael Clarke
James Collard*
Affiliation:
Cairnmillar Institute, Camberwell, Australia
Michael Clarke
Affiliation:
Cairnmillar Institute, Camberwell, Australia
*
*Corresponding author. Email: [email protected]
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Abstract

Research on self-practice/self-reflection (SP/SR) programmes in training cognitive behavioural therapy (CBT) have shown promising outcomes over the past decade. To date, the SP/SR framework research has generally focused on entire programmes and has rarely assessed the utility of specific exercises as teaching tools. This study aimed to determine the utility of an exposure intervention known as a shame attack in helping to facilitate CBT training in a clinical psychology programe when delivered in a SP/SR framework. It also sought to examine the potential for the exercise to be used as a form of competency-based assessment. Forty-one student trainees engaged in self-directed shame attack exercises and provided written reflections on their experiences. The reflections were then studied via thematic analysis. The results indicate that the exercise provides an avenue for competency-based assessment of trainee therapists’ conceptual knowledge, formulation skills and intervention planning. It also promoted learning outcomes relating to a ‘deeper’ and more nuanced appreciation of CBT theory and practice. The shame attack exercise provided for personal development and the opportunity to experience typical client challenges with engaging in exposure interventions, which have the potential for enhancing empathy and cognitive behavioural skills.

Key learning aims

  1. (1) To understand the usefulness of a shame attack exercise for training within a SP/SR framework.

  2. (2) To examine the potential for using SP/SR as a form of competency-based training.

  3. (3) To demonstrate the benefits of experiential learning through SP/SR in training CBT.

Keywords

cognitive behavioural therapy trainingexperiential learningself-practice self-reflectionshame attack
Type
Original Research
Information
the Cognitive Behaviour Therapist , Volume 13 , 2020 , e53
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Further reading

Bennett-Levy, J. (2019). Why therapists should walk the talk: the theoretical and empirical case for personal practice in therapist training and professional development. Journal of Behavior Therapy and Experimental Psychiatry, 62, 133–145. https://doi.org/10.1016/j.jbtep.2018.08.004 CrossRefGoogle ScholarPubMed
Bennett-Levy, J., Thwaites, R., Haarhoff, B., & Perry, H. (2015). Experiencing CBT from the inside out: a self-practice/self-reflection workbook for therapists. Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists. New York, NY, USA: Guilford Press.Google Scholar

References

Beck, J. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd edn). New York, USA: Guilford Press. https://doi.org/10.1017/CBO9781107415324.004 Google Scholar
Beck, J. S. (1995). Cognitive Therapy: Basics and Beyond. New York, USA: Guilford Press.Google Scholar
Belleau, E., Chin, E., Wanklyn, S., Zambrano-Vazquez, L., Schumacher, J., & Coffey, S. (2017). Pre-treatment predictors of dropout from prolonged exposure therapy in patients with chronic posttraumatic stress disorder and comorbid substance use disorders. Behaviour Research and Therapy, 91. https://doi.org/10.1016/j.brat.2017.01.011 CrossRefGoogle Scholar
Bennett-Levy, J. (2003). Mechanisms of change in cognitive therapy: the case of automatic thought records and behavioural experiments. Behavioural and Cognitive Psychotherapy, 31, 261–277. https://doi.org/10.1017/S1352465803003035 CrossRefGoogle Scholar
Bennett-Levy, J. (2019). Why therapists should walk the talk: the theoretical and empirical case for personal practice in therapist training and professional development. Journal of Behavior Therapy and Experimental Psychiatry, 62, 133–145. https://doi.org/10.1016/j.jbtep.2018.08.004 CrossRefGoogle ScholarPubMed
Bennett-Levy, J., Lee, N., Andrews, K., Pohlman, S., Hamernik, E., Travers, K., … & Hamernik, E. (2003). Cognitive therapy from the inside: enhancing therapist skills through practising what we preach. Behavioural and Cognitive Psychotherapy, 31, 143–158. https://doi.org/10.1017/S1352465803002029 CrossRefGoogle Scholar
Bennett-Levy, J., & Lee, N. K. (2014). Self-practice and self-reflection in cognitive behaviour therapy training: what factors influence trainees’ engagement and experience of benefit? Behavioural and Cognitive Psychotherapy, 42, 48–64. https://doi.org/10.1017/S1352465812000781 CrossRefGoogle Scholar
Bennett-Levy, J., Thwaites, R., Chaddock, A., & Davis, M. (2009). Reflective practice in cognitive behavioural therapy: the engine of lifelong learning. In Reflective Practice in Psychotherapy and Counselling (pp. 115–135). https://doi.org/10.13140/2.1.1111.9040 CrossRefGoogle Scholar
Bennett-Levy, J., Thwaites, R., Haarhoff, B., & Perry, H. (2015). Experiencing CBT from the inside out: a self-practice/self-reflection workbook for therapists. Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists. New York, NY, USA: Guilford Press.Google Scholar
Bennett-Levy, J., Turner, F., Beaty, T., Smith, M., Paterson, B., & Farmer, S. (2001). The value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists. Behavioural and Cognitive Psychotherapy, 29, 203–220.CrossRefGoogle Scholar
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. https://doi.org/10.1191/1478088706qp063oa CrossRefGoogle Scholar
Chigwedere, C., Thwaites, R., Fitzmaurice, B., & Donohoe, G. (2019). Self-practice/self-reflection as an alternative to personal training-therapy in cognitive behavioural therapy training: a qualitative analysis. Clinical Psychology & Psychotherapy, 26, 74–83. https://doi.org/doi:10.1002/cpp.2331 CrossRefGoogle ScholarPubMed
Craske, M. G., Treanor, M., Conway, C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006 CrossRefGoogle ScholarPubMed
Davis, M. L., Thwaites, R., Freeston, M. H., & Bennett-Levy, J. (2015). A measurable impact of a self-practice/self-reflection programme on the therapeutic skills of experienced cognitive-behavioural therapists. Clinical Psychology & Psychotherapy, 22, 176–184. https://doi.org/doi:10.1002/cpp.1884 CrossRefGoogle ScholarPubMed
Deacon, B. J., & Farrell, N. R. (2013). Therapist barriers to the dissemination of exposure therapy. In Handbook of Treating Variants and Complications in Anxiety Disorders. (pp. 363–373). New York, USA: Springer Science + Business Media. https://doi.org/10.1007/978-1-4614-6458-7_23 CrossRefGoogle Scholar
Ellis, A. (1994). Reason and Emotion in Psychotherapy. Secaucus, NJ, USA: Carol Publishing Group.Google Scholar
Ellis, A., & MacLaren, C. (1998). Rational Emotive Behavior Therapy: A Therapist’s Guide. Impact Publishers.Google Scholar
Fereday, J., & Muir-Cochrane, E. (2006). Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. International Journal of Qualitative Methods, 5, 80–92. https://doi.org/10.1177/160940690600500107 CrossRefGoogle Scholar
Foa, E. B., & McLean, C. P. (2016). The efficacy of exposure therapy for anxiety-related disorders and its underlying mechanisms: the case of OCD and PTSD. Annual Review of Clinical Psychology, 12, 1–28. https://doi.org/10.1146/annurev-clinpsy-021815-093533 CrossRefGoogle ScholarPubMed
Gale, C., & Schröder, T. (2014). Experiences of self-practice/self-reflection in cognitive behavioural therapy: a meta-synthesis of qualitative studies. Psychology and Psychotherapy: Theory, Research and Practice, 87, 373–392. https://doi.org/doi:10.1111/papt.12026 CrossRefGoogle ScholarPubMed
Haarhoff, B., Gibson, K., & Flett, R. (2011). Improving the quality of cognitive behaviour therapy case conceptualization: the role of self-practice/self-reflection. Behavioural and Cognitive Psychotherapy, 39, 323–339. https://doi.org/10.1017/S1352465810000871 CrossRefGoogle ScholarPubMed
Hofmann, S. G. (2007). Cognitive factors that maintain social anxiety disorder: a comprehensive model and its treatment implications. Cognitive Behavioural Therapy, 36, 193–209.CrossRefGoogle ScholarPubMed
Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience, 17, 337–346. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/26487814 Google ScholarPubMed
McGillivray, J., Gurtman, C., Boganin, C., & Sheen, J. (2015). Self-practice and self-reflection in training of psychological interventions and therapist skills development: a qualitative meta-synthesis review. Australian Psychologist, 50, 434–444. https://doi.org/10.1111/ap.12158 CrossRefGoogle Scholar
Mineka, S., & Thomas, C. (1999). Mechanisms of change in exposure therapy for anxiety disorders. Handbook of Cognition and Emotion. New York, USA: John Wiley & Sons Ltd. https://doi.org/10.1002/0470013494.ch35 Google Scholar
Moldovan, R., & David, D. (2013). The impact of supervisor characteristics on trainee outcome in clinical supervision: a brief report. Journal of Cognitive and Behavioral Psychotherapies, 13, 517–527.Google Scholar
Motivational Interviewing Network of Trainers (2014). Motivational Interviewing Training: New Trainers Manual. Retrieved from: https://motivationalinterviewing.org/motivational-interviewing-training Google Scholar
Norton, P. J., Hayes-Skelton, S. A., & Klenck, S. C. (2011). What happens in session does not stay in session: changes within exposures predict subsequent improvement and dropout. Journal of Anxiety Disorders, 25, 654–660. https://doi.org/10.1016/J.JANXDIS.2011.02.006 CrossRefGoogle Scholar
Padesky, C. A. (1996). Developing cognitive therapist competency: teaching and supervision models. Frontiers of Cognitive Therapy. New York, USA: Guilford Press.Google Scholar
Pittig, A., Treanor, M., LeBeau, R. T., & Craske, M. G. (2018). The role of associative fear and avoidance learning in anxiety disorders: gaps and directions for future research. Neuroscience and Biobehavioral Reviews, 88, 117–140. https://doi.org/10.1016/j.neubiorev.2018.03.015 CrossRefGoogle ScholarPubMed
Richard, D. C. S., & Lauterbach, D. (2007). Handbook of Exposure Therapies. Academic Press. https://doi.org/10.1016/B978-0-12-587421-2.X5000-5 Google Scholar
Scherr, S. R., Herbert, J. D., & Forman, E. M. (2015). The role of therapist experiential avoidance in predicting therapist preference for exposure treatment for OCD. Journal of Contextual Behavioral Science, 4, 21–29. https://doi.org/10.1016/J.JCBS.2014.12.002 CrossRefGoogle Scholar
Spendelow, J. S., & Butler, L. J. (2016). Reported positive and negative outcomes associated with a self-practice/self-reflection cognitive-behavioural therapy exercise for CBT trainees. Psychotherapy Research: Journal of the Society for Psychotherapy Research, 26, 602–611. https://doi.org/10.1080/10503307.2015.1058983 CrossRefGoogle ScholarPubMed
Thwaites, R., Bennett-Levy, J., Cairns, L., Lowrie, R., Robinson, A., Haarhoff, B., … & Perry, H. (2017). Self-practice/self-reflection (SP/SR) as a training strategy to enhance therapeutic empathy in low intensity CBT practitioners. New Zealand Journal of Psychology, 46, 63–70.Google Scholar
Thwaites, R., Bennett-Levy, J., Davis, M., & Chaddock, A. (2014). Using self-practice and self- reflection (SP/SR) to enhance CBT competence and meta-competence. In Whittington, A. & Grey, N. (eds), How to Become a More Effective CBT Therapist: Mastering Metacompetence in Clinical Practice (pp. 241–254). Wiley-Blackwell.Google Scholar
Thwaites, R., Cairns, L., Bennett-Levy, J., Johnston, L., Lowrie, R., Robinson, A., … & Perry, H. (2015). Developing metacompetence in low intensity cognitive-behavioural therapy (CBT) interventions: evaluating a self-practice/self-reflection programme for experienced low intensity CBT practitioners. Australian Psychologist, 50, 311–321. Retrieved from: http://10.0.4.87/ap.12151 CrossRefGoogle Scholar
von Treuer, K. M., & Reynolds, N. (2017). A competency model of psychology practice: articulating complex skills and practices. Frontiers in Education, 2, 1–7. https://doi.org/10.3389/feduc.2017.00054 CrossRefGoogle Scholar
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