CBT World Congress: 2nd conference day - sp/sr, imagery rescripting, personal practice, effective therapists, & compassion
Last updated on 23rd July 2019
Well this was a fascinating day ... I went to my friend James Bennett-Levy's fine symposium on "Self-practice/self-reflection (SP-SR) at 18: an experiential training strategy maturing into adulthood", then on to an interesting & helpful symposium discussing broader applications of Arnoud Arntz's imagery approaches - "Efficacy of imagery rescripting as a transdiagnostic intervention". And to complete the morning's cornucopia I was back listening to James delivering a barn-storming plenary on "Personal practice: why therapists should walk the talk." I sat with Judy, James's wife, and we considered standing to applaud at the end but decided this might be a bit over-the-top, even if richly deserved.
The afternoon started with queueing well ahead of time to get into Jaime Delgadillo's symposium "Why are some therapists more effective than others?" (some conference rooms were way to small for the numbers wanting to attend a particular event). Then another James B-L offering (he was having a very busy & productive day) - "How can we develop more effective therapists? Implications of the effective therapists' literature for training, supervision, and professional development". Finally then on to Paul Gilbert's plenary "Evolution, attachment & compassion focused therapy".
There's a real danger at conferences like this that there is so much potentially useful information that one comes away empty-handed. This sounds a bit crazy, but like a hawk faced with a huge flock of smaller birds ... the sheer quantity & choice can be confusing. Then we go home post-conference, often with a backlog of tasks to catch up on ... and within a few weeks all these potential riches have slipped through our fingers. Someone once made a wise comment along the lines of "If you come away from a conference with one important new idea and one good new contact, you're doing well". I'm greedy. I would like to take a couple of good new ideas from each day of this conference and do my very best to apply & not simply forget them.
So what do I want to take away from today? Well, I thought James B-L's linking of personal practice to intra- and inter-personal abilities was innovative & exciting. I guess that this isn't so new for me. Newer is an appreciation of how widely Arnoud Artnz's imagery rescripting approach can be applied & how powerful it can be, even as a fairly stand-alone treatment. And then further immersion in the developing 'effective therapist' literature has been a joy and I want to consider more what my personal next steps might be here.
Arnoud was the discussant at the symposium on his imagery rescripting. What a fine, intelligent, deeply helpful life he has led. Sandra Raab talked on "Imagery rescripting versus STAIR/imagery rescripting for PTSD related to childhood abuse: a randomized controlled trial". Unlike earlier studies on Marylene Cloitre's STAIR intervention - see for example her well-known 2010 study - skills training in affect & interpersonal regulation didn't add usefully to simply intervening with imagery rescripting on its own. Very interesting ... possibly this finding was helped by the way that imagery rescripting doesn't involve the kind of more obviously emotionally intense experience that one sees in prolonged exposure.
More to follow ...
Jaime Delgadillo's symposium "Why are some therapists more effective than others?" had three presentations. The first was by Anne-Katharina Deisenhoffer from University of Trier, in Germany. It was titled somewhat opaquely "How research on therapist effects can support modern treatments: self-confidence in critical treatment parameters as a therapist factor". More helpfully it soon became clear she was focusing on therapist resilience, mindfulness & self-confidence as possible contributors to therapist effects. This was, in part, a replication of Jo-Anne Pereira's work at the University of Sheffield - see my post from 2015 "What personal qualities distinguish more & less effective therapists?" and Jo-Anne's subsequent paper "The role of practitioner resilience and mindfulness in effective practice: a practice-based feasibility study."
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Findings from the mindfulness and resilience measures appear more immediately useful. So, using multilevel modelling again, more effective therapists scored higher than averagely effective therapists on the mindfulness and resilience measures. They in turn scored higher than the less effective therapists. Mindfulness was measured with the Mindful Attention Awareness Scale (MAAS). This is a helpful questionnaire that reverse scores a series of "mindlessness" items like "I find it difficult to stay focused on what’s happening in the present" and "I could be experiencing some emotion and not be conscious of it until some time later". It makes good sense that better scores on the MAAS might well be associated with improved ability as a therapist. Here's a copy of the MAAS as a Word doc and here in PDF format ... and here's a daily MAAS diary in Word doc form and in PDF format. For much more background and research on the MAAS, see the rather wonderful Self-determination theory website. Of particular interest is that (especially if these MAAS/effectiveness findings are replicated) therapists could quite possibly train to improve their MAAS scores and potentially their effectiveness ... a good research question for the future. And another good research question would be ... does the fairly narrowly focused MAAS measure link more or less strongly with therapist effectiveness than a broader measure of mindfulness like the (shortened) "Five facet questionnaire"?
What about the resilience findings? The results don't seem surprising. Spending day after day working at the coalface with suffering fellow human beings isn't easy. The value of resilience makes good sense. Jo-Ann seems to have used the full CD-RISC questionnaire ... see the Connor-Davidson website for more on this. There's a slightly geeky query I would raise here as to whether a shorter version of this measure might have been better ... see "Psychometric analysis and refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience". Either way, it's easy to see that more effective therapists might well score better on items assessing ability to "Deal with whatever comes", "Can stay focused under pressure" and "Can handle unpleasant feelings". The talk went on to describe some interesting themes that emerged when questioning the therapists more fully on their professional lives, personal approaches, and how they responded to challenging patients. The answers threw doubt on the idea that empathy isn't relevant. In fact, it seemed that the reverse pattern emerged with more effective therapists being quoted as giving empathic, mindful answers like "Being open to all experience other people bring and being open to all aspects (that I am aware of) in myself" or (with challenging patients) " ... respect, listening, realise my own limitations and be flexible with approaches". Less effective therapists seemed to retreat into "technical concerns" e.g. emphasising becomng "More confident in my skills ... more flexible with ... models and treatment protocols."
More to follow ...