MARCH 2021 • VOL. 7, ISSUE 1

THE INTEGRATIVE THERAPIST

ARTICLES • INTERVIEWS • COMMENTARIES

ISSN # 2520-2464

ALAN JEREMY KIAN FORSYTHE EDITOR ASSOCIATE President's Column EDITOR ALBERTA POS

Hello to all the membership of SEPI!

I was very surprised and pleased to win the presidency of WHAT'S SEPI, this great organization, when the elections were over INSIDE in the fall of 2019. I am now the president of SEPI for the coming year. SEPI has meant a lot to me for many years. As a student, I was never a card-carrying anything. I chose to President's Column (by be involved in all of the approaches. Once I Alberta Pos) - Pg. 1 got my job at , I taught and was well suited to the task of teaching psychotherapy theory in York SEPI 37th Annual Meeting University’s graduate clinical program because I - Pg. 5 was an integrationist at heart. Sure enough, I was first trained as an experiential therapist and was trained by a SEPI Awards Spot - Pg. 6 very good one, Dr. Leslie Greenberg. I do come from a Continued... strong lineage of client-centered therapists and can trace

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Upcoming SEPI Webinar beginnings from Dr. Greenberg, Dr. Laura Rice, and to Carl - Pg. 7 Rogers himself. However, I also appreciated and sought training in CBT and behavioral approaches such as A Message from Your Dialectical Behavior therapy. I was trained by strong New Editors (by Alan proponents, like Zindel Segal and Shelly McMain. I also Kian & Jeremy Forsythe) - began to better appreciate Based Pg. 8 Psychotherapy as a result of my collegial connection to Dr.

SEPI Featured Members Ken Levy. Furthermore, I also experienced psychodynamic - Meital Dendet (by therapy on a couch in Vienna and enjoyed that as well. I Markus Böckle) - Pg. 9 noted that all these approaches had their own strengths to offer and that each of them had their own focus. SEPI Featured Members - Alexandre Vaz (by At first, individuals criticized some of us for not being loyal Markus Böckle) - Pg. 11 enough to one approach. I do understand that it can be important to do something well, and perhaps that means Shifting being loyal to one approach, at least at first. This is truest if Psychotherapy’s Core there is lots of empirical support for one approach. We are Paradigm (by Stephen Bacon) - Pg. 13 after all very attracted to science. I myself have been involved at York, strengthening the edifice of empirical Walking in Trainees' support for -focused therapy for years for this very Shoes (by Michaela reason. I think some CBT researchers like Louis Castonguay Ladmanová & Tomáš are quite good at keeping us all honest about our political Řiháček) - Pg. 19 leanings and reminding us to not be too arrogant as researchers. He reminds us that clinicians (as opposed to an academic researcher) may face the need to integrate more often as they struggle to help individuals with their problems. As a result, clinicians may also be able to direct research more and point us to more relevant science. As such, Art Bohart (2000) is right when he sees the client and the clinician working with him or her as the strongest proponent for integration. I agree with him.

We will continue to need to fight politically for centers in the world where psychotherapy integration has a place. We must continue to have a strong integration at York University, as well as the University of Berne Switzerland. At York, we attract scholars ready to integrate. For instance, Dr. Henny Westra (2011) is integrating CBT and Motivational Interviewing (MI). We also

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had very open psychodynamic thinkers like Morris Eagle, who was talking to a lot of CBT theorists and clinicians. Les Greenberg has integrated all the client-centered and experiential approaches, and has also been broadly trained in systems approaches. We are working hard to maintain a "psychotherapy process markers of process training model" at York.

So the time is ripe for integration. Now that we know over and over that the horse race model of trying to ‘win the race’ is an old and dysfunctional one, we have to go about that job of understanding how therapy processes work, how each model of change (whether CBT or experiential or dynamic) all participate in change in their particular ways. The ascendance and importance of emotion as an important variable, is, I think, a part of that shift. This is a new mandate that we must take up and champion. We need to make more certain the scientific basis for what we do. Dr. Gregg Henriques is trying to set the stage for this and is starting the conversation boldly. You will notice that Gregg, Marv, and Jeffery Smith, will talk about this at our upcoming online meeting. We have begun and will continue to articulate the vision of one of our founding fathers, Marv Goldfried, as he searched for principles of change (Goldfried, 1980) that would be intermediate in theoretical level and help us all find some common ground in terms of creating a convergence in our understanding of what makes all work. It appears that we as integrationists are becoming more and more relevant than ever as time goes by. We will need to continue to establish a common ground and articulate the science that supports the principles of change we are all trying to establish. This knowledge of what all therapy approaches bring to our conversations will continue to strengthen everyone’s attraction to SEPI’s mandate.

To this end let me remind you all of our upcoming online meeting, June 10-12, 2021, and its theme. Clearly COVID 19 has had a much longer impact on all of us than we expected. For this reason, we had to cancel our annual meeting last year in Vancouver and will have a total online meeting this year. I realize that some of you could travel at this point but I felt it was fairer to all and safer for all to do the online route. I am so happy that our conference theme this year is emotion related. Click here to go to our website and find out more about this year's theme. You will notice that several panels will be devoted to COVID and to the remote therapy options we are having to engage in more. When you consider that emotion is a multi- component process, as Klaus Scherer suggested in 2007, you realize that whether you provide a corrective and new emotional experience (Sharpless & Barber, 2012), or whether you provide good psychoeducation on exposure and habituation (Mowrer, 1956), or whether you are dealing with systemic rules from our cultures which may or may not value our feelings, there is an abundance of conversation to have here. Emotion does provide a common meeting ground that can provide a space for dialogue across approaches and scientific methods. We are going to have many international panels, workshops, and discussions from Romania to Israel, from

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Norway to San Francisco. I am very happy and proud to be hosting our first totally online annual meeting devoted to this topic.

So as we are moving past the dinosaur age of trying to find only one approach to therapy that can be declared a winner, we are realizing three things: 1) we realize that conversation across approaches, and the ability to create dialogue amongst us, is important, 2) we realize that the fact that clients are diverse and have different needs in different context is an important knowledge to bring to our helping relationships, and 3) there will have to be a more solid conversation between science and psychotherapy practice. We will need to be both more scientific and more clinical and this tension between science and practice must be kept alive by the membership. Keep talking and dialoguing!

References

1. Bohart, A. C. (2000). The client is the most important common factor: Clients' self-healing capacities and psychotherapy. Journal of Psychotherapy Integration, 10(2), 127–149. https://doi.org/10.1023/A:1009444132104 2. Goldfried, M. R. (1980). Toward the delineation of therapeutic change principles. American , 35(11), 991–999. https://doi.org/10.1037/0003-066X.35.11.991 3. Mowrer, O. H. (1956). Two-factor learning theory reconsidered, with special reference to secondary reinforcement and the concept of habit. Psychological Review, 63(2), 114–128. https://doi.org/10.1037/h0040613 4. Scherer, K. R. (2007). Component models of emotion can inform the quest for emotional competence. In G. Matthews, M. Zeidner, and R. D. Roberts (Eds.), The Science of Emotional Intelligence: Knowns and Unknowns. (pp. 101-126). New York: Oxford University Press. 5. Sharpless, B. A., & Barber, J. P. (2012). Corrective emotional experiences from a psychodynamic perspective. In L. G. Castonguay & C. E. Hill (Eds.), Transformation in psychotherapy: Corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches (p. 31–49). American Psychological . https://doi.org/10.1037/13747-003 6. Westra, H. A. (2011). Comparing the predictive capacity of observed in-session resistance to self- reported motivation in cognitive behavioral therapy. Behavior Research and Therapy, 49, 106-113. https://doi.org/10.1016/j.brat.2010.11.007

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SEPI 37th Annual Meeting J U N E 1 0 - 1 2 , 2 0 2 1 ( V I R T U A L )

Conference Theme Working with Emotion in Psychotherapy: Clients, Diagnoses, Methods

We know that COVID-19 has thrown a wrench into the academic world of conferences and broader than that, a wrench into the lives of all mankind. It is for this reason that we have decided to hold a completely online/virtual meeting this year. We are disappointed that we not be able to join together in Lausanne, Switzerland as planned. But, we believe meeting online for 2021 is the safest, most inclusive option. We also realize that an online format will likely facilitate presentations by students who have had financial considerations, clinicians who have been unable to attend in the past, and those who likely have to or are unable to come from afar for any number of reasons. This is the potential silver lining of the COVID pandemic for SEPI. We are looking forward to seeing many of you in this new virtual format.

For more information on this meeting, including registration, specific themes, guidelines, and schedules, please click below:

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SEPI Awards Spot The SEPI Research Committee is issuing a call for nominations for the 2021 SEPI Dissertation and Marvin R. Goldfried New Researcher Awards. Please nominate your students and junior colleagues! See below for details.

S E P I D I S S E R T A T I O N A W A R D

Graduate students who are (a) SEPI student members, (b) not members of the SEPI research committee, and (c) had a dissertation proposal approved by their university, but have not yet completed the project at the time of submission, are eligible. The topic of the dissertation must be related to psychotherapy integration-the integration of different theoretical orientations and/or the integration of research and practice. This $1,000 monetary award can be used for any purpose related to the dissertation, such as materials, instruction, or conference participation. Doctoral students can nominate themselves or can be nominated by any SEPI member. M A R V I N R . G O L D F R I E D S E P I N E W R E S E A R C H E R A W A R D

Graduate students who are (a) SEPI student members, (b) not members of the SEPI research committee, and (c) had a dissertation proposal approved by their university, but have not yet completed the project at the time of submission, are eligible. The topic of the dissertation must be related to psychotherapy integration-the integration of different theoretical orientations and/or the integration of research and practice. This $1,000 monetary award can be used for any purpose related to the dissertation, such as materials, instruction, or conference participation. Doctoral students can nominate themselves or can be nominated by any SEPI member. SEPI's Research Committee will choose recipients for both awards. Awardees will receive their awards at the annual SEPI Conference.

Electronic submissions are required. For further details, please contact: Dr. Ioana Podina [email protected]

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Upcoming SEPI Webinar T U E S D A Y , A P R I L 6 , 2 0 2 1 , 1 1 : 3 0 A M - 1 : 0 0 P M E A S T E R N T I M E ( N Y )

Integrative Formulation of the Alliance and the Alliance-Focused Training Model This webinar introduces an integrative formulation of the alliance and the Alliance-Focused Training model, highlighting rupture (markers of complications in communication) and repair (strategies to improve communication and promote a corrective experience). The presenters define withdrawal (movements away) and confrontation (movements against) ruptures and introduce repair principles and strategies to renegotiate an in-session therapy task or to explore desires and needs underlying a rupture (via the principle of metacommunication: communication about the communication process as it unfolds). The definitions, principles and strategies presented are based on research supported by the National Institute of Mental Health and will be clarified with video illustrations.

Learning Objectives: 1. Describe an integrative formulation of the alliance, from purposeful collaboration and affective bond to intersubjective negotiation. 2. Describe alliance ruptures (including confrontation and withdrawal markers) as negative process involving both patient and therapist. 3. Apply alliance development and rupture repair strategies, including immediate and expressive interventions.

J . C H R I S T O P H E R M U R A N , P H . D . C A T H E R I N E E U B A N K S , P H . D .

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A Message from Your New Editors A L A N K I A N & J E R E M Y F O R S Y T H E

Hi all! We are both grateful and excited to be the new editors for The Integrative Therapist. As we transition into these roles, we want to thank Alexandre Vaz and Sasha Rudenstein, two wonderful professionals who laid the groundwork for us. They have been fantastic editors and mentors. We would like to thank them both on behalf of all members of SEPI, and we are sure we speak for everyone when say that we hope to hear more from them in future issues!

We look at our new roles with a sense of awe. On the one hand, we are able to connect with many of the most renowned researchers, practitioners, and experts around the field. On the other hand, we are aware of the fact that we are but graduate students in ; in other words, budding psychotherapists. We are seeing our first clients, slowly easing our way into the massive and wonderful world that is therapy. With each issue, we see our task as editors and students - we will strive to provide the SEPI membership with a quality newsletter, while absorbing new and exciting information at the forefront of psychotherapy integration. We would be glad to keep the conversation going! Please feel free to reach out to us at:

Alan Kian (Editor) - [email protected] Jeremy Forsythe (Associate Editor) - [email protected]

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Spotlight: SEPI Featured Members M A R K U S B Ö C K L E

Meital Bendet, MA F E A T U R E D M E M B E R

Markus: How has SEPI influenced you?

Meital: I deeply appreciate the spirit of collaboration and exploration around psychotherapy integration. It feels like coming home to a place where my role models are present, and I can take it in and grow into the integrative therapist that I want to be.

Markus: You recently won the Jeremy Safran Memorial Poster Award. Tell us about your research.

Meital: I am fascinated with the literature on psychotherapy expertise. For my dissertation, I looked into expert supervisors' work through analyzing the incredible collection of the APA supervision video series, created by hosts Hanna Levenson and Arpana G. Inman. Since I'm interested in common factors, I tried to capture the behaviors that characterize supervisors across different approaches and orientations. In the absence of an existing

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observer measure that focuses on psychotherapy supervisors work, my colleagues and I developed the SIS-o (Supervisory Intervention Scale-observer). We were very curious to find how prevalent supervisor's supportive interventions were across orientations and identify the various interventions and styles they used in order to teach and challenge their supervisees.

Markus: What do you see as the future of psychotherapy integration?

Meital: I think lots of people will agree that the therapeutic relationship is key to successful psychotherapy. However, the signs of problems in the alliance are not always obvious, and I believe we still have a long way to go to characterize and implement effective rupture/resolution strategies that work across treatment orientations and modalities. I hope that accumulating knowledge about psychotherapy integration will help us create increasingly effective training programs, that prepare therapists to identify and address ruptures in the alliance whenever they arise with their patients. I am also a firm believer that experiential learning and deliberate practice are key in promoting expertise in psychotherapy across orientations, and I hope to see these components integrated more in future training.

Markus: How has SEPI influenced your career?

Meital: It's too soon to tell! All I know is that I finally found my professional community. I'm so excited about the recent establishment of SEPI-Israel and hope to become an active member when I graduate. In a world characterized by polarized views, I always resisted the implicit expectation to "choose a camp." In SEPI, I found like-minded people who truly value diversity of opinions and are curious to find the commonalities, alongside the differences.

Markus: Tell us a fun fact about you.

Meital: My fear of heights never stopped me from skydiving!

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Spotlight: SEPI Featured Members M A R K U S B Ö C K L E

Alexandre Vaz F E A T U R E D M E M B E R

Markus: How has SEPI influenced you?

Alex: Oh man, too many ways. SEPI turned some of my favorite therapy authors into real humans who were always a joy to connect with. Because of SEPI I got to make what I'm sure will be lifelong friendships, started exciting research and writing projects, traveled a bunch... What more could you ask for, right?

Markus: Tell us about your research.

Alex: The most exciting thing I'm working on right now is developing many resources for therapist's training and deliberate practice. A ton of these are available for free at the Deliberate Practice Institute's website (www.dpfortherapists.com). My friend Tony Rousmaniere and I are also editing an entire APA book series that will provide many skill building exercises for different therapy

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models. Exciting times!

Markus: What do you see as the future of psychotherapy integration?

Alex: Psychotherapy integration is at a crossroads, I think. Most models now consider themselves fairly integrative (if they are or aren't is a different question). So the controversy surrounding an interest in integration has largely dissipated, I think. I don't know about the future of psychotherapy integration, but my hopes is that it moves from a focus on integration different therapy models, to a much more solid integration of clinical research, training and practice.

Markus: How has SEPI influenced your career?

Alex: The most meaningful aspect of SEPI for me is connecting with people I already admired from readings. I was hugely influenced by psychotherapy integration authors, and the chance to collaborate and befriend many of them was and continues to be a true luxury.

Markus: Tell us a fun fact about you.

Alex: I play six music instruments, only two of them fairly competently!

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Shifting Psychotherapy’s Core Paradigm: Implications of the Absence of Training and Experience Effects in Psychotherapists S T E P H E N B A C O N C L I N I C A L P S Y C H O L O G I S T , S A N T A B A R B A R A , C A

The psychotherapy world is divided by a debate about how psychotherapy works and how it should be developed. On the one side are the adherents for the status quo: the medical model. These theoreticians and practitioners believe that psychotherapy works like medicine and that the way forward is to develop more accurate methods of diagnosis and to find specific, evidence-based treatments that address each diagnosis. On the other side is a smaller group of thinkers who argue that the outcome research findings refute the basic assumptions underlying the medical model. They believe that psychotherapeutic techniques lack inherent power and that change is essentially due to the common factors that underlie all models of psychotherapy.

These two groups have had a particularly fervent debate over the existence and validity of the Dodo bird theory—the research finding that all schools of therapy, in spite of their differing techniques and underlying theories, create positive, and equivalent, outcomes in psychotherapy. When the Dodo bird conclusion is accepted, it implicitly destroys the argument for specific factors. This is due to the obviously irrational idea that every school has “coincidentally” developed specific factors that account for an equivalent amount of the variance in outcome. In other words, given that each school has very different theories and very different interventions, can we possibly believe that they would generate the exact same positive effect sizes? Clearly, that’s highly unlikely. That, in turn, leads us to conclude that therapy is nothing but common factors; the differing interventions, therefore, are simply therapeutic rituals. The rituals must be convincing and believable but, in truth, their form and structure are unimportant; they are simply functional therapeutic vehicles powered by expectations.

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This conclusion would completely upend most of our psychotherapeutic assumptions. If psychotherapeutic techniques are rituals that achieve equivalent results as long as clients believe in them, and all the new systems and techniques we develop also achieve the same results, then technique-centric training and practice models would need to be abandoned. Why bother learning DBT or EMDR when your new tools would simply recreate the results you already achieve? Why bother inventing a new system like ACT when this new perspective on pathology and healing would fail to improve your results?

Understandably, in the face of this kind of paradigm shift, the medical model adherents strongly dispute the Dodo bird findings. The primary counter argument is simple: there are literally hundreds of studies that have found one technique superior to another, at least in certain circumstances. In addition, there are dozens of meta-analytic dismembering studies— studies that attempt to determine statistically the factors responsible for the effectiveness of psychotherapy. These studies allocate a certain percentage of the variance of the effectiveness to, for example, client factors, therapist factors, and the specific factors connected to the inherent power of techniques. These estimates of the variance due to specific factors range from a low estimate of 5% to a more commonly cited number of 15%.

If techniques have inherent power, then there will be an experience effect on outcomes. Training effects are even more clear. The untrained do not know psychotherapeutic techniques and the trained know a significant number.

The Dodo bird/common factors adherents respond with many meta-analyses that support the Dodo bird finding; in addition, they argue that the specific factors studies are flawed by poor design and allegiance effects. At this point, the two sides have fought to a draw with much of the field summarizing the dispute with a conclusion something like, “while common factors account for a large share of client improvement, specific factors—psychotherapeutic techniques and underlying systems—continue to make a significant contribution.”

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Fortunately, there is another perspective—one that leaves behind the Dodo bird metanalyses and the dismembering studies—that is capable of resolving the dilemma. More specifically, the studies on the effects of therapist experience and therapist training on outcomes shed new light on the stalemate. The connections are simple and logical. More experienced therapists know more techniques than the inexperienced; moreover, they have practiced them more assiduously. If techniques have inherent power, then there will be an experience effect on outcomes. Training effects are even more clear. The untrained do not know psychotherapeutic techniques and the trained know a significant number. Similarly, the lightly trained know and have practiced fewer techniques than the relatively highly trained. If techniques have inherent power, the more highly trained professionals will achieve better therapeutic outcomes.

Measuring the effects of therapist experience on outcomes is rather easy; psychology has performed hundreds of treatment outcome studies which have also included measurements of therapist experience. Put simply, hard as it may be to believe, there is no significant evidence that therapists achieve improved outcomes as a result of experience (Bacon, 2020; Bacon, 2021). Beginners get the same outcomes as licensed, trained therapists; paraprofessionals— with little training and experience—get as good or better outcomes than licensed, trained therapists, and virtually all larger studies—which measure the outcomes of experienced therapists against the less experienced—fail to favor the experienced. The training literature parallels the experience literature; there is no significant evidence that trained, and better trained, therapists out perform the untrained and the lesser trained. In sum, the Dodo bird thesis is sustained; psychotherapeutic techniques lack inherent power and are, instead, therapeutic rituals supported by beliefs and expectations.

But wait, there’s more, as the late-night commercials promise. The lack of training and experience effects also have implications for psychotherapy’s privileged knowledge. As used here, privileged knowledge refers to all the accumulated information that defines the profession of psychotherapy; examples include diagnostic information, client characteristics, research results, techniques and underlying systems, and analyses of essential processes. Our privileged knowledge is the basis of what we teach in graduate school and what we continue to develop and study throughout our careers. Since training and experience fail to improve results, it is logical to conclude that our privileged knowledge has no innate usefulness, at least when measured against enhancing client functioning.

There is a famous Sherlock Holmes quote which goes, “Once you eliminate the impossible, whatever remains, no matter how improbable, must be the truth.” The research is clear and the evidence is overwhelming; our assumptions about how psychotherapy works and how it should evolve are contradicted by the research results. Clearly, accepting the conclusions requires a massive paradigm shift. Unfortunately, such shifts are very difficult to make; as a result, I have

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speculated (Bacon, 2021) that the field will have trouble accepting these conclusions until they are supported by substantial research. On example of such research would be a series of studies that show that new graduate students, upon arrival at their program, achieve the same therapeutic outcomes as their professors.

Wild as that hypothesis might seem, the evidence cited in this article certainly predicts this outcome. If the untrained match the trained in terms of positive outcome, and psychotherapists don’t improve as the result of experience, shouldn’t the students do as well as the professors? Of course, the experiment would need to be done carefully. The students and the professors would need to be matched by age, office status, and title. The new graduate students might want to do two or three cases before the experiment to diminish their anxiety. A careful researcher might come up with several other extraneous factors that would need to be controlled.

Imagine, however, that three or four really good studies are done on this topic and they all find that the students match the outcomes of the professors; wouldn’t that help the field absorb these findings? In response, the professors would need to figure out why these equivalencies occur; how come we can’t develop techniques with inherent power and how come we can’t come up with training programs that improve outcomes? Hopefully, the answer to those questions would point towards a new paradigm that would allow the professors to achieve better results than the students, to create effective training programs, and to learn from experience.

One of the most useful places to begin this search for explanations is with Greg Henriques (2021) Tree of Knowledge (ToK) model. The ToK argues that we can look at the evolution of the universe in terms of four planes of existence and consciousness—starting with Matter, moving through Life and Mind, and concluding with person/language/culture. Each plane is best understood via its own epistemology; not surprisingly, the scientific method and the medical

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model work well on the lower planes but need to be replaced and/or supplemented by other epistemologies—e.g., social constructionism—on the higher planes. Given that rationality, empiricism and science have been the ruling paradigms since the Enlightenment, it is understandable why psychotherapy would adopt them as their ruling paradigms. The fact that they don’t explain language, culture and person adequately is the underlying reason that psychotherapy cannot develop techniques with inherent power.

A simple metaphor will illustrate the issues. Picture an imaginary culture that believes that mental health problems occur secondary to spirit possession and that healing is achieved via exorcisms. From inside the culture, it is believed that the spirits are real and the exorcisms are techniques with inherent power. The outside observer, of course, believes that the spirits are constructs and the exorcisms are rituals powered by beliefs and expectations.

In that world, privileged knowledge is knowledge about the nature of the spirits and the details of the exorcisms. They ask questions like: what person, with what kind of spirit, will respond to which exorcism? This imaginary culture demonstrates why amassing more privileged knowledge fails to generate better outcomes. All their privileged knowledge focuses on the constructs of “spirits” and “exorcisms;” since the one is not real and the other has no innate power, the accumulation of privileged knowledge is unrelated to outcomes. Moreover, since the focus of the exorcists is on factors unrelated to outcome—spirits and the details of the exorcisms--they fail to learn from experience.

In our culture, knowledge of spirits is equivalent to all of psychotherapy’s privileged knowledge: diagnoses, client characteristics, underlying theoretical systems, etc. The specific exorcisms are equivalent to all of our psychotherapeutic techniques. No matter how much the exorcists learn about the nature and characteristics of “spirits,” they aren’t likely to get better; and no matter how many types of exorcisms they learn about and practice, their results aren’t likely to improve.

What should we focus on instead? I have written a book and a series of articles (Bacon, 2018a, 2018b, 2020, 2021) speculating on possible ways forward, new approaches that would align with the research results and which have the possibility of improving client outcomes. In truth, however, the most important impact of the new research analysis is the opportunity for the field as a whole to devote its creative energies to a new conceptualization of psychotherapy. Psychotherapy works but we have been unable to develop ways forward that allow it to work better. These provocative research findings have the capacity to shake up our complacence and allow us to move forward in a fresh direction.

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References

1. Bacon, Stephen. (2018a). Implications of the “kill the buddha” tradition for psychotherapy: Rituals, charisma, and constructed reality. Spirituality in Clinical Practice, 5 (2), 133- 143. https://doi.org/10.1037/scp0000162 2. Bacon, Stephen. (2018b). Practicing Psychotherapy in Constructed Reality: Ritual, charisma, and enhancing therapeutic outcomes. New York: Lexington Books. 3. Bacon, Stephen. (2020). A constructionist extension of the contextual model: Ritual, charisma, and client fit. Journal of Psychotherapy Integration, 30(4), 506–521. https://doi.org/10.1037/int0000188 4. Bacon, Stephen. (2021). Resolving the common factors debate: Training and practice development after the collapse of the specific factors paradigm. drstephenbacon.com. http://drstephenbacon.com/Articles/resolving.pdf 5. Henriques, Greg. (2021). Overview of Henriques’ unified framework. Greghenriques.com. https://www.gregghenriques.com/overview-of-the-system.html

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What the study taught us was that the training content – often emphasized as the main ingredient – was only one Walking in Trainees' Shoes M I C H A E L A L A D M A N O V Á & T O M Á Š Ř I H Á Č E K of five key D E P T . O F P S Y C H O L O G Y , F A C U L T Y O F S O C I A L S T U D I E S , areas of M A S A R Y K U N I V E R S I T Y , B R N O trainees’ Although psychotherapy training has been traditionally experience considered the main formative influence in psychotherapists’ development, we still know little about how trainees develop and how they perceive the training process (Hill & Knox, 2013). Several qualitative studies have offered an insight into trainees’ lived experience but – with a few exceptions – they relied on a one-time retrospection. In our study, we employed a longitudinal perspective and took a closer look at what trainees consider important in their training. To achieve this goal, we adopted the significant events paradigm, so far used in psychotherapy process research. It assumes that some parts of the therapeutic or, in our case, the training process are more important than others, either in the positive or in the negative sense (Timulak, 2010).

We collected helpful and hindering events descriptions from a group of 26 trainees in an integrative psychotherapy training over the course of five years (for details, see Ladmanová et al., 2020). Altogether, we have obtained 1,283 helpful and 450 hindering event descriptions and

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categorized them into 24 categories of helpful and 14 categories of hindering events, further clustered into five thematic domains: trainees’ personal self-awareness, trainees’ professional self-awareness, training group, trainers, and training content.

Trainees reported self-exploration and growth, both on the personal and the professional level, as one of the main benefits of their training. It corresponds to the results of other studies on trainees’ lived experience (e.g., Pascual-Leone et al., 2012) suggesting that it may be an essential domain of experience across contexts and theoretical orientations. However, facing one’s self in training also seems to be one of the most disturbing factors in the process of becoming a therapist. The frequency of hindering events related to the trainees’ personal self- awareness was as frequent as that of helpful events in this domain. Clearly, self-exploration is a personally demanding process. In the professional self-awareness domain, feelings of professional uncertainty were salient. Although perceived negatively, professional self-doubts may be positively related to professional performance (Nissen-Lie et al., 2017).

The training group domain contained moments of support, acceptance, sense of belonging, self-disclosure, and interpersonal learning which corresponds to other studies on trainee experience (e.g., Folkes-Skinner et al., 2010; Pascual- Leone et al., 2012). Trainees’ group experience thus seemed to cultivate their interpersonal skills related to themselves (e.g., capacity for self-acceptance) and to others (e.g., the ability to accept another person). Given the centrality of interpersonal skills in the therapeutic process (Anderson et al., 2016), the development of these skills is highly desirable.

Trainers served as models of the therapist’s role from which trainees could learn. They not only presented their styles of working with clients, shared their professional experiences, and provided guidance and support but also revealed their private selves by expressing real and sharing authentic life stories. Although the trainees tended to appreciate this influence rather late in the training, it is reasonable to assume that trainers exerted an implicit role-model influence from the outset.

The training content domain was associated mainly with gaining theoretical understanding and practicing therapeutic interventions. Both categories have been reported as particularly important in previous studies on psychotherapy trainees (e.g., Folkes-Skinner et al., 2010; Hill et al., 2007; Pascual-Leone et al., 2012). The trainees in our sample tended to judge teaching methods the trainers used and often reported the perceived inconvenience of these methods as a hindering factor. Indeed, matching trainees’ learning with trainers’ teaching style represents a major challenge in training (Fraser & Wilson, 2011). However, this type of hindering events may also signal trainees’ growing capacity to be critical of their trainers.

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What the study taught us was that the training content – often emphasized as the main ingredient – was only one of five key areas of trainees’ experience. Trainees’ self-awareness, both at the personal and the professional level, was an essential source of learning, and so were the other people taking part in the training process – trainers and fellow trainees. Analogous to psychotherapy itself, psychotherapy training should place an emphasis on a safe and stimulating environment in which trainees can explore their selves and integrate this personal experience with their professional competence. The formal content of the training, however important, represents just “one fifth” of the training process.

References

1. Anderson, T., McClintock, A. S., Himawan, L., Song, X., & Patterson, C. L. (2016). A prospective study of therapist facilitative interpersonal skills as a predictor of treatment outcome. Journal of Consulting and Clinical Psychology, 84, 57–66. http://dx.doi.org/10.1037/ccp0000060 2. Folkes-Skinner, J., Elliott, R., & Wheeler, S. (2010). ‘A baptism of fire’: A qualitative investigation of a trainee counsellor’s experience at the start of training. Counselling & Psychotherapy Research, 10, 83–92. http://dx.doi.org/10 .1080/14733141003750509 3. Fraser, N., & Wilson, J. (2011). Students’ stories of challenges and gains in learning . New Zealand Journal of Counselling, 31, 79–95. 4. Hill, C. E., & Knox, S. (2013). Training and supervision in psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (6th ed., pp. 775–811). New York, NY: Wiley. 5. Hill, C. E., Sullivan, C., Knox, S., & Schlosser, L. Z. (2007). Becoming psychotherapists: Experiences of novice trainees in a beginning graduate class. Psychotherapy: Theory, Research, & Practice, 44, 434–449. http://dx.doi.org/10.1037/0033-3204.44 .4.434 6. Ladmanová, M., Řiháček, T., & Roubal, J. (2020). Helpful and hindering events in an integrative psychotherapy training. Journal of Psychotherapy Integration. https://doi.org/10.1037/int0000246 7. Nissen-Lie, H. A., Rønnestad, M. H., Høglend, P. A., Havik, O. E., Solbakken, O. A., Stiles, T. C., & Monsen, J. T. (2017). Love yourself as a person, doubt yourself as a therapist? Clinical Psychology & Psychotherapy, 24, 48–60. http://dx.doi.org/10 .1002/cpp.1977 8. Pascual-Leone, A., Wolfe, B. J., & O’Connor, D. (2012). The reported impact of psychotherapy training: Undergraduate disclosures after a course in experiential psychotherapy. Person-Centered and Experiential Psychotherapies, 11, 152–168. http://dx.doi.org/10.1080/14779757.2011.648099 9. Rønnestad, M. H., & Ladany, N. (2006). The impact of psychotherapy training: Introduction to the special section. Psychotherapy Research, 16, 261– 267. http://dx.doi.org/10.1080/10503300600 612241 10. Timul’ák, L. (2010). Significant events in psychotherapy: An update of research findings. Psychology and Psychotherapy: Theory, Research and Practice, 83, 421–447. http://dx.doi.org/10.1348/ 147608310X499404

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