Psychotherapist trainees’ professional self-doubt and negative personal reaction: Changes during cognitive behavioral therapy and association with patient progress

Abstract

Patients' progress is associated with therapists' experiences of difficulties. Yet, trait- and state-based difficulties lead to different results. Clinical or methodological significance of this article: Associations between therapists' difficulties and patient-reported outcomes depended on whether therapists' difficulties were assessed once across all patients (trait-level) or for each individual patient repeatedly during CBT (state-level). Contrary to previous research on trait-level difficulties, the difficulty professional self-doubt (PSD) was associated with a less favorable course of patients' interpersonal problems, whereas the difficulty negative personal reaction (NPR) was associated with a more favorable progress. Moreover a patient-therapist-time contextualization (state-level) seems relevant for the assessment of complex therapist variables and an elaborated understanding of the therapist effect. Altogether, CBT trainees should not be scared of their negative personal reactions towards their patients and professional self-doubt of CBT trainees should be monitored and discussed (e. g., in supervision).

An exploratory study of patients’ sudden losses during outpatient CBT and therapists’ experience of difficulties

“…The TDS‐IP is a patient‐specific adaptation of the TDS (Orlinsky & Rønnestad, ) from the International Study on the Development of Psychotherapists (ISDP; Orlinsky & Rønnestad, ). For more information about the construction of the TDS‐IP see Odyniec, Victor, Berner, and Willutzki () and Odyniec et al (). The TDS‐IP focuses on the patient–therapist dyad and can be interpreted as therapists’ state‐based difficulties by asking the therapists about the frequency of difficulties they experienced with each of their patients at several time points over the course of therapy.…”

“…” followed by the different core items. Thus, it is possible to assess therapists’ difficulties contextualized for a particular therapist–patient dyad with the TDS‐IP (Odyniec et al, ). With 19 items the TDS‐IP assesses three subscales: “professional self‐doubt”, “negative personal reaction”, and “frustrating treatment case.” Nissen‐Lie et al () showed that PSD and NPR accounted for a meaningful amount of variance in early patient‐rated alliance and outcome.…”

“…Therefore, we focused on these two scales in our research. For a comprehensive description of the two scales see Odyniec et al, .…”

“…Further, there is a set of recent studies using a quantitative approach, that explored therapists’ experience of difficulties and its association with early patient‐rated working alliance (Nissen‐Lie, Monsen, & Rønnestad, ) and patient‐reported therapy outcome (Nissen‐Lie et al, ; Nissen‐Lie, Monsen, Ulleberg, & Rønnestad, ; Odyniec, Probst, Margraf, & Willutzki, ). These studies focused on two factors representing challenging emotions which therapists can encounter during their therapeutic work: Therapists’ professional self‐doubt (PSD) and negative personal reaction (NPR).…”

“…While PSD reflects therapists’ doubt of their professional efficacy, NPR represents negative feelings toward patients and reduced empathy for them. Both scales were discussed as indicators of therapists’ emotional maturity and willingness to critically evaluate one's work as a therapist (Nissen‐Lie et al, ; Odyniec et al, ). While PSD seems to predict better treatment outcomes and working alliances among experienced therapists (Nissen‐Lie et al, , , ), NPR, in terms of self‐confidence, seems to be beneficial in novice therapists (Odyniec et al, ).…”