Emily Blake

Trainees’ experiences of impasses in counselling and the impact of group supervision on their resolution: A pilot study

A qualitative analysis of eight interviews was conducted to answer the following questions: ‘How do trainees experience a clinical impasse?’ and ‘How does the experience of group supervision help or hinder the resolution of these impasses?’ MA students in a counselling psychology program at a Canadian university were interviewed at two points in time: after experiencing a clinical impasse and after receiving group supervision for the impasse. Data were analyzed using consensual qualitative research methodology (CQR; Hill, Thompson & Nutt-Williams, 1997) to identify themes relative to our two questions. Results indicated that when trainees experienced an impasse they reacted with negative emotions because they did not know what to do in session with the client at that point in time, and they experienced the impasse as a failure. Trainees reported seeking supervision to obtain validation/support, and found that supervision provided them with this. As well, a new perspective on the impasse event and increase in self-awareness was reported. An unexpected finding included dissatisfaction with the dynamics of the supervision group. These findings have implications for trainers: for understanding the supervisory needs of trainees, for appreciating the impact of supervision on counsellor development, and for generating alternate practices of supervision.

Client relationship incidents in early therapy: doorways to collaborative engagement.

Abstract The purpose of this study was to elaborate how clients understand the development of the alliance and to highlight aspects of the process particular to depressed clients working with experienced therapists. Fifteen participants described critical incidents in early therapy that influenced how they understood their working relationships with therapists. All incidents involved clients appraising what their therapists were doing. Through interviewer probing, participants were able to identify the importance of their own activity (disclosing and working with therapist input) as their collaboration in the incidents. Positive emotional responses were woven through the descriptions of the incidents. The research underscores how client understanding of collaboration might be accessed by researchers or clinicians and the potential importance of the interaction of client active exploration with positive emotions in understanding alliance development.

Cognitive errors, coping patterns, and the therapeutic alliance: A pilot study of in-session process

Aim: This exploratory study examined the association between clients’ assessment of the therapeutic alliance and their cognitive errors (CE) and coping action patterns (CAP). Method: Selected therapy sessions of clients (N = 26) were rated for cognitive errors and coping action patterns using the CERS and CAPRS methods (Drapeau, Perry, & Dunkley, 2008; Perry, Drapeau, & Dunkley, 2005). The therapeutic alliance was assessed using the Working Alliance Inventory (WAI; Horvath & Greenberg, 1989). Results: Following Bonferroni corrections, no significant relationship was found between clients’ CEs and their ratings of the WAI. However, the ‘Negotiation’ CAP was associated with the total alliance score, and with the Task and Goal subscales. Implications: A better understanding of the cognitive processes presented by clients in session can enable clinicians to address these factors early on when the alliance is most critical.

The relationship between therapeutic engagement, cognitive errors, and coping action patterns: An exploratory study

Aim: This exploratory study examined the relationship between clients’ involvement in therapy and their cognitive errors (CE) and coping action patterns (CAP). Method: Therapy sessions from N = 26 clients were rated for CE and CP using the CE and CAP methods. Client involvement was measured with the Positive and Negative Affect Schedule, as well as the . Results: The CEs’ ‘magnification of the negative or minimisation of the positive’ and ‘labelling’ were associated with measures of affective therapeutic engagement. The coping styles ‘negotiation’, ‘opposition’, ‘submission’, ‘isolation’, ‘support seeking’, ‘information seeking’, ‘delegation’, and ‘escape’ were found to be associated with affective and behavioural dimensions of therapeutic involvement. Conclusions: These findings provide preliminary supporting evidence that CE and CP are related to the extent to which clients engage in the work of therapy. Implications for researchers and therapists are discussed.

Defensive Flexibility and Its Relation to Symptom Severity, Depression, and Anxiety

Numerous studies have examined which individual defense mechanisms are related with mental health, and which are linked with psychopathology. However, the idea that a flexible use of defensive mechanisms is related to psychological wellbeing remained a clinical assumption, which this study sought to test empirically. A total of 62 (N = 62) outpatients participated in the study and were assessed with the Symptom Checklist-90R and the Social Adjustment Self-rated Scale. A subsample of 40 participants was further assessed using the Hamilton Depression (HAMD-21) and Anxiety scales (HAMA-21). The first therapy session of all participants was transcribed and rated using the Defense Mechanisms Ratings Scales (Perry, 1990b), and the Overall Defensive Functioning (ODF) score, which indicates the maturity of ones defensive functioning, was computed. An indicator of flexible use of defenses was also calculated based on the Gini Concentration C measure. Results showed that defensive flexibility, but not ODF, could predict anxiety scores. Symptom severity was predicted by both ODF and defensive flexibility, although in directions opposite to our predictions. Results suggest that defensive flexibility captures another aspect of an individuals functioning not assessed by the ODF, and that it is a promising new way of documenting defensive functioning.

Changes in Cognitive Errors Over the Course of Cognitive Therapy for Depression

Cognitive therapy (CT) aims to treat major depression symptomatology by restructuring the patients’ cognitive distortions to more adaptive thinking patterns. This study examined changes in cognitive errors (CEs) as patients undergo CT for depression. Forty-five participants were assessed at early and late therapy for CEs using the Cognitive Errors Rating System (Drapeau, Perry, & Dunkley, 2008) and for depression using the Beck Depression Inventory (A. T. Beck, Rush, Shaw, & Emery, 1979). Although the total number of CEs did not change from early to late therapy, negative CEs significantly decreased, and positive CEs increased. Recovered participants had fewer total CEs, negative CEs, and negative overgeneralization than nonrecovered participants. Depressive symptoms were inversely related to late therapy positive CEs among the nonrecovered participants. Research and clinical implications are discussed.