Jan Roubal

The proportion of integrationists among Czech psychotherapists and counselors : A comparison of multiple criteria

A psychotherapist’s integrationism/eclecticism can be operationalized in different ways. Existing studies estimating the proportion of integrationists/eclectics typically utilized a single criterion, often yielding incomparable results. The goal of this study was to estimate the prevalence of integrationism/eclecticism using 4 different criteria based on psychotherapy training, self-identified theoretical orientation, and the use of psychotherapy techniques. The analysis was based on questionnaire data obtained from 373 Czech psychotherapy and counseling practitioners in an online survey. The proportion of integrationists was estimated to be 21.7%, 32.7%, 87.7%, and 98.9% depending on the criterion used. Furthermore, the endorsement of several types of integration was estimated and the frequency of combinations of the main theoretical orientations was explored. The findings are discussed in the context of previous studies and emphasize the role of the adequate operationalization of integrationism. The results suggest that although the self-rated theoretical orientation may reflect a practitioner’s professional identity and affiliation, measurement on the level of techniques may be more sensitive to the real-life integration of various orientations. La proporción de integrativos entre psicoterapeutas y consejeros checos: Una comparación de criterios multiples La integración o el eclecticismo de un psicoterapeuta puede operar en diferentes maneras. Estudios típicamente han estimado la proporción de integrativos/eclécticos utilizando un solo criterio, frecuentemente rindiendo resultados incomparables. El objetivo de éste estudio fue estimar la frecuencia de integración/eclecticismo utilizando 4 criterios distintos basados en entrenamiento psicoterapéutico, orientación teórica auto-identificada, y el uso de técnicas psicoterapéuticas. El análisis se basó en data obtenida a través de un cuestionario en-línea completado por 373 psicoterapeutas o consejeros checos. Estimamos la proporción de practicantes integrativos a 21.7%, 32.7%, 87.7% y 98.9% dependiendo del criterio utilizado. Adicionalmente, estimamos el endoso de diferentes tipos de integración y exploramos la frecuencia de combinaciones de las orientación teóricas primarias. Discutimos los resultados colocándolos en el contexto de estudios previos y damos énfasis al rol de la operacionalización adecuada de la integración. Los resultados sugieren que a pesar de que la orientación teórica auto-identificada puede reflejar la identidad profesional del practicante, medir el nivel de técnicas puede ser más sensible a la integración real de varias orientaciones.

Personal therapeutic approach: Concept and implications.

Psychotherapist professional development can be viewed as the development of a therapist’s personal approach. Research evidence suggests that psychotherapy practitioners actively select from the vast array of psychotherapy theories and techniques, often from outside their primary theoretical orientation, and “metabolize” them into unique personal approaches. While the idea of a personal approach is by no means new and is shared by many scholars, practitioners, trainers, and supervisors, a fundamental reflection of this phenomenon is still missing in psychotherapy literature. The goal of this article is to make a step toward the conceptualization of personal therapeutic approach and to explore its implications for psychotherapy integration, practice, training, and research. Enfoque Terapéutico Personal: Conceptos e implicaciones El desarrollo profesional de psicoterapia se puede ver como el desarrollo del enfoque personal de un terapeuta. La evidencia de la investigación sugiere que los practicantes de psicoterapia seleccionan activamente de los varios teorías y técnicas de psicoterapia, muchas veces fuera de sus orientaciones teoréticas primarias, y se ‘metabolizan’ en enfoques únicos y personal. Mientras la idea de un enfoque personal no es nada nuevo y es compartido por varios becarios, practicantes, entrenadores, y supervisores, una reflexión fundamental de este fenómeno es todavía perdido en la literatura de psicoterapia. El objetico de este artículo es hacer un paso hacia la conceptualización de Enfoque Terapéutico Personal (Personal Therapeutic Approach; PTA por sus siglas en ingles) y explorar sus implicaciones para la integración, practica, entrenamiento, e investigación en la psicoterapia.

How beginning counselors learn: The interaction of personal and professional experiences in counselors with an experiential orientation

Research suggests that the way counselors work is influenced not only by training and practice but also by their personal experiences and qualities. In this study, we aimed to explore how beginning counselors with an experiential orientation integrate the experiences from different sources (e.g. training, supervision, individual therapy, practice, and their personal life) and how they utilize them in practice. Seven in-depth interviews with beginning Gestalt-oriented counselors were conducted and grounded theory method was used for analysis. The results show that personal experiences and qualities play an important role in shaping the way beginning Gestalt counselors work. We conceptualized two main components of counselors’ working style – Personal Core and Professional Extension, and 10 specific types of interaction between these components which were subsumed into two broad categories: (1) cultivation of personal qualities and (2) adoption of new competencies. These findings challenge earlier assumptions that beginning counselors simply imitate their trainers, supervisors, and senior colleagues. Implications for further research and use in practice are discussed.

How do trainees choose their first psychotherapy training? The case of training in psychotherapy integration

ABSTRACT Future trainees go through difficult decision-making processes when starting their first psychotherapy training. The choice of training in psychotherapy integration is a specific type of this process. In this study, qualitative data were obtained from the motivational letters, in-depth semi-structured interviews and e-mail questionnaires of 26 future trainees to answer the research question, ‘How do trainees choose their first psychotherapy training?’ We primarily employed the grounded theory approach as well as consensual qualitative research to shed light on the central category of Gaining Certainty to enter the training. This category was elaborated into a four-phase model, specifically comprised of the: (1) Critical Comparison, (2) Identification, (3) Self-Confirmation and (4) Waiting phases. The model was then discussed in connection with relevant concepts, such as the degree of complexity and flexibility within the epistemological development of trainees [Vasco, A. B., & Dryden, W. (1994). The development of psychotherapists’ theoretical orientation and clinical practice. British Journal of Guidance & Counselling, 22(3), 327–341].

LAS ENTREVISTAS RETROSPECTIVAS A LOS PACIENTES PUEDEN INFORMAR ACERCA DE LA PRÁCTICA DE LOS CLÍNICOS Y COMPLEMENTAR EL MONITOREO DE RUTINA DE LOS RESULTADOS

espanolObjetivo: Si bien el monitoreo de rutina de resultados (routine outcome monitoring, ROM siglas en ingles) es beneficioso, introduce un reduccionismo considerable en la medicion del cambio terapeutico. El objetivo de este estudio es ilustrar como la entrevista retrospectiva con el cliente puede captar la amplitud y el significado personal del cambio de un cliente. Metodo: Se presentan cuatro vinetas clinicas. Se utilizaron la Entrevista de cambio del cliente y de Cambio despues de la psicoterapia, para evaluar el cambio junto con las medidas de resultado estandarizadas. Resultados: Se presentan multiples ejemplos de como se pueden implementar las entrevistas retrospectivas para comprender y contextualizar mejor los cambios de los clientes e informar el proceso de psicoterapia. Conclusiones: Las entrevistas retrospectivas pueden complementar el ROM al explicar el exito o el fracaso de la psicoterapia y proporcionar informacion longitudinal y multinivel sobre la naturaleza de los cambios de los clientes. Se exploran las implicaciones para la investigacion orientada a la practica. EnglishObjective: While demonstrably beneficial, routine outcome monitoring (ROM) introduces a considerable reductionism in the measurement of psychotherapy change. The goal of this study is to illustrate how retrospective client interviewing can capture the breadth and personal meaningfulness of a client’s change. Method: Four clinical vignettes are presented. The Client Change Interview and Change After Psychotherapy methods were used to assess change alongside standardized outcome measures. Results: Multiple examples of how retrospective interviewing can be used to better understand and contextualize clients’ change and inform the psychotherapy process are presented. Conclusions: Retrospective interviewing can complement ROM by explaining psychotherapy success or failure and by providing longitudinal and multi-level insight into the nature of clients’ changes. Implications for practice-oriented research are explored.

INVESTIGANDO LA TERAPIA GESTALT PARA LA ANSIEDAD EN DISPOSITIVOS BASADOS EN LA PRÁCTICA: UN DISEÑO EXPERIMENTAL DE CASO ÚNICO

espanolA pesar de la eficacia comprobada de los tratamientos de TCC para los trastornos de ansiedad, entre el 33% y el 50% de los pacientes no responden o abandonan estos tratamientos. La terapia Gestalt ha afirmado ser una alternativa efectiva, pero hay poca evidencia empirica sobre su eficacia con la ansiedad. Se utilizo el diseno experimental de caso unico con analisis de series temporales como un estudio de eficacia orientado por la practica. Se presenta evidencia sobre diez clientes diagnosticados con trastornos de ansiedad, lo que apoya la afirmacion de que la terapia Gestalt puede ser un tratamiento util para estos casos. El analisis detallado de un caso ilustra los cambios en los puntajes de sintomas y bienestar, que indican puntos de inflexion durante la terapia. El articulo discute el uso de esta metodologia para crear una red de investigacion orientada por la practica. EnglishDespite the proven efficacy of CBT treatments for anxiety disorders, between 33% and 50% of patients do not respond or drop out of these treatments. Gestalt therapy has claimed to be an effective alternative, but there is little empirical evidence on its efficacy with anxiety. The Single-Case Experimental Design with Time Series Analysis was used as a practice-oriented study of efficacy. Evidence on ten clients diagnosed with anxiety disorders is presented, supporting the claim that Gestalt therapy can be a useful treatment for this. Detailed analysis of one case illustrates the changes in symptom and well-being scores, indicating turning points during the therapy. The paper discusses the use of this methodology for creating a practice-oriented research network.

The Development of the Commitment to Lifetime Alcohol Abstinence in the Czech Republic: Grounded Theory

Objective: Lifetime abstinence is often an explicit goal in the treatment of alcohol addiction. However, there is a lack of empirical studies on the development process of patients’ commitment to lifetime abstinence. In this study, patient experiences during a 13-week in-patient treatment programme based on Apollinaire’s treatment system, which is widespread in the Czech Republic, were explored. Methods: Patients of the Psychiatric Hospital in Brno participated either in focus groups (N=14) or in regular individual semi-structured interviews every two weeks (N=13). Data triangulation was ensured by including data from individual interviews, focus groups, and patients’ diaries. A grounded analysis was conducted. Results: A Final theory is presented through a sequential model of 4 distinct phases that describe the change of patients’ commitment to lifetime abstinence. The central concept is building self-esteem supported by a process of improving selfefficacy and receiving positive feedback. Conclusion: The research findings are discussed within existing empirical findings in the process of addiction recovery, and research and clinical implications are provided. The results highlight the importance of an individually tailored therapeutic approach, with each model phase serving as a clue guiding clinicians towards a therapy focused on patients’ needs during the development of the commitment to lifetime abstinence.

Common principles of psychotherapeutic change: patterns of use

ABSTRACT Many authors have proposed the existence of common principles of counselling and psychotherapeutic change. However, little is known about how practitioners use these change principles. A sample of 373 Czech psychotherapists and counsellors participated in an online survey and rated their use of 10 psychotherapy change principles in their practice over the previous year. The frequency of the use of the 10 change principles is reported. Furthermore, three principal components of the change principles were identified: exploration, acceptance, and understanding of clients’ experience; attending to clients’ own resources; and furnishing clients with new skills and advice. The use of these components was mainly associated with the practitioners theoretical orientation. The implications of the component structure for psychotherapist and counsellor training and practice are discussed.

Aesthetic Diagnosis in Gestalt Therapy

The diagnostic process in psychotherapy using the aesthetic evaluation is described in this article. Unlike the classical diagnostic process, which presents a result of comparing clinicians´ observations with a diagnostic system (DSM, ICD, etc.), the aesthetic evaluation is a pre-reflexive, embodied, and preverbal process. A Gestalt Therapy theoretical frame is used to introduce a concept of the aesthetic diagnostic process. During this process, the clinicians use their own here-and-now presence, which takes part in the co-creation of the shared relational field during the therapeutic session. A specific procedure of the aesthetic evaluation is introduced. The clinical work with depressed clients is presented to illustrate this perspective.