Background:Family functioning in Huntington’s disease (HD) is known from previous studies to be adversely affected. However, which aspects of family functioning are disrupted is unknown, limiting the empirical basis around which to create supportive interventions.Objective:The aim of the current study was to assess family functioning in HD families.Methods:We assessed family functioning in 61 participants (38 HD gene-expanded participants and 23 family members) using the McMaster Family Assessment Device (FAD; Epstein, Baldwin and Bishop, 1983), which provides scores for seven domains of functioning: Problem Solving; Communication; Affective Involvement; Affective Responsiveness; Behavior Control; Roles; and General Family Functioning.Results:The most commonly reported disrupted domain for HD participants was Affective Involvement, which was reported by 39.5% of HD participants, followed closely by General Family Functioning (36.8%). For family members, the most commonly reported dysfunctional domains were Affective Involvement and Communication (both 52.2%). Furthermore, symptomatic HD participants reported more disruption to Problem Solving than pre-symptomatic HD participants. In terms of agreement between pre-symptomatic and symptomatic HD participants and their family members, all domains showed moderate to very good agreement. However, on average, family members rated Communication as more disrupted than their HD affected family member.Conclusion:These findings highlight the need to target areas of emotional engagement, communication skills and problem solving in family interventions in HD.

Self-disclosure is a necessary component of group self-practice/self-reflection (SP/SR), a teaching method whereby (trainee) psychotherapists engage in reflections with their peers and the facilitator on the self-practice of therapeutic techniques on personally relevant experiences. The making of personal disclosures by nature and within a professional educational environment can be associated with challenging emotions and must be managed appropriately by trainees and facilitators. This study aimed to understand how participants navigate and benefit from this self-disclosure process. In semistructured interviews, eight clinical psychology trainees recounted their experiences, decision-making processes, and the associated learning outcomes of self-disclosures made and witnessed during a group cognitive behaviour therapy (CBT) program using SP/SR principles. Four themes were developed: “to disclose or not to disclose,” “the virtuous (and nonvirtuous) cycle of self-disclosure,” “sitting in the other chair,” and “making it safer, making it better.” Trainees described that the CBT program using SP/SR helped them to understand and empathize with client self-disclosure and their role as a psychologist in supporting this process and facilitated their understanding of psychotherapist self-disclosure. Recommendations for effective and safe promotion of self-disclosure in SP/SR are made.

Self-practice/self-reflection (SP/SR) supports understanding and delivery of cognitive behavioral therapy (CBT) in participants by facilitating reflection on the practice of CBT techniques on personally relevant experiences. To date, little is known about the online potential of SP/SR training, particularly relevant through the course of the COVID-19 pandemic which saw an increase in online teaching and training delivery. The present study examined the perspectives of ten trainee therapists and three clinical educators (facilitators) on the experience, benefits, and challenges of participating in and facilitating an online CBT group integrating SP/SR principles. Reflective thematic analysis of semistructured interviews led to two trainee themes ("experiencing the other chair" and "learning to be a CBT therapist") and two facilitator themes ("learning to facilitate online" and "reflections on unexpected gains"). Facilitators and trainees described the online platform as a suitable delivery format, providing a comparable experience to in-person teaching and an authentic therapeutic experience to facilitate trainees' understanding of delivering CBT generally and in a telehealth context. Some trainees noted challenges being vulnerable online and all facilitators noted being less likely to push trainees to experience and express difficult thoughts and emotions online. Recommendations are provided to enhance learning in similar groups in psychology training. Public Significance StatementThis is the first study to explore the experience, benefits and challenges of an online cognitive behavioral therapy group using self-practice/self-reflection principles. Findings indicated that the online group facilitated a comparable personal and professional experience to the traditional delivery of in-person groups, with the added benefit of trainees and facilitators learning how to adapt therapy to a telehealth setting.