A case study of the challenges for an integrative practitioner learning a new psychological therapy

Abstract

Background Many psychotherapy practitioners draw from several psychotherapeutic models in an effort to maximise the help they can give to individual patients. Such “integrative” practice is promoted by training that typically encompasses multiple models, but might impair practitioners’ ability to learn any single approach proficiently. Aims One way to identify the influence of integrative practice on therapists’ ability to learn a new approach is by examining the challenges that arise when a psychotherapist, previously socialised into the integrative approach, tries to learn a new single approach. Here we describe the experience of the first author, a clinical psychologist being supervised by the last author, to make the transition from an integrative way of working to a single approach. Method In a single case of post‐qualification training, we aimed to identify the influence of the integrative approach to clinical practice by analysing the challenges that arose when one experienced clinical psychologist was supervised with the aim to reach competence in an unfamiliar psychotherapeutic model: metacognitive therapy. The present paper is based on the experience of the training period, documented contemporaneously by the supervisee and supervisor and analysed subsequently in discussion amongst all authors. Results The challenges included learning to adhere to the model consistently, resisting previous habits of engaging with the content of patients’ distress, dismantling beliefs about the nature and importance of therapeutic relationship, and learning not to interpret patient improvement as indicating therapeutic competence. Conclusions These challenges reflect fundamental weaknesses of the integrative approach that characterise current psychotherapy training in the USA and more generally and highlight implications for how training and supervision might be strengthened to ensure psychotherapists’ competence.

Qualitative Evaluation of Cancer Survivors’ Experiences of Metacognitive Therapy: A New Perspective on Psychotherapy in Cancer Care

“…Our participants’ experiences indicate that a therapeutic relationship formed as the patient became socialized to the therapeutic model, and developed as participants witnessed their own progress. Therefore, for most patients, psychologists might not need to address the therapeutic relationship explicitly beyond working in a collaborative and Socratic manner (Byrne et al, 2018). However, these findings arose in the context of MCT, and it remains to be seen whether patients engaging with other process-focused models would have similar experiences.…”

Brief Metacognitive Therapy for Emotional Distress in Adult Cancer Survivors

“…However, unlike the ConquerFear study, our open trial included participants with depression and severe trauma symptoms indicative of PTSD. Developing specific interventions for each aspect of psychological morbidity for cancer survivors may be unnecessary and integrating treatment components from theoretically inconsistent models could “dilute” treatment efficacy and compromise therapist training (Wells and Fisher, 2015; Byrne et al, 2018).…”

Metacognitive therapy.

“…Training in MCT adheres to the specific metacognitive model, and therapists should receive appropriate training and supervision by highly experienced and qualified therapists. It is possible that without such training, the efficacy and scientific validity of MCT could be diluted (Byrne et al, 2018, Wells & Fisher, 2015; see also Metacognitive Therapy Institute at https://www.mct-institute.co.uk/). To this end, specialist training should be sought, and therapists of all approaches should avail themselves of appropriate training to ensure effective delivery.…”