The use of structured learning for empathy enhancement in paraprofessional psychotherapist training

Abstract

PROBLEMThe recent and accelerating use of paraprofessional psychotherapists has given rise to increased concern over the training of such 6 , 7 ) . A wide variety of training procedures, both traditional and innovative, are currently being implemented though only very rarely with accompanying evaluation of their efficacy.Earlier efforts''. 4 . l o ) towards these training ends sought to be responsive to laboratory research which very strongly demonstrates the efficacy of modeling procedures for bringing about a diverse array of behavior change. Working with a potential paraprofessional therapist sample of psychiatric nurses, Goldstein, el d ( 5 )found that modeling procedures, when combined with information about the patient's purported social class, yielded a significant increase in nurse attraction to traditionally unattractive patients, as well as similarly significant increases in the level of empathy and warmth displayed by the nurses immediately following the observation of an attracted model. I n response to J o u r a r d )~(~) findings that self-disclosure by one member of a dyad increases the self-disclosure level of the other member, we next sought to increase the level of paraprofessional therapist self-disclosure by means of modeling procedures (ll). Once again, this time utilizing a psychiatric attendant sample, exposure to a high self-disclosing model yielded the predicted effect. The findings of Carkhuff ( 2 ) , Truax and Carkhuff ( 1 4 ) , Hart and Tomlinson(8) and others led us t o empathy as a third training target. Their investigative findings consistently point to therapist empathy as a potent psychotherapeutic ingredient. Both of our subsequent l 3 ) seeking t o enhance the level of empathy displayed, by use of modeling procedures, yielded significant increases in psychiatric attendant and minister samples.I n spite of the consistency of these beginning demonstrations of the efficacy of modeling for paraprofessional skill training purposes, a highly important proviso must be considered. One of the most frequently noted outcomes of attitude and behavior change research is that most research SS (or therapy patients) will do almost anything asked of them by the experimenter (or therapist) while in the experimental setting, but a distressingly few will be noted to be sustaining the behavior change out of the laboratory (or consulting room) context. This may mean our manipulations are weak; that Ss very often respond as we wish (predict) because of experimenter bias, evaluation apprehension or experimental demand characteristics; or simply, that we have given grossly insufficient attention to implementing transfer training principles. For whatever reason, follow-up results most often yield evidence of non-enduring effects, and such proved to be the case in our studies noted above aimed at self-disclosure or empathy-enhancement.Our typical paradigm involved pre-exposure subject measurement on the particular skill, exposure for approximately one hour to a model displaying high levels of the skill, ...

A prescriptive approach for counselor training.

“…Results indicated that both self-and guided-instruction SLT were effective for teaching confrontation skills. This finding is similar to results from previous investigations assessing the overall effectiveness of communication skill training (Goldstein & Goedhart, 1973;Guzzetta, 1974) and suggests that both self-instruction SLT and traditional SLT may be valuable for training in development of counseling skills. On the other hand, whatever the benefits of each approach, consideration of trainees' personality characteristics and possible interaction with training approaches seems most important.…”

Gender differences in the perception of quality of life during internal medicine training: a qualitative and quantitative analysis

“…In contrast, other studies suggested that female physicians have higher empathy ratings than men [ 57 , 58 ] due to their increased receptiveness to emotional signals [ 59 ]. Another possibility is that male residents from this study might have achieved higher empathy ratings resulting from the interpersonal skills training emphasis of this internal medicine residency program [ 60 ].…”

Empathy, experience of burnout and attitudes towards demented patients among nursing staff in geriatric care

“…The necessity for empathy in a therapeutic relationship between nursing stafiF and patients is stated in a numberof articles (Kalisch 1973, Rogers 1975, Bagshaw & Adams 1985 Empathic ability in the nursing staff and possibilities to leam empathy and raise their empathic ability have also been discussed (Goldstein & Goedhart 1973, Fine & Themen 1977, Layton 1979, Pool & Sanson-Fisher 1980, LaMonica 1981, Ehzur & Rosenheim 1982 Accordmg to LaMonica (1981), empathy is an abihty in the nursing stafif to place himself mentaUy and emotionally mto the world of the patient with whom he is interacting, to communicate his understanding to the patient and the patient's perception of the helper's understanding Patients suffenng from dementia often have behavioural disturbances due to the bram damage This will make it difficult for the nursing staff to understand and place themselves m the patient's world The nurse has to use his imagination and be creative in his contact with the patient Expenence of bumout among nursmg staff workmg m genatnc care is often descnbed as a cause of low empathy, negative attitudes towards the patients, low job satisfaction and turnover (Pines et al 1981, Maslach 1982 Accordmg to Pmes et al (1981), bumout is defmed as 'feelmgs of physical, emotional and mental exhaustion associated with an intense mvolvement with the patient over time' They also state that the expenence of bumout always at least partly contams more general demands which are not pnnumly related to deep mvolvement with the patient Expenence of bumout is charactenzed by physical depletion, feelings of helplessness and hopelessness, negative self-concept, negative attitudes towards work, hfe and other people, as well as a lowenng of empathic ability (Chemiss 1980, Pmes rffl/ 1981, Maslach 1982 Bumout is also shown to be related to somatic complamts and illness (Belcastro 1982) Bumout expenences have been found among health care workers (Keane et al 1985, Cronm-Stubbs & Schaffner 1985 m different kmds of health care speaalizahons (Pnce & Bergen 1977, Mor & Laliberte 1984 Development and signs of the expenence of bumout as well as demands and strams causmg bumout have also been ldenti&ed (Pmes & Masladi 1978, Chemiss 1980, Maslach 1982…”