You really are too kind: implications regarding friendly submissiveness in trainee therapists

Abstract

To facilitate patient growth, therapists must immerse themselves in the patient’s world while also being able to see what is needed for change. This process requires finding a delicate balance between supporting and pushing patients. Therapists in training are additionally tasked with incorporating supervisors’ suggestions with their own views on what is needed to help their patients. Beginning therapists with tendencies to be overly accommodating may struggle to reconcile these competing demands. Thus, the aim of the present work is to explore how trainee friendly submissiveness (FS) interfaces with psychotherapy. Prior to training, clinical graduate trainee (n = 35) FS was assessed using the Inventory of Interpersonal Problems-32. Process and outcome data were then collected from each therapist’s first training case. Specifically, each trainee was assigned an undergraduate student volunteer with whom they had four non-manualized therapy sessions over the academic semester. After the third session, patients and trainees completed questionnaires assessing session impact and the working alliance, and two expert raters coded third session videotapes for techniques. Following termination, patients rated the overall helpfulness of the therapy. Trainee FS was significantly negatively associated with patient-rated depth, alliance, and overall helpfulness with moderate effects. Findings from a mediation analysis further suggested that trainees with higher FS struggled to focus the therapy in a way that felt productive to patients. Implications for clinical training are discussed.

Antisocial personality disorder in group therapy, kindling pro-sociality and mentalizing

“…We propose that employing boundaries together with respect for the patient is a helpful approach. As a parallel to this, one study found that friendly submissiveness in therapists was negatively related to the alliance, which informs us of the importance of an authoritative therapist (Cain et al ., 2018 ). It seems from our findings that also the patients feel safer in a context of clear rules and expectations, the trick is of course to implement a curious and flexible focus on mental stances inside this framework.…”

Outcomes of beginning trainee therapists in an outpatient community clinic

“…Few studies have specified the precise level of experience of the student therapists, though some authors have suggested that there may be differences in effectiveness between beginning trainee therapists and more experienced trainee therapists (Dyason et al., 2019; Stein & Lambert, 1995). In the beginning of their clinical training, trainee therapists seem to struggle with numerous clinical operations conceptually linked to the successful engagement of relationships (Butler et al., 2008), such as ‘being too kind’ (Cain et al., 2018). They also seem to experience elevated stress levels due to a combination of educational and professional challenges which may influence their therapeutic work (Pakenham & Stafford‐Brown, 2012), and which may be mitigated over time by, for example, their ability to benefit from clinical supervision (Wilson et al., 2016) and their personal development, for example via personal therapy (Bellows, 2007; Edwards, 2018; Rodolfa, et al., 2005).…”

“…Few studies have specified the precise level of experience of the student therapists, though some authors have suggested that there may be differences in effectiveness between beginning trainee therapists and more experienced trainee therapists (Dyason et al, 2019;Stein & Lambert, 1995). In the beginning of their clinical training, trainee therapists seem to struggle with numerous clinical operations conceptually linked to the successful engagement of relationships (Butler et al, 2008), such as 'being too kind' (Cain et al, 2018).…”