In this episode, host Steph Curnow interviews Vickie Presley, the lead author of a paper titled "Crossing the Reflective Bridge: How Therapists Synthesize Personal and Professional Development through Self-Practice/Self-Reflection (SP/SR) during CBT Training", published in The Cognitive Behaviour Therapist. Vickie shares her insights from the research, discussing the importance of reflective practice in CBT training and how it shapes therapists’ professional growth and personal awareness.
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Useful links:
The full version of the article being discussed can be found freely available here
The SP/SR book that Vickie mentions is “Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists (Self-Practice/Self-Reflection Guides for Psychotherapists)” by James Bennett-Levy, Richard Thwaites, Beverly Haarhoff, and Helen Perry. Foreword by Christine A. Padesky
Credits:
Music is Autmn Coffee by Bosnow from Uppbeat
Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee
License code: 3F32NRBYH67P5MIF
Transcript:
Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT.
Today, I'm talking to Vickie Presley. Vickie is course director for CBT training at Coventry university. She's also the lead author of the paper “Crossing the reflective bridge’: how therapists synthesise personal and professional development from self-practice/self-reflection during CBT training” which she co-wrote with Gwion Jones and is published in the Cognitive Behaviour Therapist.
Hi, Vickie. Welcome to the podcast.
Vickie: Hi Steph, thanks for having me.
Steph: Thank you. It's lovely to have you here. I was wondering if you would mind telling everyone a bit about who you are and the areas where you work.
Vickie: Yeah, of course. So my name is Vickie, Vickie Presley. I'm currently the lead for psychological therapies training at Coventry University and the course director for our CBT training programme. And I guess outside of my university role, I'm also a CBT therapist and supervisor in private practice. I guess for the purposes of today as well, it'd be important to say I am also Vickie. I am a lady heading quickly towards my 45th birthday. I am a mum. I'm a wife to a long-suffering husband. I'm a sister. I'm an auntie. I'm a great auntie, Lots of things outside of that sort of professional context. And I guess also I'm a nervous wreck today, if I'm honest. I guess just thinking about conveying things around this research, but it just seems important to say that given we're going to talk about sort of how therapists might synthesise their personal and professional development, there's bits about me that might come through today that are about my personal self, not just my professional self.
Steph: Great. Thank you. And that's great that you've sort of brought in some of the personal as well. That's really nice. And I'm always nervous when we start doing podcasts as well. So it's fine. And I've been doing this for a while now.
Vickie: Oh, that's good to know. Thanks, Steph.
Steph: The paper we're going to be talking about today is about self-practice, self-reflection in CBT training but before we get into talking a bit about the paper, would you be able to tell me a bit about how this research came about? What inspired it?
Vickie: Yeah, of course. I mean, I suppose the answer to that question is, one that takes me back, sort of, 15 years or so to my own CBT training. So, I trained at Coventry. Coventry's got quite a long-standing ethos of reflective practice as part of the training course. And for me, I think that allowed me to really think about the role of myself in my therapeutic interactions with clients. And I started to notice as part of my training that I was getting in the way sometimes. So sometimes my own stuff was getting in the way of my work with clients. There's this example that I always give where, I was working with a lady who was very, very depressed, and as part of that presentation she was very perfectionist and held herself to really high standards, which, is something that I have to manage myself. So, there's kind of this schema match, I guess, if you like, that we noticed, and we did some work around that. And technically it was really good. Technically we did this continuum exercise. It worked really well, it was really helpful for her in the session. But right in the last minute, I suggested to her that she took the worksheet home, and she rewrote it because mine was too messy.
And I suppose the whole irony of that, that one statement, which, I mean, I suppose we look back at that and sort of laugh at the irony, but it really had the potential to undo a lot of good work in the session. And that was about my own stuff. So, I really do think that's the point where it started for me, and I started looking at some of the research that was around about therapist perfectionism in particular. I suppose as my career has gone on and I've supervised trainees and qualified staff and obviously I've worked at the university for many years now, we notice the same patterns that therapist’s own stuff will get in the way a lot of the time. So some of my previous papers have focused on areas like therapist perfectionism, like things like experiential avoidance and one of the things we always suggest at the back end of those papers is that therapists get involved in SP/SR so they can get to know themselves a bit better. And I guess that brings us to this paper where we wanted to know whether that was working as part of our own program. And if it is, how trainees experience that, how do they get to know themselves as part of SP/SR and as part of the training process? And how do they make sense of that in a professional context? What meanings and what the experience of synthesising those two parts of themselves is like. So that's how we got here and that's what this paper aims to elucidate in some way.
Steph: And I think that's really important, isn't it? Because when you're really busy training and you're taking in all this new information and then you're putting it into practice, it must be really difficult actually to take that time to think about yourself and to really self-reflect and think about how that might be impacting you.
Vickie: I think it's really difficult and I think, in some ways, it seems more difficult in the CBT model, I think, because lots of the things that we have to teach are quite technical and there's lots of demands on trainees to show technical flair and that they understand quite complex models and ways of working. But that can become, this whole reflection stuff can become sidelined and feel like it's less important. I think my view is that the technical stuff, the technicalities of CBT take place within a relational context, and they take place within the dynamic between two people and if the therapist isn't holding what's their own stuff in that dynamic, that can become problematic.
Steph: Could I ask you to just explain a bit about what is self-practice/self-reflection for anyone who might not be, familiar with the term?
Vickie: Yeah, of course. So, I mean, I suppose the simplest terms, self-practice/self-reflection is about practicing CBT techniques on oneself, so using, the interventions of CBT on oneself and then having time to reflect on what that experience is like. I guess there's a myriad of ways that people can get involved in self-practice/self-reflection but on our training course specifically, we use the text “Experiencing CBT from the inside out”. So that's a well-established text. It's an evidence-based text, and we provide one of our trainees with a shiny workbook at the beginning of the year, and that's what we use to scaffold the process of SP/SR. So, we find that's a really nice text that helps the trainees work through some of the stuff that SP/SR incorporates, but also helps our staff who are facilitating that process to keep some framework around the process.
So for our trainees, we give them that book and actually SP/SR is a mandatory part of our training program, so all of our trainees will be given the book and have space to work through that, but they'll also meet 12 times across the training year with their group facilitator to have space to reflect with peers and to reflect with the group facilitator about the process of taking part in SP/SR.I suppose for us it's an integrated part of our training programme and we find that this huge benefits from for including that as part of the training program. So yeah, so each of our trainees would be working through the process and have a formal space to reflect on how that's going across the year. And then they're also asked to submit an assessed summary of their learning from SP/SR and how they're making sense of that in terms of their clinical practice. And I guess that last bit is the key point. That we don't want people just to do SP/SR. We don't want them just to experience what it's like to do CBT interventions. We want to give them space to make sense of that in a professional context so, bridging that professional arena and what those insights mean for their clinical practice and how it can help with their skills developmentment.
Steph: Yeah. And that's a really nice segue into my next question, actually because we're going to dive into the paper now on what you did and it's that reflective piece of work was kind of the basis for how you recruited your participants really, wasn't it? Am I right in thinking that you were analysing that part of their reflective work.
Vickie: Yeah, so each of our trainees will just as part of the training program, submit a 1000 word reflective piece in which we ask them to say a bit about their personal learning. So what they've learned about themselves as part of the SP/SR process. Also, then to bridge that to their clinical practice and what does that mean for their clinical practice and how they sort of synthesise what they've learned about themselves and how that's helped their professional development. That's what we use for the basis of this piece of work. I guess we've noticed across years that even though it's a brief summary, a thousand words isn't a lot. It's so rich with the sort of data for this piece of research. I guess because instead of interviewing people really have chance to sit down and think about what they want to convey about their learning. It's a deeply personal piece of work. So yeah, so our trainee needs to submit that 1000 word summary of their learning. And we analysed that using thematic analysis, really just to try and, highlight what it is that people are learning about the self and how they make sense of that in a professional context.
Steph: Yeah. And so several themes then came out of that analysis that you and your colleague did. We were saying just before we started recording, I actually felt very seen during some of that as well. There's definitely schemas that I've had during my counselling training. Were there any that surprised you when you looked at them?
Vickie: You know what, that’s such good question. Probably not, and I think that was a really important part of how we approached the analysis. So I'm a CBT therapist, and I'm involved with the facilitation of those SP/SR groups. And we were really aware that might sort of skew how I came at the data. So it wasn't just me that analysed the data, a colleague analysed the data with me, my colleague Gwion. Gwion’s not a CBT therapist, Gwion's a psychoanalyst, so we came to the analysis from a completely different psychotherapeutic model, which we thought was really important for us to have a more sort of nuanced relationship with the data. Gwion also doesn't facilitate the SP/SR groups so it's interesting that you asked that because I probably wasn't particularly surprised, but I think that's because of how I'm positioned in terms of the data and the way it was collected and the training process as a whole but maybe if you were interviewing Gwion he may give a different answer to that. I suppose the only thing that might have surprised me was how strong the themes were, so most of the participants engaged with most of the themes. There was such similarity and it's interesting how you're saying Steph that you felt seen and that's coming from a different model again and somebody who's not involved in our training course having sort of similar things and that's quite heartening really. There's a sort of shared humanity perspective on this that these are things that we lots of us struggle with.
Steph: Yeah. And the first theme was really about the identification of self schemas, wasn't it? And that sub theme about not feeling good enough. And that's definitely something that I think comes up in any kind of therapy training a lot I think.
Vickie: Yeah, I mean, probably any kind of training, really, if we strip it back. Training is difficult, isn't it, right? There's often a transition from what you know to what you don't know, and I think that's really quite hard. And for us, we know that people are transitioning into this profession from lots of different varied sort of professional backgrounds, but also personal backgrounds as well. Our cohorts are hugely professionally and personally diverse, which is wonderful. But I think that sort of sense of being de skilled at the same time as having your practice evaluated from every conceivable angle is quite exposing. And I think that sense is not good enough really came through in their reflections and their ways of coping with it, which is often about getting into compensatory strategies like perfectionism. Yeah, so a really strong theme around the not good enough stuff, which I think we need to pay a bit more attention to because that's a difficult place to be for anybody.
Steph: And I think one of the quotes from one of the participants that came out in that was about, really worrying about not being liked then and the kind of interpersonal relationships. And I was wondering, do you think that was being liked by their client or not being liked by their colleagues on their cohort from being able to express what they were saying?
Vickie: Do you know what? I think it might have been multifaceted. I suppose this is one of the downsides is the data in some respects is very rich, but it is two dimensional. And we didn't follow up with any interviews or any focus groups or have any opportunity to ask questions like that, which are really important. I suppose what we did find as we move into the other themes is people did identify that there was sort of historical longitudinal backdrop to a lot of the things that were happening professionally. I think maybe the quote you're talking about is, that’s sort of not good enough thing, even coming into the SP/SR process and being worried about whether they're doing it right, whether they're reflecting right, whether they're feeding back right in the sessions, all of that stuff can be really difficult.
Steph: yeah, definitely. I just, I think what I was saying, I felt seen, that was something I really felt when I was doing my training as well. There was often a question of am I doing this right? And often there is no right, is there?
Vickie: No, often that there isn't and you know, one of the things I always say to my trainees is that sense of imposter syndrome It never really goes away or you know, I have that now talking to you about this paper and Yeah, the need to get it right and to have approval and be likable all of those things. There's such a commonality there with lots of us experience.
Steph: And like you said in theme two as well, that was round about the increased awareness of the personal context. And as you were saying, it was helpful for the trainees then to maybe be able to put that into some sort of context for them and maybe why they were feeling some of things that they were.
Vickie: Yeah, absolutely. We have this really strong theme of identification of self-schemas which is around the not good enough stuff, but also around sort of having difficulty sitting with difficult internal experiences and difficult emotions. And what we found is people sort of extended those reflections to start thinking about where does this come from in terms of my personal context? And there was, you know, so much data, which was deeply personal, I guess, with people linking those things back to relationships within their family, the meaning they've given to some of the expectations within their own culture. For some people it was about sort of their socioeconomic status and some of the meanings that they'd given to that. For some people it was this sort of process of making sense of what they'd learned about themselves in the backdrop of their own faith and spirituality. There was lots of things around personal context which, it was so important and I know when I was writing this paper just feeling like I'd got all of this data and really needed to be quite delicate with how it was conveyed in the paper.
I know when I wrote the first drafts, that results section was pages and pages long because there were so many things that I wanted to give credit to or, to be seen and to be valued by other people, but you know, you can't do that, you have to sort of get less attached to your data in some respects. Yeah, I thought that part was really quite powerful, how people had sort of made sense of themselves in that sort of longitudinal framework.
Steph: Yeah. And what about the other themes that you found? Is there anything else that you wanted to highlight from those?
Vickie: Yeah, I mean, I suppose one of the important things was this idea of, okay, this is what I've learned about myself and who I am. And then the trainees sort of conceptualising how that then came into their clinical work. And I guess this is about sort of this bridging process, which is reflected in other research papers, that there needs to be this process where people, they learn about themselves, but then they think about what actually means for their practice. And lots of the trainees noticing that their own need to be good enough, their own need to not make mistakes, or to be liked, or to not experience discomfort was actually getting in the way of them doing CBT with a lot of their clients or getting in the way of a therapeutic alliance. So that kind of became a central theme, I guess, that holds the other ones together. But then what we found is a lot of the trainees had then been brave enough to sort of step out of the reflective space and do things more experientially to try and find out what happens when they don't adhere to some of those schemas and the rules that come out of those and when they try to change things in their personal and professional sort of arenas.
That was quite powerful. I guess part of their reflective summaries was thinking about how they'd been brave enough to make changes and then how they just sort of reach professional benefit from that. Which I guess matched a lot of the stuff we already know about SP/SR, certainly in terms of helping people to work more effectively within the therapeutic alliance. But I think a major thing that came out of this study in particular, was people's ability to just work more authentically with difficult emotions. And to see that as a really key part of cognitive behavioural therapy that we talk a lot about cognitions and behaviours right? But there needs to be a real sort of processing of emotion when we're trying to change those things with people and I think that lived experience was really important for the participants, for the trainees, but that lived experience of how difficult that is was really important to helping develop their professional practice.
Steph: So sometimes think as well when working with my own clients, you know, bringing about change sometimes brings about almost like a grief process because they've been holding onto whatever they've been holding onto for such a long time. And that can really bring up some really quite strong feelings and even if they want to let it go and they don't want to be like that anymore, it can be quite surprising what comes up, isn't it?
Vickie: Yeah definitely. And you know that's a difficult part of therapy and that's a difficult part of SP/SR. You know, a lot of the trainees that took part in this study said they flew through all the sort of reflective self-formulation stuff, but then got really sort of halted by the more experiential things. So when it gets to letting go of safety behaviours that give us comfort or letting go of, things that we do to try and soothe our emotions in the short term, letting go of those things and making changes is really hard.
Steph: So is there anything else on the themes that came up that we haven't discussed yet that you want to kind of bring up a talk about?
Vickie: I think we had these five themes and we weren't sort of intending to provide any sort of conceptual framework, but those themes just beautifully linked together to show this journey of finding out who I am, finding out where that comes from, understanding how that comes into my work, being brave enough to change it, and then knowing that I've taken personal and professional benefit from that, that, I guess that sums up what we found.
Steph: Yeah, brilliant. So given these findings then, what do you think are the implications for clinical practice or even for some future research? So I always ask the question, what impact do you think this paper will have on the world of CBT?
Vickie: Well, gosh, I mean, I'd love it to have some impact. I suppose the first thing it brings me to because we run a CPT training program. It's just really encouraging training courses to bring SP/SR into their teaching and learning strategy. I think a lot of courses do more of this now, which is brilliant, I don't think it's necessarily alien in the way it might have been going back a decade or so. But I think that's the key implication, that if we don't allow space for trainees to get to know who they are, get to know who they are as a therapist, they may well go out into the world and continue to practice in ways which isn't optimum for clients doing well in treatment. I guess it brings a circle to what I was saying at the beginning, that we can get so focused on the technical flair of CBT that we forget those unique interpersonal dynamics which is the context where it all takes place. So I think hat's one of the key implications is how do we bring SP/SR into CBT training programs in a way that is safe, that is ethical, that is well resourced, which looks after trainees as part of that process and allows them to gain some of these insights that are really important to their professional practice.
Steph: And what you were saying there was something my course tutor always spoke to me about, which was always, you know, you shouldn't be asking clients to do something that you won't be prepared to do yourself as well. And you know, if you're asking them to really look and analyse something, then you should be able to do that for yourself and have that your own self-reflection and your own reflective space too.
Vickie: Absolutely. And I think a sort of strong, sense that we got. It was really interesting because Gwion and I had seen this data before because we'd marked it as part of an assessment. When we came back to it to analyse it, you relate to what people are saying in a much, just in a different way. And I'm not sure I can even articulate what that was about, but you come to the data in a different way. There was just this really strong sense of trainees saying that they could practice with more authenticity and more emotional connection and that just seems so important when you're working with people and asking them to do really difficult things as part of CBT sometimes.
Steph: Yeah, definitely it is really important, isn't it? So is there anything that you would have done differently if you could do this all over again?
Vickie: I mean, I suppose we've noted some limitations. I mean, I've already mentioned that we didn't go back and sort of talk to the trainees about what we found or sound out this sort of conceptual framework that we put together. And maybe that would have been a great addition to the studies to go back and perhaps do some focus groups or some interviews with the trainees.
I suppose the other thing really to say is SP/SR doesn't really take place in a silo as part of our training program. The trainees are doing other things outside of that textbook and outside of the 12 sessions that they do, they're doing things like process reports. So they're having to analyse their interpersonal transactions with clients and having to reflect on what they're bringing to that process. So there may even have been things that we could have brought in from those parts of the training program or that we should do in future research about those parts of the training program and how that helps with this whole sort of self-practice, self-reflection concept.
Steph: Yeah. And I always like to ask people this question as a managing editor, just to kind of gauge how people feel about it. But how did you find the peer review process? If you can remember, did you find reviewer comments helpful? Was there anything that was surprising for you?
Vickie: This paper in particular was just met with such warmth and that was, I suppose, equally surprising and very lovely that the reviewers were very just bought into the whole concept, very positive about it, as well as offering really helpful suggestions just to improve the paper. So for this paper in particular, I've just found the whole review process really supportive. But my impression is for the journal that was the real ethos of that of reviewers providing supportive and helpful feedback, and that was certainly my experience, Steph. So whoever the reviewers were, thank you very much.
Steph: That's good. And like you say, with the journal ethos, it is something that we really try and do is to make sure that when we have reviews, they're good, constructive reviewing, something I'm really trying to move us away from is from anyone feeling that when they go into peer review, they're going to be really judged and they're going to have a professor in an ivory tower come and critique their paper and pull it apart because that's not really what peer review should be about. So yeah, I'm pleased it was good.
Vickie: Yeah, it was really good but equally, I've also had a review processes where it has felt, you know, that you come out barely with your self-esteem intact. But do you know what, it's the fine line, isn't it? Because I want journals to produce really good research that's of benefit to the community, but you know, certainly there are ways of doing that's really supportive. And that's my sense of this journal, which is great.
Steph: Yeah, definitely. And you know, the paper was really excellent. It was covering an area that sounds like it's really needed and your passion and warmth as well came across in that. So I'm not surprised it was well received because it was really good.
Vickie: You know, it’s interesting that you say that because, obviously out of utter anxiety about being helpful as part of this process, I've read the paper this morning and had a completely different relation to it, reading it, than I did when I was writing it. And I was kind of reflecting that when you're writing a paper, you get hung up on not making mistakes, getting it right, getting it technically accurate, meeting the approval of the reviewers. You get so enmeshed with that whole process that I don't think when I wrote it, I'd emotionally connected to what I was writing. And when I read it this morning, I was really moved by some of the trainees’ reflections and how authentic and deeply personal a lot of those disclosures were to help us sort of bring this out into the research arena.
So massive thank you to the trainees that took part in that as well. It just made me think about this whole parallel processes of getting so bogged down with getting things right that we forget to emotionally connect and I guess that's really the essence of what this paper is talking about, is trainees can get so bogged down with their own stuff, some of the really nice interpersonal stuff can fall by the wayside.
Steph: Yeah. And that comes quite nicely full circle to where we started at the beginning, wasn't it? Talking about your feelings of perfectionism and CBT training and trying to get it right.
Vickie: Absolutely, I am a recovering perfectionist Steph, it's always a work in progress.
Steph: So finally, before I let you go, I just wanted to ask what's next for you. Is there anything you're working on now? Any papers we can look forward to from you in the future.
Vickie: At the moment I am very busy with lots of things course related. I am working on a little project with the BABCP, which is about just producing some helpful sort of best practice type guidance for courses for integrating equality, diversity and inclusion into training programs. I don't profess to be an expert in that area, but I think things like self-practice/self-reflection are so key. So there's a nice link there that hopefully we can pull into that work, which is about people getting to know themselves as therapists and getting to know where their stuff comes from in a cultural context as well, and how that sort of plays out when they're working with people that are different to themselves. So that's one of the things that I'm working on at the moment. If I'm very honest, I do have a raft of interviews that are awaiting analysis, they’ve been sitting there for some time, Steph, which I'm hoping we'll be able to come back to once we've got a bit more time and that's, exploring trainees experiences of working with distress as part of the training process. Because we know that trainees find it really difficult sometimes to work with difficult emotions. So, don’t hold me to that anytime soon Steph, but that is in the pipeline.
Steph: We'll look out for it when it comes. Oh, Vickie, thank you so much. This has been really great.
Vickie: No problem at all, thanks for having me Steph.
Steph: Thank you.
Thanks so much for listening. If you enjoyed this episode, then please rate, review and subscribe wherever you get your podcasts. And you can follow us on Twitter @BABCPpodcasts.
If you have any feedback or suggestions for future episodes, then I'd love to hear from you. Email us at [email protected]. And why not check out our sister podcast. Let's talk about CBT- Practice Matters. This is hosted by the lovely Rachel Handley. And it's the perfect podcast for clinicians working in CBT.
Thanks for tuning in, and I'll see you next time on Research Matters. Bye.
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By Steph Curnow for BABCPIn this episode, host Steph Curnow interviews Vickie Presley, the lead author of a paper titled "Crossing the Reflective Bridge: How Therapists Synthesize Personal and Professional Development through Self-Practice/Self-Reflection (SP/SR) during CBT Training", published in The Cognitive Behaviour Therapist. Vickie shares her insights from the research, discussing the importance of reflective practice in CBT training and how it shapes therapists’ professional growth and personal awareness.
If you enjoyed this episode, please rate, review, and subscribe wherever you get your podcasts. Follow us on Twitter at @BABCPpodcasts or on Instagram . Share your feedback or episode suggestions by emailing [email protected].
Useful links:
The full version of the article being discussed can be found freely available here
The SP/SR book that Vickie mentions is “Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists (Self-Practice/Self-Reflection Guides for Psychotherapists)” by James Bennett-Levy, Richard Thwaites, Beverly Haarhoff, and Helen Perry. Foreword by Christine A. Padesky
Credits:
Music is Autmn Coffee by Bosnow from Uppbeat
Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/bosnow/autumn-coffee
License code: 3F32NRBYH67P5MIF
Transcript:
Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT.
Today, I'm talking to Vickie Presley. Vickie is course director for CBT training at Coventry university. She's also the lead author of the paper “Crossing the reflective bridge’: how therapists synthesise personal and professional development from self-practice/self-reflection during CBT training” which she co-wrote with Gwion Jones and is published in the Cognitive Behaviour Therapist.
Hi, Vickie. Welcome to the podcast.
Vickie: Hi Steph, thanks for having me.
Steph: Thank you. It's lovely to have you here. I was wondering if you would mind telling everyone a bit about who you are and the areas where you work.
Vickie: Yeah, of course. So my name is Vickie, Vickie Presley. I'm currently the lead for psychological therapies training at Coventry University and the course director for our CBT training programme. And I guess outside of my university role, I'm also a CBT therapist and supervisor in private practice. I guess for the purposes of today as well, it'd be important to say I am also Vickie. I am a lady heading quickly towards my 45th birthday. I am a mum. I'm a wife to a long-suffering husband. I'm a sister. I'm an auntie. I'm a great auntie, Lots of things outside of that sort of professional context. And I guess also I'm a nervous wreck today, if I'm honest. I guess just thinking about conveying things around this research, but it just seems important to say that given we're going to talk about sort of how therapists might synthesise their personal and professional development, there's bits about me that might come through today that are about my personal self, not just my professional self.
Steph: Great. Thank you. And that's great that you've sort of brought in some of the personal as well. That's really nice. And I'm always nervous when we start doing podcasts as well. So it's fine. And I've been doing this for a while now.
Vickie: Oh, that's good to know. Thanks, Steph.
Steph: The paper we're going to be talking about today is about self-practice, self-reflection in CBT training but before we get into talking a bit about the paper, would you be able to tell me a bit about how this research came about? What inspired it?
Vickie: Yeah, of course. I mean, I suppose the answer to that question is, one that takes me back, sort of, 15 years or so to my own CBT training. So, I trained at Coventry. Coventry's got quite a long-standing ethos of reflective practice as part of the training course. And for me, I think that allowed me to really think about the role of myself in my therapeutic interactions with clients. And I started to notice as part of my training that I was getting in the way sometimes. So sometimes my own stuff was getting in the way of my work with clients. There's this example that I always give where, I was working with a lady who was very, very depressed, and as part of that presentation she was very perfectionist and held herself to really high standards, which, is something that I have to manage myself. So, there's kind of this schema match, I guess, if you like, that we noticed, and we did some work around that. And technically it was really good. Technically we did this continuum exercise. It worked really well, it was really helpful for her in the session. But right in the last minute, I suggested to her that she took the worksheet home, and she rewrote it because mine was too messy.
And I suppose the whole irony of that, that one statement, which, I mean, I suppose we look back at that and sort of laugh at the irony, but it really had the potential to undo a lot of good work in the session. And that was about my own stuff. So, I really do think that's the point where it started for me, and I started looking at some of the research that was around about therapist perfectionism in particular. I suppose as my career has gone on and I've supervised trainees and qualified staff and obviously I've worked at the university for many years now, we notice the same patterns that therapist’s own stuff will get in the way a lot of the time. So some of my previous papers have focused on areas like therapist perfectionism, like things like experiential avoidance and one of the things we always suggest at the back end of those papers is that therapists get involved in SP/SR so they can get to know themselves a bit better. And I guess that brings us to this paper where we wanted to know whether that was working as part of our own program. And if it is, how trainees experience that, how do they get to know themselves as part of SP/SR and as part of the training process? And how do they make sense of that in a professional context? What meanings and what the experience of synthesising those two parts of themselves is like. So that's how we got here and that's what this paper aims to elucidate in some way.
Steph: And I think that's really important, isn't it? Because when you're really busy training and you're taking in all this new information and then you're putting it into practice, it must be really difficult actually to take that time to think about yourself and to really self-reflect and think about how that might be impacting you.
Vickie: I think it's really difficult and I think, in some ways, it seems more difficult in the CBT model, I think, because lots of the things that we have to teach are quite technical and there's lots of demands on trainees to show technical flair and that they understand quite complex models and ways of working. But that can become, this whole reflection stuff can become sidelined and feel like it's less important. I think my view is that the technical stuff, the technicalities of CBT take place within a relational context, and they take place within the dynamic between two people and if the therapist isn't holding what's their own stuff in that dynamic, that can become problematic.
Steph: Could I ask you to just explain a bit about what is self-practice/self-reflection for anyone who might not be, familiar with the term?
Vickie: Yeah, of course. So, I mean, I suppose the simplest terms, self-practice/self-reflection is about practicing CBT techniques on oneself, so using, the interventions of CBT on oneself and then having time to reflect on what that experience is like. I guess there's a myriad of ways that people can get involved in self-practice/self-reflection but on our training course specifically, we use the text “Experiencing CBT from the inside out”. So that's a well-established text. It's an evidence-based text, and we provide one of our trainees with a shiny workbook at the beginning of the year, and that's what we use to scaffold the process of SP/SR. So, we find that's a really nice text that helps the trainees work through some of the stuff that SP/SR incorporates, but also helps our staff who are facilitating that process to keep some framework around the process.
So for our trainees, we give them that book and actually SP/SR is a mandatory part of our training program, so all of our trainees will be given the book and have space to work through that, but they'll also meet 12 times across the training year with their group facilitator to have space to reflect with peers and to reflect with the group facilitator about the process of taking part in SP/SR.I suppose for us it's an integrated part of our training programme and we find that this huge benefits from for including that as part of the training program. So yeah, so each of our trainees would be working through the process and have a formal space to reflect on how that's going across the year. And then they're also asked to submit an assessed summary of their learning from SP/SR and how they're making sense of that in terms of their clinical practice. And I guess that last bit is the key point. That we don't want people just to do SP/SR. We don't want them just to experience what it's like to do CBT interventions. We want to give them space to make sense of that in a professional context so, bridging that professional arena and what those insights mean for their clinical practice and how it can help with their skills developmentment.
Steph: Yeah. And that's a really nice segue into my next question, actually because we're going to dive into the paper now on what you did and it's that reflective piece of work was kind of the basis for how you recruited your participants really, wasn't it? Am I right in thinking that you were analysing that part of their reflective work.
Vickie: Yeah, so each of our trainees will just as part of the training program, submit a 1000 word reflective piece in which we ask them to say a bit about their personal learning. So what they've learned about themselves as part of the SP/SR process. Also, then to bridge that to their clinical practice and what does that mean for their clinical practice and how they sort of synthesise what they've learned about themselves and how that's helped their professional development. That's what we use for the basis of this piece of work. I guess we've noticed across years that even though it's a brief summary, a thousand words isn't a lot. It's so rich with the sort of data for this piece of research. I guess because instead of interviewing people really have chance to sit down and think about what they want to convey about their learning. It's a deeply personal piece of work. So yeah, so our trainee needs to submit that 1000 word summary of their learning. And we analysed that using thematic analysis, really just to try and, highlight what it is that people are learning about the self and how they make sense of that in a professional context.
Steph: Yeah. And so several themes then came out of that analysis that you and your colleague did. We were saying just before we started recording, I actually felt very seen during some of that as well. There's definitely schemas that I've had during my counselling training. Were there any that surprised you when you looked at them?
Vickie: You know what, that’s such good question. Probably not, and I think that was a really important part of how we approached the analysis. So I'm a CBT therapist, and I'm involved with the facilitation of those SP/SR groups. And we were really aware that might sort of skew how I came at the data. So it wasn't just me that analysed the data, a colleague analysed the data with me, my colleague Gwion. Gwion’s not a CBT therapist, Gwion's a psychoanalyst, so we came to the analysis from a completely different psychotherapeutic model, which we thought was really important for us to have a more sort of nuanced relationship with the data. Gwion also doesn't facilitate the SP/SR groups so it's interesting that you asked that because I probably wasn't particularly surprised, but I think that's because of how I'm positioned in terms of the data and the way it was collected and the training process as a whole but maybe if you were interviewing Gwion he may give a different answer to that. I suppose the only thing that might have surprised me was how strong the themes were, so most of the participants engaged with most of the themes. There was such similarity and it's interesting how you're saying Steph that you felt seen and that's coming from a different model again and somebody who's not involved in our training course having sort of similar things and that's quite heartening really. There's a sort of shared humanity perspective on this that these are things that we lots of us struggle with.
Steph: Yeah. And the first theme was really about the identification of self schemas, wasn't it? And that sub theme about not feeling good enough. And that's definitely something that I think comes up in any kind of therapy training a lot I think.
Vickie: Yeah, I mean, probably any kind of training, really, if we strip it back. Training is difficult, isn't it, right? There's often a transition from what you know to what you don't know, and I think that's really quite hard. And for us, we know that people are transitioning into this profession from lots of different varied sort of professional backgrounds, but also personal backgrounds as well. Our cohorts are hugely professionally and personally diverse, which is wonderful. But I think that sort of sense of being de skilled at the same time as having your practice evaluated from every conceivable angle is quite exposing. And I think that sense is not good enough really came through in their reflections and their ways of coping with it, which is often about getting into compensatory strategies like perfectionism. Yeah, so a really strong theme around the not good enough stuff, which I think we need to pay a bit more attention to because that's a difficult place to be for anybody.
Steph: And I think one of the quotes from one of the participants that came out in that was about, really worrying about not being liked then and the kind of interpersonal relationships. And I was wondering, do you think that was being liked by their client or not being liked by their colleagues on their cohort from being able to express what they were saying?
Vickie: Do you know what? I think it might have been multifaceted. I suppose this is one of the downsides is the data in some respects is very rich, but it is two dimensional. And we didn't follow up with any interviews or any focus groups or have any opportunity to ask questions like that, which are really important. I suppose what we did find as we move into the other themes is people did identify that there was sort of historical longitudinal backdrop to a lot of the things that were happening professionally. I think maybe the quote you're talking about is, that’s sort of not good enough thing, even coming into the SP/SR process and being worried about whether they're doing it right, whether they're reflecting right, whether they're feeding back right in the sessions, all of that stuff can be really difficult.
Steph: yeah, definitely. I just, I think what I was saying, I felt seen, that was something I really felt when I was doing my training as well. There was often a question of am I doing this right? And often there is no right, is there?
Vickie: No, often that there isn't and you know, one of the things I always say to my trainees is that sense of imposter syndrome It never really goes away or you know, I have that now talking to you about this paper and Yeah, the need to get it right and to have approval and be likable all of those things. There's such a commonality there with lots of us experience.
Steph: And like you said in theme two as well, that was round about the increased awareness of the personal context. And as you were saying, it was helpful for the trainees then to maybe be able to put that into some sort of context for them and maybe why they were feeling some of things that they were.
Vickie: Yeah, absolutely. We have this really strong theme of identification of self-schemas which is around the not good enough stuff, but also around sort of having difficulty sitting with difficult internal experiences and difficult emotions. And what we found is people sort of extended those reflections to start thinking about where does this come from in terms of my personal context? And there was, you know, so much data, which was deeply personal, I guess, with people linking those things back to relationships within their family, the meaning they've given to some of the expectations within their own culture. For some people it was about sort of their socioeconomic status and some of the meanings that they'd given to that. For some people it was this sort of process of making sense of what they'd learned about themselves in the backdrop of their own faith and spirituality. There was lots of things around personal context which, it was so important and I know when I was writing this paper just feeling like I'd got all of this data and really needed to be quite delicate with how it was conveyed in the paper.
I know when I wrote the first drafts, that results section was pages and pages long because there were so many things that I wanted to give credit to or, to be seen and to be valued by other people, but you know, you can't do that, you have to sort of get less attached to your data in some respects. Yeah, I thought that part was really quite powerful, how people had sort of made sense of themselves in that sort of longitudinal framework.
Steph: Yeah. And what about the other themes that you found? Is there anything else that you wanted to highlight from those?
Vickie: Yeah, I mean, I suppose one of the important things was this idea of, okay, this is what I've learned about myself and who I am. And then the trainees sort of conceptualising how that then came into their clinical work. And I guess this is about sort of this bridging process, which is reflected in other research papers, that there needs to be this process where people, they learn about themselves, but then they think about what actually means for their practice. And lots of the trainees noticing that their own need to be good enough, their own need to not make mistakes, or to be liked, or to not experience discomfort was actually getting in the way of them doing CBT with a lot of their clients or getting in the way of a therapeutic alliance. So that kind of became a central theme, I guess, that holds the other ones together. But then what we found is a lot of the trainees had then been brave enough to sort of step out of the reflective space and do things more experientially to try and find out what happens when they don't adhere to some of those schemas and the rules that come out of those and when they try to change things in their personal and professional sort of arenas.
That was quite powerful. I guess part of their reflective summaries was thinking about how they'd been brave enough to make changes and then how they just sort of reach professional benefit from that. Which I guess matched a lot of the stuff we already know about SP/SR, certainly in terms of helping people to work more effectively within the therapeutic alliance. But I think a major thing that came out of this study in particular, was people's ability to just work more authentically with difficult emotions. And to see that as a really key part of cognitive behavioural therapy that we talk a lot about cognitions and behaviours right? But there needs to be a real sort of processing of emotion when we're trying to change those things with people and I think that lived experience was really important for the participants, for the trainees, but that lived experience of how difficult that is was really important to helping develop their professional practice.
Steph: So sometimes think as well when working with my own clients, you know, bringing about change sometimes brings about almost like a grief process because they've been holding onto whatever they've been holding onto for such a long time. And that can really bring up some really quite strong feelings and even if they want to let it go and they don't want to be like that anymore, it can be quite surprising what comes up, isn't it?
Vickie: Yeah definitely. And you know that's a difficult part of therapy and that's a difficult part of SP/SR. You know, a lot of the trainees that took part in this study said they flew through all the sort of reflective self-formulation stuff, but then got really sort of halted by the more experiential things. So when it gets to letting go of safety behaviours that give us comfort or letting go of, things that we do to try and soothe our emotions in the short term, letting go of those things and making changes is really hard.
Steph: So is there anything else on the themes that came up that we haven't discussed yet that you want to kind of bring up a talk about?
Vickie: I think we had these five themes and we weren't sort of intending to provide any sort of conceptual framework, but those themes just beautifully linked together to show this journey of finding out who I am, finding out where that comes from, understanding how that comes into my work, being brave enough to change it, and then knowing that I've taken personal and professional benefit from that, that, I guess that sums up what we found.
Steph: Yeah, brilliant. So given these findings then, what do you think are the implications for clinical practice or even for some future research? So I always ask the question, what impact do you think this paper will have on the world of CBT?
Vickie: Well, gosh, I mean, I'd love it to have some impact. I suppose the first thing it brings me to because we run a CPT training program. It's just really encouraging training courses to bring SP/SR into their teaching and learning strategy. I think a lot of courses do more of this now, which is brilliant, I don't think it's necessarily alien in the way it might have been going back a decade or so. But I think that's the key implication, that if we don't allow space for trainees to get to know who they are, get to know who they are as a therapist, they may well go out into the world and continue to practice in ways which isn't optimum for clients doing well in treatment. I guess it brings a circle to what I was saying at the beginning, that we can get so focused on the technical flair of CBT that we forget those unique interpersonal dynamics which is the context where it all takes place. So I think hat's one of the key implications is how do we bring SP/SR into CBT training programs in a way that is safe, that is ethical, that is well resourced, which looks after trainees as part of that process and allows them to gain some of these insights that are really important to their professional practice.
Steph: And what you were saying there was something my course tutor always spoke to me about, which was always, you know, you shouldn't be asking clients to do something that you won't be prepared to do yourself as well. And you know, if you're asking them to really look and analyse something, then you should be able to do that for yourself and have that your own self-reflection and your own reflective space too.
Vickie: Absolutely. And I think a sort of strong, sense that we got. It was really interesting because Gwion and I had seen this data before because we'd marked it as part of an assessment. When we came back to it to analyse it, you relate to what people are saying in a much, just in a different way. And I'm not sure I can even articulate what that was about, but you come to the data in a different way. There was just this really strong sense of trainees saying that they could practice with more authenticity and more emotional connection and that just seems so important when you're working with people and asking them to do really difficult things as part of CBT sometimes.
Steph: Yeah, definitely it is really important, isn't it? So is there anything that you would have done differently if you could do this all over again?
Vickie: I mean, I suppose we've noted some limitations. I mean, I've already mentioned that we didn't go back and sort of talk to the trainees about what we found or sound out this sort of conceptual framework that we put together. And maybe that would have been a great addition to the studies to go back and perhaps do some focus groups or some interviews with the trainees.
I suppose the other thing really to say is SP/SR doesn't really take place in a silo as part of our training program. The trainees are doing other things outside of that textbook and outside of the 12 sessions that they do, they're doing things like process reports. So they're having to analyse their interpersonal transactions with clients and having to reflect on what they're bringing to that process. So there may even have been things that we could have brought in from those parts of the training program or that we should do in future research about those parts of the training program and how that helps with this whole sort of self-practice, self-reflection concept.
Steph: Yeah. And I always like to ask people this question as a managing editor, just to kind of gauge how people feel about it. But how did you find the peer review process? If you can remember, did you find reviewer comments helpful? Was there anything that was surprising for you?
Vickie: This paper in particular was just met with such warmth and that was, I suppose, equally surprising and very lovely that the reviewers were very just bought into the whole concept, very positive about it, as well as offering really helpful suggestions just to improve the paper. So for this paper in particular, I've just found the whole review process really supportive. But my impression is for the journal that was the real ethos of that of reviewers providing supportive and helpful feedback, and that was certainly my experience, Steph. So whoever the reviewers were, thank you very much.
Steph: That's good. And like you say, with the journal ethos, it is something that we really try and do is to make sure that when we have reviews, they're good, constructive reviewing, something I'm really trying to move us away from is from anyone feeling that when they go into peer review, they're going to be really judged and they're going to have a professor in an ivory tower come and critique their paper and pull it apart because that's not really what peer review should be about. So yeah, I'm pleased it was good.
Vickie: Yeah, it was really good but equally, I've also had a review processes where it has felt, you know, that you come out barely with your self-esteem intact. But do you know what, it's the fine line, isn't it? Because I want journals to produce really good research that's of benefit to the community, but you know, certainly there are ways of doing that's really supportive. And that's my sense of this journal, which is great.
Steph: Yeah, definitely. And you know, the paper was really excellent. It was covering an area that sounds like it's really needed and your passion and warmth as well came across in that. So I'm not surprised it was well received because it was really good.
Vickie: You know, it’s interesting that you say that because, obviously out of utter anxiety about being helpful as part of this process, I've read the paper this morning and had a completely different relation to it, reading it, than I did when I was writing it. And I was kind of reflecting that when you're writing a paper, you get hung up on not making mistakes, getting it right, getting it technically accurate, meeting the approval of the reviewers. You get so enmeshed with that whole process that I don't think when I wrote it, I'd emotionally connected to what I was writing. And when I read it this morning, I was really moved by some of the trainees’ reflections and how authentic and deeply personal a lot of those disclosures were to help us sort of bring this out into the research arena.
So massive thank you to the trainees that took part in that as well. It just made me think about this whole parallel processes of getting so bogged down with getting things right that we forget to emotionally connect and I guess that's really the essence of what this paper is talking about, is trainees can get so bogged down with their own stuff, some of the really nice interpersonal stuff can fall by the wayside.
Steph: Yeah. And that comes quite nicely full circle to where we started at the beginning, wasn't it? Talking about your feelings of perfectionism and CBT training and trying to get it right.
Vickie: Absolutely, I am a recovering perfectionist Steph, it's always a work in progress.
Steph: So finally, before I let you go, I just wanted to ask what's next for you. Is there anything you're working on now? Any papers we can look forward to from you in the future.
Vickie: At the moment I am very busy with lots of things course related. I am working on a little project with the BABCP, which is about just producing some helpful sort of best practice type guidance for courses for integrating equality, diversity and inclusion into training programs. I don't profess to be an expert in that area, but I think things like self-practice/self-reflection are so key. So there's a nice link there that hopefully we can pull into that work, which is about people getting to know themselves as therapists and getting to know where their stuff comes from in a cultural context as well, and how that sort of plays out when they're working with people that are different to themselves. So that's one of the things that I'm working on at the moment. If I'm very honest, I do have a raft of interviews that are awaiting analysis, they’ve been sitting there for some time, Steph, which I'm hoping we'll be able to come back to once we've got a bit more time and that's, exploring trainees experiences of working with distress as part of the training process. Because we know that trainees find it really difficult sometimes to work with difficult emotions. So, don’t hold me to that anytime soon Steph, but that is in the pipeline.
Steph: We'll look out for it when it comes. Oh, Vickie, thank you so much. This has been really great.
Vickie: No problem at all, thanks for having me Steph.
Steph: Thank you.
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