Introducing self-practice/self-reflection sessions on the high-intensity training course in cognitive behavioural therapy (CBT)

Introducing self-practice/self-reflection sessions on the high-intensity training course in cognitive behavioural therapy (CBT)

By michaelkilmister Comment Closed

 

By: Julia Limper, Charlie Waller Institute, j.limper@reading.ac.uk
Pink flamingo on water during daytime
Photo by Chris Stenger on Unsplash

Overview

This article discusses the integration of Self-Practice and Self-Reflection (SP/SR) into our as part of cognitive-behavioural therapy (CBT) programs. SP/SR is designed to enhance therapists’ practical skills and emotional resilience by addressing gaps in traditional training methods and helping trainees manage the emotional demands of their learning.

Objectives

The primary goal of introducing SP/SR was to deepen trainees’ understanding of CBT through reflective practices, by supporting trainees to move from rigid adherence to more flexible and competent use of CBT techniques. Additionally, the program sought to provide emotional support during the intensive training process by incorporating opportunities for reflection and normalisation of course challenges smaller groups.

Context

Self-Practice/Self-Reflection (SP/SR) is recognised as a valuable tool for acquiring and refining CBT skills, enhancing both competence and emotional resilience (Bennett-Levy et al., 2009). This approach involves practicing CBT techniques on oneself (self-practice) and then reflecting on both personal benefits and challenges, as well as potential implications for patient work (self-reflection).The approach aligns with the NHS England Curriculum for HI (high intensity) trainees, which emphasises experiential learning and self-reflection (NHS England, 2022). While longer SP/SR formats exist and offer more extensive evidence of their benefits, the shorter format used here was designed to meet the course structure’s time constraints and to lay the groundwork for trainees to continue the practice independently.

In practice, many trainees acknowledged the importance of SP/SR but found it difficult to engage with SP/SR as a solely self-directed element due to the demanding nature of their course. This reflects the broader challenges faced by trainees in intensive programs (Boud & Walker, 1998).

The course involves intensive clinical training, provided through a mixture of lectures which include practicing clinical skills through role-plays, and supervision, provided in smaller groups of a maximum of four students. The lectures allow trainees to learn core skills, whilst supervision supports refining these skills and applying them to specific patient challenges.

Implementation

To address these challenges, SP/SR was integrated into four structured supervision sessions The format included:

  • Initial lecture: Introducing goals, ground rules, and safeguarding strategies.
  • Four SP/SR sessions (scheduled for 1 hour and 45 minutes)
      1. Setting and discussing personal goals.
      2. Evaluating techniques and maintenance cycles (maps that show how the trainees beliefs and behaviours could be maintaining a challenge).
      3. Open discussion on selected topics related to personal or professional challenges.
      4. Reflecting on endings and future use of SP/SR in professional practice.

To support trainees, a handbook, screencasts, and ongoing supervision guidance were provided, encouraging engagement and accountability in the reflective process.

Results and impact

The feedback from trainees, gathered through an online questionnaire showed positive reception to SP/SR in terms of its impact on skill development, wellbeing, and group cohesion. The whole cohort (N=28) was asked for feedback, with 17 responses received (61% response rate).

  • Around 70% agreed that SP/SR sessions contributed significantly to their growth as CBT therapists, with most others somewhat agreeing.
  • 64% found the sessions beneficial for their overall wellbeing.
  • 76% felt SP/SR improved their connection with peers and supervisors, fostering a greater sense of group cohesion.

In terms of session frequency, just over half of the cohort felt the number of sessions was ideal, with some wanting more opportunities to engage in the practice.

Qualitative feedback revealed that the dedicated time for SP/SR in supervision sessions was particularly appreciated. One trainee noted the value of having structured time for reflection on CBT practices, which might otherwise be neglected. Supervisors also observed that discussing SP/SR in small groups led to a deeper understanding among students and highlighted its potential to improve clinical practice.

Discussion and limitations

While SP/SR was well received by trainees, the evaluation had certain limitations, most importantly the reliance on self-reporting. The lack of objective measures of SP/SR’s direct impact on clinical practice or wellbeing leaves room for further investigation. Moreover, focusing primarily on professional self-reflection may limit its effectiveness. Expanding the approach to include reflections on both personal and professional challenges could enhance its utility (Chaddock et al., 2014).

Reflections

The introduction of SP/SR demonstrated its value in supporting both the professional development and emotional resilience of HI trainees. However, refining the programme, incorporating objective outcome measures, and addressing both personal and professional reflections may enhance its impact. Ongoing adjustments will be needed to further align SP/SR with the evolving needs of trainees.

Follow up and future directions

Future evaluations should focus on the long-term impact of SP/SR on trainees’ clinical practice and emotional well-being. Additionally, exploring how trainees continue to use SP/SR after formal training and how services can support this practice is essential. For future cohorts, a more formalised assessment process, combining both quantitative and qualitative feedback, will provide clearer insights into SP/SR’s effectiveness.

References

  • Bennett-Levy, J., McManus, F., Westling, B. E., & Fennell, M. (2009). Acquiring and refining CBT skills and competencies: which training methods are perceived to be most effective? Behavioural and Cognitive Psychotherapy, 37(5), 571–583.
  • Boud, D., & Walker, D. (1998). Promoting reflection in professional courses: The challenge of context. Studies in higher education, 23(2), 191–206.
  • Chaddock, A., Thwaites, R., Bennett-Levy, J., & Freeston, M. H. (2014). Understanding individual differences in response to Self-Practice and Self-Reflection (SP/SR) during CBT training. The Cognitive Behaviour Therapist, 7, e14.
  • NHS England (2022). Curriculum for High-Intensity CBT Trainees.
  • Thwaites, R., & Bennett-Levy, J. (2014). Using Self-Practice and Self-Reflection (SP/SR) to Enhance CBT Competence and Metacompetence. How to become a more effective CBT therapist: Mastering metacompetence in clinical practice, 239–254.
Whose getting the development here? Utlising SoTL frameworks to reflect on personal development modules for senior level apprentices

Whose getting the development here? Utlising SoTL frameworks to reflect on personal development modules for senior level apprentices

By michaelkilmister Comment Closed

 

By: Dr Elizabeth Houldsworth, Associate Professor of Leadership, Organisations and Behaviour at Henley Business School, liz.houldsworth@henley.ac.uk
Group of people sitting around a table looking at paper and a laptop
Photograph from a staff development workshop at Whiteknights Campus, July 2023 © Liz Houldsworth

Overview

This entry offers an overview of a collaborative study by Dr Elizabeth Houldsworth (Henley Business School) and Emma Watton (Lancaster University Management School)

The researchers met at both their institutions to review personal development (PD) materials and to hear reports from learners on the impact of PD modules on their development as reflective practitioners. An exploratory empirical study was designed using Henley Business School students to consider the relative degree of reflective thinking displayed by learners in their PD assignments.

The approach was informed by scholarship of teaching and learning (SoTL) frameworks designed by Boyer (1990) and Kern et al. (2015) and, in particular, the need to ‘go public’ about the study. The collaborators reflected that the study had an unexpected positive impact on their own personal development as reflective practitioners.

Selfie photograph of Liz Houldsworth and Emma Watton.
Liz Houldsworth (left) and Emma Watton (right) © Liz Houldsworth

The project has had the following outputs, which are available for download by selecting the links:

    1. A peer reviewed presentation to the Research in Management Learning and Education Conference in Banff June 2022 (abstract)
    2. A peer reviewed conference presentation to Advance HE on the SoTL aspects of the collaboration (abstract)
    3. Staff development workshops at Henley Business School and Lancaster University Management School. Materials from the final one, held at Whiteknights Campus in July 2023, is available for download here (PDF of PowerPoint slides)

References

  • Boyer, E.L. (1990). Scholarship reconsidered: Priorities of the professoriate. Princeton University Press.
  • Kern, B. Mettetal G, Dixson M, et al. (2015). The role of SoTL in the academy: Upon the 25th anniversary of Boyer’s Scholarship Reconsidered. Journal of the Scholarship of Teaching and Learning, 15(3): 1-14.

This entry is a first for the T&L Exchange. Liberated from the constraints of the usual case study, contributors are encouraged to present their writing in a style and format of their choosing. This format offers colleagues an opportunity to quickly share their research, practice and ideas in a way that is authentic to their research or project. These entries might be intended to inspire interest, stimulate debate, foster collaboration, propose new ideas or even entertain. If you would like to submit an entry like this, please email CQSDTandL@reading.ac.uk.

 

Developing innovative teaching: The importance of reflective practice

By peteandrews Comment Closed

Dr Allán Laville, School of Psychology and Clinical Language Sciences

a.laville@reading.ac.uk

Overview

In the training of Psychological Wellbeing Practitioners (PWPs), it is crucial to support students in the development of their reflective thinking and writing skills. Therefore, I implemented the Self-Practice/Self-Reflection (SP/SR; Bennett-Levy, 2001) approach into our PWP training programmes. Impact was measured by asking students to complete questionnaires on their experience of SP/SR and the results informed my PGCAP research project.

Objectives

  • To improve the level of support and guidance for reflective thinking and writing within the programme.
  • To support students to review their current clinical practice and to create action points in order to develop their practice based on the use of SP/SR.

Context

As part of the BPS PWP national curriculum, students are required to complete summative pieces of reflective writing based on their clinical practice. This is contained within the Evidence-based low-intensity treatment of common mental health problems module (PY3TRT1 and PYMTRT) in both PWP training programmes at the University.

Implementation

The first step was to review the current literature on SP/SR to see how we could implement this approach in the training of low-intensity Cognitive Behavioural Therapy (LICBT) for PWPs. Previous use of this approach was for Cognitive Behavioural Psychotherapists who completed training over two years, whereas PWPs train over 9 months, and so there is significantly less time for implementation.

Based on the length of the training programme, we agreed on including 6 SP/SR activities. We then explored the three different components to this. The first component, which was already in the programme, is for students to receive teaching on a LICBT intervention, such as Behavioural Activation i.e. supporting patients with depression to increase their amount of routine, necessary, and pleasurable activities. The second component, which was new to the programme, was for students to practice completing the LICBT intervention on themselves to identify what went well and what could have gone better.  The third component, which was also new to the programme, was for students to then blog about their experience via the discussion board feature on Blackboard.

Impact

The student feedback, elicited in the questionnaires, were very positive with comments such as ‘practicing the intervention and then blogging about it really made me see the difficulties that patients might face’ and ‘completing SP/SR really made me review my current practice and see what I can do to improve.  Our experience of including the SP/SR training was presented at the National British Association of Behavioural and Cognitive Psychotherapies Conference at the University of Birmingham. Overall, I think that the activity did meet the objectives however, an unexpected outcome was the need to reduce the number of activities due to student feedback.

Reflections

In relation to the success of the activity, the consultation with other Clinical Educators and Programme Directors (both at Reading and other Universities) enabled us to implement the activity with very little difficulty. Furthermore, within our teaching, we provide an ‘Introduction to SP/SR’ session so students are informed of the evidence-base for this approach, what the requirements are for SP/SR on our programmes, as well as when they will need to complete the activity, and how to post their experiences on Blackboard. This has been commented on as very useful within student feedback.

In relation to better implementation, the earlier versions of the activity included 6 SP/SR tasks however, students commented that whilst SP/SR is very useful, they found completing 6 tasks too much when considering the rest of their workload. Therefore, we reduced the number to 4 SP/SR tasks, which has been working well.

Follow up

In the previous two years, we have developed our practice by providing students with the opportunity to receive written staff feedback on one of their SP/SR blogs. The student feedback in regard to this has been very positive and we have seen an improvement in the reflective writing skills of our students in their summative reflective assignments.

Links

https://www.researchgate.net/publication/231747637_The_value_of_self-practice_of_cognitive_therapy_techniques_and_self-reflection_in_the_training_of_cognitive_therapists