Browsing by Author "Vaz, Alexandre"
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- Development and validation of the facilitative interpersonal skills scale for clientsPublication . Santos, João M.; Barata, Matilde; Rathenau, Sara; Amaro, Inês; Vaz, Alexandre; Sousa, Daniel; Severino, Margarida; Taveira, Mafaldapsychotherapist development, psychotherapy expertise, statistical methodology, test development, therapist effects1| INTRODUCTION The role of the therapist in psychotherapy research has a controversial history. The widespread focus on investigating specific treatment protocols for specific psychological disorders made the study of individual differences among therapistsalong‐neglected research topic (e.g., Beutler et al.,2004;Castonguay&Hill,2017). However, despite the historicallygreater emphasis on randomized controlled trials to understand differences between specific treatment models, researchhas consistently shown thattherapistscontribute more to therapy outcomes than the type of treatment or level ofadherence to a particular protocol (Wampold & Imel,2015). It seems that therapist effects can explain 5%–9% of theoutcome variance (Baldwin & Imel,2013). These results overshadow the 0%–1% variability attributable to specifictreatment models (Miller et al.,2013; Wampold & Imel,2015).The existing literature suggests that the therapeutic alliance is one of the best predictors of clinical outcomes identified to date, along with the therapist's ability to convey empathy (Nor cross &Lambert,2019; Nor cross & Wampold,2019; Wampold & Imel,2015). The therapeutic alliance is described by Bordin (1979) as a collaborative relationship intended to overcome the client's suffering. This relation shipe incompasses three important aspects: (a) agreement on the goals of the treatment, (b) agreement on thetasks, and (c) the development of a mutual bond betweentherapist and client. The therapeutic alliance isconsidered a common factor or a nonspecific factor in psychotherapy. These factors include therapeuticqualities (such as empathy and the therapist's ability to be persuasive and to create compelling expectations)foundintherapistsandprofessionalsacrosstherapeutic approaches and helping professions (Frank &Frank,1993).Commonfactorsaresubjecttovariousdefinitionswhichposessomechallengestocontrolledexperimental research (Anderson & Patterson,2013). Following the need to measure and operationalizethese factors, Anderson and Patterson (2013) created the facilitative interpersonal skills (FIS) rating scale,which assesses several relational therapist skills relevant to therapeutic effectiveness (Anderson &Patterson,2013). These skills play an important role in the ability to develop and maintain a solid therapeutic alliance and might go beyond the therapist's use of a particular treatment model or technique(Wampold & Imel,2015).The FIS rating scale (Anderson & Patterson,2013)isaperformance‐based measure of eight therapist interpersonalskills, namely verbal fluency, emotional expression, persuasiveness, warmth/positive regard, hopefulness, empathy, alliancebond capacity, and alliance–rupture–repair responsiveness. This measure was designed for the assessment of thetherapist's performance by an external observer. More specifically, it evaluates participants' responses to a performance‐based task where they provide therapeutic responses to standardvideostimulithatportraychallenging psychotherapeuticevents. In these clips, one actor/actress plays the role of a client explaining a certain problem to which the participantshave to respond in a therapeutic manner as if they were in session. The FIS‐in session (FIS‐IS) rating scale (Uhlin,2011)isan adaptation of the original FIS ratingscale applied to actual recorded or observed therapy sessions. Similarly to theoriginal FIS, an external coder rates the therapist's performance. Our goal is to create a new FIS scale (the FIS‐clientversion [FIS‐C]) where clients evaluate their therapists' performance.Anderson et al. (2009) found that therapists' observer‐rated FIS predicted those therapists' real‐lifeclinical outcomes. Subsequent studies confirmed that FIS scores predicted outcome and alliance (Anderson,Crowley, et al.,2016; Anderson, McClintock, et al.,2016) and that these skills were trainable throughdeliberate practice(Anderson et al.,2020;Rousmaniereetal.,2017). The effects of observer‐rated therapist 2|SANTOS ET AL.
- Does deliberate practice surpass didactic training in learning empathy skills? A randomized controlled studyPublication . Larsson, Johannes; Werthén, David; Carlsson, Jan; Salim, Osame; Davidsson, Edvin; Vaz, Alexandre; Sousa, Daniel; Norberg, JoakimA large body of research identifies therapist expressed empathy as one of the most important predictors of psychotherapy outcome. Deliberate practice (DP) is an effective method to improve skills in many fields. We asked if DP also can be used to enhance the skill of expressing empathy. Objective: The aim was to compare the efficacy of DP to didactical learning methods (DLM) in enhancing the skill of empathic expression in students. Method: A repeated measures randomized controlled group design was used. Novice students (N ¼ 36) from psychologist-, medicine-, social work-, and nursing programs received two training sessions of either DP (n ¼ 21) or DLM (n ¼ 15). Participants’ skills in empathic expression were assessed with the Measure of Expressed Empathy (MEE) on three occasions: before the first, between, and after the last training session. Results: Participants in the DP-group showed improved empathic expression, whereas participants in the DLM-group did not. Conclusions: These findings suggest that DP is an effective training method for therapeutic skills such as empathic expression and holds implications for the future development of educational practices to incorporate active skill training methods.
- Does deliberate practice surpass didactic training in learning empathy skills? – A randomized controlled studyPublication . Larsson, Johannes; Werthén, David; Carlsson, Jan; Salim, Osame; Davidsson, Edvin; Vaz, Alexandre; Sousa, Daniel; Norberg, JoakimA large body of research identifies therapist expressed empathy as one of the most important predictors of psychotherapy outcome. Deliberate practice (DP) is an effective method to improve skills in many fields. We asked if DP also can be used to enhance the skill of expressing empathy. Objective: The aim was to compare the efficacy of DP to didactical learning methods (DLM) in enhancing the skill of empathic expression in students. Method: A repeated measures randomized controlled group design was used. Novice students (N¼36) from psychologist-, medicine-, social work-, and nursing programs received two training sessions of either DP (n¼21) or DLM (n¼15). Participants’ skills in empathic expression were assessed with the Measure of Expressed Empathy (MEE) on three occasions: before the first, between, and after the last training session. Results: Participants in the DP-group showed improved empathic expression, whereas participants in the DLM-group did not. Conclusions: These findings suggest that DP is an effective training method for therapeutic skills such as empathic expression and holds implications for the future development of educational practices to incorporate active skill training methods.
- Memory reconsolidation in psychotherapy for severe perfectionism within borderline personalityPublication . Vaz, Alexandre; Ecker, BruceFor a case of severe perfectionism, comorbid with complex trauma symptomatology including suicidality, self-harming, and other markers of borderline personality, we demonstrate the use of the empirically confirmed process identified in memory reconsolidation (MR) research for the unlearning and nullification, or "erasure," of emotional and behavioral responses driven by learned expectations and mental models. MR has been proposed as a transtheoretical, unifying mechanism underlying profound psychotherapeutic change. The therapist (first author), under the second author's supervision, used a varied set of clinical skills woven together through a focus on the MR process.
- A Review of empirical studies investigating narrative, emotion and meaning-making modes and client process markers in psychotherapyPublication . Aleixo, Ana; Pires, António Pazo; Angus, Lynne; Dias Neto, David; Vaz, AlexandreDespite the importance of narrative, emotional and meaning-making processes in psychotherapy, there has been no review of studies using the main instruments developed to address these processes. The objective is to review the studies about client narrative and narrative-emotional processes in psychotherapy that used the Narrative Process Coding System or the Narrative-Emotion Process Coding System (1.0 and 2.0). To identify the studies, we searched The Book Collection, PsycINFO, PsycARTICLES, PsycBOOKS, PEP Archive, Psychology and Behavioral Sciences Collection, Academic Search Complete and the Web of Knowledge databases. We found 27 empirical studies using one of the three coding systems. The studies applied the Narrative Process Coding System and the Narrative-Emotion Process Coding System to different therapeutic modalities and patients with various clinical disorders. In some studies, early, middle and late phases of therapy were compared, while other studies conducted intensive case analyses of Narrative Process Coding System and Narrative-Emotion Process Coding System patterns comparing recovered vs unchanged clients. The review supports the importance to look for the contribution of narrative, emotion, meaning-making patterns or narrative-emotion markers, to treatment outcomes and encourages the application of these instruments in process-outcome research in psychotherapy.
- Significant events identified by clients engaged in Existential Psychotherapy: A descriptive phenomenological explorationPublication . Sousa, Daniel; Vaz, AlexandreThis research focuses on the descriptions of significant events experienced in the context of existential psychotherapy as described by five clients. The results include a set of eidetic dimensions in which the human relationship stands out as being particularly meaningful. Clients considered the therapy process to be significant for a number of different reasons, ranging from the development of the capacity to cope with difficulties to a basic sense of increased self-understanding. Significant events in therapy are sometimes preceded by tensions between the therapist and the client, which, in turn, promote turning points and breakthroughs in the therapeutic relationship. The results also seem to corroborate the affect and interdependence of the relational dimensions of psychotherapy, such as common factors, and more specific ingredients, such as the techniques used by the therapist. However, the experience of significant events is multifaceted and dynamic, and only a holistic perspective would seem to do justice to the complexity of these interrelated phenomena. Implications for practice and research are discussed.
- The relationship between lifelong learning and professional development activities in a Portuguese samplePublication . Ponces Coelho, Rodrigo; Pires, António A. Pazo; Neimeyer, Greg; Vaz, Alexandre; Dias Neto, David; Sousa, DanielObjective: A dispositional commitment to lifelong learning (LL) is an important aspect of continuing professional development for practicing psychotherapists. Equally important is the dedication of psychotherapists to engaging in professional development activities to foster growth and maintain competence. However, there are limited available data on the range of practices and factors influencing psychotherapists' commitment to these activities. The primary objective of this study was to examine whether a higher commitment to LL would significantly predict greater participation in a range of different professional development activities. Method: A sample of 166 Portuguese psychotherapists completed an online survey on professional development. The survey included two key measures: the Jefferson Scale of Psychotherapist Lifelong Learning and a list of professional development activities based on the Retrospective Analysis of Psychotherapists' Involvement in Deliberate Practice. Exploratory factorial analysis was conducted to determine an alternative and suitable grouping for the list of activities, and structural equation modelling was utilised to assess the relationship between the commitment to LL and engagement in these activities. Findings: Results provided valuable insight into the diverse levels of participation among therapists across five categories of activities: (1) supervision and case discussion; (2) recording-related activities; (3) reading and focussed learning; (4) reflecting; and (5) workshops supporting ongoing professional competence. Findings indicated that a stronger commitment to LL significantly predicted increased dedication to reading, focussed learning activities and attendance to training workshops. The implications and limitations of the study are discussed concerning their practical application for professional psychologists, counsellors and psychotherapists