“Bumps in the Road”: A Pilot Study of a Therapeutic Technique for the Integration of Unresolved Family Loss and Trauma

The ability to sustain a coherent narrative about experiences of trauma and loss is a prominent feature of secure-autonomous attachment states of mind as assessed in narrative tasks such as the Adult Attachment Interview. The current study examines the clinical application of the concepts of narrative coherence and discourse segregation within a therapeutic intervention for whole families. Bumps in the Road is a family drawing task, which aims to facilitate the co-construction of family narratives about adversities such as trauma, loss and hardship. The technique aims to increase the family’s narrative coherence about such challenging events. The paper first presents a description of the task itself together with the discourse theories of defensive processing of adverse events. The study also presents pilot quantitative findings from 19 parents on the psychometric properties of a coding system of the families’ discourses in undertaking the task and the therapist’s techniques in administering the task. The predictive association of coding of the narratives were examined as predictors of change in internalising and externalising symptoms in the referred child, using the Child Behaviour Checklist. Findings showed that therapist competence in administration of the task did significantly predict the magnitude of treatment efficacy. The current study is the first presentation of this novel therapeutic task and sets a platform for further research on the use of narrative tasks and the formal coding of discourse in therapeutic work with children and families.

Assessing panic disorder-specific competencies: evaluation of the Cognitive Therapy Competence Scale for panic disorder

Background: Evidence-based treatment for panic disorder consists of disorder-specific cognitive behavioural therapy (CBT) protocols. However, most measures of CBT competence are generic and there is a clear need for disorder-specific assessment measures. Aims: To fill this gap, we evaluated the psychometric properties of the Cognitive Therapy Competence Scale (CTCP) for panic disorder. Method: CBT trainees (n = 60) submitted audio recordings of CBT for panic disorder that were scored on a generic competence measure, the Cognitive Therapy Scale – Revised (CTS-R), and the CTCP by markers with experience in CBT practice and evaluation. Trainees also provided pre- to post-treatment clinical outcomes on disorder-specific patient report measures for cases corresponding to their therapy recordings. Results: The CTCP exhibited strong internal consistency (α = .79–.91) and inter-rater reliability (ICC = .70–.88). The measure demonstrated convergent validity with the CTS-R (r = .40–.54), although investigation into competence classification indicated that the CTCP may be more sensitive at detecting competence for panic disorder-specific CBT skills. Notably, the CTCP demonstrated the first indication of a relationship between therapist competence and clinical outcome for panic disorder (r = .29–.35); no relationship was found for the CTS-R. Conclusions: These findings provide initial support for the reliability and validity of the CTCP for assessing therapist competence in CBT for panic disorder and support the use of anxiety disorder-specific competence measures. Further investigation into the psychometric properties of the measure in other therapist cohorts and its relationship with clinical outcomes is recommended.

Behavioural couple therapy: measuring therapist competence

This paper outlines a pilot validation study of the newly developed Behavioural Couple Therapy Scale for Depression (BCTS-D). The BCTS-D aims to assess therapist competence in delivering behavioural couple therapy (BCT) and provide therapists with summative and formative feedback on their performance. Completed by both therapist and supervisor, this will aid therapists’ reflection on practice and improve performance. This paper will report on two stages in the development of the BCTS-D: (a) a study evaluating content validity, face validity and usability and (b) a focus group examining usability and utility. Both parts of the study were conducted in the context of a BCT training course and included 20 participants who were either BCT supervisors or BCT trainees. Results suggest that the BCTS-D has good face validity, content validity and usability, and provides a useful tool for promoting self-reflection and providing formative feedback. The studies also provided insight into the strengths of the scale and into areas of refinement, and a number of modifications were undertaken to improve the BCTS-D in response to feedback collected. Future research will need to focus on evaluating the psychometric properties of the BCTS-D and continue to adapt the scale to its users’ needs. Key learning aims (1) Readers will understand the importance of measuring therapists’ competence to improve practice. (2) Readers will understand the development of the BCTS-D scale and its initial psychometric properties. (3) Readers will know how to use the BCTS-D in everyday clinical practice. (4) Readers will know about the challenges of developing a therapist competence measure within a real-world clinical context.