Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation

In this study, we investigated the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether child age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 level III certified pivotal response treatment therapists who recorded three 10-min pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. Results indicated that therapists’ attitude toward evidence-based practices, specifically openness to innovation, and therapists’ experience with pivotal response treatment significantly predicted fidelity of pivotal response treatment implementation. Cross-validation methods largely confirmed these findings. Therapist personality, therapist–child relationship, and child characteristics were not significantly related to pivotal response treatment fidelity. Implications for clinical practice and directions for future research are discussed. Lay abstract Pivotal response treatment is a naturalistic behavioral intervention that teaches pivotal skills to children with autism spectrum disorder to produce widespread gains in other skills. Although most children with autism spectrum disorder benefit from pivotal response treatment, intervention outcomes vary considerably among children. Fidelity of intervention implementation (i.e. the extent to which an intervention is implemented as intended) may affect intervention outcomes. In this study, we studied the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether a child’s age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 pivotal response treatment therapists who videotaped three pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. This study found that therapists’ openness to innovation and their experience with pivotal response treatment predicted fidelity of implementation. Therapist personality, therapist–child relationship, and child characteristics were not related to pivotal response treatment fidelity. The results of this study emphasize that it is important (1) to target therapists’ attitudes toward innovation prior to or during training in pivotal response treatment and (2) to provide therapists with ongoing supervision and feedback after training to increase fidelity of implementation and thus to improve intervention outcomes for children with autism spectrum disorder.

What Makes a Good EMDR Therapist? Exploratory Findings From Client-Centered Inquiry

There are several qualities of good EMDR (eye movement desensitization and reprocessing) therapists that must be examined to understand what clients most value in this specialized treatment. These qualities, as defined by former clients, include therapist personality, an ability to empower clients, flexibility, intuition, a sense of ease and comfort in working with trauma, and a commitment to the small measures of caring that clients identify as helping them feel safer. This article highlights the importance of honoring client safety in EMDR treatment by further exploring a theme from a phenomenological parent study on the use of EMDR with women in addiction continuing care. The parent study offered qualitative evidence showing that there is a place for EMDR as part of a comprehensive women’s addiction recovery program when applied properly. In this article, participants’ descriptions of their EMDR therapists and how these therapists were able to establish safety are described in greater detail than the parent study article allowed. Implications for emphasis on client-centered factors in the training and formation of EMDR therapists are discussed using the data extrapolated from the clients’ experiences, and further directions for researching the client-centered perspective in EMDR are presented.

Personality Profiles of Undergraduate and Graduate Students in Rehabilitation Counselling and Services

This study examined personality characteristics of undergraduate and graduate students in rehabilitation counselling programs. Cluster analysis of 204 NEO Five-Factor Inventory (NEO-FFI) personality profiles of these students indicated a three-cluster solution as optimal. These three personality clusters were identified as the Therapist Personality cluster, Case Manager Personality cluster, and the Sensitive Personality cluster. Implications for rehabilitation job roles, rehabilitation education, and counselling are discussed.