Fluent Essays

See Attached article and instructions. Assignment Details Article Review Instructions You will write two article reviews for this course. Each review is worth 100 points. The review should be 1-2 single-spaced pages in a 12-point, Times New Roman font. It is in your best interest to submit your review before it is due so you may check your originality report and correct any spelling and grammatical errors identified by the software program. The purpose of the review is to provide students knowledge of how research is conducted and reported. The main part of your review needs to include the following information. Please comment on these aspects of the article as part of your review. Provide only the briefest summary of content. What I am interested in is your critique. Reference. Listed at the top of the paper in APA style. Introduction. Read the introduction carefully. The introduction should contain: ·  A thorough literature review that establishes the nature of the problem to be addressed in the present study (the literature review is specific to the problem) ·  The literature review is current (generally, articles within the past 5 years) ·  A logical sequence from what we know (the literature review) to what we dont know (the unanswered questions raised by the review and what this study intended to answer ·  The purpose of the present study ·  The specific hypotheses/research questions to be addressed. Methods. The methods section has three subsections. The methods sections should contain: ·  The participants and the population they are intended to represent (are they described as well in terms of relevant demographic characteristics such as age, gender, ethnicity, education level, income level, etc?). ·  The number of participants and how the participants were selected for the study ·  A description of the tools/measures used and research design employed. ·  A detailed description of the procedures of the study including participant instructions and whether incentives were given. Results. The results section should contain a very thorough summary of results of all analyses. This section should include: ·  Specific demographic characteristics of the sample ·  A thorough narrative description of the results of all statistical tests that addressed specific hypotheses ·  If there are tables and figures, are they also described in the text? ·  If there are tables and figures, can they be interpreted stand alone (this means that they contain sufficient information in the title and footnotes so that a reader can understand what is being presented without having to go back to the text)? Discussion. The discussion is where the author wraps up the research. This section should include: ·  A simple and easy to understand summary of what was found ·  Where the hypotheses supported or refuted? ·  A discussion of how the authors findings compares to those found in prior research ·  The limitations of the study ·  State the overall purpose of the paper. What was the main theme of the paper? ·  What new ideas or information were communicated in the paper? ·  Why was it important to publish these ideas? Updated: 08.03.18  The implications of the findings to basic and applied researchers and to practitioners Critique. Conclusion. Once you provide the main critique of the article, you should include a final paragraph that gives me your overall impression of the study. Was the study worthwhile? Was it well-written and clear to those who may not have as much background in the content area? How does it relate to other weekly readings? APA Format Review If you are unfamiliar or a bit “rusty” on your APA format, you may want to use the tutorial available through the APA website which is listed on your syllabus. Grading Criteria I will grade your paper based upon: ·  How well you followed directions (as indicated in this page) ·  How thoroughly you used examples to support the critique ·  How accurately you used APA format ·  And your organization, grammar, and spelling ·  Integration of assigned weekly readings In your opinion, what were the strengths and weaknesses of the paper or document? Be sure to think about your impressions and the reasons for them. Listing what the author wrote as limitations is not the same thing as forming your own opinions and justifying them to the reader. ·  Were the findings important to a reader? ·  Were the conclusions valid? Do you agree with the conclusions? ·  If the material was technical, was the technical material innovative? Behavioural and Cognitive Psychotherapy, 2003, 31, 143–158 Printed in the United Kingdom DOI: 10.1017/S1352465803002029 COGNITIVE THERAPY FROM THE INSIDE: ENHANCING THERAPIST SKILLS THROUGH PRACTISING WHAT WE PREACH James Bennett-Levy Oxford Cognitive Therapy Centre, UK Nicole Lee Turning Point Alcohol and Drug Centre, Melbourne, Australia Katrina Travers Griffith University, Gold Coast, Australia Sonja Pohlman and Elisabeth Hamernik Prince Charles Hospital, Brisbane, Australia Abstract. Experiential training and personal therapy have rich traditions in various therapies as strategies to enhance self-awareness and therapist skills. However, personal experiential work has not traditionally been part of cognitive therapy (CT) training. The purpose of the present study is to map the impact of personal experiential work on CT skills in a group of CT practitioners. Fourteen cognitive therapists undertook training courses utilizing a struc- tured approach to self-practice of CT techniques, known as self-practice/self-reflection (SP/ SR). Six therapists from one training group engaged in ‘‘co-therapy’’ sessions with a partner, while eight therapists from another training group practised CT techniques on their own. Both groups engaged in regular written reflections about their experience. Follow-up 1–5 months after the courses identified six areas of self-reported skill enhancement: Refinement of specific CT skills; Enriched communication of the conceptual framework of CT; Increased attention to the therapeutic relationship; Empathic attunement; Therapist self-reflection; and Therapeutic flexibility. The results suggested that SP/SR enhances the ‘‘professional art- istry’’ of therapists, a finding consistent with literature suggesting that reflection is a key process in the development of therapist expertise. It is concluded that SP/SR represents a promising training strategy for cognitive therapists. Keywords: Cognitive therapy training, experiential learning, self-reflection, therapist skills, adult learning. Reprint requests to James Bennett-Levy, Oxford Cognitive Therapy Centre, Psychology Department, Warneford Hospital, Headington, Oxford OX3 7JX, UK. E-mail: [email protected]  2003 British Association for Behavioural and Cognitive Psychotherapies J. Bennett-Levy et al.144 Introduction Since the time of Freud (1937/1957), personal therapy and/or experiential work has been seen as an important component in the training of psychotherapists and counsellors. In many traditions of psychotherapy and counselling (e.g. Freudian psychoanalysis, Jungian analysis, transactional analysis, gestalt therapy), therapists-in-training undergo personal therapy (Macran & Shapiro, 1998; Williams, Coyle, & Lyons, 1999). In other traditions (e.g. family therapy, group therapy), personal experiential work (e.g. classroom work on family-of-origin experience) is included as part of training course exercises (Beck & Munson, 1988; Feiner, 1998; McDaniel & Landau-Stanton, 1991). Despite the widespread use of personal therapy as a training device for psychotherapists and counsellors, there has been a paucity of studies evaluating its effectiveness. The empir- ical evidence that exists is weak. Therapists themselves rate the influence of personal therapy on their professional development very highly (Orlinsky, Botermans, Rønnestad et al., 2001). However, in a review of personal therapy for therapists, Macran and Shapiro (1998) suggested that while there was some evidence that personal therapy has a positive effect on empathy, warmth and genuineness, there was little other objective evidence of changes. Methodological problems pervade the literature, and may partially account for the lack of relevant studies and useful findings. Not only is it difficult to determine whether any change of skill is the result of personal therapy, some other training process, or concurrent clinical experience – especially as personal therapy frequently lasts a considerable time – but also there is an embedded assumption that all personal therapists are competent, and all therapy is of value, which is unlikely to be true (Strupp, Butler, & Rosser, 1988). Further- more, most of the personal therapy literature comes from one form of therapy, psychodyn- amic therapy. Only in the last few years is there any indication in the research literature of personal therapy with therapists from other therapy traditions e.g. humanistic, eclectic (Norcross, Dryden, & DeMichele, 1992; Williams et al., 1999). Evidence for a positive impact of personal experiential work in therapist training courses is only marginally better. Perhaps the strongest evidence is provided by a meta-analytic review of three major counselling programs, suggesting that the program with a personal experiential component – Carkhuff’s Human Resource Training/Human Resource Develop- ment – had the best outcomes (Baker, Daniels, & Greeley, 1990). Behaviour therapy and cognitive therapy stand out as two psychological therapies that, in most countries, have not included personal experiential work as a requisite part of training (see Laireiter, 1998). With the advent of behaviour therapy, the practice of therapy was seen as a largely technological pursuit, and the value of personal development for the therapist was often de-emphasized (Gray, 1991). More recently, several leading cognitive therapists have suggested that practising CT techniques on oneself may make a valuable contribution to therapist training (Beck, 1995; Friedberg & Fidaleo, 1992; Linehan & McGhee, 1994; Padesky, 1996; Padesky & Greenberger, 1995; Safran & Muran, 2001). Padesky (1996, p. 288), for example, has written: ‘‘To fully understand the process of the therapy, there is no substitute for using cognitive therapy methods on oneself.’’ In part, acknowledgement of the value of personal experiential work may be a response to the growing recognition of the importance of interpersonal processes in CT (Safran & Segal, 1990), particularly in the context of working with more complex diagnostic groups e.g. personality disorders, sub- stance abuse, bipolar disorder (Basco, 2000; Beck, Freeman, & Associates, 1990; Beck, Cognitive therapy from the inside 145 Wright, Newman, & Liese, 1993; Linehan, 1993). As Wills and Sanders (1997, p. 21) have stated, being a cognitive therapist now demands ‘‘a high degree of self-knowledge – an awareness emphasised more readily in other therapies but now a necessary part of cognitive therapy.’’ In an earlier study examining the impact of personal experiential work on the training of cognitive therapists, Bennett-Levy et al. (2001) devised a training strategy known as SP/SR (self-practice/self-reflection), based on the adult learning principles of experiential learning and self-reflection (Kolb, 1984; Schön, 1983; Boud, Keogh, & Walker, 1985). In SP/SR, trainees practise CT techniques on themselves (SP), either from workbooks on their own, or they do ‘‘co-therapy’’ with a training partner. Then they reflect in writing on the sessions (SR), looking at the implications for themselves, for their clients, and for cognitive theory. Bennett-Levy et al. (2001) found that trainee cognitive therapists in a university clinical psychology program, using SP/SR, reported a ‘‘deeper sense of knowing’’ of CT practices. Participant reports suggested that SP/SR impacted at a conceptual level on therapeutic under- standings, at a practical level on therapist skills, and at an attitudinal level on therapist self-concept. For many, the value of SP/SR was personal as well as professional. However, as Bennett-Levy et al. (2001, p. 214) noted, most of the data related to changes in therapist understandings, with only a limited amount on changes in therapists skills: The fact that less than 10\% of the data referred to impact on therapist skills, or therapist self-concept, is not surprising. The course was only 13 weeks long, and the majority of trainees were doing their first clinical placements, and thus had little chance or context to gauge possible changes. With novice trainees, since all aspects of CT are new – reading about theory, role-playing skills, observational learning via clinical demonstrations, SP/SR etc – it is reasonable to assume that the learning curve is steep, and that all teaching methods contribute in various ways to early skills development. When novice trainees comment on therapist skill develop- ment, it is extremely difficult to discern what proportion of the impact is caused by SP/SR, compared with other training techniques. However, the spontaneous comments of the more experienced therapists in the training program suggested that, amongst this group, it might be more possible to identify the specific impact of SP/SR on therapist skills, the assumption being that practitioners who have already learned basic therapy skills can more readily differentiate the impact of SP/SR from other learning processes. Accordingly, the primary purpose of the study was to ‘‘map the territory’’: to determine which therapist skills may be affected by personal experiential work, in a group of practi- tioners who were already working professionally as cognitive therapists. ‘‘Mapping’’ was undertaken through a qualitative analysis of practitioners’ self-reported changes in skill. No attempt has been made to measure actual changes in skill at this stage, since the present study, designed to identify the most relevant dimensions of SP/SR-induced change, is seen as the logical precursor to future skill measurement studies. Method Participants The 14 participants whose observations have contributed to the present study were drawn from two different training groups: six were cognitive therapists from Brisbane (all female; J. Bennett-Levy et al.146 mean age = 38.3 years), who attended an SP/SR-based ‘‘cognitive therapy experiential training group’’; five had more than five years experience, and the other one had one-and-a- half years. The North Queensland group (NQ) were practising psychologists (seven female, one male; mean age = 34.5 years; 7 months to 7 years of experience), who were undertaking a one-semester course in CT within a university-based clinical psychology program. The SP/SR courses The Brisbane course was advertised on the e-mail lists of relevant professional bodies, and, following an introductory evening, eight people decided to participate. It comprised an introductory session, followed by five fortnightly workshops. Having made formal agree- ments regarding confidentiality, goals and course commitments, each participant engaged in a ‘‘co-therapy’’ relationship with a partner, focusing on a ‘‘personal change project’’ of low to moderate emotional intensity. At each workshop, partners engaged in both therapist and client roles, and reflected on the experience verbally at the end of sessions, and in writing between sessions. Therapy sessions were also undertaken during the alternative week to the workshop. Each fortnight, participants e-mailed written reflections on their experience to the course facilitator, who then circulated them anonymously. A clear distinction was made between reflection on process and reflection on content; to preserve feeling of safety within the group, it was agreed that participants should only reflect on process. SP/SR for the NQ group included the key ingredients of experiential learning and written reflection, but took a different form. Participants practised CT techniques on their own, using an SP/SR workbook designed by the first author. This utilized exercises from the client manual Mind over mood (Greenberger & Padesky, 1995) and followed them with specific reflective questions (e.g. what did you notice? what are the implications of your experience for your work with clients?). Participants e-mailed their reflections to the course coordinator, who then e-mailed back out to the group a weekly digest of the reflections with a brief commentary. Methodological orientation The present study is one of a series of studies designed to assess the experience and impact of SP/SR on practitioner development (Bennett-Levy et al., 2001; Bennett-Levy, 2003a). The research orientation has been founded on certain assumptions: 1. With the paucity of data and theory in this field, the aim of the research has been to develop a database, founded on the experience of practitioners, and to use an inductive approach to build theory methodically from the data. 2. Participants are in a unique position to comment on ways in which their experience has been impacted by personal experiential work. Formal measures (e.g. the Cognitive Therapy Scale, Young & Beck, 1980) may fail to pick up relevant dimensions of change (Milne, Claydon, Blackburn, & James, 2001; Whisman, 1993), and thus con- strain data and theorizing. 3. There is a growing acceptance of qualitative methodologies within psychology (Banister, Burman, Parker, Taylor, & Tindall, 1994; Hayes, 1997; Richardson, 1996; Cognitive therapy from the inside 147 Smith, Harre, & Van Langenhove, 1995), and they have now reached a level of soph- istication where verbal reports of participant experiences can be coded and classified in recognized, systematic ways. 4. The success of experiential learning programs (including SP/SR) is dependent on the development of trusting, engaged relationships between facilitator and participants (Robertson, 1996), and willingness to share experience. Hence, the traditional positiv- ist detached relationship between researcher and ‘‘the researched’’ may often be unsympathetic to the context of SP/SR, unfeasible in practice, and pedagogically undesirable. The research has been based on three qualitative methodologies: action research (Kemmis & McTaggart, 2000; Zuber-Skerritt, 1996), grounded theory (Glaser & Strauss, 1967; Pidgeon, 1996; Strauss & Corbin, 1994) and practitioner researcher self-study (Schön, 1983, 1987). Details of these are provided in Bennett-Levy et al. (2001) and the cited references. In brief, action research contributed the participatory, cooperative approach, and the cyclical process of the plan-act-observe-evaluate spiral, which structured the research process; grounded theory contributed the methodological framework and a systematic, rigor- ous set of methods to collect and analyse data; and practitioner-researcher self-study pro- vided the focus on personal experience, and the reflective orientation of the study. Research process The Brisbane group was established with an explicit evaluative/research emphasis, based on action research principles. During the course, the principal research focus was on evaluation of automatic thought records and behavioural experiments as techniques for change (Bennett-Levy, 2003b). In meetings following the course, the present authors – four group members who wished to continue the research, and the facilitator – decided to evaluate formally the impact of SP/SR on therapist skills, since participants had noticed changes in their performance that they attributed to SP/SR. Accordingly, three to five months after the course, the four Brisbane participant- researchers undertook two specific assessments to determine the impact of SP/SR on therap- ist skills: 1. They wrote a general reflection indicating the various ways in which they thought their therapy skills had changed as a result of SP/SR. 2. They closely observed a suggested 8–10 of their therapy sessions with clients, and noted immediately after the session the perceived differences in their skills (tapes were not used). Later, they formally wrote up these reflections, commenting on the differences; comparing them with the past; and linking them, where appropriate, with their SP/SR experience. These two methods provided the data for the four Brisbane participants. Macran and Shapiro (1998) proposed similar methods to evaluate the impact of personal therapy on therapist skills. In order to increase the size and representativeness of the sample, the data set was expanded to include every recorded written or spoken reflection in the Brisbane and NQ groups, which linked changes in therapy skills to the practice of SP/SR. Hence data were J. Bennett-Levy et al.148 included from two other members of the Brisbane group, who commented on skills changes during tape recorded group reflections during the course; and from eight practitioners in the NQ program, who had also made incidental comments about SP/SR-induced changes in skills in written reflections, or during interviews with the first author 4–6 weeks after course completion. Approximately 66\% of the data (by word count) were contributed by the four Brisbane action researchers, who specifically focused their inquiry on the research question; the remaining data were contributed by the other 10 participants. Data analysis All relevant data were assembled and analysed as a group by the five authors, using the Technologies of Participation (ToP) workshop method (Spencer, 1989). The ToP workshop method provides a way for researchers to make group decisions about category naming and membership. Figure 1 illustrates the three-stage ToP process for forming category groups. One criticism sometimes levelled at qualitative methodologies is the potential for distorted, idiosyncratic interpretations, lacking credibility (Miles & Huberman, 1994). A particular strength of the ToP method is that it largely avoids these pitfalls, by demanding classification agreements across multiple researchers. 1. Give category labels to each written reflection (self-observation) of change in therapist skill 2. Form categories into groups of items that the researchers determine ‘‘go together’’ 3. Once groups are stabilized and agreed, researchers name each category group I have a clearer understanding about the practice of CBT these days, more so than before the workshop: prior to the workshop, I would describe myself as very cognitive, and would not pay much attention to behavioural experiments. However, since the workshop, I have learned to appreciate the enormity of the benefits from behavioural experiments in confirming and strengthening the cognitive work and I am beginning to include them within CBT therapy much more. Increased use of behavioural experiments Making homework easier and more effective Writing down Reinforcement of existing skills Increased practice within sessions Challenging cognitions More effective use of formulation Guided reflection Reduced assumptions about clients Empathy for undone homework Rolling with resistance Sensitivity to clients’ readiness to change Increased use of behavioural experiments Refining specific CT skills Empathic attunement Figure 1. Technologies of participation data analytic method Cognitive therapy from the inside 149 The data reported in the Results section are directly derived from the ToP analysis. Although there were differences in data collection methods between the four Brisbane practi- tioner-researchers, who directly focused their reflections on the research question, and the other 10 participants, for whom these were incidental observations, the results were pooled as the type of observations appeared broadly similar. Specific similarities and differences between the groups are reported below. Results Changes in therapist skills formed six principal categories, and 22 subcategories. Only the principal categories are reported here. These were: (1) Refining specific CT skills; (2) Com- municating the conceptual framework of CT; (3) Attention to the therapeutic relationship; (4) Empathic attunement; (5) Therapist self-reflection; and (6) Therapist flexibility. For each category, there were many examples, but for reasons of space just one illustrative example is given. All names have been changed to preserve anonymity. Comparing the Brisbane and NQ groups, all 22 subcategories contained examples from the Brisbane therapists. The NQ group was represented in 16 subcategories: in all seven subcategories of (4), (5) and (6) above, 3/4 subcategories for (3), 5/8 subcategories for (1), and 1/3 subcategories for (2). Thus, while there was a large degree of overlap in the reported impact of SP/SR, the two groups appear to have differed to some degree in the extent to which they reported gains in the more specifically CT-oriented skills. Refining specific cognitive therapy skills Participants referred to a number of ways in which their technical CT skills had been refined through self-practice. The thrust of this refinement was towards making the delivery of CT more effective. Practitioners were using the formulation to greater effect by staying with it longer and using it to drive their selection of techniques. There was an increased focus on effective skills building for clients: existing skills were deliberately reinforced; homework was simplified, practised more within sessions, and anticipated difficulties prepared for more effectively. There was greater emphasis on behavioural experiments as a key component of therapy. The value of guided discovery and reflection, and testing and challenging cogni- tions, was reinforced, with an emphasis on the value of writing things down both in sessions and homework. For instance, Sue recognized the value of self-reflection and guided discovery in her own SP/SR process, and noted how this had impacted on her therapy work: I think the main change for me is an increased awareness of the use of self-reflection as a therapy tool. I use much more socratic questioning and guided reflection with clients now and my focus is on teaching them to reflect on their behaviour, thoughts etc. I give them a lot more reflection for homework. I spend much more time (more sessions) on increasing awareness of cognitions through reflection on behaviour. I use guided discovery much more and I think I’m better at it because I think about it and use it deliberately. Communicating the conceptual framework of cognitive therapy The emphasis in this category was on communicating the conceptual framework of CT with the client more effectively: for example, explaining the cognitive model, sharing the J. Bennett-Levy et al.150 formulation, and conveying belief in the model. Participants alluded to such strategies as providing a stronger rationale for CT; taking more time to teach and explain the model; and ‘‘selling the model’’ better by providing more examples and showing greater enthusiasm and increased confidence in the possibility of change. An example is provided by Martina, who was running CT groups in her workplace, and had the following interaction in a group session: This session involved clients questioning the rationale of the CT model and ‘‘Does it work?’’ Normally I hate those questions – I always felt like a salesperson (and a shonky one at that). I think that feeling came from my own doubts of ‘‘Well, all the evidence says it works but . . .’’ – I am always much more convinced by personal experience. During this session, I now felt the confidence to relate that they really could expect changes. My own SP/SR experience really filled me with a renewed respect for the effectiveness of CT techniques and I think that enthusiasm and sincerity is evident to clients. No longer the shonky salesperson! Increased attention to the therapeutic relationship Participants noted changes, or a re-emphasis, on their relationship skills as a result of SP/ SR. A sound therapeutic relationship was seen as creating the necessary basis for change. Being emphatic and collaborative, showing respect for courage and bravery, building rap- port, being patient, and sometimes self-disclosing when appropriate were all areas in which participants judged that they had made often quite subtle, but important, changes. The experience of being ‘‘in the client’s shoes’’ demonstrated starkly some of the anxiety and difficulties in making changes, even as high functioning individuals; and served to emphas- ize how valuable empathy, understanding, respect, tolerance and guidance of the therapist is. Terri noted how her approach to the initial assessment interview had altered as a result of her SP/SR experience: I tend to let the client lead the talk (i.e. run with the client’s agenda) and I get what I need from the conversation, rather than running the interview like a structured interview . . . I have found that running the interview like a conversation helps the rapport building of the relationship. In the past, I was much more structured in my initial interview techniques. The experience of being a client in the SP/SR process helped me to realize this. I found the initial interviews very ‘‘hard’’ as a client as you are describing problems that you may not be proud of, and to have a therapist ask questions that were seemingly unrelated would, I feel, damage rapport building. However, if I had the freedom to speak of my issues, with only occasional prompts, it gave the impression the therapist was more interested in ME, rather than getting a thorough history. Empathic attunement As a result of SP/SR, participants reported that they had greater acceptance of ‘‘where the client was at’’, and adapted their skills and strategies accordingly. They were more sensitive to the client’s readiness or lack of readiness to change; they made fewer assumptions about the client’s level of knowledge or skills, and checked these out or gave simple explanations before proceeding; their empathy for homework non-compliance was increased substantially as a result of their own experience; and they ‘‘rolled with resistance’’ in various ways – Cognitive therapy from the inside 151 for instance, by making use of ‘‘failures’’ in therapy, being more accepting of apparent resistance, and reinterpreting the meaning of resistance. Jane noted that she had changed her attitude and response to homework non-compliance as a result of her experience of SP/SR: The other effect this exercise had for me was that I am more understanding of clients not doing their homework because I wasn’t very good with it either and by the second week had a really hard time keeping up with the writing of thoughts. Somehow behavioural experi- ments seem a bit easier to complete than homework and so, I guess I changed what I give clients as homework too. If they don’t record thoughts by the third session, the homework is behavioural and that seems to work pretty well. I give behavioural experiments as home- work earlier in therapy. Therapist self-reflection SP/SR enhanced therapist self-reflection, both during sessions (reflection-in-action) and after sessions (reflection-on-action). During sessions, some therapists reported that they were more aware of their own internal process, and two of them commented that this increased awareness enabled them to increase the separation between their own process and that of the client, allowing them to be more objective in their response. After sessions, therapists were more inclined to use self-reflection as a self-initiated learning tool to improve their therapy skills. For Eve, who was still in her first year working professionally as a therapist, reflecting systematically on a therapy session was a new skill: I also think, an important skill I have learned is self-reflection, for two reasons. One, for myself as a psychologist, to learn to look more into the therapeutic relationship and reflect on my sessions. Was my client trying to convey something to me through affect or some- thing they said? Did I pick up on things that happened/were said in the session? I don’t think I ever really did this before; I think I just assumed that therapy would work like a well-oiled machine. I plan the session, deliver the session – client leaves. I think I wrongly assumed that everything I did and taught my client would automatically work. How wrong was I!! This has definitely showed me to be more sensitive to what is happening within the session and to direct my attention to it. Therapist flexibility A number of practitioners commented that they were more flexible and adaptable in their use of CT techniques, and more inclined to experiment as a result of their SP/SR. For example, Henry said in his interview: You lose this rigid thinking in therapy that you are not even aware of. With the self-reflection you start to dig deeper and then you realize that slight changes can have different results and you are more willing to experiment with clients and take it on a deeper level and you get more self-confidence by testing it out on yourself. And really it’s like you can know something very well and it works but once you have applied it to yourself it has got a different meaning and you lose these pre-conceived ideas ‘‘if I do this, this should happen’’. J. Bennett-Levy et al.152 And with cognitive therapy I lost being afraid, if things …