Parallel process as a tool for supervision and therapy: A cognitive behavioral and schema therapy perspective.

INTRODUCTION: The parallel process is a psychosocial phenomenon where the relationship dynamics between the therapist and the client are repeated in the supervisory relationship between the therapist and the supervisor. The concept of the parallel process can be a useful tool for understanding and solving problems in therapy. However, it can induce supervision drift or block the supervision process. OBJECTIVE: This article aims to familiarize the reader with parallel processes in cognitive-behavioural therapy (CBT) and schema therapy supervision and discuss how to manage this phenomenon in supervision. METHOD: This article is a narrative review with illustrations of supervision interviews in which the parallel process unfolds. The text provides an overview of theoretical constructions and empirical studies related to the parallel process. We searched PubMed, PsycINFO, Web of Science, and Google Scholar for relevant resources using the keywords "parallel process," "cognitive behavioural therapy," "schema therapy," "transference," and "countertransference." Case vignettes were collected from trainees, training leaders and supervisors to provide real-life examples of how self-reflection and self-experience can enhance CBT and schema therapy training, practice, and supervision.

The importance of self-experience and self-reflection in training of cognitive behavioral therapy.

PURPOSE: Self-awareness can be characterised as impartial, non-judgmental thoughtful attention towards the self. Self-reflection in therapy is when a therapist reviews their experiences, thoughts, and behaviours concerning therapy and changes them as needed to enhance the therapeutic process. Therapists with good quality self-reflection can make more effective and ethical decisions, differentiate their own needs from clients', understand transference and countertransference, and consider the optimal response during a session. Practising the CBT approach and reflecting on one's own experiences can be essential for successful therapeutic development. Furthermore, self-reflection forms the basis of a fruitful therapeutic relationship and the therapist's self-confidence and sense of competence.

Homework in Cognitive Behavioral Supervision: Theoretical Background and Clinical Application.

The homework aims to generalize the patient's knowledge and encourage practicing skills learned during therapy sessions. Encouraging and facilitating homework is an important part of supervisees in their supervision, and problems with using homework in therapy are a common supervision agenda. Supervisees are encouraged to conceptualize the patient's lack of homework and promote awareness of their own beliefs and responses to non-cooperation. The supervision focuses on homework twice - first as a part of the supervised therapy and second as a part of the supervision itself. Homework assigned in supervision usually deals with mapping problems, monitoring certain behaviors (mostly communication with the patient), or implementing new behaviors in therapy.

Managing Transference and Countertransference in Cognitive Behavioral Supervision: Theoretical Framework and Clinical Application.

Dysfunctional patterns, beliefs, and assumptions that affect a patient's perception of other people often affect their perceptions and behaviours towards the therapist. This tendency has been traditionally called transference for its psychoanalytical roots and presents an important factor to monitor and process. In supervision, it is important to put the patient's transference in the context of the conceptualization of the case. Countertransference occurs when the therapist responds complementary to the patient's transference based on their own dysfunctional beliefs or assumptions. Transference and countertransference provide useful insights into the inner world of the patient, therapist, and supervisor. Guided discovery is one of the most common approaches used by a supervisor and a supervisee to map all types and directions of transference and countertransference. Other options to map transference and countertransference are imagery and role-playing techniques.

Older adult psychopathology: international comparisons of self-reports, collateral reports, and cross-informant agreement.

OBJECTIVES: To conduct international comparisons of self-reports, collateral reports, and cross-informant agreement regarding older adult psychopathology. PARTICIPANTS: We compared self-ratings of problems (e.g. I cry a lot) and personal strengths (e.g. I like to help others) for 10,686 adults aged 60-102 years from 19 societies and collateral ratings for 7,065 of these adults from 12 societies. MEASUREMENTS: Data were obtained via the Older Adult Self-Report (OASR) and the Older Adult Behavior Checklist (OABCL; Achenbach et al., ). RESULTS: Cronbach's alphas were .76 (OASR) and .80 (OABCL) averaged across societies. Across societies, 27 of the 30 problem items with the highest mean ratings and 28 of the 30 items with the lowest mean ratings were the same on the OASR and the OABCL. Q correlations between the means of the 0-1-2 ratings for the 113 problem items averaged across all pairs of societies yielded means of .77 (OASR) and .78 (OABCL). For the OASR and OABCL, respectively, analyses of variance (ANOVAs) yielded effect sizes (ESs) for society of 15% and 18% for Total Problems and 42% and 31% for Personal Strengths, respectively. For 5,584 cross-informant dyads in 12 societies, cross-informant correlations averaged across societies were .68 for Total Problems and .58 for Personal Strengths. Mixed-model ANOVAs yielded large effects for society on both Total Problems (ES = 17%) and Personal Strengths (ES = 36%). CONCLUSIONS: The OASR and OABCL are efficient, low-cost, easily administered mental health assessments that can be used internationally to screen for many problems and strengths.

Association between Anxiety, Quality of Life and Academic Performance of the Final-Year-Students in Latvia.

The main objective of this study was to investigate the association between final-year students' anxiety level and quality of life (QOL) with their academic achievements. A longitudinal study was performed in regular schools and in high-rated gymnasiums at the beginning and at the end of the school year. Multiple linear regression models were built for the association between level of anxiety/QOL with academic achievements. Type of school and gender-but not the level of anxiety-were the main predictors of academic achievements of 287 adolescents (e.g., for mathematics, the effect estimates were: ß = -1.71 [95% confidence interval -2.21; -1.21]; ß = -0.50 [-0.95; -0.06], ß = 0.09 [-0.02; 0.20] for the type of school, gender, and changes in level of anxiety, respectively). To conclude, particular efforts should be made to reduce the level of anxiety in girls, especially those that study in high-rated schools.

Development of the Signposting Questionnaire for Autism (SQ-A): measurement comparison with the 10-item Autism Spectrum Quotient-Child and the Strengths and Difficulties Questionnaire in the UK and Latvia.

BACKGROUND: Recognising the signs of autism spectrum disorder (ASD) can be a challenge for frontline professionals. The use of brief parent-completed questionnaires for recording the signs of ASD in school-aged children may be an important and efficient contributor to professional insight. However, to date, such questionnaires have not been designed to be used in coordination with current standardised Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic tools. Furthermore, the measurement characteristics of such questionnaires have been unexplored across countries that differ in levels of national autism service provision and cultural interpretation of the signs of ASD. METHODS: A new 14-item questionnaire (Signposting Questionnaire for Autism (SQ-A)) was developed using published DSM-5 items from a clinical interview, the Diagnostic Interview for Social Communication Disorders (DISCO). Measurement comparison was tested with the Short Autism Spectrum Quotient-Child (AQ-10) and the Strengths and Difficulties Questionnaire (SDQ). Parents of 4-11-year-old children in the UK (N = 200) and Latvia (N = 104) completed all three questionnaires. Information on clinical diagnosis provided by parents led to classification into three groups: ASD diagnosis, other conditions and no conditions. In the UK, a subsample of teachers also provided cross-informant reliability. RESULTS: In both countries, there was evidence of acceptable to good internal consistency for the SQ-A, with significantly higher scores for the ASD group and evidence of convergent and discriminant validity. There was also good parent-teacher reliability for the three measures. Notably, the questionnaires designed specifically to measure autism (SQ-A, AQ-10) performed more similarly to one another compared to the broader SDQ, with differences found for the ASD group. The overall pattern of responding to the three questionnaires was highly similar between countries. CONCLUSIONS: These results indicate the potential of the 14-item SQ-A to guide frontline professionals in the recognition of the signs of autism in children, facilitating the provision of appropriate support.

The generalizability of Older Adult Self-Report (OASR) syndromes of psychopathology across 20 societies.

OBJECTIVES: As the world population ages, psychiatrists will increasingly need instruments for measuring constructs of psychopathology that are generalizable to diverse elders. The study tested whether syndromes of co-occurring problems derived from self-ratings of psychopathology by US elders would fit self-ratings by elders in 19 other societies. METHODS/DESIGN: The Older Adult Self-Report (OASR) was completed by 12 826 adults who were 60 to 102 years old in 19 societies from North and South America, Asia, and Eastern, Northern, Southern, and Western Europe, plus the United States. Individual and multigroup confirmatory factor analyses (CFAs) tested the fit of the seven-syndrome OASR model, consisting of the Anxious/Depressed, Worries, Somatic Complaints, Functional Impairment, Memory/Cognition Problems, Thought Problems, and Irritable/Disinhibited syndromes. RESULTS: In individual CFAs, the primary model fit index showed good fit for all societies, while the secondary model fit indices showed acceptable to good fit. The items loaded strongly on their respective factors, with a median item loading of .63 across 20 societies, and 98.7% of the loadings were statistically significant. In multigroup CFAs, 98% of items demonstrated approximate or full metric invariance. Fifteen percent of items demonstrated approximate or full scalar invariance, and another 59% demonstrated scalar invariance across more than half of societies. CONCLUSIONS: The findings supported the generalizability of OASR syndromes across societies. The seven syndromes offer empirically based clinical constructs that are relevant for elders of different backgrounds. They can be used to assess diverse elders and as a taxonomic framework to facilitate communication, services, research, and training in geriatric psychiatry.