Therapist Emotional Reactivity and Performance Following a Motivational Interviewing Workshop With and Without Deliberate Practice

Some individuals are more reactive to emotional stimuli than others, and this is particularly relevant to psychotherapists due to their frequent interaction with emotionally evocative material. Therapist reactivity can be particularly triggered during challenging clinical moments such as resistance, leading to negative therapy process which can be detrimental to client outcome. Motivational Interviewing (MI) is a therapeutic approach that specifically focuses on exploring ambivalence about change and minimizing resistance in psychotherapy, and therefore is a beneficial strategy to address many challenging interpersonal moments in psychotherapy. Therapists would benefit from training in MI to specifically address these challenging clinical moments, and this may be especially important for therapists who are highly emotionally reactive. Deliberate Practice (DP) has shown promise as a training approach that may result in greater maintenance of skill, and therefore may be explored as a more impactful and long-lasting way to train therapists in MI. The present study involved both traditional and DP training in the context of a continuing education workshop. The impact of training type on therapist reactivity to challenging clinical moments was examined immediately following training, and four months later. The relationship between therapist reactivity, performance, and type of training was also investigated. Eighty-eight community therapists participated in training to use MI principles to effectively manage client ambivalence and resistance. Therapists were randomly assigned to receive a 2-day training workshop based on DP principles, or to receive a 2-day traditional didactic workshop. Self-reported arousal to video vignettes of difficult scenarios was collected prior to the workshop, immediately following the workshop, and 4 months later, and therapists participated in 20-minute interviews with ambivalent volunteers at both post-workshop and follow-up. Therapist dynamic Respiratory Sinus Arrhythmia (dynamic RSA) was measured during these interviews as a psychophysiological measure of emotional reactivity, and interviews were coded for resistance to measure therapist performance. Results demonstrated a decrease in self-reported arousal only for those who engaged in DP training, though this was not maintained at follow-up. There was a difference in dynamic RSA between groups at post-treatment, where the DP group uniquely demonstrated quadratic change, indicating the training had a differing effect. Despite this differing trajectory, RSA showed an overall increase at both post-workshop and follow-up in both groups. This suggests that regardless of training type, therapists were regulating their emotions and possibly having a compassionate response, rather than a stress response, to these interviews. Dynamic RSA between workshop groups was unable to be assessed at follow-up due to a smaller sample size for psychophysiological assessment. In the investigation of the impact of training on performance, greater self-reported arousal was found to predict less resistance in interviews, but there was no relationship observed between psychophysiological arousal and resistance. This study supports the efficacy of DP training in reducing therapist arousal to difficult clinical scenarios, and the importance of continued DP in order to maintain one’s skills. Clinical and training implications are discussed.

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