Psychotherapist trainees' professional self-doubt and negative personal reaction: Changes during cognitive behavioral therapy and association with patient progress

Objective: This study examined psychotherapist trainees' experiences of "professional self-doubt" (PSD) and " negative personal reaction" (NPR) during cognitive behavioral therapy (CBT) and their associations with patients' symptoms and interpersonal problems. Method: Forty therapists treating 621 patients were analyzed. Patients' symptoms and interpersonal problems were collected repeatedly during therapy. Data about patients' interpersonal problems were available only for 106 patients and 18 therapists. Therapists' difficulties were assessed as trait-based (one assessment across all patients) and as state-based (repeated assessments for each individual patient) difficulties. Multilevel models were performed. Results: None of the trait-based difficulties correlated with the change of the patients' symptoms. Yet, more NPR at the trait-level predicted a more favorable change, whereas higher PSD at the trait-level showed an opposite effect on change of patients' interpersonal problems. Regarding state-based difficulties, PSD as well as NPR decreased significantly over the course of CBT. Patients whose therapists' experienced PSD to increase during CBT were at risk of a less favorable patient progress regarding symptoms, whereas the change of interpersonal problems was not significantly associated with changes in therapists' difficulties. Conclusion: Patients' progress is associated with therapists' experiences of difficulties. Yet, trait-and state-based difficulties lead to different results.