Measures (see Appendix 5.1)

Therapeutic Training and Practice Orientation. For each of “client-centered / humanistic”, “psychodynamic”, “cognitive-behavioural”, “existential”, “transpersonal / spiritual”, “integrative” and “eclectic”, participants indicated the extent to which their training had focused on the approach, and, separately, the extent to which their current practice drew from the approach. These responses were made using a four point scale (anchored Not at all; A little; Moderately; A lot).

Clinical Supervision, Personal Therapy, Personal Trauma History. Each of these areas was assessed using a dichotomous “yes / no” format: “Have you previously received personal therapy to deal with the effects of your work as a therapist?”; “Are you currently receiving personal therapy to deal with the effects of your work as a therapist?”; “Do you receive formal supervision or support for your work as a therapist?”; and “Do you have a personal trauma history?”

Crisis Support Scale (Joseph, Andrews, Williams, & Yule, 1992). A seven item measure of social support that taps both practical (“Are people helpful in a practical sort of way?”) and emotional (“Are you able to talk about your thoughts and feelings?”) support, and social support satisfaction (“Overall, are you satisfied with the support you receive?”). Participants were asked about the “support that you receive during your work as a therapist.” Test-retest reliabilities

have not been reported, but a recent review endorsed the psychometric properties of the scale (Elklit et al., 2001). Higher scores indicate greater social support.

Jefferson Scale of Physician Empathy (JSPE; Hojat et al., 2002). A 20-item measure of therapist empathy, scored using a 7 point Likert format scale (1 =

strongly disagree; 7 = strongly agree). The JSPE was selected in preference to the more general Interpersonal Reactivity Index (Davis, 1983) because it is more clearly anchored to the experiential world of the therapist, and so provides a more specific assessment of empathy within the therapeutic setting, rather than empathy as a general construct. Minor amendments were made so that the items were consistent with therapy rather than medical interventions. These included replacing “patient” with “client”, and using the more general “treatment” rather than the specific “medical or surgical treatment.” Sample items include “I try to imagine myself in my clients’ shoes when providing care to them” and “I try to think like my clients in order to render better care.” Test-retest reliability over three-four months was reported at r = .65 (Hojat et al., 2002). Higher scores indicate greater empathy.

Working Alliance Inventory, Form T – Bond subscale (WAI-Bond; Horvath & Greenberg, 1989). For the present study we used the 12-item WAI-Bond, a measure of the positive personal attachments between the client and therapist, assessing themes such as mutual trust, acceptance, and confidence. Sample items include “I am genuinely concerned for my clients’ welfare” and “I appreciate my

clients as people.” Higher scores indicate a greater perceived bond between the therapist and their clients.

Professional Quality of Life Scales (ProQOL; Stamm, Larsen, & Davis-Griffel, 2002). A 30-item scale with three 10-item subscales assessing Burnout, Compassion satisfaction, and Compassion fatigue. Four items are reverse-scored. Sample items include: “I feel overwhelmed by the amount of work or the size of my caseload I have to deal with” (Burnout); “I find it difficult to separate my personal life from my life as a helper” (Compassion fatigue) and; “I get satisfaction from being able to help people” (Compassion satisfaction). Minor amendments were made to four items so that these items were general rather than trauma-specific. Higher scores indicate greater burnout, compassion fatigue, and compassion satisfaction respectively.

Sense of Coherence Scale – Short form (SOC-13; Antonovsky, 1987). A 13-item self-report measure of one’s general orientation to life, scored using a seven-point (1–7) Likert format scale, giving a potential range of 13 - 91. Five questions have a negative formulation and are reverse-scored. The SOC-13 contains items assessing a person’s perception of the world as comprehensible (five items, e.g., “Do you have very mixed up feelings and ideas?”, scored 1 = very often, 7 = very seldom or never), manageable (four items, e.g., “Do you have the feeling that you’re being treated unfairly?”, scored 1 = very often, 7 = very seldom or never), and meaningful (four items, e.g., “How often do you have the feeling that there’s little meaning in the things you do in your daily life?”, scored 1 = very often, 7 =

very seldom or never). Higher scores indicate a greater sense of coherence (i.e., that the world is perceived as comprehensible, manageable, and meaningful). Test-retest reliability over six months was reported at r = .77 (Antonovsky, 1993).

Posttraumatic Growth Inventory (PTGI; Tedeschi, & Calhoun, 1996). A 21-item self-report measure of positive outcomes, scored using a six-point Likert format scale (0 = “I did not experience this change as a result of my therapy work”; 5 = “I experienced this change to a very great degree as a result of my therapy

work”). Sample items include “A sense of closeness with others” and

“Appreciating each day.” All 21 items are positively scored, yielding a potential range of 0 – 105, where higher scores indicate greater experience of posttraumatic growth. Test-retest reliability over two months was reported at r = .71 (Tedeschi & Calhoun, 1996).

Changes in Outlook Questionnaire (CiOQ; Joseph et al., 1993). A 26-item self-

report measure of positive and negative changes “following your work as a

therapist”, scored using a six-point Likert format scale (1 = strongly disagree; 6 =

strongly agree). The CiOQ has two sub-scales: positive changes (11 items, e.g., “I value my relationships much more now”; “I don’t take life for granted anymore”), and negative changes (15 items, e.g., “I have very little trust in other people now”; “I feel very much as if I’m in limbo”). The positive change subscale has a range of 11–66, and the negative change subscale a range of 15–90, with higher scores indicating greater reports of positive and negative changes respectively. Test- retest reliabilities have not been reported to date.

5.3 Results

5.3.1 Data Analyses

Group differences according to the professional experience variables of clinical supervision, personal therapy (previous or current), personal trauma history (all dichotomized, yes or no) and gender were assessed using four separate multivariate analyses of variance, with the professional experience variable used as the grouping variable in each analysis. Associations between therapeutic training orientations, therapeutic practice orientations, length of time working as a therapist, hours worked per week as a therapist, and the outcome variables (posttraumatic growth, positive changes, compassion satisfaction, negative changes, compassion fatigue, and burnout) were assessed using Pearson’s correlation.

Associations between the psychosocial variables (sense of coherence, empathy, therapeutic alliance, and social support) and the outcome variables were assessed using Pearson’s correlations. The prediction of each outcome variable from the psychosocial variables was estimated using six separate multiple regression analyses, with simultaneous entry of the four psychosocial variables to predict each of the outcome variables.

Given the early stages of empirical work exploring positive changes in therapists, we opted to use a .05 significance level for the analyses. While mindful of the potential inflation of a Type I error, we believe this is appropriate for the generation of areas of investigation that should guide future research at these early stages.

Table 5.1 provides the descriptive statistics for the study variables.