Learning to Be a Psychomotor Therapistfinal

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LEARNING TO BE A PSYCHOMOTOR THERAPIST: RELATIONSHIPS

BETWEEN EMPATHY, INTERPERSONAL COMPETENCIES, DISTRESS, IN

PMT STUDENTS

Ana Paula Lebre dos Santos Branco [email protected] Roque [email protected]

Universidade Tcnica de Lisboa - Faculdade de Motricidade Humana

ABSTRACT

Purpose: The purpose of this study was to investigate empathy, interpersonal

competencies and associated distress, in first year psychomotor therapy

students 8 N=49) at the Faculdade de Motricidade Humana, Lisbon Portugal,

identifying correlations with the students perception of gains after a firstsemester training in PMT personal competencies. Methods: First year students

of psychomotor rehabilitation course at FMH were recruited at the last day of

the first semester 2012. The Jefferson Scale of Empathy (JSE), The Social

competence questionnaire (ICQ), Perspective taking items fromthe

Interpersonal Reactivity Index (IRI) , The five Beck Youth Inventories (BYI-II)

and the questionnaire Self report gains of the psychomotor therapist (SRGPMT)

were used. Results: First year students from PMT, involved in the study,

showed good empathy, social competence levels and good perception of gains

in the training of PMT received. The relation between empathy, social

competencies and low distress was found and perception of gains in PMT first

year students was correlated with higher self concept, health related empathy

and social competence. Conclusions: The increasing need to promote the

PMT role in national and international contexts and the changes in the

university education programs highlight the need for continued research into the

development of personal competencies such as the ones of empathy, social

competencies and professionalism within PMT training. The findings concerning

empathy, social competence and distress among PMT students are of potential

importance in order to improve new and evidence based educational strategies

for all students regardless their entry level in terms of personal competencies.

KEYWORDS: Psychomotor therapy, Empathy, Interpersonal competencies,

Distress, Pofessional training, Psychomotor Therapist (PMT)
mailto:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]:[email protected]


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INTRODUCTION

The development of the professional role in Psychomotor Rehabilitation

in Portugal

Included in the curriculum of Psychomotor Rehabilitation at the Faculty of

Human Motricity the discipline Foundations of Psychomotricity, offered to

students of the 1st year integrates theory and practice with a particular

emphasis on experiential learning, towards the student self awareness essential

for the development of future professional role of the psychomotor therapy

(PMT). Aims include understanding supporting theories (phenomenological,

psychoanalytic, psychosomatic, psychological; describing educational,

rehabilitation and therapeutic psychomotor intervention dimensions, identifying

competencies in professional roles and organizations that support it. Theoretical

lectures are developed in the following topics: History and Epistemology of

Psychomotricity. Foundations and Paradigms of Psychomotricity; Fields of

Application of Psychomotricity; Features of the psychomotor intervention;

Psychomotor developmental factors. Practical lessons, based in experiential

learning include body mediated activities in order to allow students to identify

personal competencies in the development of their professional role. The

following topics are developed: body awareness body image, communication

and interpersonal relationships, the relation; play and spontaneity; use of play,

drama, dance, music, and visual arts. Concepts of body mediation to

demonstrate effective communication, warmth, unconditional support, respect

and empathy in PMT is concerned with the assumption that psychomotor

therapy involves the body as the main mediator of the relation. Thus a

particular emphasis on the training of the students body is expected to enable

in the future professional role in what concerns relational ability, and a better

understanding and integration of several theoretical frameworks used in PMT.

The training, while not being held under a therapeutic process of the student, is

based on respect for the subjectivity, the needs and the personal time of each

student. A climate of security involving flexible dynamics and developing

reflection on behaviours, attitudes and values of the student is valued. Using thestudent implication in body mediated activities it is expected to develop


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competencies such as empathy and social competences related with the future

professional practice in PMT. Although the ambiguity and lack of a consensual

definition regarding the concept (Fields et al., 2011), empathy refers the ability

to see the world as others see it, understand others feelings, and communicate

that understanding (Wilson, Prescott, & Becket, 2012). Developmental

psychology usually refers to emotional (taking the perspective of the other) and

cognitive (experiencing the feeling of the other) components of empathy (Davis,

1983), but also empathy is assumed as a fundamental therapist ability that

allows him to be in the client shoes (Egan, 1998). Different empathy skills may

be necessary in therapeutic situations related with the psychomotor therapy

profession. Nonetheless, empathy is commonly accepted as a beneficial aspect

in all relationships, and considered essential for appropriate therapeutic

interventions (Spiro H. (2009). Some studies refer that in many health

professions, students are unable to demonstrate empathy (Hojat, Gonnella,

Nasca, Mangione, Vergare, Magee, 2002; Fields, et al., 2011) and little

attention is given to this in the curricula of health professional training programs

(Graber et al., 2012). In psychomotor professional training, although empathy

has been considered, little empirical research regarding empathy in PMT

training is available. In PMT a related field of research concerned with this area

of empathy and other domains is being undertaken in order to best understand

the bodily training impact in Spain and Uruguai (Camps & Mila, 2011).

Related with the empathy concept, social competence which has various

definitions often not clearly differentiated refers in social psychology to social

skills necessary for the realization of socially competent behaviours within

interactions, including verbal and nonverbal skills. Developmental psychology

often defining social competence as the individuals ability in the socialization

process to fulfill the demands of the social environment (DuBois & Felner, 1996)

brings us the idea that empathy and social competence should be closely

related. In health professions, social competences sucha as social interaction

skills in therapeutic relationships is proposed to be related with empathy (Hojat,

Mangione, Kane, & Gonnella, 2005). Since social competence can be

understood as implying interpersonal competencies, referring to a group of skills

that facilitate relationships with others, such as the ability to initiate interactionsand relations with others, emotional support, managing conflicts, being


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assertive and revealing necessary information (Buhrmester, 1996), all those

should be developed and recognized in the professional training of any health

professional, including the PMT.

Although distress or mental health problems such as those involved in

depression, anxiety, anger and self esteem, are not frequently associated in

research as a factor to be taken into consideration either for the selection and

acquisition of competencies of the psychomotor therapist it is proposed to test if

emotional and social difficulties may impair therapeutic relations due to the

association with the lack of social and interpersonal skills.

PMT has been embedded in several psychotherapeutic approaches (behaviour,

cognitive, or psychodynamic therapy) (Probst, Knapen, Poot, & Vancampfort,

2010), and the search of the best training of PMT students should include

looking into the benefits of personal training regarding the body as well as

therapeutic competencies (Probst, et al., 2010). Empathy and interpersonal

competencies are regarded as fundamental for effective training in mental

health interventions and they should be included in the training of PMT. The

need to look for evidences that support our educational efforts undertaken to

develop the future psychomotor therapist and in order to ensure the quality of

such training we believe that the studying empathy, interpersonal competencies

and distress and the association with students perceptions of changes during

their training in PMT is relevant.

OBJECTIVES

The purpose of this study was to investigate empathy, interpersonal

competencies and associated distress, understood as the existence of

emotional and social difficulties in first year psychomotor therapy students, and

identifying correlations with the students perception of gains after the being

introduced in the first semester with the core personal skills of the professional

in psychomotor therapy.

METHODOLOGY

Participants

First year students of psychomotor rehabilitation course at FMH were recruited

at the last day of the first semester 2012. An explanation of the study was given

and students were informed that consent was implied by their voluntarycompletion of the questionnaire. It was reinforced that questionnaires would be


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used only for the purpose of this study. All first year students accepted to

participate (n= 49), 94% were female (n= 46) and 6 % male (n=3), ranged in

age from 17 to 25 years, with 75.5% aged 18 (n=37), 14.3% (n=7) aged 19 and

8.1% (n=4) older than 19 years.

Instruments

The Jefferson Scale of Empathy (JSE) an instrument to measure empathy in

health care providers is a self report inventory composed by 20 Likert-type

items scored on a seven-point scale ranging from 1 strongly disagree to 7

strongly agree, including three factors: perspective taking, compassionate care

and standing in the patients shoes Hojat, Gonnella, Nasca, Mangione, Vergare

& Magee, 2002). Higher scores represent greater empathic orientation. JSE

originally developed for medical students, has also a revised version of the

scale to assess empathy in other health professionals slightly modified

(Prescott J, Wilson S, Becket G., 2011). The psychometric properties have

been reported as satisfactory and the construct validity of the scale has been

confirmed(Hojat, Gonnella, Nasca, Mangione, Veloski & Magee, 2002). For the

current study a modified translated version done by the researchers was used

due to the need to direct the questioning to the PMT students. The statements

were slightly reframed, in order to use the term psychomotor therapist instead of

the term health care provider. Examples of the original and the changed

statement, include: Patients feel better when the psychomotor therapist (health

care provider) understands their feelings and Understanding body language is

as important as verbal communication in psychomotor therapy (health care

provider-patient relationships).

The ICQ (Buhrmester, Furman, Wittenberg e Reis, 1988) is an instrument used

to measure social competence, refers to behaviours regarding interpersonal

relations. The ICQ contains 40 items, with eight items relating to five

dimensions: (a) initiation of interactions and relationships, (b) assertion of

personal interests, (c) self-disclosure, (d) emotional support of others, and (e)

management of interpersonal conflicts. Respondents indicate in a five point

likert type scale the competence level and comfort dealing with several

situations. The factorial structure was confirmed in the original scale, as well as

satisfactory internal consistency of each scale, ranging from .77 to .87 was


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obtained. The ICQ has been applied in several studies within the framework of

developmental and clinical psychology. The Portuguese version found also

adequate levels of internal consistency (Assuno, & Matos, 2009).

The Interpersonal Reactivity Index (IRI) (Davis, 1983) is a self report

questionnaire aimed at measuring empathy. Contains 28 items consisting of

four 7-items subscales answered in a five point likert scale. For the current

study only seven items from the dimension Perspective Taking (PT) were used.

This dimension is aimed at measuring the individuals dispositional tendency to

adopt another persons perspective.Beck Youth Inventories (BYI-II) (Beck, Beck, Jolly, Steer, 2005) are five self

report scales aimed to assess, experience of depression, anxiety, anger,

disruptive behaviour and self concept. Each inventory contains 20 statements

about thoughts, feelings or behaviours associated with emotional and social

impairments. For each item the individual should describe how frequently each

statement is true for him answering in a four point scale. A Portuguese

translated version was used ( Simes, Matos, Lebre, 2005). The original version

has T scores equivalents from raw scores for children and adolescents aged

between 7 to 18 years, although for the current study they were not calculated,

since a Portuguese version is not yet validated.

Self report gains of the psychomotor therapist (SRGPMT), is a questionnaire

about the perceptions of changes occurred due to the training in PMT, includes

20 questions that aim to collect the student perception on the competencies

expected to be worked during the training, namely respect for the framework in

the training, psychomotor expressiveness, body in relation, availability for the

group work, self awareness, emotional management, articulation between the

practice and theory of PMT learned. Each statement is answered in a 5 point

likert scale, from 1 point- totally disagree to 5 absolutely agree with the

statement. For the current study only the overall summative score will be used

(Garcia, Camps, Mila, & Peceli, 2011). A Portuguese translated version was

used after requesting permission for one of the authors.

Statistics

Statistical treatment was performed using SPSS, V.21 including descriptive

analysis (minimum, maximum, mode), means, standard deviations, cronbach


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alphas and Pearson correlation analysis for the total scores obtained on each of

the scales used.

RESULTS

The scores of the items from each scale used in the study (JSE, IRI, ICQ, BYI-

II, SRGPMT) are reported in Table 1. In the JSE empathy scale, the majority

of items had a mode ranging from 6 to 7, meaning that the students agree/or

totally agree with the statements concerning empathy that compose this scale.

Exception of a mode of 2 meaning that most students disagree with the

statement) in item 10 Disease or difficulties can be treated only with the

intervention methodology, since the bonds of relation among the therapist and

the client do not influence the results of the treatment and a mode of 3,

(disagree partially) on the statement Emotions are important in psychomotor

therapy. In both cases the sentence comprehension may be the cause of

such results. In what concerns IRI empathy scale, in all 7 items the most

frequent answer refers to an agreement (mode 4) referring that most students

perceives as being empathic in their ability to take the others perspective. In

ICQ items, higher perceptions on social competence were reported by most

students (Mode=5) in items 9 (able to listen patiently), 24 (good listener of a

friend that is worried), 29 (able to say and do things to support someone close

who is down) and 33 (tell someone close how much he appreciates and

worries about him).

In what concerns SRGPMT gains obtained after the personal training in PMT

training, the most frequent answer was the agreement/ totally agreement with

the items included in the scale (Mode=4/5). Item 4 concerned with the respect

for the confidentiality in the group, was the one where the most frequent reply

(Mode=5) was the total agreement with the statement.

Table 1 Mode obtained in items composing the scales JSE, IRI, ICQ, SRGPMT.

JSE items1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Mode 7 6 6 7 7 7 7 6 6 2 7 6 6 6 6 6 6 3 7 6

IRI items1 2 3 4 5 6 7

Mode 4 4 4 4 4 4 4

ICQ items 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Mode 3 4 2 4 4 3 3 3 5 4 4 3 3 4 4 3 4 4 4 4

ICQ (cont .) 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40


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Mode 2 3 4 5 4 4 4 3 5 4 4 4 5 4 4 3 3 3 4 4

SRGPMT 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Mode 4 4 4 5 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

The internal consistency in all the scales was tested for the overall composite

score of each scale (Table 2), in order to verify that the items in each inventory

were assessing the construct proposed. All scales had satisfactory or good

internal consistency, with Cronbachs alphas coefficients computed for each

scale ranging from .71 to .91. The total scores obtained from each scale used

in the study are reported in Table 2. According to the means obtained, the

participants in this study report high empathy levels (JSE M=108.68; IRI

M=26.20) high social competence (QCI M= 142.24), and good self concept

(M=37.18). Also low levels of anger, disruptive behavior, depression, anxiety,

can be observed. To notice that the higher value can be observed in what

concerns anxiety (Mean=25.4).

Table 2 Minimum, Maximum, Mean Scores, Standard deviation, coefficient Alphas forJSE, IRI, BYI-II, CQI, MILA

Minimum Maximum Mean Std.

Deviation

Cronbach

AlphaJSE

IRI

BYI-II

Self Concept

91.00

19.00

26.00

124.00

35.00

54.00

108.68

26.20

37.18

7.60

3.81

6.53

.718

.776

.853

Anxiety 5.00 41.00 25.44 7.49 .860

Depression 1.00 25.00 11.64 5.99 .882

Anger 1.00 28.00 12.51 5.70 .871

Disruptive behaviour

QCI

SRGPMT

.00

102.0

65.00

15.00

178.0

98.00

5.40

142.24

82.51

3.63

16.6

7.3

.811

.901

.907

In Table 3 significantly positive correlations ( p


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higher self concept is correlated with more gains perceived from the students

training in PMT.

Also, significantly positive correlations between empathy-perspective taking

(IRI) and social competence (r=.542) confirming that higher perspective taking

abilities are associated with higher social competence in the students

participating in this study. In terms of empathy, curiously the two empathy

measures did not correlate with each other, which may be the result that being

emphatic at a social level is not the same situational empathy revealed in health

related situations.

Positive correlations were also found among anxiety and depression ( r=.401),

anxiety and anger (r= .324) anger, anger and disruptive behaviour ( r=.630).

Also significantly correlations (negative) between self concept and depression

(r=-.366) and between self concept and anger (r= -.292), which can tell us that

high values in those social emotional difficulties tend to be concurrent among

each other. Positive correlations also were found among empathy/ perspective

taking IRI and social competence (QCI) (r=.542), meaning that high empathy is

associated with high social competence.

Table 3 Pearson Correlations among Empathy, IRI, Beck, QCI Mila scores

IRI selfconcept

anxiety depression

anger Disruptive

Qci SRGPMT

JSE,030 ,132 -,003 ,020 -,139 ,078 ,262 ,334,838 ,366 ,982 ,891 ,340 ,594 ,069 ,019

IRI,014 ,104 ,006 -,143 -,309

*,542

** ,265

,922 ,478 ,969 ,328 ,031 ,000 ,066

Selfconcept

-,141 -,366 -,292 -,131 ,387 ,392

,333 ,011 ,042 ,368 ,006 ,005

Anxiety,401 ,324 ,028 -,120 ,156,005 ,023 ,847 ,412 ,285

Depression,616

** ,280 -,337

* -,041

,000 ,054 ,019 ,782

Anger,630 -,357 -,183,000 ,012 ,208

Disruptive

Behav.

-,254 -,229,078 ,114

QCI ,334


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,019

*. Correlation is significant at the 0.05 level (2-tailed).**. Correlation is significant at the 0.01 level (2-tailed).

DISCUSSION

The positive values found in this study may be in a way related with the fact that

also has been found in other health professions. The fact that those

professionals tend to be more empathic and social competent since the

attraction to healthcare professions is quite related with being appreciative of

supporting others. With respect to the current findings, being social competence

correlated with empathy and with low levels of distress should bring us into a

future discussion on why and how we as trainers should screen and influence

positive changes in the training of PMT. Particularly interesting to compare our

results is a study designed to examine the relationships two empathy measures

found statistically significant correlation of a moderate magnitude between the

total scores of the JSPE and IRI, confirming that the scales of the IRI that were

more relevant to patient care included empathic concern and perspective taking

and related factors on JSPE (compassionate care, perspective taking) (Hojat, et

al., 2005).

CONCLUSIONS AND RECOMMENDATIONS

Noticing the high scores obtained in the instruments used, we can say that first

year students from PMT, involved in the study, showed good empathy, social

competence levels and good perception of gains in the training of PMT

received. The current study also supports the relation between empathy, social

competencies and low distress. In what concerns the self perception of

improvement in PMT training for first year students, this seems to be related

with higher self concept, health related empathy and social competence.

The increasing need to promote the PMT role in international contexts and the

changes in the education programs highlight the need for continued research

into the development of personal competencies such as the ones of empathy,

social competencies and professionalism within PMT training. The findings

concerning high empathy and social competence scores among PMT students

during their education is of potential importance in order to improve


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educational strategies for all students regardless their entry level in terms of

personal competencies.

The current study contributes to the literature in this domain in a unique way,

although from the relations found more research is needed to understand

empathy and social competence in PMT students, namely in longitudinal

studies and transnational studies comparing students evolution along the

different years of the course.. Also this study highlights the need to continue

developing robust and valid measures necessary for further empirical

research. A stronger methodological design would allow to follow the students

throughout the study years more effectively. Future research should

investigate students from various European universities to increase the

generalizability of research in this area. More research is needed on how and

why empathy and social competence changes during the education and

training of PMT, concerning the development of suitable training programmes

for the PMT. Longitudinal research that takes into account educational

interventions and their impact would also aid the development of research in

this field of study and a greater understanding of what students are taught and

at what point in the curriculum may interventions focused on personal

development would be most successful.

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Acknowledgments

The authors would like to thank the first year students of the academic year

2012/2013 from Psychomotor Rehabilitation Course at the Faculty of Human

Kinetics for their participation in this study.

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