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Yarwood B, Taylor R, Angelakis I. User Experiences of CBT for Anxiety and Depression: A Qualitative Systematic Review and Meta-synthesis. Community Ment Health J 2024; 60:662-671. [PMID: 37884830 DOI: 10.1007/s10597-023-01196-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023]
Abstract
Cognitive behavioural therapy (CBT) is an evidence-based treatment for anxiety and depression. It is important to determine the positive and negative aspects of CBT from the perspective of service users. However, there has been a lack of qualitative exploration into service user experiences of the therapy. This review aimed to address this gap by examining participants' experiences of CBT for anxiety and depression. Databases were searched and data were synthesised thematically. CBT was well-received by participants, though barriers to engagement were identified. CBT was often perceived as too difficult or demanding, as well as interventions being short and therefore superficial. Clinician qualities of being trustworthy, non-judgemental, and understanding appear to be significant contributors to client engagement and recovery. Findings support the delivery of in-depth clinician led CBT for anxiety and depression, as well as highlighting the need to review CBT delivery to better support service users.
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2
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Vybíral Z, Ogles BM, Řiháček T, Urbancová B, Gocieková V. Negative experiences in psychotherapy from clients' perspective: A qualitative meta-analysis. Psychother Res 2024; 34:279-292. [PMID: 37410872 DOI: 10.1080/10503307.2023.2226813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVE A considerable number of clients report adverse or unwanted effects of psychological treatments. This study aimed to synthesize the findings of qualitative studies focused on what clients perceive as negative experiences in psychotherapy. METHOD A database search was conducted to find primary studies, and a qualitative meta-analysis was used to aggregate the findings on the kinds of negative experiences psychotherapy clients reported. RESULTS A total of 936 statements were extracted from 51 primary studies and categorized into 21 meta-categories, some of which were further divided into subcategories. These meta-categories covered clients' experiences, which fell into four broad clusters: therapists' misbehaviour, hindering aspects of the relationship, poor treatment fit, and negative impacts of treatment. CONCLUSION Clients' negative experiences of psychotherapy are a vast and heterogeneous area, the breadth of which is not captured by any single study. By synthesizing the findings of many primary studies, this meta-analysis represents the most comprehensive summary of these experiences to date.
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Affiliation(s)
- Zbyněk Vybíral
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Benjamin M Ogles
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Barbora Urbancová
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Veronika Gocieková
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
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3
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Ladmanová M, Řiháček T, Timulak L. Client-Identified Impacts of Helpful and Hindering Events in Psychotherapy: A Qualitative Meta-analysis. Psychother Res 2021; 32:723-735. [PMID: 34806550 DOI: 10.1080/10503307.2021.2003885] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Understanding the client perspective is important for the provision of psychotherapy. The significant events paradigm, within which clients report on the most significant events of a therapy session immediately after the session, represents a useful means to explore clients' in-session experience. METHOD The aim of this study was to investigate what types of client-identified impacts are reported in qualitative studies on helpful and hindering events in psychotherapy. Seventeen primary studies focusing on client-identified helpful and hindering events were identified through database searches and subsequent manual searches. The data were subjected to qualitative meta-analysis. RESULTS The descriptions of event impacts were classified into 12 helpful (e.g., gaining a new perspective on the self; feeling heard, understood, and accepted; and feeling engaged in the therapeutic process) and eight hindering (e.g., lacking guidance from the therapist and feeling emotionally overwhelmed) impact meta-categories. CONCLUSION The findings provide an update to a previous meta-analysis by identifying several new categories of helpful event impacts and by categorizing hindering event impacts.
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Affiliation(s)
- Michaela Ladmanová
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Tomáš Řiháček
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czechia
| | - Ladislav Timulak
- School of Psychology, Trinity College Dublin, University of Dublin, Dublin, Ireland
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4
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Pickard JA, Lumby C, Deane FP. True beauty lies within: therapist interview of a client who received acceptance and commitment therapy for body dysmorphic disorder. CLIN PSYCHOL-UK 2021. [DOI: 10.1080/13284207.2021.1948304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Judy A. Pickard
- School of Psychology, University of Wollongong, NSW, Wollongong, Australia
| | - Carrie Lumby
- School of Psychology, University of Wollongong, NSW, Wollongong, Australia
| | - Frank P. Deane
- School of Psychology, University of Wollongong, NSW, Wollongong, Australia
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5
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Morrison NR, Constantino MJ, Santorelli GD, McVicar EL, Ametrano RM. Determinants of psychotherapy outcome expectations: Qualitative accounts from socially anxious college students. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Nicholas R. Morrison
- Department of Psychological and Brain Sciences University of Massachusetts Amherst Amherst MA01003USA
| | - Michael J. Constantino
- Department of Psychological and Brain Sciences University of Massachusetts Amherst Amherst MA01003USA
| | - Gennarina D. Santorelli
- Department of Psychological and Brain Sciences University of Massachusetts Amherst Amherst MA01003USA
| | - Erin L. McVicar
- Department of Psychological and Brain Sciences University of Massachusetts Amherst Amherst MA01003USA
| | - Rebecca M. Ametrano
- Department of Psychological and Brain Sciences University of Massachusetts Amherst Amherst MA01003USA
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6
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Bear HA, Dalzell K, Edbrooke-Childs J, Garland L, Wolpert M. How to manage endings in unsuccessful therapy: A qualitative comparison of youth and clinician perspectives. Psychother Res 2021; 32:249-262. [PMID: 33950789 DOI: 10.1080/10503307.2021.1921304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Approximately half of those who access child and adolescent mental health services do not show measurable improvement in symptoms. This study aimed to provide practice recommendations for managing treatment endings, particularly when outcomes have not improved. Method: Semi-structured interviews were carried out with 26 young people with a history of anxiety and/or depression along with 7 roundtable sessions with 52 mental health clinicians. Data were analyzed using Framework Analysis. Results: A common experience for young people when outcomes did not improve was a poor experience of the treatment ending, which often resulted in setbacks in their mental health and feelings of loss and abandonment. Clinicians agreed that ending was hard for young people and reported that they found managing ending hard on a personal and professional level. This was compounded by unrealistically high public expectations about the impact of therapy on outcomes and trying to strike a balance between fostering hope and managing expectations, within a context of inflexible service structures and resource constraint. Implications: Recommendations include establishing expectations from the outset and a shared understanding of what outcomes matter most to the young person. This can be achieved through communicating honestly about likely outcomes, while also providing hope.
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Affiliation(s)
- Holly Alice Bear
- Research Department for Clinical, Educational and Health Psychology, University College London, London, UK.,Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK.,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Kate Dalzell
- Child Outcomes Research Consortium, The Kantor Centre of Excellence, London, UK
| | - Julian Edbrooke-Childs
- Research Department for Clinical, Educational and Health Psychology, University College London, London, UK.,Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK.,Child Outcomes Research Consortium, The Kantor Centre of Excellence, London, UK
| | - Lauren Garland
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, London, UK.,Wellcome Trust, London, UK
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7
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Watsford C, Rickwood D. Young people's expectations, preferences, and experiences of therapy: Effects on clinical outcome, service use, and help‐seeking intentions. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12034] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Clare Watsford
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia,
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia,
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8
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Exposing Worry's Deceit: Percentage of Untrue Worries in Generalized Anxiety Disorder Treatment. Behav Ther 2020; 51:413-423. [PMID: 32402257 PMCID: PMC7233480 DOI: 10.1016/j.beth.2019.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 05/15/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022]
Abstract
Theories of cognitive therapy have long proposed that those with generalized anxiety disorder (GAD) have inaccurate expectations. By challenging them with objective evidence, symptoms are thought to decrease. To test these premises, this study used ecological momentary assessment (EMA) during the Worry Outcome Journal (WOJ) treatment to determine the percentage of GAD worries that did not come true. We then analyzed the association between participants' untrue worry percentages and GAD symptom change across treatment. Twenty-nine participants with GAD recorded worries when prompted for 10 days, reviewed them online nightly, and tracked their worry outcomes across 30 days. These recordings were then coded by independent raters. Analyses applied bias-correct bootstrapping path analysis on slopes extracted from longitudinal linear mixed models. Primary results revealed that 91.4% of worry predictions did not come true. Higher percentages of untrue worries significantly predicted lower GAD symptoms after treatment, as well as a greater slope of symptom reduction from pre- to post-trial. Participants' average expected likelihoods of worries coming true were much greater than actual observed likelihoods. The most common percentage of untrue worries per person was 100%. Thus, worries in those with GAD were mostly inaccurate. Greater evidence of this inaccuracy predicted greater improvement in treatment. As theorized, disconfirming false expectations may significantly contribute to treatment's effect.
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9
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Holding JC, Haddock G, Gregg L. Young people’s beliefs about psychological therapy for psychosis: a Q-Methodological study. J Ment Health 2019; 29:446-454. [DOI: 10.1080/09638237.2019.1677869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Gillian Haddock
- School of Health Sciences, The University of Manchester, Manchester, UK
| | - Lynsey Gregg
- School of Health Sciences, The University of Manchester, Manchester, UK
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10
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Tzur Bitan D, Abayed S. Process expectations: Differences between therapists, patients, and lay individuals in their views of what works in psychotherapy. J Clin Psychol 2019; 76:20-30. [PMID: 31576576 DOI: 10.1002/jclp.22872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In this study, we aimed to assess the degree to which individuals with varying levels of psychotherapeutic experience have predisposed ideas regarding what works in psychotherapy. METHOD Therapists (n = 107), patients (n = 97), and lay individuals with no prior experience in psychotherapy (n = 160) reported their process expectations and ranked seven mechanisms of change in the order of their perceived importance. RESULTS Therapists rated emotional processing and patient-therapist relations as higher in importance than did patients and lay individuals, but patients and lay individuals rated cognitive and emotional reconstruction higher than did therapists. Furthermore, therapists ranked the exploration of unconscious contents as most important, while patients and lay individuals ranked cognitive control to be the most important mechanism of change. CONCLUSIONS Therapists, patients, and lay individuals expect different mechanisms of change to take place in psychotherapy. Limitations and directions for future research are discussed.
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Affiliation(s)
- Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Israel.,Shalvata Mental Health Center, Hod Hasharon, affiliated with the Sackler school of medicine, Tel Aviv university, Ramat Aviv, Israel
| | - Shiran Abayed
- Department of Behavioral Sciences, Ariel University, Israel
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11
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Omylinska‐Thurston J, McMeekin A, Walton P, Proctor G. Clients' perceptions of unhelpful factors in CBT in IAPT serving a deprived area of the UK. COUNSELLING & PSYCHOTHERAPY RESEARCH 2019. [DOI: 10.1002/capr.12249] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Aaron McMeekin
- Greater Manchester Mental Health NHS Foundation Trust Prestwich UK
| | - Peter Walton
- Queen's University Belfast, Centre for Public Health Institute of Clinical Sciences, B, Royal Victoria Hospital Belfast UK
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12
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Koekkoek B, van Meijel B, Perquin A, Hutschemaekers G. Decision making on (dis)continuation of long-term treatment in mental health services is an interpersonal negotiation rather than an objective process: qualitative study. BMC Psychiatry 2019; 19:92. [PMID: 30885155 PMCID: PMC6421659 DOI: 10.1186/s12888-019-2072-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 03/04/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Research into termination of long-term psychosocial treatment of mental disorders is scarce. Yearly 25% of people in Dutch mental health services receive long-term treatment. They account for many people, contacts, and costs. Although relevant in different health care systems, (dis)continuation is particularly problematic under universal health care coverage when secondary services lack a fixed (financially determined) endpoint. Substantial, unaccounted, differences in treatment duration exist between services. Understanding of underlying decisional processes may result in improved decision making, efficient allocation of scarce resources, and more personalized treatment. METHODS A qualitative study design, according to Grounded Theory principles, was used to understand the decision making process. In four teams in three large Dutch mental health services, 29 multidisciplinary case conferences were observed, and 12 semi-structured interviews were conducted. RESULTS We describe two constituent elements of decision making: the process through which decision making is prepared and executed, and the substantial factors guiding its outcomes. The first consists of: (1) steps towards a team discussion on treatment termination, (2) team-related factors that influence decisions, and (3) the actual team decision making process. The second consists of factors related to patients, professionals, organization, and wider environment. Our main finding was that discussions of treatment (dis)continuation are highly unstructured. Professionals find it difficult to discuss with patients and teams, team discussion are ad-hoc, and clear decisions are scarce. We offer four explanations: first, long-term treatment lacks golden rules on outcome and process to base decisions on. Second, in the absence of such rules professionals rely on experience but underappreciate their own biases. Third, consequently, professionals aim for decisional consensus, which however is scarce among professionals. Fourth, treatment environments are hardly in favour of changing default (continuation) settings. CONCLUSION Clear decision making, and terminating treatment when appropriate, is systematically hampered within secondary mental health services. Since continuation is the 'easy' default option, discontinuation requires skillful and determined navigation of interpersonal negotiations. Given services' scarce means, people's large demands for help, and patients' unused potential autonomy, it is desirable to invest in decision making skills and procedures - both human and economic benefits may be substantial.
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Affiliation(s)
- B. Koekkoek
- 0000 0000 8809 2093grid.450078.eHAN University of Applied Sciences, Research Group Social Psychiatry & Mental Health Nursing, Kapittelweg 33, 6525 EJ Nijmegen, The Netherlands ,0000 0004 0466 1666grid.491369.0Pro Persona Mental Health Services, Wolfheze, The Netherlands
| | - B. van Meijel
- grid.448984.dInholland University of Applied Sciences, Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, Amsterdam Public Health research institute, Amsterdam UMC, VU Amsterdam, Amsterdam, The Netherlands ,Parnassia Psychiatric Institute, The Hague, The Netherlands ,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands
| | - A. Perquin
- 0000 0000 8809 2093grid.450078.eHAN University of Applied Sciences, Research Group Social Psychiatry & Mental Health Nursing, Kapittelweg 33, 6525 EJ Nijmegen, The Netherlands
| | - G. Hutschemaekers
- 0000000122931605grid.5590.9Research Group Clinical Psychology, Radboud University, Nijmegen, The Netherlands ,0000 0004 0466 1666grid.491369.0Pro Persona Mental Health Services, Wolfheze, The Netherlands
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13
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Tuchina OD, Agibalova TV, Shustov DI, Shustova SA, Buzik ОG, Petrosyan YE. [The practical use of placebo effect in psychotherapeutic treatment of patients with substance use disorders: therapeutic and ethic consequences]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 116:61-68. [PMID: 28300816 DOI: 10.17116/jnevro201611611261-68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article discusses therapeutic potential of placebo and nocebo effects in treatment of substance use disorders. The authors review the background of the issue, describe neurobiological and psychological mechanisms of placebo effects and demonstrate their impact on psychotherapy of patients with substance use disorders. Attention is drawn to the clinical and ethical issues of practical use of placebo effects including that in terms of placebo-therapy, indirect suggestion psychotherapy, motivational interventions and cognitive-behavioral psychotherapy, psychotherapy with the use of disulfiram, psychopharmacotherapy with opioid antagonists. The authors conclude that the ethical use of placebo-effects in treatment of substance use disorders may improve its overall efficiency.
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Affiliation(s)
- O D Tuchina
- Peoples' Friendship University of Russia, Moscow, Russia
| | - T V Agibalova
- Peoples' Friendship University of Russia, Moscow, Russia; Serbsky Federal Medical Research Center for Psychiatry and Narcology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - D I Shustov
- Academician Pavlov Ryazan State Medical University, Ryazan, Russia
| | - S A Shustova
- Academician Pavlov Ryazan State Medical University, Ryazan, Russia
| | - О G Buzik
- Peoples' Friendship University of Russia, Moscow, Russia
| | - Yu E Petrosyan
- Peoples' Friendship University of Russia, Moscow, Russia
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14
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Button ML, Norouzian N, Westra HA, Constantino MJ, Antony MM. Client reflections on confirmation and disconfirmation of expectations in cognitive behavioral therapy for generalized anxiety disorder with and without motivational interviewing. Psychother Res 2018; 29:723-736. [PMID: 29357757 DOI: 10.1080/10503307.2018.1425932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Objective: Addressing methodological shortcomings of prior work on process expectations, this study examined client process expectations both prospectively and retrospectively following treatment. Differences between clients receiving cognitive behavioral therapy (CBT) versus motivational interviewing integrated with CBT (MI-CBT) were also examined. Method: Grounded theory analysis was used to study narratives of 10 participants (N = 5 CBT, 5 MI-CBT) who completed treatment for severe generalized anxiety disorder as part of a larger randomized controlled trial. Results: Clients in both groups reported and elaborated expectancy disconfirmations more than expectancy confirmations. Compared to CBT clients, MI-CBT clients reported experiencing greater agency in the treatment process than expected (e.g., that they did most of the work) and that therapy provided a corrective experience. Despite nearly all clients achieving recovery status, CBT clients described therapy as not working in some ways (i.e., tasks did not fit, lack of improvement) and that they overcame initial skepticism regarding treatment. Conclusions: Largely converging with MI theory, findings highlight the role of key therapist behaviors (e.g., encouraging client autonomy, validating) in facilitating client experiences of the self as an agentic individual who is actively engaged in the therapy process and capable of effecting change.
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Affiliation(s)
- Melissa L Button
- a Department of Psychology , York University , Toronto , ON , Canada
| | - Nikoo Norouzian
- a Department of Psychology , York University , Toronto , ON , Canada
| | - Henny A Westra
- a Department of Psychology , York University , Toronto , ON , Canada
| | - Michael J Constantino
- b Department of Psychology , University of Massachusetts Amherst , Amherst , MA , USA
| | - Martin M Antony
- c Department of Psychology , Ryerson University , Toronto , ON , Canada
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15
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Duarte J, Fischersworring M, Martínez C, Tomicic A. "I couldn't change the past; the answer wasn't there": A case study on the subjective construction of psychotherapeutic change of a patient with a Borderline Personality Disorder diagnosis and her therapist. Psychother Res 2017; 29:445-462. [PMID: 28774224 DOI: 10.1080/10503307.2017.1359426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Qualitative research has provided knowledge about the subjective experiences of therapists and patients regarding the psychotherapy process and its results. Only few studies have attempted to integrate both perspectives, considering the influence of a patient's characteristics and diagnosis in the construction of this experience. AIM To identify aspects of psychotherapy that contribute to therapeutic change based on the experience of a patient and her therapist, and to construct an integrated comprehension of the change process of a patient with Borderline Personality Disorder. METHOD A single case was used to carry out a qualitative analysis of follow-up interviews of the participants of a long-term psychotherapy. Two qualitative approaches were combined into a model entitled "Discovery-Oriented Biographical Analysis" to reconstruct an integrated narrative. RESULTS This method yielded an integrated narrative organized into four "chapters" that reflect the subjective construction of both the patient's and the therapist's experience of psychotherapy in terms of meaning. DISCUSSION The understanding of psychotherapy as a multilevel process, in which different themes occur and develop simultaneously, is discussed. From this perspective, psychotherapy can be characterized as a process that involves the recovery of trust in others through corrective emotional experiences and the construction of a shared implicit relational knowledge. Clinical or methodological significance of this article: Research on the subjective experiences of psychotherapy must consider both patient and therapist as privileged but always complementary witnesses of their interaction. In addition, it should be noted that the experience of studying this biographical reconstruction generates a space where research and practice converge. The analysis of participants' narratives provides fascinating windows into their perceptions of psychotherapy and the process of change (Safran, 2013); here, the researcher is not merely a advantaged observer or a good summarizer: He/she has the chance to imbue the psychotherapy with a new meaning by connecting it with a common set of knowledge and a body of socially shared experience.
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Affiliation(s)
- Javiera Duarte
- a Faculty of Medicine and Faculty of Social Sciences , Universidad de Chile , Santiago , Chile.,b Millennium Institute for Depression and Personality Research (MIDAP) , Santiago , Chile
| | - Martina Fischersworring
- a Faculty of Medicine and Faculty of Social Sciences , Universidad de Chile , Santiago , Chile.,b Millennium Institute for Depression and Personality Research (MIDAP) , Santiago , Chile
| | - Claudio Martínez
- b Millennium Institute for Depression and Personality Research (MIDAP) , Santiago , Chile.,c Faculty of Psychology , Universidad Diego Portales , Santiago , Chile
| | - Alemka Tomicic
- b Millennium Institute for Depression and Personality Research (MIDAP) , Santiago , Chile.,c Faculty of Psychology , Universidad Diego Portales , Santiago , Chile
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16
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Picariello F, Ali S, Foubister C, Chalder T. 'It feels sometimes like my house has burnt down, but I can see the sky': A qualitative study exploring patients' views of cognitive behavioural therapy for chronic fatigue syndrome. Br J Health Psychol 2017; 22:383-413. [PMID: 28349621 DOI: 10.1111/bjhp.12235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/10/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Cognitive behavioural therapy (CBT) is currently a first-line treatment for chronic fatigue syndrome (CFS). Even though the results from trials are promising, there is variability in patient outcomes. The aim of this study was to explore the experiences of patients with CFS who undertook CBT at a specialist service for CFS. DESIGN This was a qualitative study. METHODS Thirteen patients with CFS, approaching the end of CBT, participated in semi-structured interviews. In addition, participants were asked to rate their satisfaction with CBT and perceived level of improvement. The data were analysed using inductive thematic analysis. RESULTS The majority of participants were satisfied with treatment and reported marked improvements. This was evident from the ratings and corroborated by the qualitative data, yet recovery was in general incomplete. Participants often disclosed mixed feelings towards CBT prior to its start. Behavioural aspects of treatment were found useful, while participants were more ambivalent towards the cognitive aspects of treatment. The tailored nature of CBT and therapist contact were important components of treatment, which provided participants with support and validation. Engagement and motivation were crucial for participants to benefit from CBT, as well as the acceptance of a bio-psychosocial model of CFS. Illness beliefs around CFS were also discussed throughout the interviews, possibly impeding engagement with therapy. CONCLUSIONS The results suggest that various factors may moderate the effectiveness of CBT, and a greater understanding of these factors may help to maximize benefits gained from CBT. Statement of contribution What is already known on this subject? CBT is effective in reducing CFS symptoms, but not all patients report marked improvements following treatment. Predictors of outcome have been explored in the literature. Few studies have looked at the experience of adult patients with CFS who have had CBT. What does this study add? Findings provide insights as to why variability in CBT-related improvements exists. Beliefs about CFS and CBT may shape engagement and consequently contribute to post-treatment outcomes. Flexibility and sensitivity are necessary from therapists throughout treatment to ensure full engagement.
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Affiliation(s)
- Federica Picariello
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sheila Ali
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Caroline Foubister
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Trudie Chalder
- South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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17
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Awenat YF, Shaw-Núñez E, Kelly J, Law H, Ahmed S, Welford M, Tarrier N, Gooding PA. A qualitative analysis of the experiences of people with psychosis of a novel cognitive behavioural therapy targeting suicidality. PSYCHOSIS 2016. [DOI: 10.1080/17522439.2016.1198827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Yvonne F. Awenat
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, MAHSC, University of Manchester, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Centre for New Treatments and Understanding in Mental Health (CENTRUM), University of Manchester, Manchester, UK
| | - Emma Shaw-Núñez
- Research and Innovation, Manchester Mental Health and Social Care NHS Trust, Manchester, UK
| | - James Kelly
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Heather Law
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Sehar Ahmed
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Mary Welford
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Nicholas Tarrier
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Department of Psychology, Institute of Psychiatry, London, UK
| | - Patricia A. Gooding
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, MAHSC, University of Manchester, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
- Centre for New Treatments and Understanding in Mental Health (CENTRUM), University of Manchester, Manchester, UK
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Heinrich S, Rozental A, Carlbring P, Andersson G, Cotter K, Weise C. Treating tinnitus distress via the Internet: A mixed methods approach of what makes patients seek help and stay motivated during Internet-based cognitive behavior therapy. Internet Interv 2016; 4:120-130. [PMID: 30135798 PMCID: PMC6096122 DOI: 10.1016/j.invent.2016.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/16/2016] [Accepted: 04/17/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Internet-based cognitive behavioral therapy (ICBT) has proven to be an effective treatment in improving patients' ability to cope with tinnitus. However, some patients prefer face-to-face therapy to ICBT, and a few studies have shown considerable dropout rates if the treatment is not guided. This renders it important to identify factors that contribute to the commencement and continuation of ICBT programs. AIMS Because treatment motivation and expectations are important factors in psychological treatment, the aim of our study was to investigate what leads tinnitus patients to seek out ICBT, what helps them to keep up with the treatment, and what (if any) impact these factors have on dropout rates and treatment outcomes. METHOD 112 tinnitus patients taking part in ICBT for tinnitus responded to symptom-related questionnaires at three points in time (pre-treatment, post-treatment, and one-year-follow-up) and to a questionnaire consisting of open-ended questions about their treatment motivation and expectations before beginning treatment. Data were analyzed using qualitative content analysis, and the results were used to divide the participants into groups. The treatment outcomes of these groups were compared using t-tests, χ2-tests, and both one-factorial and mixed ANOVAs. RESULTS Four main categories emerged as factors conducive to starting treatment: 1) Targets participants wanted to address, 2) circumstances that led to participation, 3) attitudes towards the treatment, and 4) training features. Participants identified six facilitators for continuing the treatment: success, training, individual attitude, hope, evidence, and support. Naming specific tinnitus-associated problems as targets was associated with greater improvement from pre-treatment to 1-year-follow-up. Describing an active involvement in the treatment was related to increased improvement from post-treatment to follow-up. CONCLUSION There are several motivational factors that tinnitus patients consider relevant for beginning and continuing ICBT. Particularly, focusing on specific targets that do not involve the tinnitus itself, and encouraging participants to take an active role in treatment may increase treatment effectiveness. However, further hypothesis-guided research is necessary to confirm our explorative results.
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Affiliation(s)
- Sarah Heinrich
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Katherine Cotter
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Cornelia Weise
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany,Department of Behavioural Sciences and Learning, Linnaeus Centre HEAD, Swedish Institute for Disability Research, Linköping University, Linköping, Sweden,Corresponding author at: Philipps-University Marburg, Department of Psychology, Division of Clinical Psychology and Psychotherapy, Gutenbergstrasse 18, 35032 Marburg, Germany
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19
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Walls J, McLeod J, McLeod J. Client preferences in counselling for alcohol problems: A qualitative investigation. COUNSELLING & PSYCHOTHERAPY RESEARCH 2016. [DOI: 10.1002/capr.12064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Julia McLeod
- Division of Mental Health Nursing and Counselling; University of Abertay; Dundee UK
| | - John McLeod
- Department of Psychology; University of Oslo; Oslo Norway
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20
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Individuals' experiences and opinions of psychological therapies for psychosis: A narrative synthesis. Clin Psychol Rev 2016; 43:142-61. [DOI: 10.1016/j.cpr.2015.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 08/17/2015] [Accepted: 10/29/2015] [Indexed: 11/20/2022]
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21
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Helpful aspects of metacognitive therapy and cognitive behaviour therapy for depression: a qualitative study. COGNITIVE BEHAVIOUR THERAPIST 2015. [DOI: 10.1017/s1754470x15000574] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractSix clients in cognitive behaviour therapy (CBT) or metacognitive therapy (MCT) were interviewed about their experiences of therapy with a focus on helpful elements. Clients in both CBT and MCT mentioned the positive and informal relationship with the therapist as helpful. However, while clients in both therapies emphasized insight into the causes of depression and modification of negative maintenance patterns as helpful, the understanding of depression and the remedies for the condition differed. Clients in CBT focused on previous negative experiences as the cause of present maintenance patterns and mentioned changing negative thought patterns as helpful. Clients in MCT stated that the realization that rumination was their key problem and that they could choose not to engage in negative thinking had been crucial. Furthermore, clients in CBT tended to describe increased personal strength and self-confidence as the main gain from therapy, whereas MCT clients mentioned improved ways of coping with thoughts or problems. The importance attributed by the clients to technical factors differs from previous qualitative studies conducted across various therapeutic approaches, which have typically concluded that common therapeutic factors are more important than specific factors. It does, however, correspond with conclusions from other qualitative studies focusing explicitly on CBT.
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Patients with medically unexplained physical symptoms experience of receiving treatment in a primary-care psychological therapies service: a qualitative study. COGNITIVE BEHAVIOUR THERAPIST 2015. [DOI: 10.1017/s1352465815000235] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAs a pilot site under the primary-care Increasing Access to Psychological Therapies (IAPT) Long Term Condition/Medically Unexplained Physical Symptoms (MUPS) project, patients with MUPS were offered cognitive behaviour therapy (CBT)-based treatments or attendance at a mindfulness-based stress reduction (MBSR) programme. This study aimed to gain an understanding of the views and experiences of MUPS patients that received CBT-based therapy or MBSR within an IAPT service and to investigate the relationship between their experiences and health outcomes measured on self-report questionnaires. Thematic analysis was used to analyse data gathered via semi-structured interviews with 11 patients. Data collected from three self-report measures were considered in relation to key features of participants’ reported experiences and patterns identified. Four main themes emerged: (1) something needs to change; (2) making connections between physical symptoms and mood, thoughts or activities; (3) sharing experiences and feeling understood; and (4) reflections on treatment experience. Participants generally reported a positive experience of treatment and felt better able to cope with their symptoms, although treatment did not necessarily result in reliable change in symptoms as measured by the Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7) and Work and Social Adjustment Scale (WSAS). This novel model of treatment appears to be acceptable for this patient group although evaluation of the pilot should consider the ability of routinely used measures to capture the value of treatment to patients, including improved coping with symptoms.
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24
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Frankl M, Philips B, Wennberg P. Psychotherapy role expectations and experiences - discrepancy and therapeutic alliance among patients with substance use disorders. Psychol Psychother 2014; 87:411-24. [PMID: 24415529 DOI: 10.1111/papt.12021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 11/29/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The main aim of the study was to examine how the discrepancy between role expectations prior to psychotherapy and experiences of ongoing psychotherapy related to therapeutic alliance. We hypothesized that a similarity between patient role expectations and experiences would be associated with a stronger alliance. The study also examined whether different dimensions of psychotherapy role expectations predicted retention in psychotherapy. DESIGN A naturalistic study design was used with data collected prior to therapy and during the first 6 months of therapy. METHOD Patients with substance use disorders completed the Psychotherapy Expectation Questionnaire-short version (PEX-S) at the time of therapy assessment. A subsample of these patients (n = 41; n = 24 in individual therapy and n = 17 in group therapy) provided data from therapy including psychotherapy experiences (also measured with PEX-S) and therapeutic alliance, measured with Working Alliance Questionnaire-short version. RESULTS For patients in group therapy, discrepancy between role expectations and experiences correlated negatively with alliance. Expectations prior to psychotherapy characterized by defensiveness correlated negatively with therapy retention. CONCLUSION The finding that disconfirmation of patients' role expectations in group therapy were associated with weaker therapeutic alliance highlights the importance of discussing psychotherapy expectations at an early stage in treatment. Expectations characterized by defensiveness predicted worse retention in psychotherapy, which indicates that the PEX-S can be helpful in detecting patients at risk for dropout. PRACTITIONER POINTS In targeting a patient's role expectancies prior to treatment, possible discrepancies between patient and therapist are made visible and possible to examine. Clarifying the patient's role expectations and the therapist's rationale might be a first step towards establishing a strong working alliance. Surveying the patient's defensiveness tendencies at the beginning of therapy offers a chance to discuss possible fears and other obstacles concerning therapy. Discrepancy between the patient's role expectations prior to treatment and their actual experiences of psychotherapy render valuable information that can be of use in the therapy process.
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Affiliation(s)
- My Frankl
- Department of Behavioral Science and Learning, Linköping University, Linköping, Sweden; Center for Dependency Disorders, Stockholm County Council, Stockholm, Sweden
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Midgley N, Holmes J, Parkinson S, Stapley E, Eatough V, Target M. "Just like talking to someone about like shit in your life and stuff, and they help you": Hopes and expectations for therapy among depressed adolescents. Psychother Res 2014; 26:11-21. [PMID: 25372575 DOI: 10.1080/10503307.2014.973922] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To explore hopes and expectations for therapy among a clinical population of depressed adolescents. METHOD As part of a randomized clinical trial, 77 adolescents aged 11-17, with moderate to severe depression, were interviewed using a semi-structured interview schedule. The interviews were analysed qualitatively using framework analysis. RESULTS The findings are reported around five themes: "the difficulty of imagining what will happen in therapy," "the 'talking cure,'" "the therapist as doctor," "therapy as a relationship," and "regaining the old self or developing new capacities." CONCLUSIONS Differing expectations are likely to have implications for the way young people engage with treatment, and failure to identify these expectations may lead to a risk of treatment breakdown.
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Affiliation(s)
- Nick Midgley
- a Anna Freud Centre , London , UK.,b Department of Clinical, Educational and Health Psychology , University College London , London , UK
| | - Joshua Holmes
- b Department of Clinical, Educational and Health Psychology , University College London , London , UK
| | - Sally Parkinson
- b Department of Clinical, Educational and Health Psychology , University College London , London , UK
| | - Emily Stapley
- a Anna Freud Centre , London , UK.,b Department of Clinical, Educational and Health Psychology , University College London , London , UK
| | - Virginia Eatough
- c Department of Psychology , Birkbeck University of London , London , UK
| | - Mary Target
- a Anna Freud Centre , London , UK.,b Department of Clinical, Educational and Health Psychology , University College London , London , UK
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Honda GC, Yoshida EMP. Mudança em psicoterapia: indicadores genéricos e eficácia adaptativa. ESTUDOS DE PSICOLOGIA (NATAL) 2013. [DOI: 10.1590/s1413-294x2013000400006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este trabalho apresenta proposta de se combinar o critério da eficácia adaptativa com os da Lista Hierárquica de Indicadores Genéricos de Mudança (LHIGM), para se compreender melhor como as pessoas mudam em psicoterapia. Procede-se inicialmente a uma breve revisão dos fatores de mudança que sustentam a teoria genérica de mudança em que se baseia a LHIGM. A Lista apresenta uma sequência ideal do que ocorre se a psicoterapia obtiver êxito e permite observar empiricamente os indicadores ao longo das sessões. A eficácia adaptativa compreende as respostas do indivíduo frente às dificuldades e vicissitudes da vida. Propõe-se que exista associação entre a qualidade da eficácia adaptativa e a possibilidade do paciente avançar para os níveis mais elevados da hierarquia dos Indicadores Genéricos, assim como, que o avanço na hierarquia dos indicadores corresponda a mudanças na eficácia adaptativa. Sugerem-se pesquisas para melhor avaliar essas hipóteses.
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Watsford C, Rickwood D, Vanags T. Exploring young people's expectations of a youth mental health care service. Early Interv Psychiatry 2013; 7:131-7. [PMID: 22672423 DOI: 10.1111/j.1751-7893.2012.00361.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED Client expectations about mental health services relate to the client's and the therapist's role, the therapeutic process and therapeutic outcomes. Research with adults shows that such expectations affect service engagement and clinical outcomes. AIM The present study investigated expectations for adolescents and young adults, which have not been adequately investigated and may partly explain the reluctance of young people to seek professional help. METHODS Participants included 20 young people aged 12-24 attending their initial session at a youth mental health service, who were interviewed immediately prior to their initial session. Data were analysed using qualitative methods to draw main themes around each of the four expectancy types. RESULTS Overall, the strongest theme was that young people were unsure of what to expect from attending a mental health service. The key theme for expectations of their role as a client was readiness for therapy, and for the therapist's role the key themes were who they expected to see, the directiveness and likeability of the therapist, and the type of help they expected they would receive. The young people expected that the therapy process would involve simply talking and expected their engagement to be dependent on how much they liked their first few sessions. Outcome expectations were non-specific and the theme of hopefulness was most evident. CONCLUSION As unrealistic and unmet expectations can lead to poorer engagement and outcomes in therapy, the study highlights a need for young people to be better informed about what to expect when coming to mental health services.
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Affiliation(s)
- Clare Watsford
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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Expectations, experiences, and tensions in the memory clinic: the process of diagnosis disclosure of dementia within a triad. Int Psychogeriatr 2012; 24:1756-70. [PMID: 22687191 DOI: 10.1017/s1041610212000841] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Health communication studies emphasize the importance of addressing the needs and expectations of patients and families with the disclosure of grave medical conditions. However, little attention has focused on their expectations and experiences of the clinical encounters in diagnosis disclosure of dementia. METHODS In-depth post-encounter interviews with ten patients and 17 companions from two memory clinics in Israel were analyzed using grounded theory. The analysis focused on identifying their expectations, their experiences, and their perceptions of the process and outcomes. RESULTS Major differences exist between patients' and companions' expectations. Patients' expectations were an expression of the lack of knowledge/understanding of the visit's purpose and of insight into the memory deterioration. Companions had more clear-cut expectations: some desired confirmation of the legitimacy and pertinence of their concerns about their relatives' memory problem, whereas others hoped to allay their concerns. Patients' dissatisfaction stemmed mostly from their perceptions of the process, communication, and outcome. Companions' dissatisfaction stemmed from lack of information or of tailored follow-up processes for implementing recommendations provided by the clinic. CONCLUSIONS Our findings expose two main issues challenging fulfillment of the different and frequently opposing expectations of patients and companions. The first is a consequence of the multi-participant nature of the encounter and the second relates to the character and severity of the disease itself. The discordance between the expectations of the two participants generates conflicts that interfere with meeting their diverse needs within the encounters - with consequent disappointment. The implications of these issues merit consideration in the planning of dementia management.
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Binder PE, Moltu C, Hummelsund D, Sagen SH, Holgersen H. Meeting an adult ally on the way out into the world: adolescent patients' experiences of useful psychotherapeutic ways of working at an age when independence really matters. Psychother Res 2011; 21:554-66. [PMID: 21732712 DOI: 10.1080/10503307.2011.587471] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The aim of this study was to explore how adolescents in ongoing psychotherapies prefer their therapists to interact with them when they are establishing a therapeutic bond. Semi-structured qualitative interviews were held with 14 patients. A hermeneutic-phenomenological approach was used to analyze interview transcripts. The participants' descriptions of important experiential dimensions in their interaction with their therapists clustered around five themes: the adolescents (1) feeling vulnerable and ambivalent in relationship with a potential helper when therapy started; the therapists (2) showed them that they were comfortable with being a therapist (3), strengthened their autonomy by establishing therapeutic boundaries, (4) showed that they recognized patients' individuality by respecting their personal boundaries, (5) helped them make their experiences understandable and meaningful, and (6) allowed mutuality and emotional closeness.
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Affiliation(s)
- Per-Einar Binder
- Centre for Child and Adolescent Mental Health, UniHealth, Box 7800, N-5020, Bergen, Norway.
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Marcus M, Westra H, Angus L, Kertes A. Client experiences of motivational interviewing for generalized anxiety disorder: a qualitative analysis. Psychother Res 2011; 21:447-61. [PMID: 21644188 DOI: 10.1080/10503307.2011.578265] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
While Motivational Interviewing (MI) has demonstrated efficacy, little is known about the mechanisms through which MI achieves beneficial effects or how clients perceive the process of MI. The present study addressed this gap through a qualitative analysis of client accounts following four sessions of MI for generalized anxiety disorder. Clients identified increased motivation for treatment and change, experiencing the therapist as empathic and MI as a safe place to explore their feelings regarding change. MI was also described as deviant from client initial expectations. Overall, the emergent understanding of MI derived from clients' post-treatment narratives was consistent with MI principles and processes.
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