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Lindqvist K, Mechler J, Midgley N, Carlbring P, Carstorp K, Neikter HK, Strid F, Von Below C, Philips B. "I didn't have to look her in the eyes"-participants' experiences of the therapeutic relationship in internet-based psychodynamic therapy for adolescent depression. Psychother Res 2024; 34:648-662. [PMID: 36473231 DOI: 10.1080/10503307.2022.2150583] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/09/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022] Open
Abstract
Objective: To explore young people's perceptions of the relationship with the therapist in internet-based psychodynamic treatment for adolescent depression.Method: As a part of a randomized controlled trial, 18 adolescents aged 15-19 were interviewed after participating in treatment. Interviews followed a semi-structured interview schedule and were analyzed using thematic analysis.Results: The findings are reported around four main themes: "a meaningful and significant relationship with someone who cared", "a helping relationship with someone who guided and motivated me through therapy"; "a relationship made safer and more open by the fact that we didn't have to meet" and "a nonsignificant relationship with someone I didn't really know and who didn't know me".Conclusion: Even when contact is entirely text-based, it is possible to form a close and significant relationship with a therapist in internet-based psychodynamic treatment. Clinicians need to monitor the relationship and seek to repair ruptures when they emerge.Trial registration: ISRCTN.org identifier: ISRCTN16206254..
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Affiliation(s)
- Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud Centre / University College London, UK
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | | | - Fredrik Strid
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Björn Philips
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Casari L, Areas M, Ison M, Gómez B, Roussos A, Consoli A, Gómez Penedo JM. Therapist's effect on children's therapeutic alliance: A naturalistic study. J Clin Psychol 2024; 80:207-222. [PMID: 37837638 DOI: 10.1002/jclp.23606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/11/2023] [Accepted: 09/30/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES The therapeutic alliance (TA) has been shown to be a predictor of psychotherapy treatment success. In the case of psychotherapy with children, there is a dearth of information on TA's role. The aims of the paper are: (1) To estimate the therapist effects on children TA; (2) to investigate if therapists' TA predicts children's TA; (3) to analyze if children's age and sex predict children's TA; (4) to evaluate if the therapist's characteristics predict children's TA. METHODS The sample consisted of 77 children undergoing psychotherapy in Argentina, and the therapists (N = 29) providing services to those children. The assessment tools utilized for the study included the Therapy Alliance Scale for Children and the Personal Style of the Therapist Questionnaire (PST-Q). RESULTS Findings indicated that 2% of the children's TA was explained by the therapists (ICC = 0.02), while 17% of the therapists' TA was explained by the therapists (ICC = 0.17). Therapists' TA predicted children's TA. Children's age and sex did not have an effect on their own TA. Moreover, therapists with more experience achieved higher scores of children's TA. Finally, the Operative dimension of the PST had a negative effect on children's TA (i.e., therapists who prefer more spontaneous interventions over structured ones may experience higher levels of therapeutic alliance with child patients). CONCLUSION We found a positive effect of the therapist's TA on children's TA, especially in the preference for using more spontaneous intervention techniques. We discuss the implications of the findings on the training of psychotherapists who provide services to children.
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Affiliation(s)
- Leandro Casari
- INCIHUSA, CONICET, Mendoza, Argentina
- Facultad de Humanidades y Ciencias Económicas, Pontificia Universidad Católica Argentina, Mendoza, Argentina
| | - Malenka Areas
- CONICET, Buenos Aires, Argentina
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Andrés Roussos
- IPEHCS, Universidad del Comahue/ CONICET, Bariloche, Argentina
| | - Andrés Consoli
- University of California, Santa Barbara, California, USA
| | - Juan Martín Gómez Penedo
- CONICET, Buenos Aires, Argentina
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina
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Midgley N, Mortimer R, Carter M, Casey P, Coffman L, Edbrooke-Childs J, Edridge C, Fonagy P, Gomes M, Kapoor A, Marks S, Martin P, Moltrecht B, Morris E, Pokorna N, McFarquhar T. Emotion regulation in children (ERiC): A protocol for a randomised clinical trial to evaluate the clinical and cost effectiveness of Mentalization Based Treatment (MBT) vs Treatment as Usual for school-age children with mixed emotional and behavioural difficulties. PLoS One 2023; 18:e0289503. [PMID: 37590277 PMCID: PMC10434917 DOI: 10.1371/journal.pone.0289503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The majority of children referred to Child and Adolescent Mental Health Services (CAMHS) in the UK will present with mixed emotional and behavioural difficulties, but most mental health treatments are developed for single disorders. There is a need for research on treatments that are helpful for these mixed difficulties, especially for school-age children. Emotion Regulation (ER) difficulties present across a wide range of mental health disorders and mentalizing may help with regulation. The ability to mentalize one's own experiences and those of others plays a key role in coping with stress, regulation of emotions, and the formation of stable relationships. Mentalization Based Therapy (MBT) is a well-evidenced therapy that aims to promote mentalization, which in turn increases ER capacities, leading to decreased emotional and behavioural difficulties. The aim of this study is to test the clinical- and cost-effectiveness of MBT compared to treatment as usual for school age children with emotional and behavioural difficulties. If effective, we hope this approach can become available to the growing number of children presenting to mental health services with a mix of emotional and behavioural difficulties. MATERIALS AND METHODS Children referred to CAMHS aged 6-12 with mixed mental health problems (emotional and behavioural) as primary problem can take part with their parent/carers. Children will be randomly allocated to receive either MBT or treatment as usual (TAU) within the CAMHS clinic they have been referred to. MBT will be 6-8 sessions offered fortnightly and can flexibly include different family members. TAU is likely to include CBT, parenting groups, and/or children's social skills groups. Parent/carers and children will be asked to complete outcome assessments (questionnaires and tasks) online at the start of treatment, mid treatment (8 weeks), end of treatment (16 weeks) and at follow up (40 weeks). TRIAL REGISTRATION Clinical trial registration: ISRCTN 11620914.
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Affiliation(s)
- Nick Midgley
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Rose Mortimer
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Mark Carter
- Barnet, Enfield and Haringey NHS Trust, United Kingdom
| | - Polly Casey
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | | | - Chloe Edridge
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Peter Fonagy
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | - Anoushka Kapoor
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | | | - Bettina Moltrecht
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Emma Morris
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Nikola Pokorna
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Tara McFarquhar
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
- University of East Anglia, Norwich, United Kingdom
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Roest JJ, Welmers-Van de Poll MJ, Van der Helm GHP, Stams GJJM, Hoeve M. A Meta-Analysis on Differences and Associations between Alliance Ratings in Child and Adolescent Psychotherapy. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:55-73. [PMID: 35862768 DOI: 10.1080/15374416.2022.2093210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The alliance in child and adolescent psychotherapy is widely recognized as an important factor in therapy. Studies on the alliance have increasingly focused on assessment of the alliance as a dyadic construct, measuring both client and therapist alliance ratings. However, cross-informant reports of the alliance in child psychotherapy have not yet been subjected to meta-analysis. Therefore, the present meta-analysis aims to increase knowledge on the degree of convergence and divergence between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. METHODS A series of three-level meta-analyses of 78 studies was conducted to investigate differences and associations between child, parent, therapist, and observer alliance ratings in child and adolescent psychotherapy. RESULTS Findings indicated that children and parents in general rated the alliance more positively than their therapists (d = 0.35, d = 0.72, respectively), and that child-therapist and parent-therapist alliance ratings were moderately correlated (r = .32, r = .23, respectively). Associations between child and therapist ratings and observer ratings were moderate to large (r = .43, r = .53, respectively). CONCLUSIONS It can be concluded that children and parents generally report more positively on the alliance compared to their therapists, which is consistent with research on the alliance in adult populations. The small to moderate associations between alliance ratings indicate that individuals to some extent have a shared perspective on their alliance, and that the various perspectives on alliance should be acknowledged when dealing with children and parents in therapy. Implications for future research are discussed.
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Affiliation(s)
- Jesse J Roest
- Department of Social Work and Applied Psychology, University of Applied Sciences Leiden
| | | | - G H Peer Van der Helm
- Department of Social Work and Applied Psychology, University of Applied Sciences Leiden.,Research Institute Child Development and Education, University of Amsterdam
| | | | - Machteld Hoeve
- Research Institute Child Development and Education, University of Amsterdam
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Gabriel-Vacher N, Miranda I, Olhaberry M, Capella C, Morán-Kneer J, Núñez L, Alamo N, Meza C. The adverse childhood experiences of caregivers of children who have been victims of sexual assault: their relationship with the parental alliance in child psychotherapy ( Experiencias adversas tempranas de cuidadores de niños/as que han sido víctimas de agresiones sexuales: su relación con la alianza parental en la psicoterapia infantil). STUDIES IN PSYCHOLOGY 2022. [DOI: 10.1080/02109395.2022.2139347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Fernández O, Altimir C, Reinel M, Duarte J, Krause M. “I am strong and I can get on with my life”: The subjective experience of recovery of patients treated for depression. Psychother Res 2022; 33:625-639. [DOI: 10.1080/10503307.2022.2147035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Olga Fernández
- Instituto Milenio para la Investigación de la Depresión y la Personalidad (MIDAP), Universidad de Chile, Santiago de Chile, Chile
| | - Carolina Altimir
- Instituto Milenio para la Investigación de la Depresión y la Personalidad (MIDAP), Universidad Alberto Hurtado, Santiago, Chile
| | - Mahaira Reinel
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Doctorado en Psicoterapia, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Duarte
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Center of Studies in Clinical Psychology and Psychotherapy, Universidad Diego Portales (CEPPS-UDP), Santiago, Chile
| | - Mariane Krause
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Pontificia Universidad Católica de Chile, Santiago, Chile
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Núñez L, Capella C, Midgley N, Krause M. The therapeutic relationship as a change mechanism in child psychotherapy: a qualitative study of children, parents’, and therapists’ views in different moments of the process ( La relación terapéutica como un mecanismo de cambio en la psicoterapia infantil: un estudio cualitativo de las perspectivas de niño/as, padres, y terapeutas en diferentes momentos del proceso). STUDIES IN PSYCHOLOGY 2022. [DOI: 10.1080/02109395.2022.2127233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | | | - Nick Midgley
- Anna Freud National Centre for Children and Families
- University College London
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8
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Nuñez L, Fernández S, Alamo N, Midgley N, Capella C, Krause M. The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists. RESEARCH IN PSYCHOTHERAPY: PSYCHOPATHOLOGY, PROCESS AND OUTCOME 2022; 25. [PMID: 35373965 PMCID: PMC9153753 DOI: 10.4081/ripppo.2022.556] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022]
Abstract
Through the perspectives of children, parents and therapists, this study explored the therapeutic relationship as a change facilitator in different moments of psychotherapy. The children, parents, and therapists (N=15) who formed part of five therapeutic treatments were studied using a qualitative, longitudinal design. Thirty semi-structured interviews were done; half at the beginning and half after four months of psychotherapy. Children’s drawings were incorporated, and data were analysed through grounded theory methods and qualitative analysis guidelines for drawings. Participants identified several aspects of the therapeutic relationship as change facilitators. From the first encounters, the therapists’ close and adaptable attitude promoted an improved motivation for psychotherapy and enhanced engagement among children and parents. Later in the process, a positive, child-centred and affective therapeutic relationship fostered the child’s trust with the therapist as well as a positive relational experience, promoting associated changes in children and the development of socio-affective tools. Parents and therapists saw their own relationship as a change facilitator, as well as a broader understanding in parents of their children and an improved relationship with them. Parent’s and child’s changes helped each other. Specific and common aspects between participants’ perspectives provided a richer understanding of the studied phenomena. This study supports the view that a positive therapeutic relationship facilitates early changes in the motivation of children and parents, and provides them with a healing, relational experience as it develops. A positive parent-therapist relationship is also key for changes to further progress.
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Gilson ML, Abela A. The Therapeutic Alliance with Parents and their Children Working Through a Relational Trauma in the Family. CONTEMPORARY FAMILY THERAPY 2021; 43:343-358. [PMID: 34690425 PMCID: PMC8524226 DOI: 10.1007/s10591-021-09607-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 12/04/2022]
Abstract
This study is about how a therapeutic alliance is created and maintained with parents and their children working through a relational trauma. A case study design with narrative analysis as a method of research (Riessman, 2008) and a narrative approach of storying stories, inspired by McCormack (2000), is used. The participants of this study are the parents and their four children, aged between 14 and 5 years, and their systemic therapist. Rich data on the therapeutic alliance is gathered through, two live-family session observations and seven interviews, six of which were with the family members, and a two-part interview held with their therapist. Results show that the way of being of the therapist, including her ability to be intuitive and self-reflexive, and her ability to keep manoeuvrability in conversation and hold neutrality support her to connect with all the family. Creating conjoint and separate therapeutic spaces, using a creative play-based approach and navigating an alliance with the school and medical professionals, were important suggestions for practice in the field. Additionally, collaborating with parents, and balancing the benefits and drawbacks of involving children to make therapy meaningful for all, are also suggested. Specific recommendations for engagement with siblings of the identified-problem child are elicited. The strength of this study is that children’s voices, along with those of their parents’ and their systemic therapist are reported. Suggestions for practice to support children and their families who are working through a relational trauma are brought forward.
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Affiliation(s)
| | - Angela Abela
- Department of Family Studies, University of Malta, Msida, Malta
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