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Zimney KJ, Puentedura E, Kolber MJ, Louw A. The correlation of trust as part of the therapeutic alliance in physical therapy and their relation to outcomes for patients with chronic low back pain. Physiother Theory Pract 2024:1-8. [PMID: 38578206 DOI: 10.1080/09593985.2024.2338428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/28/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Previous qualitative research has listed trust as a component of the therapeutic alliance in physical therapy. OBJECTIVE Quantitatively correlate trust and therapeutic alliance in physical therapy care for patients with chronic low back pain. The secondary aim was to investigate the relation of trust and therapeutic alliance with outcomes over the course of treatment. METHODS The Primary Care Assessment Survey was used to measure trust and the Working Alliance Inventory-Short Revised tool measured therapeutic alliance. The patient recorded these measures after the initial visit and at discharge. Self-report patient outcome measures for pain, function, and global rating of change were also measured at the same time points. RESULTS A strong correlation (rs = 0.747 and rs = 0.801) was found between trust scores and therapeutic alliance measures post-initial visit and at discharge, respectively. In addition, there were moderate to strong correlations between trust and therapeutic alliance scores with the various improved outcome measures of pain, function, and global rating of change. CONCLUSION There appears to be a connection between trust and therapeutic alliance along with improved patient outcomes related to higher trust and therapeutic alliance scores in a cohort with chronic low back pain.
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Affiliation(s)
- Kory J Zimney
- Department of Physical Therapy, University of South Dakota, Vermillion, SD, USA
| | | | - Morey J Kolber
- Department of Physical Therapy, Nova Southeastern University, Fort Lauderdale, FL, USA
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Bell SG, Althouse AD, Belin SC, Arnold RM, Smith KJ, White DB, Chu E, Schenker Y, Thomas TH. Associations of Health Care Utilization and Therapeutic Alliance in Patients with Advanced Cancer. J Palliat Med 2024; 27:515-520. [PMID: 38574330 DOI: 10.1089/jpm.2023.0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
Introduction: Therapeutic alliance (TA), or the extent to which patients feel a sense of caring and trust with their physician, may have an impact on health care utilization. We sought to determine if TA is associated with: (1) emergency department (ED) visits within 30 days of death and (2) hospice enrollment. Methods and Materials: This is a secondary analysis of data from a randomized clinical trial. We used restricted cubic splines to assess the relationship between TA scores and health care utilization. Results: Six hundred seventy-two patients were enrolled in the study, with 331 (49.3%) dying within 12 months. Patients with higher TA were less likely to have an ED visit in the last 30 days of life, but there was no evidence of a relationship between TA and enrollment in hospice. Conclusions: Higher TA was associated with decreased ED visits within 30 days of death. There was no association between TA and rates of hospice enrollment. Clinical Registration Number: NCT02712229.
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Affiliation(s)
- Sarah G Bell
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Andrew D Althouse
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shane C Belin
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert M Arnold
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth J Smith
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Douglas B White
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Edward Chu
- Department of Oncology, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Yael Schenker
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Teresa H Thomas
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Zugai JS, Gill K, Molloy L, Raeburn T, Ramjan L. The focus on weight in the inpatient care of anorexia nervosa: A qualitative investigation of consumer perspectives. Int J Ment Health Nurs 2024; 33:388-396. [PMID: 37837243 DOI: 10.1111/inm.13242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023]
Abstract
Anorexia nervosa has a high mortality rate and is often treated in the inpatient setting, where close monitoring and medical support are available. Consistent with objective biomedical benchmarks, conventional inpatient treatment is often focussed on weight gain. Consumers report that clinicians provide care focussed on weight and physical restoration without adequate consideration of their full spectrum of needs. The aim of this study was to explore consumers' perspectives of the biomedical focus on weight gain in the inpatient care of anorexia nervosa. This study employed a qualitative approach, involving semistructured interviews, and participants were recruited from relevant social media communities. This study was ethically approved by a university ethics committee and the COREQ checklist ensured ethical reporting. Ten women participated in interviews. Participants reported that the biomedical imperative of weight gain is focussed on at the exclusion of other relevant determinants of well-being, and the narrow focus on weight gain does not suitably prepare consumers for discharge. The conflict between clinicians' biomedical focus and consumers' broader unmet needs leads to harmful interpersonal dynamics and feelings of invalidation. The inpatient care of anorexia nervosa needs to develop beyond biomedically driven objectives and incorporate the merits of an approach that substantively integrates person-centred care, therapeutic relationships and trauma-informed principles.
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Affiliation(s)
- Joel Sebastian Zugai
- School of Nursing, University of Wollongong, Liverpool, New South Wales, Australia
| | - Katherine Gill
- Consumer Led Research Network, the University of Sydney, Sydney, New South Wales, Australia
| | - Luke Molloy
- School of Nursing, University of Wollongong, Liverpool, New South Wales, Australia
| | - Toby Raeburn
- School of Nursing and Midwifery, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Lucie Ramjan
- School of Nursing, University of Wollongong, Liverpool, New South Wales, Australia
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
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Hassan H, Lack S, Salkovskis PM, Thew GR. Acknowledging religion in cognitive behavioural therapy: The effect on alliance, treatment expectations and credibility in a video-vignette study. Br J Clin Psychol 2024. [PMID: 38528321 DOI: 10.1111/bjc.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/07/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES Developing mental health services which are accessible and acceptable to those from minority backgrounds continues to be a priority. In the United Kingdom, individuals who identify with a religion are underrepresented in Talking Therapies services as compared to those with no religion. This necessitates an understanding of how therapy is perceived. This online study explored the impact of explicitly acknowledging religion on anticipated alliance, treatment credibility and expectations of therapy in a non-clinical sample of British Muslims. METHODS A video-vignette experimental design was used in which participants who self-reported as either high or low in religiosity were randomly allocated to receiving information about cognitive behavioural therapy either with or without an explicit mention of religion as a value in the therapeutic process. RESULTS One hundred twenty-nine British Muslim adults aged 18-70+ years from various ethnic backgrounds participated in the study. Between-subjects ANOVAs showed that scores on the perceived credibility of therapy and treatment expectations were significantly higher when religion was explicitly mentioned by the 'therapist', but that acknowledging religion did not impact upon anticipated alliance. CONCLUSIONS These findings suggest that mentioning religion as a value to be considered in therapy has some positive impacts upon how therapy is perceived by British Muslims. Although video vignettes do not provide insight into the complexity of actual therapeutic encounters, acknowledging religion in mental health services more broadly remains an important consideration for improving equity of access and may bear relevance to other minoritized groups.
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Affiliation(s)
- Hibah Hassan
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sarah Lack
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Paul M Salkovskis
- The Oxford Institute of Clinical Psychology Training and Research, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Graham R Thew
- Oxford Health NHS Foundation Trust, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Gumz A, Daubmann A, Erices R, Berger J, Reuter L, Kästner D. Associations between therapists' verbal techniques and patient-rated therapeutic alliance, insight, and problem solving. Psychother Res 2024:1-12. [PMID: 38527181 DOI: 10.1080/10503307.2024.2327443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/04/2024] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To investigate associations between common factors (alliance, insight, problem solving) and therapists' techniques. We expected a positive association between (1) supportive techniques and the alliance, (2) interpretative techniques and insight, and (3) a stronger association between interpretative techniques and insight for patients with more severe baseline symptoms. Other associations were analyzed in an exploratory way. METHOD Sixty sessions from 15 adult female patients diagnosed with personality disorder were analyzed using the Psychodynamic Interventions List (verbal techniques, observer-rated transcripts), and the Session Questionnaire for General and Differential Individual Psychotherapy (common factors, patient-rated after each session). Multilevel modeling was applied. RESULTS A greater use of supportive techniques was related to a higher therapeutic alliance (b = .28, 95% CI: .01-.55, p = .042). Neither the positive association between interpretative techniques and insight nor the moderating effect of baseline symptom severity could be confirmed. Exploratory analyses revealed associations between problem-solving and different verbal techniques. CONCLUSION Therapists' use of supportive techniques seems to influence the therapeutic alliance positively in patients with personality disorders. The effect of interpretative techniques might depend on other factors like patient characteristics. In general, there seem to be differential and specific associations between different therapists' verbal techniques and common factors.
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Affiliation(s)
- Antje Gumz
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Erices
- Institute for History of Medicine and Medical Ethics, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Erlangen, Germany
| | - Jelka Berger
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Laurence Reuter
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| | - Denise Kästner
- Department of Psychosomatics and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
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Friedlander A, Sinai D, Zilcha-Mano S, Weiser M, Caspi A, Lichtenberg P, Amitai Z, Tzur Bitan D. Development of the Therapeutic Alliance in Alternative Settings to Psychiatric Hospitalization: An Open Comparative Study. Psychiatr Serv 2024:appips20230009. [PMID: 38500450 DOI: 10.1176/appi.ps.20230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Patient-therapist alliance in two alternative treatment settings developed similarly to that in traditional psychiatric hospitalization.
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Affiliation(s)
- Avraham Friedlander
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Dana Sinai
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Sigal Zilcha-Mano
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Mark Weiser
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Asaf Caspi
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Pesach Lichtenberg
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Ziv Amitai
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
| | - Dana Tzur Bitan
- Department of Behavioral Sciences, Ariel University, Ariel, Israel (Friedlander); Drora and Pinchas Zachai Division of Psychiatry, Sheba Medical Center, Ramat Gan, Israel (Friedlander, Weiser, Caspi, Amitai); Ramat-Chen Brüll Mental Health Center, Tel Aviv District, Clalit Health Services Community Division, Tel Aviv, Israel (Sinai); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Sinai); Departments of Psychology (Zilcha-Mano) and Community Mental Health (Tzur Bitan), University of Haifa, Haifa, Israel; Department of Psychiatry, Tel Aviv University, Faculty of Medicine, Tel Aviv, Israel (Weiser, Amitai); Soteria Israel, Jerusalem Mental Health Center, and Department of Psychiatry, Hebrew University of Jerusalem, Jerusalem (Lichtenberg); Shalvata Mental Health Center, Hod Hasharon, Israel (Tzur Bitan)
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Lo Coco G, Brugnera A, Salerno L, Compare A, Tasca GA, Kivlighan DM. Group member attachment style interacts with actor and partner helping alliance to predict decreasing binge eating episodes. Psychother Res 2024:1-15. [PMID: 38451851 DOI: 10.1080/10503307.2024.2325509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE An individual's attachment style may impact how they interact with their therapy group. This study examined the moderating role of a group member's attachment on the dynamic relationships between that group member's (actor) and other group members' (partner) therapeutic alliances and symptom outcomes. Method: This is a secondary analysis of data from a trial testing the outcome of emotionally-focused group therapy for binge-eating disorder. The sample consisted of 2,360 sessions nested within 118 group members who attended a 20-session treatment. Patients recorded binge eating episodes (BEE), their body weight and an alliance measure session-by-session. RESULTS Dynamic structural equation modelling showed decreases in BEE and weight over the therapy. When attachment style was not included in the model, higher-than-average partner's alliance scores in the previous session were related to decreases in BEE in the current session. Attachment style moderated these actor and partner effects. For patients with preoccupied attachments, higher-than-average actor alliance in the previous session was related to subsequent decreases in BEE. For patients with dismissing or disorganized attachments, higher partner alliance in the previous session was related to subsequent decreases in BEE. CONCLUSION Group members' attachment characteristics can play a role in the development of alliance-outcome patterns in group therapy.
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Ellenbogen MA, Cardoso C, Serravalle L, Vadaga K, Joober R. The effects of intranasal oxytocin on the efficacy of psychotherapy for major depressive disorder: a pilot randomized controlled trial. Psychol Med 2024:1-11. [PMID: 38445382 DOI: 10.1017/s0033291724000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
BACKGROUND Although both pharmacotherapy and psychological treatments are considered to be efficacious in the treatment of major depressive disorder (MDD), one third of patients do not respond to treatment and many experience residual symptoms post-treatment. In this double-blind placebo-controlled randomized control trial (RCT), we assessed whether intranasal oxytocin (OT) augments the therapeutic efficacy of psychotherapy for MDD and improves the therapeutic alliance. METHODS Twenty-three volunteers (12 female) with MDD underwent 16 sessions of interpersonal therapy. Prior to each session, volunteers self-administered 24 International Units of intranasal OT (n = 12; Syntocinon) or placebo (n = 11). Depressive symptoms were assessed with the Inventory of Depressive Symptomatology at pre- and post-treatment, and at a six month follow-up. RESULTS Multilevel modeling found a significant effect of OT on the negative slope of depressive symptoms over time (p < 0.05), with medium-large effect sizes at post-treatment (Cohen's d = 0.75) and follow-up (Cohen's d = 0.82). Drug intervention also predicted the intercept when examining the weekly ratings of the therapeutic alliance (p < 0.05), such that volunteers receiving OT, relative to placebo, reported improved therapeutic alliance at session 1. The agreement of goals between therapists and participants, a facet of the therapeutic alliance, mediated the relationship between drug intervention and clinical outcome. CONCLUSION In this pilot study, the administration of intranasal OT, relative to placebo, improved the therapeutic alliance at the beginning of therapy and therapeutic efficacy of psychotherapy in persons with MDD. Future RCTs should attempt to replicate these findings in larger samples with different therapeutic modalities (ClinicalTrials.gov: NCT02405715).
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Affiliation(s)
- Mark A Ellenbogen
- Centre for Research in Human Development, Department of Psychology, Concordia University, Montréal, Canada
| | - Christopher Cardoso
- Centre for Research in Human Development, Department of Psychology, Concordia University, Montréal, Canada
| | - Lisa Serravalle
- Centre for Research in Human Development, Department of Psychology, Concordia University, Montréal, Canada
| | - Kiran Vadaga
- Centre for Research in Human Development, Department of Psychology, Concordia University, Montréal, Canada
| | - Ridha Joober
- The Douglas Research Centre, Department of Psychiatry, McGill University, Montréal, Canada
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Tal S, Ben-David Sela T, Dolev-Amit T, Hel-Or H, Zilcha-Mano S. Reactivity and stability in facial expressions as an indicator of therapeutic alliance strength. Psychother Res 2024:1-15. [PMID: 38442022 DOI: 10.1080/10503307.2024.2311777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/22/2024] [Indexed: 03/07/2024] Open
Abstract
Objective: Aspects of our emotional state are constantly being broadcast via our facial expressions. Psychotherapeutic theories highlight the importance of emotional dynamics between patients and therapists for an effective therapeutic relationship. Two emotional dynamics suggested by the literature are emotional reactivity (i.e., when one person is reacting to the other) and emotional stability (i.e., when a person has a tendency to remain in a given emotional state). Yet, little is known empirically about the association between these dynamics and the therapeutic alliance. This study investigates the association between the therapeutic alliance and the emotional dynamics of reactivity and stability, as manifested in the facial expressions of patients and therapists within the session. Methods: Ninety-four patients with major depressive disorder underwent short-term treatment for depression (N = 1256 sessions). Results: Both therapist reactivity and stability were associated with the alliance, across all time spans. Patient reactivity was associated with the alliance only in a short time span (1 s). Conclusions: These findings may potentially guide therapists in the field to attenuate not only their emotional reaction to their patients, but also their own unique presence in the therapy room.
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Affiliation(s)
- Shachaf Tal
- Department of Psychology, University of Haifa, Haifa, Israel
| | | | | | - Hagit Hel-Or
- Department of Computer Science, University of Haifa, Haifa, Israel
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Abstract
Addictions are invading our daily lives. Eating and body image have become major preoccupations. Anorexia nervosa and bulimia nervosa are eating disorders with a high risk of chronicity and death. Curing them and preventing their recurrence requires a solid therapeutic alliance that aims to work around individual symptoms. The low self-esteem associated with these disorders may contribute to their maintenance, despite their negative impact on quality of life. One of the challenges of treating these disorders is to help patients find the motivation to seek treatment.
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Affiliation(s)
- Nadine Satori
- Unité spécialisée dans les troubles du comportement alimentaire, Service du Pr Philip Gorwood, GHU Paris psychiatrie et neurosciences, 1 rue Cabanis, 75014 Paris, France.
| | - Margot Domer
- Unité spécialisée dans les troubles du comportement alimentaire, Service du Pr Philip Gorwood, GHU Paris psychiatrie et neurosciences, 1 rue Cabanis, 75014 Paris, France
| | - Julia Clarke
- Unité spécialisée dans les troubles du comportement alimentaire, Service du Pr Philip Gorwood, GHU Paris psychiatrie et neurosciences, 1 rue Cabanis, 75014 Paris, France
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Fjeldheim H, Werner A, Anke T, Moe V, Norheim HS, Aalberg M. Parenting the parent without losing sight of the child. A qualitative study of therapists' experiences with intergenerational adversities in perinatal psychotherapy. Infant Ment Health J 2024; 45:201-216. [PMID: 38272852 DOI: 10.1002/imhj.22100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 10/22/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024]
Abstract
The complex work of addressing intergenerational adversities, like violence, abuse, and neglect through perinatal psychotherapy, is understudied. Especially noticeable is the paucity of studies giving voice to the therapists. This study explored therapeutic processes through the perspectives of seven Norwegian therapists. A qualitative approach was chosen with individual interviews and a follow-up focus group. Data were analyzed using reflexive thematic analysis. We identified one overarching theme: To maintain a reflective therapeutic capacity, and two main themes with associated subthemes: 1) Alliance work when a caring system comes to therapy to fight generations of adversities and 2) The complex therapeutic work of addressing generational adversities in perinatal psychotherapy. Findings from the present study indicate that maintaining a reflective stance is essential yet challenging when addressing intergenerational adversities, requiring a holding environment for the therapists. The primary vehicle of change was perceived as a safe enough therapeutic alliance to explore new ways of being together, contrasting earlier experiences. A key question raised was how to give caregivers enough time to trust the therapist without compromising the safety and development of the child. The essence of the therapeutic work was to reduce risk factors and increase protective factors through multiple ports of entry.
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Affiliation(s)
- Heidi Fjeldheim
- Akershus University Hospital and Faculty of Psychology, University of Oslo, Oslo, Norway
| | - Anne Werner
- HØKH - Health Services Research Unit, Akershus University Hospital, Nordbyhagen, Norway
| | - Teija Anke
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Vibeke Moe
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Marianne Aalberg
- Division of Mental Health Services, Akershus University Hospital, Nordbyhagen, Norway
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Shinno S, Matsumoto K, Hamatani S, Inaba Y, Ozawa Y, Kawasaki Y, Ikai T, Sutoh C, Hayashi H, Shimizu E. Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial. JMIR Form Res 2024; 8:e53659. [PMID: 38421717 PMCID: PMC10940979 DOI: 10.2196/53659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/25/2024] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is effective in treating anxiety disorders. Accessibility to CBT has been limited in Japan due to the shortage of therapists. While an open-source e-learning system can be used to create a simple internet-based cognitive behavioral therapy (ICBT) program, the safety and outpatient acceptance of this treatment approach have not been explored in Japan. OBJECTIVE The aim of this study was to investigate whether outpatients with anxiety disorders could accept and successfully complete the ICBT program with guidance by CBT therapists when implementing therapeutic modules and CBT tasks. Due to being in the initial phase of a novel treatment in Japan, this study was intended for verification with a small sample size. METHODS In total, 6 adults, including 4 male participants and 2 female participants, were enrolled in a single-arm trial. The intervention involved guided ICBT comprising 12 sessions, including CBT text, comprehension confirmation tests, and explanatory videos about cognitive behavioral models, accessible through a website. The therapist guided the participants in accessing the ICBT program and answering their questions using a chat tool. The primary outcome was anxiety severity assessed using the State-Trait Anxiety Inventory-Trait. Secondary outcomes included the Panic Disorder Severity Scale, Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Working Alliance Inventory-Short Form (WAI-SF). Statistical analyses were performed using paired 2-tailed t tests to assess the changes in clinical symptoms. The total WAI-SF score at the final session was used to evaluate the therapeutic alliance. For statistical analyses, mean changes for total State-Trait Anxiety Inventory-Trait, BAI, Panic Disorder Severity Scale, LSAS, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7 scores were analyzed using the paired 2-tailed t test. The 2-sided significance level for hypothesis testing was set at 5%, and 2-sided 95% CIs were calculated. RESULTS Most participants diligently engaged with the ICBT program. No adverse events were reported. The mean total scores for the primary outcome decreased by 11.0 (SD 9.6) points (95% CI -22.2 to 0.20; Hedges g=0.95), but it was not statistically significant. The mean total scores for the secondary outcomes that assess clinical symptoms decreased, with a significant reduction observed in the BAI of 15.7 (SD 12.1) points (95% CI -28.4 to -3.0; P=.03; Hedges g=1.24). The mean total scores for PDSS and LSAS decreased significantly, by 12.0 (SD 4.24) points (95% CI -50.1 to 26.1; P=.16; Hedges g=1.79) and 32.4 (SD 11.1) points (95% CI -59.7 to -4.3; P=.04; Hedges g=1.38), respectively. Of the participants, 67% (n=4) showed treatment response, and 50% (n=3) achieved remission after the intervention. The therapeutic alliance, measured using the WAI-SF, was moderate. CONCLUSIONS Guided ICBT may be feasible for the treatment of outpatients with panic disorder and social anxiety disorder in Japan. TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry UMIN0000038118; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043439.
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Affiliation(s)
- Seina Shinno
- Department of Integrated Medical Sciences, Graduate School of Medicine, University of Fukui, Fukui, Japan
| | - Kazuki Matsumoto
- Division of Clinical Psychology, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Yosuke Inaba
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yoshihito Ozawa
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Tomoki Ikai
- Faculty of Medical Sciences, Division of Medicine Primary Health Care, University of Fukui, Fukui, Japan
| | - Chihiro Sutoh
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
| | - Hiroyuki Hayashi
- Department of Integrated Medical Sciences, Graduate School of Medicine, University of Fukui, Fukui, Japan
- Department of Emergency and General Medicine, Fukui University Hospital, Fukui, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Di Padova M, Pettoello-Mantovani M, Giardino I, Dipace A. Educational Continuity: The Importance of Expanding School Programs in Hospital Settings. J Pediatr 2024:113958. [PMID: 38365001 DOI: 10.1016/j.jpeds.2024.113958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/11/2024] [Indexed: 02/18/2024]
Affiliation(s)
- Marilena Di Padova
- Department of Humanities, Letters, Cultural Heritage and Educational Studies, University of Foggia, Foggia, Italy
| | - Massimo Pettoello-Mantovani
- European Pediatric Association/Union of National European Pediatric Societies and Associations (EPA/UNEPSA), Berlin, Germany; Italian Academy of Pediatrics, Milan, Italy; Chair of Pediatrics, Institute for Scientific Research Casa Sollievo, University of Foggia, Foggia, Italy.
| | - Ida Giardino
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Anna Dipace
- Department of Psychology and Education of Pegaso University, Naples, Italy
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Chammas D, Brenner KO, Gamble A, Buxton D, Byrne-Martelli S, Polisso M, Shalev D, Rosenberg LB. Top Ten Tips Palliative Care Clinicians Should Know About the Psychological Aspects of Palliative Care Encounters. J Palliat Med 2024; 27:251-254. [PMID: 37449809 DOI: 10.1089/jpm.2023.0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Palliative care clinicians enhance the illness experiences of patients and their families through building therapeutic relationships. Many psychological concepts underlie a clinician's approach to a specific patient. Through high-yield tips, this article highlights ten selected psychological elements that palliative care clinicians often use to support patients. As we all (both clinicians and patients) bring our own histories and unique biographies to the work of palliative care, a more explicit focus on the psychological aspects of this work can enhance our own experience and efficacy as providers. With a thoughtful focus on the psychological aspects of how we engage with patients, palliative care clinicians can offer a more meaningful therapeutic encounter.
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Affiliation(s)
- Danielle Chammas
- Department of Medicine, Division of Palliative Medicine, University of California San Francisco, San Francisco, California, USA
| | - Keri O Brenner
- Department of Medicine, Section of Palliative Care, Stanford University School of Medicine, Stanford, California, USA
| | - Alexander Gamble
- Department of Medicine, Section of Palliative Care, Stanford University School of Medicine, Stanford, California, USA
| | - David Buxton
- Palliative Medicine AdventHealth, Orlando, Florida, USA
| | - Sarah Byrne-Martelli
- Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Mike Polisso
- Department of Social Work and Case Management, Palliative Medicine, Stanford Health Care, Stanford, California, USA
| | - Daniel Shalev
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Leah B Rosenberg
- Department of Medicine, Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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Elran-Barak R, Grundman-Shem Tov R, Zubery E, Lewis YD. Therapeutic alliance with psychotherapist versus dietician: a pilot study of eating disorder treatment in a multidisciplinary team during the COVID-19 pandemic. Front Psychiatry 2024; 14:1267676. [PMID: 38348361 PMCID: PMC10860050 DOI: 10.3389/fpsyt.2023.1267676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/07/2023] [Indexed: 02/15/2024] Open
Abstract
Little is known about the therapeutic alliance (TA) formed with different professionals in multidisciplinary eating disorder (ED) treatment, particularly in the context of online treatment during the COVID-19 pandemic. We aimed to conduct a pilot study during the COVID-19 pandemic examining characteristics of patients' TA with their dieticians and psychotherapists, associations between patients' and therapists' views of the TA, and relationships between psychological characteristics and TAs. Sixty-three patients with EDs and their treating psychotherapists and dieticians were surveyed during the COVID-19 pandemic using the Working Alliance Inventory (WAI-S). Spearman correlation tests were used to examine associations between variables. Positive associations were found between the TAs examined. Concordance was stronger in patient-dietician dyads than in patient-psychotherapist dyads. Severe ED psychopathology was associated with weaker TA (bond subscale). General psychopathology was associated with weaker TA with the dietician (task subscale). Given that several differences were found between the TAs of treatment dyads, further longitudinal studies are needed to validate our pilot findings and to investigate multidisciplinary TAs and their impact on treatment outcomes in online ED treatment settings during the COVID-19 pandemic, as well as in other treatment settings (e.g., in-person settings). This study will contribute to a deeper understanding of the dynamics of TAs in multidisciplinary ED treatment and inform the development of more effective interventions.
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Affiliation(s)
| | - Rinat Grundman-Shem Tov
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Eynat Zubery
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel
| | - Yael D. Lewis
- Hadarim Eating Disorders Treatment Center, Shalvata Mental Health Center, Hod Hasharon, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tolchin DW, Rushin C, Tolchin B, Slocum C, Meyerson JL, Havercamp SM, Keeney T, Schwartz AW, Schaefer K, Ross M, Stein MA, Jones CA, Rosa WE, Brooks FA. Top Ten Tips Palliative Care Clinicians Should Know About Providing Care for People With Disabilities. J Palliat Med 2024. [PMID: 38232708 DOI: 10.1089/jpm.2023.0662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Palliative care (PC) clinicians are well poised to help people with disabilities (PWD) live well in the context of serious illness. PC prioritizes person-centered care with a focus on function, autonomy, and quality of life. This approach aligns with principles of high-quality care for PWD. An understanding of the unique experiences and needs of PWD can advance the delivery of comprehensive, equitable PC for this population. In this article, we provide 10 tips to help PC clinicians develop an informed disability lens in their approach to care.
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Affiliation(s)
- Dorothy W Tolchin
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/MassGeneral Brigham/Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ben Tolchin
- Center for Clinical Ethics, Yale New Haven Health, New Haven, Connecticut, USA
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chloe Slocum
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/MassGeneral Brigham/Harvard Medical School, Boston, Massachusetts, USA
| | - Jordana L Meyerson
- Harvard Medical School, Boston, Massachusetts, USA
- Section of Geriatrics and Palliative Care, Department of Medicine, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
| | | | - Tamra Keeney
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea W Schwartz
- Harvard Medical School, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, Boston Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kristen Schaefer
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Care Dimensions Hospice, Danvers, Massachusetts, USA
| | - Melissa Ross
- Ross Psychotherapy, Arlington, Massachusetts, USA
| | - Michael A Stein
- Harvard Law School, Cambridge, Massachusetts, USA
- Harvard Law School Project on Disability, Cambridge, Massachusetts, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Forrest A Brooks
- Department of Medicine, Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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de Beaurepaire R, Jaury P. Baclofen in the treatment of alcohol use disorder: tailored doses matter. Alcohol Alcohol 2024; 59:agad090. [PMID: 38266071 PMCID: PMC10807704 DOI: 10.1093/alcalc/agad090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/03/2023] [Accepted: 12/16/2023] [Indexed: 01/26/2024] Open
Abstract
AIMS To address the question of tailored baclofen prescribing in alcohol use disorder (AUD) in relation to dose-dependent efficacy and the potential danger of high doses and to provide suggestions for the use of high doses of baclofen in the treatment of AUD. The context is the approvement in France of baclofen in the treatment of AUD without dose limitation, making French physicians, who usually prescribe baclofen in a tailored manner, often use high or very high doses. METHODS A narrative review of the results of randomized controlled trials (RCTs) and observational studies that used tailored baclofen prescribing and of the severe adverse effects of baclofen that have been reported in the literature. RESULTS The results show that RCTs using tailored doses of baclofen in AUD are not completely demonstrative, though they are encouraging according to certain meta-analyses, while observational studies that used tailored doses constantly show a good effectiveness of baclofen treatment. The results suggest that many severe adverse effects of baclofen could be related to a nonrespect by physicians of prescription rules and appropriate treatment monitoring. CONCLUSIONS The use of tailored doses shows that the dose required to suppress cravings is highly variable, low or high, depending on each case. Analysis of the circumstances in which severe adverse effects occur suggest that a careful monitoring of baclofen prescribing might prevent a large majority of severe adverse effects. We propose that the education of the patients and the prescription skills, seriousness, and availability of the prescribing physicians are of major importance in the managing of tailored baclofen treatment of AUD.
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Affiliation(s)
- Renaud de Beaurepaire
- Renaud de Beaurepaire, GH Paul-Guiraud, 54 Avenue de La République, 94806 Villejuif, France
| | - Philippe Jaury
- Faculté de Médecine, Université Paris Cité, Paris, France
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18
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Naganuma K, Oe M, Ishida T, Kobayashi Y, Chiba H, Matsuoka M, Ozone M. Visual Assessment of Therapeutic Relationships in Psychiatric Patients: A Pilot Study Using the Pictorial Representation of Illness and Self Measure. Kurume Med J 2024:MS6934005. [PMID: 38233184 DOI: 10.2739/kurumemedj.ms6934005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND Although the therapeutic relationship (or 'alliance') is well known to be a key component of psychiatric treatment, there has been no simple way to objectively measure the patient-therapist relationship. Here, we measured the psychological distance between patients and their therapists by using the Pictorial Representation of Illness and Self Measure (PRISM). PATIENTS AND METHODS We analyzed the patient-therapist relationship of 112 patients from two hospitals in Japan (54 males, 57 females, 1 unknown; age 46.20 ± 15.03 years [mean ± SD]) who completed the PRISM and self report questionnaires (LSNS-6, K6, and BASIS-32) about their social network, psychological distress, and outcomes of mental health treatment. RESULTS PRISM measurements were available for all patients who consented to participate. In the comparison by disease category, schizophrenia recorded the closest distance to the psychiatrist in charge, followed by bipolar disorder, depression, and neurotic disorder. Regarding the distance to the psychiatrist in charge, PRISM showed a weak negative correlation (r = -0.23, p < 0.05) with age, indicating that with increasing age, the therapeutic rela tionship was more important to the patients. CONCLUSION Our findings indicate the possibility of implementing PRISM to assess the impact of the therapeutic relationship in patients with a wide range of psychiatric disorders, and they suggest that PRISM holds great potential for clinical application.
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Affiliation(s)
- Kiyoshi Naganuma
- Department of Neuropsychiatry, Kurume University School of Medicine
| | - Misari Oe
- Department of Neuropsychiatry, Kurume University School of Medicine
- Health Service Center, Kurume University
| | - Tetsuya Ishida
- Department of Neuropsychiatry, Kurume University School of Medicine
| | - Yudai Kobayashi
- Department of Neuropsychiatry, Kurume University School of Medicine
| | - Hiromi Chiba
- Department of Neuropsychiatry, Kurume University School of Medicine
| | - Michiko Matsuoka
- Department of Neuropsychiatry, Kurume University School of Medicine
- Health Service Center, Kurume University
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Fergus A, Wyker C, Heyl N, Lewis T, Hartsook K. Factors influencing caregiver buy-in to early intervention physical therapy. J Pediatr Rehabil Med 2024:PRM230025. [PMID: 38251072 DOI: 10.3233/prm-230025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024] Open
Abstract
PURPOSE The family-centered care framework of Early Intervention (EI) has shifted the focus toward caregiver engagement, but the underlying processes that build this are unknown. The aims of this study were 1) to describe the process of caregiver engagement in therapy and (2) to identify factors perceived to influence caregiver buy-in, confidence, and engagement in EI. METHODS This preliminary descriptive study utilized quantitative questionnaires and qualitative semi-structured interviews of EI participants (23 caregivers and four physical therapists). Interviews were transcribed and theme coded until saturation was achieved and a concept map was developed. RESULTS All caregivers believed that their children benefited from EI, that they were empowered and confident in caring for their children, and their quality of life improved based on the quantitative data. The qualitative data revealed that building a rapport and therapeutic relationship is the foundation to developing buy-in. Reciprocal communication is critical to the relationship and the buy-in. Caregiver knowledge and awareness of progress foster caregiver buy-in and confidence once the relationship is established. CONCLUSION Improved understanding of the factors influencing the development of buy-in will provide a framework for the clinician to enhance caregiver buy-in. Enhanced buy-in may promote parental engagement and improved outcomes for the child and family.
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Buono N, Sassier B, Thulesius H, Hoffman R, Nabbe P, Petek D, Le Reste JY. Translation of the working alliance inventory short revised into Italian using a Delphi procedure and a forward-backward translation. Front Med (Lausanne) 2024; 10:1236273. [PMID: 38274448 PMCID: PMC10808585 DOI: 10.3389/fmed.2023.1236273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Enhancing treatment adherence, especially for chronic diseases, can be achieved through therapeutic alliance, potentially elevating the quality of care. An instrument to evaluate the therapeutic alliance could be beneficial in routine clinical settings, educational environments, and extensive research efforts at national and European levels. In this study, we translated therapist and patient versions of the Working Alliance Inventory Short Revised (WAI-SR) into Italian. Methodology An email-based Delphi method was employed for the English-to-Italian translation, incorporating a forward-backward process. The initial translation team comprised two Italian family physicians proficient in English, a linguist, and a psychiatrist. The forward translation was then reviewed by 18 Italian family physicians through a Delphi process and was subjected to a backward translation by two Italian English teachers. A cultural correspondence was subsequently identified to adjust translations within a national and international framework. Results All 18 experts fully engaged in the Delphi process, and consensus was achieved by the second Delphi round. A cultural check checked for discrepancies regarding linguistic consistency with other translations and found no difference. Conclusion This Italian translation of the WAI-SR is expected to support Italian family physicians aiming to enhance their clinical practice and therapeutic outcomes. It could also be a valuable tool for Italian medical students to foster therapeutic relationships and improve their communication skills.
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Affiliation(s)
- Nicola Buono
- National Society of Medical Education in General Practice (SNAMID), Caserta, Italy
| | - Béatrice Sassier
- ERA 7479, Departement de Mèdecine Generale, SPURBO Universite de Bretagne Occidentale, Brest, France
| | - Hans Thulesius
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Robert Hoffman
- Department of Family Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Patrice Nabbe
- ERA 7479, Departement de Mèdecine Generale, SPURBO Universite de Bretagne Occidentale, Brest, France
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jean Yves Le Reste
- ERA 7479, Departement de Mèdecine Generale, SPURBO Universite de Bretagne Occidentale, Brest, France
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Saccà R, Turrini R, Ausania F, Turrina S, De Leo D. The ménage à trois of healthcare: the actors in after-AI era under patient consent. Front Med (Lausanne) 2024; 10:1329087. [PMID: 38269319 PMCID: PMC10807288 DOI: 10.3389/fmed.2023.1329087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/27/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Artificial intelligence has become an increasingly powerful technological instrument in recent years, revolutionizing many sectors, including public health. Its use in this field will inevitably change clinical practice, the patient-caregiver relationship and the concept of the diagnosis and treatment pathway, affecting the balance between the patient's right to self-determination and health, and thus leading to an evolution of the concept of informed consent. The aim was to characterize the guidelines for the use of artificial intelligence, its areas of application and the relevant legislation, to propose guiding principles for the design of optimal informed consent for its use. Materials and methods A classic review by keywords on the main search engines was conducted. An analysis of the guidelines and regulations issued by scientific authorities and legal bodies on the use of artificial intelligence in public health was carried out. Results The current areas of application of this technology were highlighted, divided into sectors, its impact on them, as well as a summary of current guidelines and legislation. Discussion The ethical implications of artificial intelligence in the health care system were assessed, particularly regarding the therapeutic alliance between doctor and patient, and the balance between the right to self-determination and health. Finally, given the evolution of informed consent in relation to the use of this new technology, seven guiding principles were proposed to guarantee the right to the most informed consent or dissent.
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Zeifman RJ, Kettner H, Ross S, Weiss B, Mithoefer MC, Mithoefer AT, Wagner AC. Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder. Eur J Psychotraumatol 2024; 15:2297536. [PMID: 38174611 PMCID: PMC10769553 DOI: 10.1080/20008066.2023.2297536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Background: MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasised within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes.Objective: Examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP.Method: Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomised (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (n = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised.Results: Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 and 9 (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons) and sessions 4 and 9 predicted post-MDMA-AP self-reported PTSD severity.Conclusions: The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary.Trial registration: ClinicalTrials.gov identifier: NCT00090064.
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Affiliation(s)
- Richard J. Zeifman
- Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Centre for Psychedelic Medicine, New York, NY, USA
| | - Hannes Kettner
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Stephen Ross
- Department of Psychiatry, NYU Grossman School of Medicine, NYU Langone Centre for Psychedelic Medicine, New York, NY, USA
| | - Brandon Weiss
- Centre for Psychedelic Research, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
| | | | | | - Anne C. Wagner
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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Barr BL, McIntosh VVW, Britt EF, Jordan J, Carter JD. Clinical factors and early life experiences associated with therapeutic alliance development in treatment for depression or binge eating. Psychother Res 2024; 34:4-16. [PMID: 37079925 DOI: 10.1080/10503307.2023.2191800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 03/10/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE This study examines childhood and clinical factors theorized to impact therapeutic alliance development over the course of psychotherapy. METHOD Raters assessed the therapeutic alliance of 212 client-therapist dyads, participating in two randomized controlled trials of schema therapy and cognitive behavioural therapy for binge eating or major depression, at three time points. Linear mixed models were used to characterize therapeutic alliance development over time and assess the influence of childhood trauma, perceived parental bonding, diagnosis and therapy type on scores. RESULTS Participants differed in initial alliance ratings for all subscales but had similar growth trajectories in all but the patient hostility subscale. A diagnosis of bulimia nervosa or binge eating disorder predicted greater initial levels of client distress, client dependency and overall client contribution to a strong therapeutic alliance, compared with a diagnosis of depression. Therapy type, childhood trauma and perceived parental bonds did not predict alliance scores. CONCLUSION Findings highlight the potential influence of clinical and personal characteristics on alliance strength and development, with implications for maximizing treatment outcomes through anticipating and responding to these challenges.
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Affiliation(s)
- Brogan L Barr
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Virginia V W McIntosh
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Eileen F Britt
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
- Te Whatu Ora Health New Zealand - Waitaha, Canterbury, New Zealand
| | - Janet D Carter
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Orlowski EW, Chen JI, Breznik LH, Gleason LDL, Karver MS. Psychotherapist perceptions of engagement-building behaviours with youth clients across developmental levels. Clin Psychol Psychother 2024; 31:e2962. [PMID: 38404160 DOI: 10.1002/cpp.2962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/27/2024]
Abstract
Building a positive therapeutic relationship is a challenging, yet critical, first step in conducting youth psychotherapy. A number of studies in the youth treatment literature have indicated that a positive therapeutic alliance is related to increased treatment attendance, participation, and outcome. Some research has examined therapist behaviours for engaging therapy clients; however, developmental differences in alliance formation have had limited exploration. The current study surveyed clinicians about their use of specific engagement strategies and the developmental stage of their youth clients. It was hypothesised that participants would differentially rate the importance of different aspects of therapeutic engagement based upon a youth client's developmental stage and that these would correspond with differences in specific engagement strategies. A total of 64 clinicians with experience treating youth completed the study. The participants completed a questionnaire administered online that asked them to rate the importance of developmental differences to forming a therapeutic relationship and provide example client behaviours from their clinical experience for each developmental stage. Results showed clinicians felt the relative importance of collaboration, advocacy, and trustworthiness increased with age. These differences were also evidenced in the specific strategies clinicians endorsed in relation to each engagement factor across developmental stages. This program of research will eventually aid in the development of new guidelines for engaging clients in youth psychotherapy. In addition, the results may be used to enhance psychotherapy training for those working with children and adolescents.
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Affiliation(s)
- Edmund W Orlowski
- Department of Educational and Counseling Psychology, University at Albany/SUNY, Albany, New York, USA
| | - Jason I Chen
- VA HSR&D Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon, USA
- Department of Psychiatry, Oregon Health and Science University, Portland, Oregon, USA
| | | | - La Donna L Gleason
- Department of Psychology, University of South Carolina, Columbia, South Carolina, USA
| | - Marc S Karver
- Department of Psychology, University of South Florida, Tampa, Florida, USA
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Constantino MJ, Coyne AE, Gaines AN, Goodwin BJ, Muir HJ, Critchfield KL, Westra HA, Antony MM. Therapist verification of patient self-concepts as a responsive precondition for early alliance development and subsequent introject change. Psychother Res 2023:1-15. [PMID: 38158827 DOI: 10.1080/10503307.2023.2297995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Social psychological research has indicated that people strive for self-consistent feedback and interactions, even if negative, to preserve the epistemic security of knowing themselves. Without such self-verification, any interpersonal exchange may become frustrated, anxiety-riddled, and at risk for deterioration. Thus, it may be important for therapists to meet patients' self-verification needs as a responsive precondition for early alliance establishment and development. We tested this hypothesis with patients receiving cognitive behavioral therapy for generalized anxiety disorder-a condition that may render one's self-verification needs especially strong. We also tested the hypothesis that better early alliance quality would relate to subsequent adaptive changes in and posttreatment level of patients' self-concepts. METHOD Eighty-four patients rated their self-concepts at baseline and across treatment and follow-up, their postsession recollection of their therapist's interpersonal behavior toward them during session 2, and their experience of alliance quality rated after sessions 3-6. RESULTS As predicted, the more therapists verified at session 2 a patient's baseline self-concepts (which trended toward disaffiliative and overcontrolling, on average), the more positively that patient perceived their next-session alliance. Moreover, better session 3 alliance related to more adaptive affiliative and autonomy-granting self-concepts at posttreatment. CONCLUSION Results are discussed within a therapist responsiveness framework.
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Affiliation(s)
- Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Alice E Coyne
- Department of Psychology, American University, Washington, DC, USA
| | - Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Brien J Goodwin
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Heather J Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Henny A Westra
- Department of Psychology, York University, Toronto, Canada
| | - Martin M Antony
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
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Heintzsch R, Hamatschek MJ. Who With Whom: Matching Therapist and Client in Correctional Institutions. Int J Offender Ther Comp Criminol 2023:306624X231213317. [PMID: 38156629 DOI: 10.1177/0306624x231213317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
The current study investigated variables that are being considered when assigning psychotherapists to individuals convicted of sexual and violent offences. Its main aim is to inform practitioners and researchers alike of potentially beneficial combinations between therapist and client and infer hypotheses for future studies. A mixed-methods approach, combining interviews and a follow-up questionnaire, was employed. Nineteen interviews with forensic practitioners working in socio-therapeutic facilities in Germany were conducted. Relevant matching criteria were extracted from all interviews. 1.) Capacities of therapist, 2.) therapist's professional background, 3.) (severity of) clinical disorder, 4.) personal fit, and 5.) fit of client into existing groups emerged as top five matching criteria. Directive therapists were viewed as a good match for antisocial or psychopathic offenders. Opinions diverged regarding personality similarity or complementarity in client-therapist dyads. A flexible matching approach may offer unique strengths to enhance treatment outcome. Implications and ideas for future research are discussed.
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Lange E, Danielsson L. Reaching for connection: a qualitative study of communication and interaction in video-based physiotherapy. Physiother Theory Pract 2023:1-12. [PMID: 38145499 DOI: 10.1080/09593985.2023.2296574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/09/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVE Digital technology has become increasingly relevant in physiotherapy, but little is known about communication and interaction in video-based physiotherapy. Therefore, this study aimed to explore the experiences among patients and physiotherapists, of communication and interaction in digital, video-based physiotherapy. METHODS A qualitative interview study with a phenomenological approach was conducted. Participants were purposively recruited from primary health care clinics. Semi-structured, in-depth interviews were conducted with 10 physiotherapists and 6 patients. Interviews were recorded, transcribed, and analyzed using a phenomenological approach. RESULTS The analysis resulted in the overall theme Reaching for connection, which captured the central meaning of the participants' experiences. Four categories emerged from the analysis: 1) Closeness at a distance; 2) Overcoming limited bodily communication; 3) The technology as part of the meeting; and 4) Challenging the physical meeting as a norm. The results suggest that communication and interaction in digital settings differ from physical settings, but there is an ongoing adaptation process to this new paradigm. CONCLUSIONS The results of this study show that video-based physiotherapy, while having several benefits according to both patients and physiotherapists, affects the communication in several ways. Physiotherapists need to acknowledge these limitations and seek strategies to adapt and to compensate for the reduced non-verbal elements and lack of touch. Attention to the physical room and shifting between positions (face/full figure) are suggested practical strategies, but also to practice awareness and embodied communication to improve receptivity in the interaction.
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Affiliation(s)
- Elvira Lange
- Department of General Practice, Institute of Medicine at the Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
- Research, Education, Development and Innovation, Primary Health Care, Region Västra Götaland, FoUUI-centrum Göteborg och Södra Bohuslän, Göteborg, Sweden
| | - Louise Danielsson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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La Touche R, Pardo-Montero J, Grande-Alonso M, Paris-Alemany A, Miñambres-Martín D, Nouvilas-Pallejà E. Psychological, Pain, and Disability Factors Influencing the Perception of Improvement/Recovery from Physiotherapy in Patients with Chronic Musculoskeletal Pain: A Cross-Sectional Study. Healthcare (Basel) 2023; 12:12. [PMID: 38200918 PMCID: PMC10778840 DOI: 10.3390/healthcare12010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES The aim of this study was to identify the possible relationships between psychological, pain, and disability variables with respect to the perception of change/recovery from physiotherapy in patients with chronic musculoskeletal pain (CMP). METHODS A cross-sectional observational study was performed with 150 patients. All patients completed a series of self-administered questionnaires and a series of self-reports to quantify the perception of change with respect to the physiotherapy they underwent, the level of disability and pain intensity, the level of fear of movement, the level of catastrophism, the degree of self-efficacy, the level of therapeutic alliance and their adherence to the physiotherapy. RESULTS The strongest correlations were between the subjective perception of change and the number of sessions, treatment beliefs, self-efficacy, pain intensity, collaboration, and bonding. The linear regression model showed that the number of sessions, treatment beliefs, self-efficacy, compliance, pain intensity, and bonding were predictors of subjective perception of improvement, with 50% of the variance. CONCLUSIONS Treatment beliefs, therapeutic alliance, degree of self-efficacy, and pain intensity have been shown to be predictors of a subjective perception of improvement in patients with CMP. In turn, multimodal treatments had the greatest positive impact on the subjective perception of improvement.
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Affiliation(s)
- Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain; (R.L.T.)
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
| | - Joaquín Pardo-Montero
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain; (R.L.T.)
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain
| | - Mónica Grande-Alonso
- Departamento de Cirugía, Ciencias Médicas y Sociales, Facultad de Medicina, Universidad de Alcalá, 28871 Alcalá de Henares, Spain;
- Grupo de Investigación Clínico-Docente Sobre Ciencias de la Rehabilitación (INDOCLIN), Centro Superior de Estudios Universitarios La Salle, 28023 Madrid, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios (CSEU) La Salle, Universidad Autonoma de Madrid, 28023 Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
- Departamento de Radiología, Rehabilitación y Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Diego Miñambres-Martín
- Premium Madrid Global Health Care, 28016 Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Villaviciosa de Odón, Spain
| | - Encarnación Nouvilas-Pallejà
- Department of Social and Organizational Psychology, National University of Distance Education, 28040 Madrid, Spain
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Bravo C, Minano-Garrido E, Carballo-Costa L, Muñoz-Cruzado y Barba M, Solé S, Rubí-Carnacea F, Catalan-Matamoros D. Beliefs and Self-Perceptions of Spanish Mental Health Professionals about Physical Therapy in Mental Health: An Observational Survey Study. Healthcare (Basel) 2023; 11:3136. [PMID: 38132026 PMCID: PMC10742876 DOI: 10.3390/healthcare11243136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/26/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE The aim of this study is to understand the image, perception, and beliefs regarding the role of the physiotherapist in the field of mental health physiotherapy, both among the professional community and other multidisciplinary teams. METHODS An observational phenomenological qualitative study through the administration of an ad hoc survey comprising both categorical and open-ended as well as quantitative questions was conducted. RESULTS A total of 368 responses were analysed. The participants comprised 78.4% women with a mean age of 37.5, an average professional experience of 14.33 years, and 88.3% practicing physical therapists. From the qualitative analysis conducted, three categories emerged in relation to the obtained responses: (a) functions with codes of "improving quality of life" and "intervening in physical pathologies"; (b) objectives with codes of "Improving quality of life", "Intervening in physical pathologies", "Functional rehabilitation", "Health promotion", and "Intervening in mental disorders"; and (c) image with codes "unfamiliarity", "holistic vision", "necessity", and "importance". Regarding the tools, the findings highlight a strong focus on physical exercise interventions due to their well-established benefits. Cognitive strategies like therapeutic relationships and cognitive-behavioural techniques were also prominent. Additionally, embodiment techniques involving movement, relaxation, breathing, and voice usage were notable. Lastly, manual therapy and physical agents formed another distinct category. CONCLUSIONS The vision and role of this professional profile were unknown to the respondents. Despite being perceived as having a holistic view of the patient and being considered an essential need, the actual image remains vague. However, there is significant interest, indicating a promising future, although the lack of specialized training is noted. Therefore, the need for specialized education and awareness campaigns among professionals in the mental health field is highlighted.
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Affiliation(s)
- Cristina Bravo
- Group of Salut&Genesis, Campus de Salud UdL-Igualada, 08700 Barcelona, Spain;
- Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain;
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, 25198 Lleida, Spain
| | - Emilio Minano-Garrido
- International School of Doctoral Studies, University of Murcia, 30100 Murcia, Spain;
- Department of Physical Therapy, Hôpital Haut-Lévêque, CHU Bordeaux, F-33000 Bordeaux, France
| | - Lidia Carballo-Costa
- Grupo de investigación en Intervención psicosocial y Rehabilitación funcional, Faculty of Physiotherapy Universidade da Coruña, Campus de A Coruña, 15071 A Coruña, Spain;
| | | | - Silvia Solé
- Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain;
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29016 Malaga, Spain;
| | - Francesc Rubí-Carnacea
- Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain;
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, 25198 Lleida, Spain
| | - Daniel Catalan-Matamoros
- Research Group CTS 451 “Health Sciences”, University of Almeria, 04120 Almeria, Spain;
- Science/Health Communication, University Carlos III of Madrid, 28911 Madrid, Spain
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Aerts JEM, Rijckmans MJN, Bogaerts S, van Dam A. Establishing an optimal working relationship with patients with an antisocial personality disorder. Aspects and processes in the therapeutic alliance. Psychol Psychother 2023; 96:999-1014. [PMID: 37671752 DOI: 10.1111/papt.12492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/06/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023]
Abstract
OBJECTIVE Developing good interpersonal relationships is one of the main impediments for people with an antisocial personality disorder (ASPD). However, in treatment of psychiatric disorders, establishing a strong therapeutic alliance (TA) is important for effective treatment. Nevertheless, there is little knowledge on how to establish this TA with this challenging patient group. This study investigates which factors are important in TA development. METHOD For this study, a qualitative research methodology is applied. In-depth interviews with therapists experienced in treating ASPD were conducted and analysed through thematic analysis. RESULTS The analysis revealed six themes important in alliance formation: the patient's needs, regulating interpersonal dynamics, connective attitude, connective skills, treatment process and treatment goals. Each theme is defined including aspects of the recommended therapeutic attitude and required skills for therapists working with patients with ASPD. CONCLUSIONS This study determined that, for therapists working with patients with ASPD, several key factors are essential in establishing a strong TA. These factors include the ability to be firm, authentic, non-judgmental and genuinely involved. An attentive presence is crucial, in which the therapist takes initiative in establishing contact and makes the patient feel that he is truly seen as an autonomous and equal person. In doing so, the therapist needs to provide clarity and structure while remaining perceptive to boundary violations. The therapist must be able to set limits using a clear yet kind tone of voice. Furthermore, it was notable that an intensive appeal is made to the therapist's reflective capacity in these treatments.
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Affiliation(s)
- J E M Aerts
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Research and Innovation, GGZ WNB Mental Health Institute, The Netherlands
| | - M J N Rijckmans
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, The Netherlands
| | - S Bogaerts
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
- Fivoor Science and Treatment Innovation (FARID), Rotterdam, The Netherlands
| | - A van Dam
- Tranzo Scientific Center for Care and Welfare, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
- Research and Innovation, GGZ WNB Mental Health Institute, The Netherlands
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Rober P, Van Tricht K. Using questionnaires as conversational tools to bolster the therapeutic alliance in family therapy practice. Fam Process 2023; 62:1346-1361. [PMID: 37680144 DOI: 10.1111/famp.12936] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/12/2023] [Accepted: 08/13/2023] [Indexed: 09/09/2023]
Abstract
In this clinical paper, the focus is on the use of questionnaires in family therapy practice. Psychotherapy research has indicated that the quality of the therapeutic relationship is the most robust predictor of therapeutic change. While the therapeutic relationship is even more important in family therapy than in individual therapy, it is also more complex. As will be illustrated in this paper, questionnaires can be useful in clinical practice to deal with the complex alliances in family therapy. In this paper, we will introduce two questionnaires: the Worries Questionnaire and the Dialogical Feedback Questionnaire. As illustrated in detailed case stories, we use these questionnaires in our practice as conversational tools rather than measuring instruments. They serve as the starting point for the therapist's reflection and for dialogues with family members.
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Affiliation(s)
- Peter Rober
- Context, UPC K.U. Leuven, Leuven, Belgium
- Department of Neurosciences, Institute for Family and Sexuality Studies, University of Leuven, Leuven, Belgium
| | - Karine Van Tricht
- Context, UPC K.U. Leuven, Leuven, Belgium
- Context, IPRR, Leuven, Belgium
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Lavi-Rotenberg A, Kivity Y, Igra L, Atzil-Slonim D, Hasson-Ohayon I. A dyadic session-by-session assessment of therapeutic alliance and short-term outcome among clients with schizophrenia in comparison with clients with emotional disorders. Psychol Psychother 2023; 96:1029-1043. [PMID: 37665174 DOI: 10.1111/papt.12494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Although the clinical significance of the therapeutic alliance (TA) is well documented, the literature regarding the establishment of TA and the relation between client-therapist agreement on it to short-term outcome among various diagnostic groups-and specifically among clients diagnosed with serious mental illness (SMI)-is sparse. The aim of the present study was to examine the effect of client diagnosis on the abovementioned TA characteristics. METHOD Dyadic analyses of session-by-session (SBS) data were used to compare clients diagnosed with schizophrenia and clients diagnosed with emotional disorders (based on a clinical interview) in their TA characteristics. RESULTS TA as initially rated by clients was stronger in the emotional disorders group than in the schizophrenia group. Higher TA ratings, regardless of whether these were provided by the therapist or the client, predicted better subsequent functioning in the emotional disorders group, whereas in the schizophrenia group, this association was observed only among good-outcome cases. CONCLUSIONS Establishing TA, having client-therapist agreement on it, and having clients derive therapeutic benefit from it might be more challenging with clients with schizophrenia than with clients with emotional disorders. Special attention should be given to specific challenges and needs regarding clients' diagnosis in order to enhance favourable therapy outcomes.
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Affiliation(s)
| | - Yogev Kivity
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Libby Igra
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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Schreiber J. [The Importance of Attachment for Human Beings and Dogs - Implications for Dog-Assisted Psychotherapy]. Prax Kinderpsychol Kinderpsychiatr 2023; 72:685-701. [PMID: 38051062 DOI: 10.13109/prkk.2023.72.8.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Attachment theory is known as an important therapeutic foundation. Establishing a secure attachment to a caregiver is equally relevant for the mental health of both humans and dogs. A bond can be formed between humans and dogs that is comparable to the attachment between mother and child. Patients with adverse attachment experiences often struggle to maintain stable relationships due to internal working models. Building a therapeutic alliance can also be challenging. On the other hand, establishing a relationship with a dog seems to be successful for patients with adverse attachment experiences. Inclusion of a therapy dog provides them with the opportunity for experiences of trustful relationships.These experiences can then be transferred to the therapist. Later on, internal working models of the patients can indeed come into play in the relationship with the dog. The resulting patterns of relationship can become visible in the interaction with the dog. Within the therapeutic triade of patient, therapy dog and therapist, these patterns can be reflected and integrated into the therapy process. However, achieving this requires a targeted and professionally grounded use of the dog. If dogs are employed with a therapeutic purpose but without professional guidance, there is a risk of reestablishing insecure attachment patterns, which could potentially lead to more disadvantages than benefits for both humans and dogs.
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Affiliation(s)
- Janina Schreiber
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Johanniter Krankenhaus Oberhausen Steinbrinkstr. 96 a 46145 Oberhausen Deutschland
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von Wulffen C, Marciniak MA, Rohde J, Kalisch R, Binder H, Tuescher O, Kleim B. German Version of the Mobile Agnew Relationship Measure: Translation and Validation Study. J Med Internet Res 2023; 25:e43368. [PMID: 37955952 PMCID: PMC10682917 DOI: 10.2196/43368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 07/03/2023] [Accepted: 07/27/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The mobile Agnew Relationship Measure (mARM) is a self-report questionnaire for the evaluation of digital mental health interventions and their interactions with users. With the global increase in digital mental health intervention research, translated measures are required to conduct research with local populations. OBJECTIVE The aim of this study was to translate and validate the original English version of the mARM into a German version (mARM-G). METHODS A total of 2 native German speakers who spoke English as their second language conducted forward translation of the original items. This version was then back translated by 2 native German speakers with a fluent knowledge of English. An independent bilingual reviewer then compared these drafts and created a final German version. The mARM-G was validated by 15 experts in the field of mobile app development and 15 nonexperts for content validity and face validity; 144 participants were recruited to conduct reliability testing as well as confirmatory factor analysis. RESULTS The content validity index of the mARM-G was 0.90 (expert ratings) and 0.79 (nonexperts). The face validity index was 0.89 (experts) and 0.86 (nonexperts). Internal consistency for the entire scale was Cronbach α=.91. Confirmatory factor analysis results were as follows: the chi-square statistic to df ratio was 1.66. Comparative Fit Index was 0.87 and the Tucker-Lewis Index was 0.86. The root mean square error of approximation was 0.07. CONCLUSIONS The mARM-G is a valid and reliable tool that can be used for future studies in German-speaking countries.
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Affiliation(s)
- Clemens von Wulffen
- Department of Psychology, University of Zurich, Zürich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Marta Anna Marciniak
- Department of Psychology, University of Zurich, Zürich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Judith Rohde
- Department of Psychology, University of Zurich, Zürich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research, Mainz, Germany
- Neuroimaging Center, Focus Program Translational Neuroscience, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - Oliver Tuescher
- Leibniz Institute for Resilience Research, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center, University Johannes Gutenberg University, Mainz, Germany
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zürich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
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Smith KS, Kinsella EA, Moodie S, McCorquodale L, Teachman G. Mindfulness and therapeutic relationships: A phenomenological inquiry into paediatric occupational therapists' practices. Scand J Occup Ther 2023; 30:1441-1450. [PMID: 37256557 DOI: 10.1080/11038128.2023.2217670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND A growing body of literature points to the potential of mindfulness to support therapeutic relationships, and the importance of the therapeutic relationship when working with children and youth, yet little attention has been paid to this topic in occupational therapy. AIMS/OBJECTIVES The aim of this study was to inquire into occupational therapists' experiences of mindfulness in the therapeutic relationship with children and youth. MATERIALS AND METHODS Hermeneutic phenomenology was the methodological approach, with Heidegger's concepts of being-with and care as theoretical underpinnings of the study. Eight North American occupational therapists participated in semi-structured interviews that elicited first-hand accounts of mindfulness in the therapeutic relationship with children and youth. Interviews were transcribed verbatim and analysed using a phenomenological approach. RESULTS Four key themes were identified: fostering a safe space, enhancing presence, being authentic, and cultivating acceptance. CONCLUSIONS AND SIGNIFICANCE The findings offer insights regarding the potential affordances of mindfulness to support clinicians in the development of therapeutic relationships with children and youth. Further, this study highlights research priorities for future inquiry.
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Affiliation(s)
- Kirsten Sarah Smith
- Graduate Program in Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
| | - Elizabeth Anne Kinsella
- Graduate Program in Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
- Department of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Sheila Moodie
- Graduate Program in Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
- National Centre for Audiology, University of Western Ontario, London, Canada
| | - Lisa McCorquodale
- Graduate Program in Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
- School of Occupational Therapy, University of Western Ontario, London, Canada
| | - Gail Teachman
- Graduate Program in Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
- School of Occupational Therapy, University of Western Ontario, London, Canada
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de Freixo Ferreira L, Guerra C, Vieira-Coelho MA. Predictors of psychotherapy dropout in patients with borderline personality disorder: A systematic review. Clin Psychol Psychother 2023; 30:1324-1337. [PMID: 37522280 DOI: 10.1002/cpp.2888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a highly debilitating psychiatric condition. Despite the expansion of new BPD specific forms of psychotherapy in the last few decades, high dropout rates have been reported in these treatments. Treatment discontinuation is associated with poor patient outcomes, inefficient resource utilization and the demoralization of healthcare providers. METHODS In order to identify predictors of psychotherapy dropout among patients with BPD, a systematic search of Medline, the Cochrane Library, PsycInfo and PsycArticles was conducted. Studies included were randomized-controlled trials in which patients diagnosed with BPD were exposed to a therapeutic intervention consisted of an evidence-based psychotherapy. The quality of evidence in the studies was assessed through the use of revised Cochrane risk of bias tool. RESULTS Six articles, incorporating four types of psychotherapy programmes, were included. Overall, the studies present low risk of attrition and reporting bias and unclear risk of selection, performance and detection bias. Patients with weaker therapeutic alliance scores and higher hostility presented with higher dropout rates. In contrast, better mindfulness skills and greater performance in specific neuropsychological domains, such as memory and executive control, were identified as predictive of lower risk of dropout. Sociodemographic variables and treatment history did not influence treatment retention. CONCLUSIONS Factors that influence discontinuation should be taken into consideration in future treatment programmes, in an effort to optimize retention. Qualitative assessments of patients' reasons for dropping out may also help guide adjustments.
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Affiliation(s)
- Leonor de Freixo Ferreira
- Department of Biomedicine, Pharmacology and Therapeutics Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cátia Guerra
- Department of Psychiatry and Mental Health, University Hospital Centre of São João, Porto, Portugal
| | - M A Vieira-Coelho
- Department of Biomedicine, Pharmacology and Therapeutics Unit, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Psychiatry and Mental Health, University Hospital Centre of São João, Porto, Portugal
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Dimic T, Farrell A, Ahern E, Houghton S. Young people's experience of the therapeutic alliance: A systematic review. Clin Psychol Psychother 2023; 30:1482-1511. [PMID: 37537723 DOI: 10.1002/cpp.2885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE The aim of this systematic review was to synthesise qualitative evidence on young people's conceptualisation, utilisation and experiences of the therapeutic alliance in individual psychotherapy or counselling and its role in bringing about change. METHOD The thematic synthesis method was used to synthesise data. The methodological quality of included studies was assessed using the CASP checklist for qualitative research. RESULTS Four superordinate analytical themes were generated: (1) valuable therapist qualities, (2) conditions for the development and maintenance of the therapeutic alliance, (3) therapeutic processes and (4) barriers to the development of the therapeutic alliance. Findings indicate that young people appreciated the uniqueness of the therapeutic relationship that provided a sense of safety, choice and autonomy. Flexibility and accessibility were noted as important elements of therapeutic alliance building as they elicited a sense of agency. Young people emphasised the non-linear nature of therapy and prioritised process variables such as improvement in self-understanding, self-efficacy and self-worth. CONCLUSION The current systematic review is a comprehensive overview of qualitative studies of experiences of therapy from young people's perspectives. Important practical implications derived from this review as the role of autonomy in the change process and the formation and maintenance of the therapeutic relationship were outlined as important elements in youth therapy.
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Affiliation(s)
- Tamara Dimic
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Aoife Farrell
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Elayne Ahern
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Sharon Houghton
- Department of Psychology, University of Limerick, Limerick, Ireland
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Benitez B, Frankforter TL, Nich C, Kiluk BD. The connection still matters: Therapeutic alliance with digital treatment for alcohol use disorder. Alcohol Clin Exp Res (Hoboken) 2023; 47:2197-2207. [PMID: 38226756 PMCID: PMC10792249 DOI: 10.1111/acer.15199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 08/22/2023] [Accepted: 09/18/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND A strong cooperative bond between the patient and provider ("therapeutic alliance") is robustly associated with better alcohol use disorder (AUD) treatment outcomes. Although digital treatments for AUD have significant potential, the function of the alliance during digital programs is unclear. We compared the validity of patient-reported measures of the alliance with a digital treatment ("digital alliance") for AUD and the alliance with their clinician ("clinician alliance"). METHODS We used data from an 8-week, randomized clinical trial of a computerized cognitive behavioral therapy program (CBT4CBT) during outpatient AUD treatment. Treatment conditions included CBT4CBT with minimal clinical monitoring (CBT4CBT + monitor) or with treatment as usual (CBT4CBT + TAU). The digital alliance and clinician alliance were measured with similar versions of the Working Alliance Inventory (WAI). The WAI ratings were completed at the 2nd and 6th treatment sessions. A timeline followback calendar assessed daily alcohol use. Bayesian multilevel models compared the strength of the alliances and tested their associations with future alcohol use. RESULTS Data from 43 participants were included (age M = 44; 65% male; 51% Black, 40% White, 9% other; 14% Hispanic). The digital alliance ratings had similar internal reliability as the clinician alliance ratings (ω's > 0.90). Differences between digital alliance and clinician alliance ratings were negligible in both treatment conditions (BF01 = 9 and 31). During treatment, within-person increases in the digital alliance and the clinician alliance predicted modest decreases in future drinking to a similar degree (BF01 = 15). Alliance ratings were not associated with future drinking when posttreatment follow-up drinking data were included (BF10 < 3). CONCLUSIONS The digital alliance with CBT4CBT was comparable to the clinician alliance. The digital alliance and clinician alliance had similar, albeit very small, associations with abstinence during treatment. Future research can explore how the digital alliance develops to improve AUD treatment efficacy.
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Affiliation(s)
- Bryan Benitez
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Tami L Frankforter
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Brian D Kiluk
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Cersosimo BH, Hilsenroth MJ, Bornstein RF, Gold JR, Blais MA. Convergence in patient and therapist alliance ratings early in treatment with Personality Assessment Inventory clinical scales and subscales. Clin Psychol Psychother 2023; 30:1512-1519. [PMID: 37544895 DOI: 10.1002/cpp.2891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/22/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023]
Abstract
We examined discrepancies in 81 patient-therapist dyads' alliance ratings early in treatment (3rd or 4th session) in relation to Personality Assessment Inventory clinical scales, subscales and global psychopathology. Results indicated that PAI global psychopathology (mean clinical elevation) and the scales of Aggression [AGG], Somatization [SOM], and Anxiety-Related Disorders [ARD] were significantly, negatively associated with an absolute difference of patient and therapist alliance ratings at Session 3. Higher initial scores on these clinical scales at treatment onset are associated with less difference (i.e., more convergence) in patient/ therapist ratings of alliance at Session 3. Correlations between PAI clinical subscales and absolute differences of patient and therapist alliance ratings at Session 3 also demonstrated statistically significant inverse relationships for several PAI subscales of Aggression- Attitude [AGG-A], Aggression-Physical [AGG-P], Somatic- Health Concerns [SOM-H], Anxiety-Related Disorders-Traumatic Stress [ARD-T], Anxiety-Related Disorders- Obsessive Compulsive [ARD-O], Borderline Features-Affective Instability [BOR-A], Borderline- Self-Harm [BOR-S], Anxiety-Physiological [ANX-P], Depression-Physiological [DEP-P] and Antisocial-Stimulus Seeking [ANT-S]. Again, higher scores on these subscales at treatment onset are associated with less difference (i.e., more convergence) in patient/therapist ratings. We also examined group differences between patients rating alliance higher (Group 1) and therapists rating alliance higher (Group 2) and found that Group 1 had significantly lower scores on Mania-Activity Level [MAN-A]. Clinical implications of results are discussed.
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Affiliation(s)
- Bianca H Cersosimo
- Derner School of Psychology, Adelphi University, Garden City, New York, United States
| | - Mark J Hilsenroth
- Derner School of Psychology, Adelphi University, Garden City, New York, United States
| | - Robert F Bornstein
- Derner School of Psychology, Adelphi University, Garden City, New York, United States
| | - Jerold R Gold
- Derner School of Psychology, Adelphi University, Garden City, New York, United States
| | - Mark A Blais
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Grossman-Giron A, Fisher H, Atzil-Slonim D, Maoz H, Nitzan U, Tzur Bitan D. The effect of Oxytocin administration on patient-therapist alliance congruence: Results from a randomized controlled trial. Psychother Res 2023:1-11. [PMID: 37856680 DOI: 10.1080/10503307.2023.2269300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVES The effects of oxytocin (OT) administration on psychotherapeutic processes have thus far been elusive. This study explored the effect of OT administration on patient-therapist congruence of the working alliance. METHOD Inpatients with mental disorders (N = 87) participating in a randomized controlled trial received OT (n = 44) or placebo (n = 43) intranasally twice a day, for four weeks. Patients and therapists rated the alliance after each session. RESULTS Oxytocin significantly moderated the level of agreement (b = -0.56, SE = 0.25, t = -2.30, p = 0.02), such that patients receiving OT demonstrated lower discrepancy (b = -0.73, p < 0.001) than did those receiving placebo (b = -1.30, p < 0.001). On the other hand, the mutual covariance of patient-therapist ratings across sessions was positive and significant for patients receiving placebo (b = 0.26, p = 0.01) but not for patients in the OT group (b = -0.06, p = .56). CONCLUSION Oxytocin can reduce discrepancies of patient-therapist perceptions of the alliance, although additional studies are needed to explore OT's effect on alliance development over time. As alliance congruence is associated with therapy outcomes, such intervention may lead to enhancement of therapeutic gains.
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Affiliation(s)
- Ariella Grossman-Giron
- Department of Behavioral Sciences, Ariel University, Ariel, Israel
- Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Fisher
- Department of Psychology, Haifa University, Haifa, Israel
| | | | - Hagai Maoz
- Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Nitzan
- Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Tzur Bitan
- Shalvata Mental Health Center, Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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Faith L, Wiesepape C, Kukla M, Lysaker P. Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation. Neuropsychiatr Dis Treat 2023; 19:2179-2194. [PMID: 37873532 PMCID: PMC10590553 DOI: 10.2147/ndt.s386004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
Introduction Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients' experience of recovery oriented approaches, there are less studies examining clinicians' perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis. Methods Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services. Results Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work. Discussion As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.
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Affiliation(s)
- Laura Faith
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Courtney Wiesepape
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Paul Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Lochner C, Prochwicz K, Grünblatt E. Editorial: Obsessive-compulsive related disorders (OCRD) across the lifespan. Front Psychiatry 2023; 14:1296074. [PMID: 37867764 PMCID: PMC10588464 DOI: 10.3389/fpsyt.2023.1296074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- Christine Lochner
- SAMRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Katarzyna Prochwicz
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, Kraków, Poland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zürich, Switzerland
- Neuroscience Center Zurich, University of Zurich and the ETH Zurich, Zürich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zürich, Switzerland
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Bose D, Pettit JW, Silk JS, Ladouceur CD, Olino TM, Forbes EE, Siegle GJ, Dahl RE, Kendall PC, Ryan ND, McMakin DL. Therapeutic Alliance, Attendance, and Outcomes in Youths Receiving CBT or Client-Centered Therapy for Anxiety. J Clin Child Adolesc Psychol 2023:1-11. [PMID: 37796228 PMCID: PMC10995113 DOI: 10.1080/15374416.2023.2261547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Positive associations between therapeutic alliance and outcome (e.g. youth symptom severity) have been documented in the youth anxiety literature; however, little is known about the conditions under which early alliance contributes to positive outcomes in youth. The present study examined the relations between therapeutic alliance, session attendance, and outcomes in youths (N = 135; 55.6% female) who participated in a randomized clinical trial testing the efficacy of cognitive-behavioral therapy or client-centered therapy for anxiety. METHOD We evaluated a conceptual model wherein: (1) early alliance indirectly contributes to positive outcomes by improving session attendance; (2) alliance-outcome associations differ by intervention type, with stronger associations in cognitive-behavioral therapy compared to client-centered therapy; and (3) alliance-outcome associations vary across outcome measurement timepoints, with the effect of early alliance on outcomes decaying over time. RESULTS Contrary to hypotheses, provider ratings of early alliance predicted greater youth-rated anxiety symptom severity post-treatment (i.e. worse treatment outcomes). Session attendance predicted positive youth-rated outcomes, though there was no indirect effect of early alliance on outcomes through session attendance. CONCLUSIONS Results show that increasing session attendance is important for enhancing outcomes and do not support early alliance as a predictor of outcomes.
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Affiliation(s)
- Deepika Bose
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Jeremy W. Pettit
- Department of Psychology and Center for Children and Families, Florida International University, Miami, FL
| | - Jennifer S. Silk
- Department of Psychology, University of Pittsburgh, and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, PA
| | - Cecile D. Ladouceur
- Department of Psychology, University of Pittsburgh, and Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, PA
| | - Thomas M. Olino
- Department of Psychology, Temple University, Philadelphia, PA
| | - Erika E. Forbes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, PA
| | - Greg J. Siegle
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, PA
| | - Ronald E. Dahl
- School of Public Health, University of California at Berkeley, Berkeley, CA
| | | | - Neal D. Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburg, PA
| | - Dana L. McMakin
- Department of Psychology and Center for Children and Families, Florida International University, Miami, FL
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Barnes K, Wang R, Faasse K. Practitioner warmth and empathy attenuates the nocebo effect and enhances the placebo effect. Appl Psychol Health Well Being 2023. [PMID: 37793644 DOI: 10.1111/aphw.12497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
Augmented patient-practitioner interactions that enhance therapeutic alliance can increase the placebo effect to sham treatment. Little is known, however, about the effect of these interactions on maladaptive health outcomes (i.e., the nocebo effect). Healthy participants (N = 84) were randomised to a 3-day course of Oxytocin nasal drops (actually, sham treatment) in conjunction with a high-warmth interaction (Oxy-HW: N = 28), a low-warmth interaction (Oxy-LW: N = 28) or to a no treatment control group (NT: N = 28). All participants were informed that the Oxytocin treatment could increase psychological well-being but was associated with several potential side effects. Treatment-related side effects, unwarned symptoms, and psychological well-being were measured at baseline and all post-treatment days. Side effect reporting was increased in the Oxy-LW condition compared to the other groups across all days. Conversely, increased psychological well-being was observed in the Oxy-HW condition, relative to the other conditions, but only on Day 1. Among those receiving treatment, positive and negative expectations, and treatment-related worry, did not vary by interaction-style, while psychological well-being and side effect reporting were inversely associated at the level of the individual. Results have important implications for practice, suggesting poorer quality interactions may not only reduce beneficial health outcomes but also exacerbate those that are maladaptive.
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Affiliation(s)
- Kirsten Barnes
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachelle Wang
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate Faasse
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
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Accardi C, Cerritelli F, Bovo L, Esteves JE. The osteopath-parent-child triad in osteopathic care in the first 2 years of life: a qualitative study. Front Psychol 2023; 14:1253355. [PMID: 37849480 PMCID: PMC10577191 DOI: 10.3389/fpsyg.2023.1253355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023] Open
Abstract
Background Enactivism and active inference are two important concepts in the field of osteopathy. While enactivism emphasizes the role of the body and the environment in shaping our experiences and understanding of the world, active inference emphasizes the role of action and perception in shaping our experiences and understanding of the world. Together, these frameworks provide a unique perspective on the practice of osteopathy, and how it can be used to facilitate positive change in patients. Since the neonatal period is a crucial time for development, osteopaths should aim to create a therapeutic relationship. Arguably, through participatory sense-making, osteopaths can help the baby build a generative model (with positive priors) to deal with stress and needs throughout their life. Aim Since the literature considers that interactions with the environment, which enact the patients' experiences, depending on contextual factors and communication between patient and caregiver, this research explored whether there is a correspondence between the indications in the literature and clinical practice in the management of the mother/parent-child dyad during osteopathic care on children aged 0 to 2 years old. Methods Semi-structured interviews were conducted with a purposive sample of nine osteopaths with experience in the field of pediatrics. Interviews were transcribed verbatim, and constructivist grounded theory was used to conceptualize, collect and analyze data. Codes and categories were actively constructed through an interpretive/constructionist paradigm. Results The core category was the idea of the pediatric osteopath as a support for the family, not only for the child. Four additional categories were identified: (1) Preparing a safe environment for both children and parents, (2) Communication, (3) Attachment and synchrony, and (4) Synchronization. Conclusion Through participatory sense-making, osteopaths manage contextual factors to establish an effective therapeutic alliance through the osteopath-parent-child triad to facilitate the construction of the child's internal generative model to promote healthy development. The therapeutic encounter is considered an encounter between embodied subjects, occurring within a field of affordances (ecological niche) that allows the interlocutors to actively participate in creating new meanings through interpersonal synchronization. Participatory sense-making and the establishment of a therapeutic alliance through the osteopath-parent-child triad are crucial to promote healthy development in the child.
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Affiliation(s)
- Caterina Accardi
- Foundation COME Collaboration, Clinical-Based Human Research Department, Pescara, Italy
- Malta ICOM Educational Ltd., Gzira, Malta
| | - Francesco Cerritelli
- Foundation COME Collaboration, Clinical-Based Human Research Department, Pescara, Italy
| | - Lorenza Bovo
- Foundation COME Collaboration, Clinical-Based Human Research Department, Pescara, Italy
- Malta ICOM Educational Ltd., Gzira, Malta
| | - Jorge E. Esteves
- Foundation COME Collaboration, Clinical-Based Human Research Department, Pescara, Italy
- Malta ICOM Educational Ltd., Gzira, Malta
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Levendosky AA, Turchan JE, Luo X, Good E. A re-introduction of the psychodynamic approach to the standard clinical psychology curriculum. J Clin Psychol 2023; 79:2439-2451. [PMID: 37310149 DOI: 10.1002/jclp.23551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 05/02/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE There is a strong evidence-base for a psychodynamic approach, supporting primary theoretical tenets as well as the treatment effectiveness. Additionally, there are increasing calls from the field for more individualized treatment for clients, and the lack of training in multiple orientations limits the ability of students in clinical psychology Ph.D. programs in the United States to personalize their treatments. The accumulated evidence-base for contemporary relational psychodynamic theory and therapy places it in good standing to return to the standard clinical psychology curriculum, along with other evidence-based approaches. METHODS We use data from the Insider's Guide (which describes clinical Ph.D. programs in the United States) from three time points over 20 years to document the waning psychodynamic approach in clinical psychology programs. We review the scientific evidence for four primary tenets of a contemporary psychodynamic approach: three related to development-from healthy to psychopathological: (1) unconscious processes; (2) internal representations of self and other; (3) dimensional model of psychopathology, and a fourth tenet that builds on these three and is the foundation for a contemporary psychodynamic approach to psychotherapy: (4) therapeutic relationship as a primary mechanism of change. RESULTS/CONCLUSIONS Based on the review of the evidence, we make specific recommendations for clinical psychology training programs about how to include a psychodynamic approach in the curriculum.
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Affiliation(s)
- Alytia A Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Joshua E Turchan
- Counseling and Psychiatric Services, Michigan State University, East Lansing, Michigan, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, California, USA
| | - Evan Good
- Austen Riggs Center, Stockbridge, Massachusetts, USA
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Peterson S, Miciak M, Kleiner M, Woolf J, Davenport T. Drawing a "Perfect Circle": How Clinicians Can Become Better Communicators. J Orthop Sports Phys Ther 2023; 53:579-584. [PMID: 37683096 DOI: 10.2519/jospt.2023.11917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
SYNOPSIS: Despite the importance of communication in person-focused care, biomedical knowledge and technical skill development are often prioritized in physical therapy education. As clinicians and educators, we contend that mindfulness and reflection nurture effective communication approaches and support physical therapists in navigating the complexity and uncertainty that comprise most clinical interactions. We suggest that clinicians be mindful of the self, the patient, and the context when interacting with patients. Although being mindful cultivates awareness and curiosity, being reflective is an active practice that can be used while deliberating about the right thing to do or say in a particular situation. In this Viewpoint, we offer clinicians and educators suggestions for engaging in mindful and reflective practices. Through the contemplative practices of mindfulness and reflection, clinicians can better cultivate their communication expertise and good practice. J Orthop Sports Phys Ther 2023;53(10):579-584. Epub: 8 September 2023. doi:10.2519/jospt.2023.11917.
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Rodríguez-Nogueira Ó, Balaguer JM, Nogueira López A, Merino JR, Zamora-Conesa V, Moreno-Poyato AR. Adaptation of the person centered therapeutic relationship patient version (PCTR-PT) to a version for physiotherapists (PCTR-PHYS) and evaluation of its psychometric properties. Physiother Res Int 2023; 28:e2007. [PMID: 37070170 DOI: 10.1002/pri.2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND AND PURPOSE The therapeutic relationship is a central component for developing person-centered care within physiotherapy services. However, it is necessary to understand how this relationship is perceived by both parties involved. The Person Centered Therapeutic Relationship-Patient scale (PCTR-PT) was constructed to identify patients' perceptions. No instruments are currently available to correlate patients' and physiotherapists' perceptions of the therapeutic relationship. This study sought to adapt the PCTR-PT to develop a version for physiotherapists, the Person Centered Therapeutic Relationship Scale for Physiotherapists (PCTR-PHYS) and to determine its psychometric properties. METHODS A three-stage study was performed: (1) item generation, (2) pretesting of the questionnaire, (3) analysis of psychometric properties. Factor validity and psychometric properties were analyzed by confirmatory factor analysis (CFA). Convergent validity was calculated. Internal consistency was verified using the Cronbach's alpha coefficient. The intraclass correlation coefficient (ICC) was used to examine temporal stability. RESULTS Thirty-three physiotherapists participated in two rounds of cognitive interviews and 343 participated in the analysis of psychometric properties. The CFA confirmed the four-structure model. Reliability of the tool was confirmed by Cronbach's alpha (α = 0.863) for all four dimensions, as all were above 0.70, ranging from 0.704 (relational bond) and 0.898 (therapeutic communication). Test-retest was performed with 2-week intervals, indicating an appropriate stability for the scale (ICC = 0.908). DISCUSSION The Person Centered Therapeutic Relationship Scale for Physiotherapists is a useful, valid and applicable instrument to evaluate the person-centered therapeutic relationship during physiotherapy interventions. It will enable the comparison of patients' and physiotherapists' perceptions. To provide person-centered care in physiotherapy services, there is a clear need to incorporate specific resources into clinical practice to evaluate the quality of the therapeutic relationship from the perspective of both the persons being treated and the professionals providing care.
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Affiliation(s)
- Óscar Rodríguez-Nogueira
- Department of Nursing and Physiotherapy, SALBIS Research Group, Universidad de León, Ponferrada, León, Spain
| | - Jaume Morera Balaguer
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Alicante, Spain
| | - Abel Nogueira López
- Department of Physical Education and Sports, Universidad de León, León, Spain
| | - Juan Roldán Merino
- Campus Docent Sant Joan de Déu-Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Víctor Zamora-Conesa
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Alicante, Spain
| | - Antonio R Moreno-Poyato
- Mental health, psychosocial and complex nursing care research group (NURSEARCH), Barcelona, Spain
- Facultat de Medicina i Ciències de la Salut, Escola d´Infermeria Departament d'Infermeria de Salut Pública, Salut Mental I Materno Infantil, Universitat de Barcelona, Barcelona, Spain
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Raymond M, Proulx J, Ruest G, Brouillette-Alarie S. Sexual Recidivism During Treatment: Impact on Therapists. Sex Abuse 2023; 35:787-811. [PMID: 36656548 PMCID: PMC10475210 DOI: 10.1177/10790632231153636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
There are few studies of therapists' reactions to working with individuals who have committed sexual offenses, and almost none on reactions following sexual recidivism by a patient who is currently in treatment. Consequently, the aim of the current study was to analyze the cognitive and emotional reactions, as well as the intervention strategies, of therapists who have learned of the sexual recidivism of a patient. A total of 59 participants from the province of Quebec (Canada) completed a questionnaire on their reactions to this event. Participants' responses to their patient's recidivism varied as a function of gender, experience, and the way they learned of the recidivism. The most common cognitions reported were thinking of the victim and thinking about the consequences of further judicialization for the patient and those close to them. The most common emotions reported were sadness for the victim and fear that the patient would reoffend again. The most common intervention strategies were being sensitive to the experience of the patient and asking the patient what drove them to offend. Support measures for therapists working with individuals who have committed sexual offenses during treatment are discussed.
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Affiliation(s)
- Michel Raymond
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC, Canada
| | | | - Geneviève Ruest
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC, Canada
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