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Békés V, Spina DS, Aafjes-van Doorn K, Gorman BS, Stukenberg K, Waldron S. Development of a new observer-rated measure to assess the real relationship in psychotherapy sessions. Psychother Res 2024:1-11. [PMID: 38943680 DOI: 10.1080/10503307.2024.2360459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/18/2024] [Indexed: 07/01/2024] Open
Abstract
OBJECTIVES Real relationship (RR) refers to a genuine human relationship between client and therapist, that has been found to be positively related to treatment outcome, and to predict unique variance in outcome over and above the working alliance. However, thus far, the measurement of RR has been limited to self-report. We aimed to develop an observer-rated version of the RR measure (RR-O) to assess RR in therapy sessions. METHODS We adapted items from the self-report measures to an observer rated measure, which was reviewed by RR experts. The final 24-item RR-O was rated in 540 session transcripts from 27 psychoanalytic treatments that already had existing process and outcome scores. RESULTS The RR-O showed good internal consistency and good interrater reliability. In hierarchical EFA, items clustered into a general RR factor, and client realism, client genuineness, therapist genuineness, and therapist realism group factors. In addition, the RR-O was positively related to another RR measure and to the therapeutic alliance. CONCLUSION The RR-O shows initial reliability and validity as an observer-rated measure of the RR to be used in post-hoc psychotherapy research. Future research should clarify the relation between RR-O and treatment outcome.
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Affiliation(s)
- Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Daniel S Spina
- Department of Psychology, The Pennsylvania State University, University Park, PA, USA
| | - Katie Aafjes-van Doorn
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
- Psychoanalytic Research Consortium, New York, NY, USA
| | - Bernard S Gorman
- Department of Psychology, Hofstra University, New York, NY, USA
- Psychoanalytic Research Consortium, New York, NY, USA
- Derner Institute, Adelphi University, New York, NY, USA
| | - Karl Stukenberg
- Psychoanalytic Research Consortium, New York, NY, USA
- School of Psychology, Xavier University, Cincinnati, OH, USA
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Aafjes-Van Doorn K, Békés V, Luo X, Hopwood CJ. Therapists' perception of the working alliance, real relationship and therapeutic presence in in-person therapy versus tele-therapy. Psychother Res 2024; 34:574-588. [PMID: 37011405 DOI: 10.1080/10503307.2023.2193299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/14/2023] [Indexed: 04/05/2023] Open
Abstract
Objective: Although teletherapy is increasingly common, very little is known about its impact on therapeutic relationships. We aimed to examine differences between therapists' experiences of teletherapy and in-person therapy post-pandemic with regard to three variables pertinent to the therapeutic relationship: working alliance, real relationship, and therapeutic presence. METHODS In a sample of 826 practicing therapists, we examined these relationship variables, as well as potential moderators of these perceived differences including professional and patient characteristics and covid-related variables. RESULTS Therapists reported feeling significantly less present in teletherapy and their perceptions of the real relationship were somewhat impacted, but there were no average effects on their perceived quality of the working alliance. Perceived differences in the real relationship did not persist with clinical experience controlled. The relative reduction in therapeutic presence in teletherapy was driven by the ratings of process-oriented therapists and therapists conducting mostly individual therapy. Evidence for moderation by covid-related issues was also found, with larger perceived differences in the working alliance reported by therapists who used teletherapy because it was mandated and/or not by choice. CONCLUSION Our findings might have important implications for generating awareness around the therapists' lowered sense of presence in teletherapy compared to in-person teletherapy.
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Affiliation(s)
| | - Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
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Kramuschke M, Reinhardt J, Dölemeyer R, Kaiser J, Kersting A. The change of working alliance and the association to treatment outcome in an internet-based therapy after pregnancy loss. BMC Psychol 2024; 12:254. [PMID: 38715033 PMCID: PMC11077727 DOI: 10.1186/s40359-024-01751-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Working alliance is a prominent non-specific factor for treatment outcomes in face-to-face and internet-based interventions. The association between working alliance and therapy outcome appears to be time- and disorder-specific, but less is known about the change of working alliance during the intervention and the impact of working alliance in grief-specific interventions. The present study examines the association between the change of working alliance and treatment outcomes in an internet-based intervention for parents who experienced pregnancy loss. METHODS 228 participants received a grief intervention based on cognitive behavioral therapy with asynchronous text-based therapist feedback. Prolonged grief and related symptoms of traumatic stress, depression, anxiety, and general psychopathology were assessed with validated instruments before and after the intervention. The change of working alliance was assessed using the short version of the Working Alliance Inventory at mid-treatment (session 4) and the end of the treatment (session 10). RESULTS Data for N = 146 persons was analyzed. Working alliance in total and all subscales increased significantly from sessions 4 to 10. This change in working alliance correlated significantly with a reduction in prolonged grief. Changes in subscales of working alliance also correlated with symptoms of depression and general psychopathology. Regression analysis showed that a change in working alliance predicted a reduction in prolonged grief but did not predict improvements in other grief-related symptoms. CONCLUSION The results examine the change of working alliance during an internet-based intervention and the association with treatment outcome. A small impact of change in working alliance on treatment outcome of prolonged grief was confirmed, but not on related symptoms. Further research is needed to assess moderators of the alliance-outcome association to improve internet-based interventions. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Martin Kramuschke
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Jana Reinhardt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Ruth Dölemeyer
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
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Stefana A, Fusar-Poli P, Langfus J, Vieta E, Youngstrom E. Development and preliminary validation of the Clinician Affective REsponse (CARE) scale. RESEARCH IN PSYCHOTHERAPY (MILANO) 2024; 27:736. [PMID: 38551502 PMCID: PMC11064772 DOI: 10.4081/ripppo.2024.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/19/2024] [Indexed: 05/03/2024]
Abstract
The present study reports on the development and validation of the clinician affective response (CARE) scale. The CARE scale was designed as a self-report measure of therapists' patterns of thoughts, feelings, and behaviors toward the patient during an individual psychotherapy session. An initial pool of 116 items was generated, and its quality was evaluated by subject matter experts. Validation data were gathered from licensed psychotherapists (n=554). We used exploratory factor analysis and item response theory-graded response modeling to select items, confirmatory factor analysis to test how well the factor structure fit the data, and k-fold cross-validation to ascertain the robustness of the model. Criterion validity was evaluated by correlating the scores of the scale with the characteristics of therapists, patients, and treatment. The selected model consists of 15 items and a 3-factor structure, which showed excellent model fit, good internal consistency, and evidence of criterion validity. The CARE scale, short and quick to complete, enables therapists to reflect on and recognize their inner experiences and quantify these experiences in ways conducive to statistical analysis and research. Furthermore, the monitoring of these affective reactions toward their patients can guide therapeutic interventions and inform clinical supervisors.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia.
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Italy; OASIS Service, South London and Maudsley NHS Foundation Trust, London; Early Psychosis: Interventions and Clinical-detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London.
| | - Joshua Langfus
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC.
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, University of Barcelona, Hospital Clinic, IDIBAPS, CIBERSAM, Barcelona.
| | - Eric Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC; Helping Give Away Psychological Science, Chapel Hill, NC; Division of Child and Family Psychiatry, Institute for Mental and Behavioral Health Research, Ohio State University, Nationwide Children's Hospital, Columbus, OH.
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Stefana A, Fusar-Poli P, Vieta E, Gelso CJ, Youngstrom EA. Development and validation of an 8-item version of the Real Relationship Inventory-Client form. Psychother Res 2024:1-17. [PMID: 38497741 DOI: 10.1080/10503307.2024.2320331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 02/08/2024] [Indexed: 03/19/2024] Open
Abstract
OBJECTIVE To develop and validate a very brief version of the 24-item Real Relationship Inventory-Client (RRI-C) form. METHOD Two independent samples of individual psychotherapy patients (Nsample1 = 700, Nsample2 = 434) completed the RRI-C along with other measures. Psychometric scale shortening involved exploratory factor analysis, item response theory analysis, confirmatory factor analysis (CFA), and multigroup CFA. Reliability and convergent and discriminant validity of the scale and subscales were also assessed. RESULTS The 8-item RRI-C (RRI-C-SF) preserves the two-factor structure: Genuineness (k = 4, α = .86) and Realism (k = 4, α = .87), which were correlated at r = .74. CFA provided the following fit indices for the bifactor model: X2/df = 2.16, CFI = .99, TLI = .96, RMSEA = .07, and SRMR = .03. Multigroup CFA showed that the RRI-C-SF was invariant across in-person and remote session formats. The RRI-C-SF demonstrated high reliability (α = .91); high correlation with the full-length scale (r = .96); and excellent convergent and discriminant validity with measures of other elements of the therapeutic relationship, personality characteristics, current mental health state, and demographic-clinical variables. Clinical change benchmarks were calculated to serve as valuable tools for both research and clinical practice. CONCLUSION The RRI-C-SF is a reliable measure that can be used for both research and clinical purposes. It enables a nuanced assessment of the genuineness and the realism dimensions of the real relationship.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Hospital Clinic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Charles J Gelso
- Department of Psychology, University of Maryland, College Park, MA, USA
| | - Eric A Youngstrom
- Institute for Mental and Behavioral Health Research, Nationwide Children's Hospital and Department of Psychiatry, The Ohio State University, Columbus, OH, USA
- Helping Give Away Psychological Science, 501c3
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Echterhoff J, Kriston L, Klein JP, Härter M, Schramm E, Schumacher L. Symptom-specific improvement across therapies and their putative mediators: A mediation network intervention analysis. Psychother Res 2024:1-12. [PMID: 38431848 DOI: 10.1080/10503307.2024.2320349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024] Open
Abstract
OBJECTIVE We evaluated differential treatment effects on specific symptoms and their mediators for Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Supportive Psychotherapy (SP) in persistently depressed patients. METHOD We conducted a Bayesian mediation network intervention analysis with data from a randomized controlled trial comparing CBASP and SP. Three networks were calculated to investigate (1) differential treatment effects on specific symptoms, (2) differential treatment effects on the potential mediators interpersonal problems and social functioning, and (3) associations between change in symptoms and change in the potential mediators. RESULTS First, we found no evidence that CBASP more strongly improves most depressive symptoms specifically, except minimal evidence of symptom-specific effects on sleeping problems and self-esteem. Second, no and minimal evidence for differential treatment effects on interpersonal problems and social functioning was shown, respectively. Third, interpersonal problems and social functioning were strongly related to depressive symptoms. CONCLUSION While CBASP showed superior treatment effects for overall symptom severity, this treatment might not be superior in improving specific symptoms and the potential mediators interpersonal problems and social functioning. Still, interpersonal problems and social functioning seem to play an important role for depression symptoms. Future research needs to further investigate potential working mechanisms of CBASP.Trial registration: ClinicalTrials.gov identifier: NCT00970437.
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Affiliation(s)
- Jette Echterhoff
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Philipp Klein
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Lübeck, Lübeck, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lea Schumacher
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Rohn EJ, Hearn JH, Philippus AM, Monden KR. "It's been a double-edged sword": An online qualitative exploration of the impact of COVID-19 on individuals with spinal cord injury in the US with comparisons to previous UK findings. J Spinal Cord Med 2024; 47:51-63. [PMID: 36260026 PMCID: PMC10795552 DOI: 10.1080/10790268.2022.2129164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The impact of COVID-19 lockdowns and social distancing for persons with spinal cord injury (SCI) are poorly understood. This exploratory online qualitative study collected self-reported COVID-19 experiences from persons with SCI in the United States (US). To enrich understanding, these data were compared to similar previously-published data from a sample of SCI participants from the United Kingdom (UK). DESIGN Explorative, online qualitative study. Participants completed an online survey of open-ended qualitative questions pertaining to their experiences during the pandemic. Thematic analysis was utilized to generate themes from the US data. These themes were compared to our previously-published thematic analysis of data from the UK. SETTING Community-based sample of persons with SCI in the US. PARTICIPANTS Participants were recruited via SCI-focused research registries and social media outlets serving the SCI community, using convenience sampling (n = 36). Key themes identified in the US data were compared to themes identified in a similar sample from the UK (n = 42) collected at the same time and published previously. RESULTS Analysis resulted in three themes from the US data, each containing positive and negative qualitative reflections. Themes included (1) health and access to care, (2) making sense of the pandemic, and (3) daily life during the pandemic. Each theme captured common facets of life during the pandemic, often shared by those without physical disabilities, but included accounts particularly relevant to persons with disabilities. Comparisons to thematic findings from the UK study revealed similarities (e.g. healthcare access challenges, isolation) and differences (e.g. importance of previous SCI experiences). CONCLUSION We detailed common experiences of COVID-19 pandemic lockdowns and their impact on people with SCI, while contrasting these with sense-making positive reflections and social benefits that appeared to be helpful in managing distress and coping with the pandemic.
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Affiliation(s)
- Edward J. Rohn
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jasmine H. Hearn
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Angela M. Philippus
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kimberley R. Monden
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Israel P, Steffensen C, Hadland HH. Experiences of family therapists working with parents after the forced removal of children: What can the contextual model tell us? COGENT PSYCHOLOGY 2023. [DOI: 10.1080/23311908.2022.2151731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Pravin Israel
- Faculty of Health Sciences, VID Specialized University, Oslo, Norway
- Family Counselling Services, Stavanger, Norway, South Rogaland
| | - Cathrine Steffensen
- Family Counselling Services, Stavanger, Norway, South Rogaland
- Bufetat: The National Competence Center- Support services for birth parents
| | - Hege H. Hadland
- Family Counselling Services, Stavanger, Norway, South Rogaland
- Bufetat: The National Competence Center- Support services for birth parents
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Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC PRIMARY CARE 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
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Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
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Cogan AM, Bailie JM. Therapeutic Relationship in mTBI Rehabilitation: The Disparity Between the Illness Experience and Clinical Definitions. Mil Med 2023; 188:e3010-e3016. [PMID: 37192051 DOI: 10.1093/milmed/usad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/15/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023] Open
Abstract
INTRODUCTION A positive therapeutic relationship is characterized by trust and mutually perceived genuineness. It is positively associated with patients' adherence to treatment, satisfaction, and health outcomes. When service members with a history of mild traumatic brain injury (mTBI) present to rehabilitation clinics with nonspecific symptoms, a disparity between their experience of disability and clinical expectations of mTBI may disrupt the establishment of a positive therapeutic relationship between patients and providers. The objectives of this study are to (1) explore disparities between military service members and rehabilitation clinicians about the clinical diagnosis and illness experience of mTBI and (2) identify barriers to the establishment of a positive therapeutic relationship. MATERIALS AND METHODS This is a qualitative descriptive study of military service members with prior mTBI (n = 18) and clinicians (n = 16) who participated in interviews and focus groups. Data were analyzed thematically using Kleinman's framing of illness experience and clinical diagnosis. RESULTS Three themes reflected the potential breakdowns in the therapeutic relationship. The first theme, clinical expectations for post-injury recovery versus patients' experience of ongoing disability, reflects the inconsistency between clinicians' expectations of symptom resolution within 90 days following mTBI and service members' experiences of symptoms that worsened over several months or years. The second theme, symptom attribution to mental health conditions versus tissue injury, describes the difficulty in attributing symptoms to the physical impact of the mTBI or mental health diagnoses that may also stem from the injury event. The third theme, suspected malingering versus valid disability, describes clinicians' reports of frustration with cases in which they suspected malingering for secondary gains in contrast with service members' feelings that their problems were not taken seriously by clinicians. CONCLUSIONS This study extended previous research on therapeutic relationships by examining the situation of mTBI rehabilitation services for military service members. The findings reinforce the best practice recommendations of acknowledging patients' experiences, addressing the presenting symptoms and problems, and encouraging progressive return to activity following mTBI. Acknowledgment of and attention to patients' illness experience by rehabilitation clinicians is necessary and important for supporting a positive therapeutic relationship and ultimately to optimize patients' health outcomes and reduce disability.
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Affiliation(s)
- Alison M Cogan
- Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA 90089, USA
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Jason M Bailie
- Traumatic Brain Injury Center of Excellence (TBICoE), Defense Health Agency (DHA), Intrepid Spirit, Naval Hospital Camp Pendleton, Oceanside, CA 92058, USA
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Solness CL, Holdefer PJ, Hsu T, Thomas EBK, O'Hara MW. Relationship Factors in Internet-Delivered Psychological Interventions for Veterans Experiencing Postpartum Depression: Qualitative Analysis. JMIR Ment Health 2023; 10:e46061. [PMID: 37581917 PMCID: PMC10466152 DOI: 10.2196/46061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/28/2023] [Accepted: 06/29/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Internet-delivered psychological interventions (IPIs) have been shown to be effective for a variety of psychological concerns, including postpartum depression. Human-supported programs produce better adherence and larger effect sizes than unsupported programs; however, what it is about support that affects outcomes is not well understood. Therapeutic alliance is one possibility that has been found to contribute to outcomes; however, the specific mechanism is not well understood. Participant perspectives and qualitative methodology are nearly absent from the IPI alliance research and may help provide new directions. OBJECTIVE In this study, we aimed to provide participant perspectives on engagement with an IPI for postpartum depression to help inform alliance research, development of new IPIs, and inform resource allocation. METHODS A qualitative methodology was used to explore participant perspectives of veteran women's engagement with the MomMoodBooster program, a human-supported internet-delivered intervention for postpartum depression. Participants were asked 4 open-ended questions with the 3-month postintervention survey, "In what ways did you find the MomMoodBooster most helpful?" "How do you think the MomMoodBooster could have been improved?" "In what ways did you find the personal coach calls to be helpful?" and "How do you think the personal coach calls could have been improved?" RESULTS Data were collected from 184 participants who responded to at least 1 of the open-ended questions. These were analyzed using thematic analysis and a process of reaching a consensus among coders. The results suggest that not only the engagement with the support person is perceived as a significant contributor to participant experiences while using the MomMoodBooster content but also the relationship factors are particularly meaningful. The results provide insights into the specific qualities of the support person that were perceived as most impactful, such as warmth, empathy and genuineness, and feeling normalized and supported. In addition, the results provide insight into the specific change processes that can be targeted through support interactions, such as encouraging self-reflection and self-care and challenging negative thinking. CONCLUSIONS These data emphasize the importance of relationship factors between support persons and an IPI program for postpartum depression. The findings suggest that focusing on specific aspects of the alliance and the therapeutic relationship could yield fruitful directions for the training of support personnel and for future alliance-based research of internet-delivered treatments.
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Affiliation(s)
- Cara L Solness
- Department of Psychiatry, School of Medicine, University of Colorado, Aurora, CO, United States
| | - Paul J Holdefer
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Ti Hsu
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
| | - Michael W O'Hara
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, United States
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Rodrigues Ribeiro P, Dias Neto D. The real relationship: the Portuguese version of the <em>Real Relationship Inventory-Client</em> form. RESEARCH IN PSYCHOTHERAPY (MILANO) 2023; 26:678. [PMID: 37403924 PMCID: PMC10481421 DOI: 10.4081/ripppo.2023.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 05/05/2023] [Indexed: 07/06/2023]
Abstract
The Real Relationship is a relational construct that has influenced other constructs, like the working alliance, although empirically neglected. The development of the Real Relationship Inventory provides a reliable and valid way of measuring the Real Relationship in research and clinical applications. This study aimed to validate and explore the psychometric properties of the Real Relationship Inventory Client Form with a Portuguese adult sample in the context of psychotherapy. The sample includes 373 clients currently in psychotherapy or concluded recently. All clients completed the Real Relationship Inventory (RRI-C) and the Working Alliance Inventory. The confirmatory analysis revealed the same two factors in the RRI-C for the Portuguese adult population, Genuineness and Realism. The observation of the same factor structure suggests the cross-cultural value of the Real Relationship. The measure demonstrated good internal consistency and acceptable adjustment. A significant correlation was found between the RRI-C and the Working Alliance Inventory and significant correlations between the Bond and Genuineness and Realism subscales. The present study reflects on the RRI-C while also contributing to the importance of the Real Relationship in different cultures and clinical contexts.
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Affiliation(s)
- Pedro Rodrigues Ribeiro
- Applied Psychology Research Center Capabilities and Inclusion, School of Psychology, ISPA - Instituto Universitário, Lisbon.
| | - David Dias Neto
- Applied Psychology Research Center Capabilities and Inclusion, School of Psychology, ISPA - Instituto Universitário, Lisbon.
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Cataldo F, Mendoza A, Chang S, Buchanan G, Van Dam NT. Enhancing Therapeutic Processes in Videoconferencing Psychotherapy: Interview Study of Psychologists' Technological Perspective. JMIR Form Res 2023; 7:e40542. [PMID: 36927506 PMCID: PMC10019766 DOI: 10.2196/40542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic caused a surge in the use of telehealth platforms. Psychologists have shifted from face-to-face sessions to videoconference sessions. Therefore, essential information that is easily obtainable via in-person sessions may be missing. Consequently, therapeutic work could be compromised. OBJECTIVE This study aimed to explore the videoconference psychotherapy (VCP) experiences of psychologists around the world. Furthermore, we aimed to identify technological features that may enhance psychologists' therapeutic work through augmented VCP. METHODS In total, 17 psychologists across the world (n=7, 41% from Australia; n=1, 6% from England; n=5, 29% from Italy; n=1, 6% from Mexico; n=1, 6% from Spain; and n=2, 12% from the United States) were interviewed. We used thematic analysis to examine the data collected from a sample of 17 psychologists. We applied the Chaos Theory to interpret the system dynamics and collected details about the challenges posed by VCP. For collecting further information about the technology and processes involved, we relied on the Input-Process-Output (IPO) model. RESULTS The analysis resulted in the generation of 9 themes (input themes: psychologists' attitude, trust-reinforcing features, reducing cognitive load, enhancing emotional communication, and engaging features between psychologists and patients; process themes: building and reinforcing trust, decreasing cognitive load, enhancing emotional communication, and increasing psychologist-patient engagement) and 19 subthemes. Psychologists found new strategies to deal with VCP limitations but also reported the need for more technical control to facilitate therapeutic processes. The suggested technologies (eye contact functionality, emergency call functionality, screen control functionality, interactive interface with other apps and software, and zooming in and out functionality) could enhance the presence and dynamic nature of the therapeutic relationship. CONCLUSIONS Psychologists expressed a desire for enhanced control of VCP sessions. Psychologists reported a decreased sense of control within the therapeutic relationship owing to the influence of the VCP system. Great control of the VCP system could better approximate the critical elements of in-person psychotherapy (eg, observation of body language). To facilitate improved control, psychologists would like technology to implement features such as improved eye contact, better screen control, emergency call functionality, ability to zoom in and out, and an interactive interface to communicate with other apps. These results contribute to the general perception of the computer as an actual part of the VCP process. Thus, the computer plays a key role in the communication, rather than remaining as a technical medium. By adopting the IPO model in the VCP environment (VCP-IPO model), the relationship experience may help psychologists have more control in their VCP sessions.
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Affiliation(s)
- Francesco Cataldo
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Antonette Mendoza
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Shanton Chang
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - George Buchanan
- School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Melbourne, Australia
| | - Nicholas T Van Dam
- School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
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14
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Bechtold S, Hall M, Scherner PV, Kaven L, Rubel J. [Therapists' Perspectives on Changes in the Therapeutic Relationship after Switching from in-Person to Online Video Therapy Due to Corona: A Qualitative Analysis]. Psychother Psychosom Med Psychol 2023; 73:221-230. [PMID: 36878308 DOI: 10.1055/a-2017-5338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the extent to which the therapeutic relationship changed as a result of the COVID-19-related switch from face-to-face to video therapy. METHOD Twenty-one psychotherapists, who had changed the setting of therapy from face-to-face to video therapy were interviewed. The interviews were then transcribed, coded and superordinate themes were created in the context of a qualitative analysis. RESULTS More than half of the therapists reported that the therapeutic relationship with their patients remained stable. In addition, the majority of therapists described uncertainties in dealing with and responding to non-verbal signals, as well as maintaining an appropriate distance to their patients. Overall, both an improvement and a deterioration of the therapeutic relationship was reported. DISCUSSION The stability of the therapeutic relationship was mainly attributed to the therapists' previous face-to-face contact with their patients. The uncertainties expressed could be interpreted as risk factors for the therapeutic relationship. Although the sample represented only a small portion of working therapists, the findings from this study represent an important milestone in understanding how psychotherapy has changed as a result of the COVID-19 pandemic. CONCLUSION The therapeutic relationship remained stable despite the change from face-to-face to video therapy.
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Affiliation(s)
- Sara Bechtold
- Abteilung für Psychotherapieforschung, Justus Liebig Universität Giessen
| | - Mila Hall
- Abteilung für Psychotherapieforschung, Justus Liebig Universität Giessen
| | | | - Leonie Kaven
- Professur für Klinische Psychologie und Psychotherapie, Universität Greifswald
| | - Julian Rubel
- Abteilung für Psychotherapieforschung, Justus Liebig Universität Giessen
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15
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Soma CS, Knox D, Greer T, Gunnerson K, Young A, Narayanan S. It's not what you said, it's how you said it: An analysis of therapist vocal features during psychotherapy. COUNSELLING & PSYCHOTHERAPY RESEARCH 2023; 23:258-269. [PMID: 36873916 PMCID: PMC9979575 DOI: 10.1002/capr.12489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/21/2021] [Indexed: 11/07/2022]
Abstract
Psychotherapy is a conversation, whereby, at its foundation, many interventions are derived from the therapist talking. Research suggests that the voice can convey a variety of emotional and social information, and individuals may change their voice based on the context and content of the conversation (e.g., talking to a baby or delivering difficult news to patients with cancer). As such, therapists may adjust aspects of their voice throughout a therapy session depending on if they are beginning a therapy session and checking in with a client, conducting more therapeutic "work," or ending the session. In this study, we modeled three vocal features-pitch, energy, and rate-with linear and quadratic multilevel models to understand how therapists' vocal features change throughout a therapy session. We hypothesized that all three vocal features would be best fit with a quadratic function - starting high and more congruent with a conversational voice, decreasing during the middle portions of therapy where more therapeutic interventions were being administered, and increasing again at the end of the session. Results indicated a quadratic model for all three vocal features was superior in fitting the data, as compared to a linear model, suggesting that therapists begin and end therapy using a different style of voice than in the middle of a session.
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Affiliation(s)
- Christina S Soma
- Department of Educational Psychology, University of Utah, Salt Lake City, (UT) USA
| | - Dillon Knox
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
- Ming Hsieh Department of Electrical Engineering, University of Southern California, Los Angeles, (CA,) USA
| | - Timothy Greer
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
| | - Keith Gunnerson
- Department of Educational Psychology, University of Utah, Salt Lake City, (UT) USA
| | - Alexander Young
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
| | - Shrikanth Narayanan
- Viterbi Department of Computer Science, University of Southern California, Los Angeles, (CA,) USA
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16
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Correia KCR, Araújo JLD, Barreto SRV, Bloc L, Melo AK, Moreira V. Saúde Mental na Universidade: Atendimento Psicológico Online na Pandemia da Covid-19. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2023. [DOI: 10.1590/1982-3703003245664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Resumo Com a pandemia da covid-19, o contexto universitário, que já vinha sendo palco de discussões em relação à saúde mental, tem vivenciado crises mais severas pelos estudantes. Diante deste cenário, foi desenvolvido o projeto Escuta Solidária, voltado à saúde mental dos discentes de graduação e de pós-graduação. Neste artigo, temos como objetivo discutir o atendimento psicológico online com estudantes do curso de psicologia durante o período de isolamento social rígido (maio a junho de 2020). Fizemos, com os psicólogos voluntários, um grupo focal direcionado para a experiência de atendimento psicológico online de curta duração no contexto pandêmico. Trata-se de um estudo qualitativo, realizado com os 11 psicólogos clínicos participantes do referido projeto. A partir de uma análise fenomenológica crítica, os resultados foram divididos em cinco categorias: a) limitações e contribuições do projeto; b) a importância da capacitação e supervisão clínica para a qualidade do projeto; c) atendimento psicológico online; d) ser psicólogo clínico durante a crise da covid-19; e e) demandas emergentes nos atendimentos psicológicos na quarentena. Por fim, discutimos a importância da desmistificação do atendimento psicológico em situações de crise, especialmente na modalidade online, fomentando questionamentos à formação e atuação dos profissionais, no sentido de estarmos atentos às demandas psicológicas que o contexto de crise acarreta na sociedade.
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17
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Oudshoorn CEM, Frielink N, Riper H, Embregts PJCM. Measuring working alliance and technical alliance from the perspective of healthcare professionals working with people with mild intellectual disabilities: adaptation, factor structure and reliability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:49-63. [PMID: 36320102 PMCID: PMC10092498 DOI: 10.1111/jir.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The establishment of a valuable and meaningful working alliance between people with mild intellectual disabilities (IDs) and healthcare professionals is critically important for improving both the quality of life and impact of therapy for people with mild IDs. Measuring the working alliance as a treatment or support component is therefore of utmost relevance. In light of the increased use of eHealth tools, it is also essential to measure the alliance using these tools, which is referred to as technical alliance. There was a lack of validation of these two measurements for healthcare professionals working with people with mild IDs, which this study sought to address. METHOD Both the validated Working Alliance Inventory - Short Form - MID (WAI-SF-MID) and Technical Alliance Inventory - Short Form - MID (TAI-SF-MID) for general patient populations were adapted for healthcare professionals working with people with mild IDs. A two-step approach was conducted to systematically adapt both measurements with an expert group of healthcare professionals. Confirmatory factor analysis was conducted to test a three-factor structure for both the WAI-SF-MID (N = 199) and the TAI-SF-MID (N = 139), and internal consistency was determined for both scales. RESULTS An acceptable-to-good model fit was found for both the WAI-SF-MID and the TAI-SF-MID; confirmatory factor analysis confirmed a three-factor model for both measurements. Cronbach's alpha and McDonald's omega were excellent for both total scales (≥0.90) and acceptable to good for sub-scales of both versions. CONCLUSION Both the WAI-SF-MID and the TAI-SF-MID are promising measurements for determining healthcare professionals' perspective on the (digital) working alliance with people with mild IDs.
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Affiliation(s)
- C. E. M. Oudshoorn
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
- ASVZSliedrechtThe Netherlands
| | - N. Frielink
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - H. Riper
- Department of Clinical, Neuro‐ & Developmental PsychologyVrije Universiteit Amsterdam, Amsterdam Public Health, Mental Health ProgramAmsterdamThe Netherlands
- Department of PsychiatryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - P. J. C. M. Embregts
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
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18
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Muran JC, Lipner LM, Podell S, Reinel M. Rupture repair as change process and therapist challenge ( Reparación de rupturas como proceso de cambio y desafío para el terapeuta). STUDIES IN PSYCHOLOGY 2022. [DOI: 10.1080/02109395.2022.2127234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Lauren M. Lipner
- Adelphi University
- Mount Sinai Beth Israel Psychotherapy Research Program
| | - Samuel Podell
- Adelphi University
- Mount Sinai Beth Israel Psychotherapy Research Program
| | - Mahaira Reinel
- Pontificia Universidad Católica de Chile, Millennium Institute for Research in Depression and Personality (MIDAP)
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19
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Stefana A, Fusar-Poli P, Gnisci C, Vieta E, Youngstrom EA. Clinicians' Emotional Reactions toward Patients with Depressive Symptoms in Mood Disorders: A Narrative Scoping Review of Empirical Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15403. [PMID: 36430122 PMCID: PMC9692756 DOI: 10.3390/ijerph192215403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this article is to narratively review the empirical literature on clinicians' emotional, cognitive, and behavioral responses (i.e., countertransference) to depressive and other symptoms of patients with mood disorders. Therapist subjective responses (countertransference) can negatively affect both diagnostic and therapeutic processes, especially when they are not recognized and managed promptly. However, at the same time, countertransference recognition, processing, and management can help inform the diagnostic process and improve the therapy process and outcome. In the last couple of decades, the number of studies that empirically explore countertransference toward mood disordered patients, as well as its relationship with various characteristics of both patients and treatment, has increased. Current evidence suggests that patients with depression tend to elicit more positive feelings among clinicians than patients with other severe mental disorders such as borderline personality disorder or schizophrenia. Furthermore, it documents the existence of associations between patients' severity of depressive symptoms and clinicians' subjective reactions, although the results regarding which specific countertransference patterns are evoked in relation to the different phases of the treatment are not entirely consistent. Lastly, growing evidence suggests the presence of clinicians' specific emotional reactions towards patients with suicidal ideation and behavior.
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Affiliation(s)
- Alberto Stefana
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London WC2R 2LS, UK
| | - Cristina Gnisci
- Riabilmente—Centro di Riabilitazione Monterotondo, Monterotondo, 00015 Roma, Italy
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, University of Barcelona Hospital Clinic, IDIBAPS, CIBER-SAM, 08007 Barcelona, Catalonia, Spain
| | - Eric A. Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Helping Give Away Psychological Science (HGAPS.org), Chapel Hill, NC 27599, USA
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20
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Factors promoting alliance quality: Differentiation of therapeutic alliance according to the formal aspects of the psychotherapeutic process and demographic variables. THE EUROPEAN JOURNAL OF PSYCHIATRY 2022. [DOI: 10.1016/j.ejpsy.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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21
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Stefana A, D’Imperio D, Dakanalis A, Vieta E, Fusar-Poli P, Youngstrom E. Probing the impact of psychoanalytic therapy for bipolar disorders: A scoping review. INTERNATIONAL FORUM OF PSYCHOANALYSIS 2022. [DOI: 10.1080/0803706x.2022.2097307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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22
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Fernández O, Espinosa HD, Krause M, Altimir C, Mantilla C, Paz C, Lozano AG, Argumedo D, De La Cerda C, Juan S, Fernández S, Lancho MP, Fernández-Álvarez J. Personal experience of Latin American therapists on their clinical practice during the COVID-19 pandemic ( Experiencia personal de terapeutas latinoamericanos sobre su práctica clínica durante la pandemia por COVID-19). STUDIES IN PSYCHOLOGY 2022. [DOI: 10.1080/02109395.2022.2133456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | | | | | - Clara Paz
- Universidad de las Américas, Ecuador
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23
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Hearn JH, Rohn EJ, Monden KR. Isolated and anxious: A qualitative exploration of the impact of the COVID-19 pandemic on individuals living with spinal cord injury in the UK. J Spinal Cord Med 2022; 45:691-699. [PMID: 34292136 PMCID: PMC9542803 DOI: 10.1080/10790268.2021.1949562] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE People living with spinal cord injury (SCI) are often immunocompromised, and at increased risk of respiratory infection. Given the restrictions in response to the COVID-19 pandemic, those with SCI may be at increased risk of health deterioration, though how this is experienced is poorly understood. This study explored the experiences of people living with SCI during the COVID-19 pandemic. DESIGN Participants completed an online survey consisting of demographic questions, and open-ended qualitative questions pertaining to their experiences during the pandemic. Thematic analysis was utilized for the analytical approach. SETTING Community-based sample in the UK. PARTICIPANTS Participants were recruited via social media outlets of UK-based SCI-specific support charities, and snowball sampling (N = 42, F = 34, M = 8). RESULTS Key themes included: (1) lost access to health services and support, capturing concerns surrounding barriers to healthcare and rehabilitation, which intensified secondary consequences of SCI such as spasm and pain; (2) health anxiety, which was perpetuated by perceived heightened vulnerabilities to respiratory complications; (3) social isolation, with significantly reduced social contact, even with care providers, compounding health experiences. CONCLUSION People living with SCI during the COVID-19 pandemic experienced a variety of personal physical, psychological, and social challenges, each of which could disrupt daily functioning and quality of life. Increased utilization of telehealth is recommended to support continued engagement in rehabilitation, and foster connection and community amongst others with SCI and health professionals.
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Affiliation(s)
- Jasmine Heath Hearn
- The Department of Psychology, Manchester Metropolitan University, Manchester, UK,Correspondence to: Jasmine Heath Hearn, Department of Psychology, Manchester Metropolitan University, Bonsall Street, ManchesterM15 6GX, UK.
| | - Edward J. Rohn
- The Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan, USA
| | - Kimberley R. Monden
- The Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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24
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Prasko J, Ociskova M, Vanek J, Burkauskas J, Slepecky M, Bite I, Krone I, Sollar T, Juskiene A. Managing Transference and Countertransference in Cognitive Behavioral Supervision: Theoretical Framework and Clinical Application. Psychol Res Behav Manag 2022; 15:2129-2155. [PMID: 35990755 PMCID: PMC9384966 DOI: 10.2147/prbm.s369294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/10/2022] [Indexed: 11/23/2022] Open
Abstract
Dysfunctional patterns, beliefs, and assumptions that affect a patient’s perception of other people often affect their perceptions and behaviours towards the therapist. This tendency has been traditionally called transference for its psychoanalytical roots and presents an important factor to monitor and process. In supervision, it is important to put the patient’s transference in the context of the conceptualization of the case. Countertransference occurs when the therapist responds complementary to the patient’s transference based on their own dysfunctional beliefs or assumptions. Transference and countertransference provide useful insights into the inner world of the patient, therapist, and supervisor. Guided discovery is one of the most common approaches used by a supervisor and a supervisee to map all types and directions of transference and countertransference. Other options to map transference and countertransference are imagery and role-playing techniques.
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Affiliation(s)
- Jan Prasko
- Department of Psychiatry, Faculty of Medicine, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic.,Department of Psychological Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic.,Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, Czech Republic.,Rehabilitation Hospital Jessenia Inc, Akeso Holding, Beroun, Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, Faculty of Medicine, Palacky University, University Hospital Olomouc, Olomouc, Czech Republic
| | - Julius Burkauskas
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Milos Slepecky
- Department of Psychological Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic
| | - Ieva Bite
- University of Latvia, Latvian Association of CBT, Riga, Latvia
| | - Ilona Krone
- Riga's Stradins University, Latvian Association of CBT, Riga, Latvia
| | - Tomas Sollar
- Department of Psychological Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, Slovak Republic
| | - Alicja Juskiene
- Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
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25
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Békés V, Aafjes-Van Doorn K. Patients’ attachment avoidance and their perceived quality of the real relationship predict patients’ attitudes towards telepsychotherapy. COUNSELLING PSYCHOLOGY QUARTERLY 2022. [DOI: 10.1080/09515070.2022.2075324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Vera Békés
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, USA
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26
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Lee WL, Lau PL, Baranovich DL, Chan SL. A Phenomenological Study of Malaysian Counsellors’ Experiences in Managing Countertransference. INTERNATIONAL JOURNAL FOR THE ADVANCEMENT OF COUNSELLING 2022. [DOI: 10.1007/s10447-022-09474-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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27
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Aafjes-van Doorn K, Bar-Sella A, Zilcha-Mano S, Luo X, Silberschatz G, Kealy D, McCollum J, Snyder J. Within-patient perceptions of alliance and attunement: Associations with progress in psychotherapy. Clin Psychol Psychother 2022; 29:1717-1727. [PMID: 35352860 DOI: 10.1002/cpp.2737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
The most frequently examined aspect of the therapeutic relationship is the working alliance, which reflects the conscious collaborative bond, and agreement on task and goal. In addition to the established importance of the working alliance, the therapists' attunement and responsiveness might reflect another important aspect of the therapeutic relationship that can be considered in relation to session-by-session progress over treatments. Emerging research suggests that the quality of the working alliance not only differs between patients but also within patients over time. However, little is known about the quality of the therapeutic relationship between and within patients in relation to progress in psychotherapy. We examined fluctuations of the working alliance measure (WAI) and the newly developed measure of the Patients' Experiences of Attunement and Responsiveness (PEAR) during treatment in a naturalistic sample of patients in an outpatient psychotherapy clinic. Multilevel modelling was used to examine the respective contribution of these measures to subsequent improvement in psychological functioning longitudinally. Results suggest that the within-patient effect, instead of between-patient effect, was significant for WAI (and did not reach significance for PEAR), indicating that the fluctuation of WAI was predictive of psychological functioning in the subsequent month. Based on these findings, therapists and their patients might benefit from regular tracking of the patient-reported working alliance. The findings underscore the importance of the alliance, specifically at the within-patient level. It also highlights the challenge for research to tap into other aspects of the therapeutic relationship that can help explain progress in therapy. Given the breadth and accessibility of the working alliance construct, more work is needed for researchers to examine the construct of attunement and responsiveness.
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Affiliation(s)
| | | | | | - Xiaochen Luo
- Department of Counseling Psychology, Santa Clara University, Santa Clara, CA, USA
| | | | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - James McCollum
- San Francisco Psychotherapy Research Group, San Francisco, CA, USA
| | - John Snyder
- San Francisco Psychotherapy Research Group, San Francisco, CA, USA
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28
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Nuñez L, Fernández S, Alamo N, Midgley N, Capella C, Krause M. The therapeutic relationship and change processes in child psychotherapy: a qualitative, longitudinal study of the views of children, parents and therapists. RESEARCH IN PSYCHOTHERAPY: PSYCHOPATHOLOGY, PROCESS AND OUTCOME 2022; 25. [PMID: 35373965 PMCID: PMC9153753 DOI: 10.4081/ripppo.2022.556] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022]
Abstract
Through the perspectives of children, parents and therapists, this study explored the therapeutic relationship as a change facilitator in different moments of psychotherapy. The children, parents, and therapists (N=15) who formed part of five therapeutic treatments were studied using a qualitative, longitudinal design. Thirty semi-structured interviews were done; half at the beginning and half after four months of psychotherapy. Children’s drawings were incorporated, and data were analysed through grounded theory methods and qualitative analysis guidelines for drawings. Participants identified several aspects of the therapeutic relationship as change facilitators. From the first encounters, the therapists’ close and adaptable attitude promoted an improved motivation for psychotherapy and enhanced engagement among children and parents. Later in the process, a positive, child-centred and affective therapeutic relationship fostered the child’s trust with the therapist as well as a positive relational experience, promoting associated changes in children and the development of socio-affective tools. Parents and therapists saw their own relationship as a change facilitator, as well as a broader understanding in parents of their children and an improved relationship with them. Parent’s and child’s changes helped each other. Specific and common aspects between participants’ perspectives provided a richer understanding of the studied phenomena. This study supports the view that a positive therapeutic relationship facilitates early changes in the motivation of children and parents, and provides them with a healing, relational experience as it develops. A positive parent-therapist relationship is also key for changes to further progress.
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Villiger D. How Psychedelic-Assisted Treatment Works in the Bayesian Brain. Front Psychiatry 2022; 13:812180. [PMID: 35360137 PMCID: PMC8963812 DOI: 10.3389/fpsyt.2022.812180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 02/11/2022] [Indexed: 11/25/2022] Open
Abstract
Psychedelics are experiencing a renaissance in clinical research. In recent years, an increasing number of studies on psychedelic-assisted treatment have been conducted. So far, the results are promising, suggesting that this new (or rather, rediscovered) form of therapy has great potential. One particular reason for that appears to be the synergistic combination of the pharmacological and psychotherapeutic interventions in psychedelic-assisted treatment. But how exactly do these two interventions complement each other? This paper provides the first account of the interaction between pharmacological and psychological effects in psychedelic-assisted treatment. Building on the relaxed beliefs under psychedelics (REBUS) hypothesis of Carhart-Harris and Friston and the contextual model of Wampold, it argues that psychedelics amplify the common factors and thereby the remedial effects of psychotherapy. More precisely, psychedelics are assumed to attenuate the precision of high-level predictions, making them more revisable by bottom-up input. Psychotherapy constitutes an important source of such input. At best, it signalizes a safe and supportive environment (cf. setting) and induces remedial expectations (cf. set). During treatment, these signals should become incorporated when high-level predictions are revised: a process that is hypothesized to occur as a matter of course in psychotherapy but to get reinforced and accelerated under psychedelics. Ultimately, these revisions should lead to a relief of symptoms.
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Affiliation(s)
- Daniel Villiger
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland.,Institute of Philosophy, University of Zurich, Zurich, Switzerland
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Gelso CJ, Hill CE, Kivlighan DM. The Synergistic but Troubled Relationship Between Psychotherapy Science and Practice: Moving Forward. COUNSELING PSYCHOLOGIST 2021. [DOI: 10.1177/00110000211030183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
How to foster the integration of science (especially empirical research) and practice has been a vexing problem since the beginnings of counseling psychology and other applied fields. We propose that the basis for this problem is the very different, even contradictory, demands of empirical research and practice, and the resulting ways of being research scientists and practitioners. Focusing on psychotherapy, we posit seven such demands/pulls and ways of being and seven tactics for strengthening integration. Clinically relevant research on the therapeutic relationship and therapist skills/interventions conducted at the Maryland Psychotherapy Clinic and Research Lab is summarized. We emphasize that for science and practice to be mutually facilitative, the field will need to pay close and ongoing attention to ways of strengthening integration.
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Affiliation(s)
| | - Clara E. Hill
- University of Maryland, College Park, College Park, MD, USA
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Nakajima M, Dykiert D, Wilkinson P, Midgley N. How do therapists assess suitability? A qualitative study exploring therapists' judgements of treatment suitability for depressed adolescents. COUNSELLING & PSYCHOTHERAPY RESEARCH 2021. [DOI: 10.1002/capr.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Mikoto Nakajima
- Anna Freud National Centre for Children and Families University College London UK
| | - Dominika Dykiert
- Anna Freud National Centre for Children and Families University College London UK
| | - Paul Wilkinson
- Anna Freud National Centre for Children and Families University College London UK
| | - Nick Midgley
- Anna Freud National Centre for Children and Families University College London UK
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Lindvig GR, Topor A, Bøe TD, Larsen IB. "I will never forget him". A qualitative exploration of staff descriptions of helpful relationships in supportive housing. J Psychiatr Ment Health Nurs 2021; 28:326-334. [PMID: 32657471 DOI: 10.1111/jpm.12673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 05/14/2020] [Accepted: 07/01/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Recovery-oriented studies show that the quality of the professional relationship plays an essential role in the recovery from mental illness. Within mental health care in general, previous studies show that helpful professional relationships are characterized by several reciprocal aspects, such as friendship resemblance and self-disclosure. The literature is scarce on in-depth explorations of professional relationships within the often long-lasting and intimate help context of institutional supportive housing. Explorations of staff members' experiences are absent. The scientific rationale of this study was to expand the current knowledge about professional relationships in mental health care by exploring staff members' descriptions of helpful professional relationships in supportive housing institutions. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: The study shows that helpful relationships may involve staff experiences of reciprocity in terms of both a two-way influence between staff and residents and a reciprocal gain from being part of the helpful relationships. A conceptualization of reciprocity that complements existing concepts is suggested and connected to a "good match" between staff and residents. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When support and care are intended to be provided within a dyadic relationship, both parties' preferences should be considered when pairing service users and professionals. Practitioners should get involved in ways that open up for being influenced and inspired by the service user's characteristics, such as personality and attitude. Furthermore, they should dare to enjoy and make use of the company of the service user in ways that promote multifaceted reciprocity. ABSTRACT: Introduction In the aftermath of the deinstitutionalization in western countries, new community-based mental health services have been established. An essential object of studies in this new institutional landscape has been helpful professional relationships, but we still lack knowledge about helpful relationships in community-based institutional supportive housing. Aim To explore how staff members describe their relationships with residents who have identified them as helpful. Methods Qualitative interviews with nine staff members were analysed using thematic analysis. Results "Reciprocity" was identified as the main theme, and two subthemes were developed: "Something influential about the resident" and "Value for the staff member." Discussion The findings are discussed and related to existing conceptualizations of reciprocity in professional relationships, and an additional conceptualization is suggested. Implications for practice To promote reciprocity, managers should consider both parties' personal preferences when matching professionals and service users. Further, professionals should get involved in ways that open up for being influenced and inspired by several of the service user's characteristics. They should allow themselves to enjoy the company of the service user in ways that promote multifaceted reciprocity.
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Affiliation(s)
| | - Alain Topor
- Department of Psychosocial Health, University of Agder, Grimstad, Norway.,Department of Social work, University of Stockholm, Stockholm, Sweden
| | - Tore Dag Bøe
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
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The working alliance in blended versus face-to-face cognitive therapy for depression: A secondary analysis of a randomized controlled trial. Internet Interv 2021; 25:100404. [PMID: 34401364 PMCID: PMC8350587 DOI: 10.1016/j.invent.2021.100404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 05/06/2021] [Accepted: 05/18/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION We explored the working alliance as measured by both clients and therapists. The working alliance has been known to predict the outcome of psychotherapy and is often considered an important common factor. This study raised the question of how to conceptualize the working alliance in the blended format. METHODS This was an exploratory study derived from a randomized controlled trial comparing bCBT and face-to-face cognitive behavioural therapy (ftf CBT) on depression. The change in depressive symptoms was measured with the Patient Health Questionnaire (PHQ-9) and the working alliance was measured using the Working Alliance Inventory. ANALYSES Correlation coefficients were calculated for the working alliance as reported by clients and therapists, working alliance was then examined at item and dimension level (task, bond, goal). Linear regression models were applied to investigate the predictive value of the working alliance on treatment outcome. Interaction between the level of working alliance and treatment condition was also considered. RESULTS Client and therapist working alliance ratings correlated at r = 0.44 and clients rated the working alliance higher than therapists (x̄ clients = 48.6, x̄ therapists = 44.6). ftf CBT and bCBT had comparable joint working alliance ratings (x̄ ftf = 46.4, x̄ bCBT = 46.8). Items had little deviation apart from item 4 with high positive values. The level of working alliance from the total sample did not significantly predict outcome based on the client's perspective. Contrarily, seen from the therapist's perspective, it did (b = 0.00, p = .044). Using the mean from these predictors as a composite variable, was also significant (b = 0.00, p = .039, R2 adj = 0.07). There was no significant interaction with treatment condition. DISCUSSION Clients and therapists may lay emphasis on different aspects of the working alliance. The finding that therapist-rated working alliance was better than client working alliance at predicting outcome went against common findings; this pattern may be specific to bCBT. CONCLUSION Clients rated the working alliance slightly higher than therapists on average. Clients and therapists as well as treatment conditions had different profiles on dimension deviations. Therapist ratings of the working alliance appeared to better predict treatment outcome than client ratings. Joint working alliance predicted outcome using client and therapist composite means. The working alliance was equally strong in ftf CBT and bCBT. The absence of interaction with treatment condition indicated that the working alliance was equally predictive of outcome in ftf CBT as in bCBT.
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Earle MJ, Freddolino PP. Meeting the Practice Challenges of COVID-19: MSW Students' Perceptions of E-Therapy and the Therapeutic Alliance. CLINICAL SOCIAL WORK JOURNAL 2021; 50:76-85. [PMID: 33678922 PMCID: PMC7925139 DOI: 10.1007/s10615-021-00801-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic prompted a radical shift in social work practice. Overnight, social work intervention models provided in-person gave way to the utilization of Information and Communication Technologies to facilitate direct practice in virtual environments (e-therapy). Social work's slow acceptance of e-therapy prior to the pandemic resulted in a lack of training for many social work practitioners and MSW student interns, who were required to make rapid transitions to using and operating in online environments. It appears likely that e-therapy will continue after the COVID-19 pandemic subsides, so integrating education about effective e-therapy techniques into social work curricula seems like a logical next step. A social worker's ability to establish the therapeutic alliance, which is at the heart of all helping relationships, will be central to this curricula. Understanding social work students' perceptions of e-therapy and the therapeutic alliance can help shape the development of this new curriculum. Using internal student email, students at two Research I universities were invited to participate in a fully online anonymous survey dealing with attitudes towards e-therapy and the therapeutic alliance. Surveys were conducted in 2018 and April-May 2020. Survey questions were based on the only prior comprehensive study of student attitudes towards e-therapy (Finn in J Soc Work Educ 38(3), 403-419. 10.1080/10437797.2002.10779107, 2002). Study results indicate that students have e-therapy experience, believe that a practitioner can build a good therapeutic alliance, and think that some form of e-therapy will continue after the pandemic. These results confirm that further exploration about the inclusion of e-therapy education and its efficacy in social work curricula requires urgent attention.
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Affiliation(s)
- Melissa J. Earle
- School of Social Welfare, Stony Brook University, Stony Brook, NY USA
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Núñez L, Midgley N, Capella C, Alamo N, Mortimer R, Krause M. The therapeutic relationship in child psychotherapy: integrating the perspectives of children, parents and therapists. Psychother Res 2021; 31:988-1000. [PMID: 33509052 DOI: 10.1080/10503307.2021.1876946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
This study addresses the therapeutic relationship in child psychotherapy, through an exploration of the experience of the main actors engaged in child psychotherapy. To describe and analyse the therapeutic relationship integrating the views of children, parents and therapists. This study employs a qualitative methodology, assuming a discovery-oriented approach which draws from grounded theory. Twelve psychotherapy triads participated, composed of children aged 6-10, their parents and psychotherapists. Semi-structured follow-up interviews were conducted (N=36), including a drawing in the case of the children. A positive therapeutic relationship with children and parents was viewed as a gradually constructed process, based on a positive emotional encounter between participants. It was facilitated primarily by the therapist's commitment and playful stance, the child and therapist mutual involvement, and the parent's collaboration. These aspects entailed a trustful, validating and caring relationship, that shaped children and parents' motivations towards therapy and facilitated change. From a multiple-perspective approach, therapy was conceived as a relational experience. The development of positive relationships required different and evolving dispositions from therapy main actors. Therapists' genuine feelings and engagement in therapeutic activity seem central, underlining the importance of addressing relational aspects in child therapy research and training.
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Affiliation(s)
- Lucía Núñez
- Psychology Department, Pontifical Catholic University of Chile, Santiago, Chile.,Psychology Department, University of Chile, Santiago, Chile
| | - Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London (UCL), UK
| | | | - Nicolle Alamo
- Social Work School, Pontifical Catholic University of Chile, Santiago, Chile
| | - Rose Mortimer
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
| | - Mariane Krause
- Psychology Department, Pontifical Catholic University of Chile, Santiago, Chile
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Horton A, Hebson G, Holman D. A longitudinal study of the turning points and trajectories of therapeutic relationship development in occupational and physical therapy. BMC Health Serv Res 2021; 21:97. [PMID: 33509181 PMCID: PMC7845106 DOI: 10.1186/s12913-021-06095-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 01/18/2021] [Indexed: 01/09/2023] Open
Abstract
Background The importance of the therapeutic relationship is widely recognised across healthcare professions. Despite the importance of therapeutic relationships, there are significant gaps in the knowledge base on how these relationships develop. To address these gaps, this study explores relationship dynamics by identifying relational turning points and trajectories in therapeutic relationships between occupational therapists and physical therapists and their patients. The implications for how a focus on these relational aspects can enhance clinical practice will be discussed. Methods Data collection was based on the Retrospective Interview Technique and consisted of two phases. In the first phase patients and therapists were asked to tell the story of their therapeutic relationship development and as part of this, identify the turning points that occurred. In the second phase, therapists-patient dyads were observed from their first interaction to their last to identify potential turning points and at the end of the relationship a participant verification interview was conducted with both dyadic partners individually. Template analysis was used to analyse the data. Results Therapists identified 6 distinct categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Patients, Interpersonal Problems with Patients, Positive Feedback, and Negative Feedback. Patients identified 5 categories of turning points; Progress Towards Goals, Set-backs in Progress Towards Goals, Interpersonal Affective Bonding with Therapists, Agreement with Therapist and Change in Treatment. These turning points varied regarding their impact on the trajectory of the therapeutic relationship. The trajectory patterns identified were stable, upward, downward, and multidirectional. Conclusion This study makes an important contribution to our understanding of therapeutic relationship dynamics in the occupational and physical therapy context. The results expose the challenges that therapists and patients face in building high-quality therapeutic relationships, the diversity of therapeutic relationships, and how these relationships develop over time. This is the first study to use a turning point analysis in research on therapeutic relationships.
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Affiliation(s)
| | - Gail Hebson
- Work and Equalities Institute, University of Manchester, Manchester, England
| | - David Holman
- Alliance Manchester Business School, University of Manchester, Manchester, England
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Merkt H, Wangmo T, Pageau F, Liebrenz M, Devaud Cornaz C, Elger B. Court-Mandated Patients' Perspectives on the Psychotherapist's Dual Loyalty Conflict - Between Ally and Enemy. Front Psychol 2021; 11:592638. [PMID: 33488459 PMCID: PMC7815763 DOI: 10.3389/fpsyg.2020.592638] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/01/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Mental health professionals working in correctional contexts engage a double role to care and control. This dual loyalty conflict has repeatedly been criticized to impede the development of a high-quality alliance. As therapeutic alliance is a robust predictor of outcome measures of psychotherapy, it is essential to investigate the effects of this ethical dilemma. METHODS This qualitative interview study investigates patients' perceptions of their therapists' dual role conflict in court-mandated treatment settings. We interviewed 41 older incarcerated persons using a semi-structured interview guide, the interviews were subsequently analyzed following thematic analysis. RESULTS We first present the patients' perceptions of their treating psychotherapist's dual loyalty conflict, which was linked to their overall treatment experience. In a second step, we outline the study participants' reasons for this judgment, which were most commonly linked to feelings of trust or betrayal. More specifically, they named certain therapist characteristics and activities that enabled them to develop a trustful therapeutic alliance, which we grouped into four topics: (1) respecting the patient's pace and perceived coercion; (2) patient health needs to be first priority; (3) clarity in roles and responsibilities; and (4) the art of communication - between transparency and unchecked information sharing. DISCUSSION Developing a high quality alliance in mandatory offender treatment is central due to its relationship with recovery and desistance. Our findings show that some therapists' characteristics and activities attenuate the negative impact of their double role on the development and maintenance of the alliance. To increase the effectiveness of court-mandated treatments, we need to support clinicians in dealing with their dual role to allow the formation of a high quality therapeutic alliance. Our qualitative interview study contributed to this much-needed empirical research on therapist' characteristics promoting a trustful relationship in correctional settings.
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Affiliation(s)
- Helene Merkt
- Insitute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Tenzin Wangmo
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Félix Pageau
- Insitute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Corinne Devaud Cornaz
- Unité Thérapeutique, Centre de Psychiatrie Forensique, Réseau Fribourgeois de Santé Mentale, Fribourg, Switzerland
| | - Bernice Elger
- Insitute for Biomedical Ethics, University of Basel, Basel, Switzerland
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Michel LHF, Freitas JDL. Psicoterapia e Luto: A Vivência de Mães Enlutadas. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2021. [DOI: 10.1590/1982-3703003189422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Pesquisas empíricas sobre psicoterapia ainda são escassas no Brasil. Uma das maneiras de melhor avaliar os processos psicoterapêuticos é por meio do relato dos pacientes. O processo psicoterápico de enlutados é pouco estudado, a despeito de sua demanda por psicoterapia. Não há, na literatura nacional, pesquisas que abordem especificamente a experiência de psicoterapia de mães enlutadas. O presente estudo se propõe a compreender como as mães vivenciam esse processo. Este é um estudo qualitativo, em que se utilizou o método fenomenológico. Foram entrevistadas quatro mães. As entrevistas tiveram início com a pergunta disparadora: “Você pode relatar a vivência de seu processo terapêutico durante o luto?”. Depois de transcritos, os relatos foram analisados a partir dos quatro passos metodológicos desenvolvidos por Giorgi. A análise das entrevistas revelou 18 elementos constituintes, que foram divididos em três eixos temáticos, a saber: relação terapeuta-paciente, possibilidades expressivas que emergem da relação psicoterápica e ressignificação. Concluiu-se que essa é uma vivência de uma relação particular estabelecida entre a mãe enlutada e o psicoterapeuta, da qual podem emergir possibilidades de ressignificação da sua relação com seus filhos falecidos, com seus familiares, com a morte e com a própria vida, desde que se sintam acolhidas, compreendidas e adquiram confiança para se expressarem livremente. Os dados nos levam a questionar se um projeto psicoterápico, livre de limites quanto aos temas abordados e em relação a objetivos prévios, poderia ser benéfico para pessoas enlutadas.
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Cartwright C, Rhodes P, King R, Shires A. A Pilot Study of a Method for Teaching Clinical Psychology Trainees to Conceptualise and Manage Countertransference. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12092] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Robert King
- School of Psychology and Counseling, Queensland University of Technology,
| | - Alice Shires
- Graduate School of Health, University of Technology, Sydney,
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Keidar L, Snir S, Regev D, Orkibi H, Adoni-Kroyanker M. Relationship Between the Therapist-Client Bond and Outcomes of Art Therapy in the Israeli School System. ART THERAPY 2020. [DOI: 10.1080/07421656.2020.1827651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bartholomew TT, Pérez-Rojas AE, Kang E, Joy EE. Refinement and factor structure confirmation of the Inventory of Therapist Work with Client Assets and Strengths (IT-WAS). COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2018.1563772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Andres E. Pérez-Rojas
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Ellice Kang
- Department of Educational Studies, Purdue University, West Lafayette, IN, USA
| | - Eileen E. Joy
- Department of Educational Studies, Purdue University, West Lafayette, IN, USA
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People Engaging Each Other: A Dual-Perspective Study of Interpersonal Processes in Useful Therapy. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-020-09469-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AbstractTo explore how clients and therapists experience and engage in a therapeutic relationship which the client can make use of. We explored 11 psychotherapy dyads using in-depth qualitative methods. Selected dyads were ones in which the client experienced the therapy as useful. The data collection method was serial interviews with both therapists and clients. Therapists and clients were interviewed separately, four and two times, respectively, about their personal development, their views on and experiences with therapy, and their collaboration in the concrete therapeutic dyad. Transcripts of interviews were analyzed using a hermeneutic phenomenological qualitative analysis. The analysis yielded an overarching theme identified as “engaging each other.” This theme consisted of three constituent processes, developed from complementary descriptions from clients and therapists: (1) opening up to an encounter between humans, (2) trusting professionality, and (3) creating space for an unbearable story. We discuss how technical skill and personal warmth underlie the development of a helping relationship within which humans can open up to a personal encounter with suffering. We discuss how the personal aspect of the therapist position relates to psychotherapy as a moral practice, and suggest that this perspective is meaningful in understanding the therapist factor and the real relationship.
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Gillett JL, Duff J, Eaton R, Finlay K. Psychological outcomes of MRSA isolation in spinal cord injury rehabilitation. Spinal Cord Ser Cases 2020; 6:63. [PMID: 32665604 PMCID: PMC7358562 DOI: 10.1038/s41394-020-0313-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022] Open
Abstract
STUDY DESIGN Retrospective secondary analysis with a quantitative, matched-pairs design. Patients isolated due to methicillin-Resistant Staphylococcus aureus (MRSA) were matched with controls without MRSA infection admitted to a multi-bedded ward, based on: gender, injury level, injury severity (AIS grade), age at the time of injury and year of admission. OBJECTIVES Determine the implications of MRSA-related infection isolation on spinal cord injury patients' anxiety, depression, appraisals of disability, perceived manageability and pain intensity. Hypotheses predicted patients who were isolated due to MRSA during inpatient stay would demonstrate poorer psychological health outcomes at discharge in comparison with non-isolated matched controls. SETTING National Spinal Injuries Centre, England, UK. METHODS Secondary analyses were conducted on pre-existing data based on patients' first admission for primary rehabilitation. Psychometric scales were used to measure outcome variables. Assessments were repeated at the time of admission and discharge. RESULTS Nonparametric longitudinal analyses using the nparLD package in R were conducted. Relative treatment effects demonstrated that there were no significant differences between groups across all outcome measures. There was a significant effect of time (admission vs discharge) on perceived manageability and pain intensity, indicating improved outcomes at discharge. There was no difference in the overall length of stay between the isolated and non-isolated groups. CONCLUSIONS Isolation experienced by rehabilitation inpatients with spinal cord injury with MRSA had no effect on a series of psychological outcomes. Engaging with rehabilitation had a positive impact in reducing pain unpleasantness and increasing perceived manageability of spinal cord injury, irrespective of infection isolation.
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Affiliation(s)
- Jenna L Gillett
- The University of Buckingham, Buckingham, Buckinghamshire, UK.
| | - Jane Duff
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Rebecca Eaton
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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Pérez-Rojas AE, Gelso CJ. International counseling students: acculturative stress, cultural distance, and the process of counseling with U.S. clients. COUNSELLING PSYCHOLOGY QUARTERLY 2020. [DOI: 10.1080/09515070.2018.1553145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Charles J. Gelso
- Department of Psychology, University of Maryland, College Park, MD, USA
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Soma CS, Baucom BRW, Xiao B, Butner JE, Hilpert P, Narayanan S, Atkins DC, Imel ZE. Coregulation of therapist and client emotion during psychotherapy. Psychother Res 2020; 30:591-603. [PMID: 32400306 DOI: 10.1080/10503307.2019.1661541] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Close interpersonal relationships are fundamental to emotion regulation. Clinical theory suggests that one role of therapists in psychotherapy is to help clients regulate emotions, however, if and how clients and therapists serve to regulate each other's emotions has not been empirically tested. Emotion coregulation - the bidirectional emotional linkage of two people that promotes emotional stability - is a specific, temporal process that provides a framework for testing the way in which therapists' and clients' emotions may be related on a moment to moment basis in clinically relevant ways. METHOD Utilizing 227 audio recordings from a relationally oriented treatment (Motivational Interviewing), we estimated continuous values of vocally encoded emotional arousal via mean fundamental frequency. We used dynamic systems models to examine emotional coregulation, and tested the hypothesis that each individual's emotional arousal would be significantly associated with fluctuations in the other's emotional state over the course of a psychotherapy session. RESULTS Results indicated that when clients became more emotionally labile over the course of the session, therapists became less so. When changes in therapist arousal increased, the client's tendency to become more aroused during session slowed. Alternatively, when changes in client arousal increased, the therapist's tendency to become less aroused slowed.
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Affiliation(s)
- Christina S Soma
- Department of Educational Psychology, University of Utah, Salt Lake City, UT, USA
| | - Brian R W Baucom
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Bo Xiao
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Jonathan E Butner
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
| | - Peter Hilpert
- School of Psychology, University of Surrey, Guilford, UK
| | - Shrikanth Narayanan
- Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Zac E Imel
- Department of Educational Psychology, University of Utah, Salt Lake City, UT, USA
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Mallory DB. Trumped: a case study and critical reflections on the threats of unweighted positivity and external context to appreciative inquiry-led participative action research. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2020. [DOI: 10.1080/1359432x.2020.1747532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Drew B. Mallory
- Faculty of Economics and Business/Research Centre for Organisation Studies, KU Leuven, Leuven, Belgium
- Core Faculty, Sasin School of Management of Chulalongkorn University, Bangkok, Thailand
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Barker SL, Maguire NJ, Das S, Bryant V, Mahata K, Buck DS. Values-Based Interventions in Patient Engagement for Those with Complex Needs. Popul Health Manag 2019; 23:140-145. [PMID: 31503526 DOI: 10.1089/pop.2019.0084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The objective was to evaluate a novel intervention that integrates a psychological, values-based approach with coordinated care management. This paper describes an integrated comprehensive health record system to enhance engagement with a subset of those with complex needs; those who are high-needs, high-cost (HNHC). Patients are selected after conducting data analysis on the most costly and complex patients of a payer system that works with HNHC patients. Specifically, the Patient Care Intervention Center in Houston TX, applies the values-based intervention to HNHC patients. This pilot study reports data from 18 HNHC patients over 6 months; specifically, outcomes related to daily functioning, depression, working alliance, stages of change, and overall well-being. Additionally, this paper reports preliminary findings from qualitative monitoring of provider experiences implementing the values-based approach and integrated evaluation. HNHC patients improved their daily functioning over 4 months but no other significant changes were found over time. Patients self-reported mild depression, strong working alliances with their provider, being in the contemplation phase of change, and moderate well-being. There also was variation when patients completed the assessments and data points were collected. Although this is a small sample and short time frame, preliminary results suggest that the intervention has a positive impact on HNHC patient daily functioning. Provider accounts of the implementation describe using the evaluation items to inform their interactions with patients, and also suggest that patient literacy level impacts when data can be collected. Other changes to the approach are suggested.
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Affiliation(s)
- Stephanie L Barker
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Nick J Maguire
- Department of Psychology, University of Southampton, Southampton, United Kingdom
| | - Sophiya Das
- Patient Care Intervention Center, Houston, Texas
| | | | | | - David S Buck
- Patient Care Intervention Center, Houston, Texas
- College of Medicine, University of Houston, Houston, Texas
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Gelso CJ, Kline KV. The sister concepts of the working alliance and the real relationship: on their development, rupture, and repair. ACTA ACUST UNITED AC 2019; 22:373. [PMID: 32913801 PMCID: PMC7451341 DOI: 10.4081/ripppo.2019.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/01/2019] [Indexed: 11/23/2022]
Abstract
Jeremy Safran has presented seminal and widely applicable clinical theory and research around the therapeutic alliance and ruptures in the alliance. We explore areas of agreement with and departure from some of Safran’s key conceptualizations on these topics, focusing on overlap and distinctions between two constructs theorized to be fundamentally significant elements of all therapeutic relationships: the working alliance and the real relationship. We share Safran’s view that the alliance centrally implicates an emotional bond between patient and therapist, as well as an agreement about the goals of treatment and the tasks needed to attain those goals. We depart from Safran, however, in his belief that the real relationship should be seen as part of the emotional bond of the working alliance. Instead, we argue that the real relationship and the working alliance (including the bond aspect of the alliance) are best viewed as highly interrelated but distinct aspects of the therapeutic relationship. In addition, a distinction is made between the working bond (part of the working alliance) and the personal bond (part of the real relationship). Hence, we examine the concept of rupture in the working alliance, and in the real relationship as well. The nature of ruptures is discussed, as well as what therapists can do to repair them. A more limited definition of ruptures than the broader conception that has evolved in recent years is proposed. It is suggested that, whereas ruptures in the working alliance generally can be repaired to the benefit of the work, ruptures in the real relationship are likely to be more damaging to the treatment.
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Affiliation(s)
- Charles J Gelso
- Department of Psychology, University of Maryland, College Park
| | - Kathryn V Kline
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, MD, USA
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Pedhu Y. Efforts to Overcome Countertransference in Pastoral Counseling Relationships. THE JOURNAL OF PASTORAL CARE & COUNSELING : JPCC 2019; 73:74-81. [PMID: 31189452 DOI: 10.1177/1542305019852587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Countertransference is considered as a negative factor that may impede counseling relations but some assume that countertransference is a normal reaction. The purpose of this article is to explore countertransference in pastoral counseling and efforts to overcome it. The author examines the concepts, approaches, and structure of countertransference. Previous research is also reviewed. Based on this review, the author elaborates some strategies that can help pastoral counselors to overcome countertransference in their counseling practice.
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Affiliation(s)
- Yoseph Pedhu
- Department of Guidance and Counseling, Universitas Katolik Indonesia Atma Jaya, Indonesia
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Abstract
Psychotherapies may work through techniques that are specific to each therapy or through factors that all therapies have in common. Proponents of the common factors model often point to meta-analyses of comparative outcome studies that show all therapies have comparable effects. However, not all meta-analyses support the common factors model; the included studies often have several methodological problems; and there are alternative explanations for finding comparable outcomes. To date, research on the working mechanisms and mediators of therapies has always been correlational, and in order to establish that a mediator is indeed a causal factor in the recovery process of a patient, studies must show a temporal relationship between the mediator and an outcome, a dose–response association, evidence that no third variable causes changes in the mediator and the outcome, supportive experimental research, and have a strong theoretical framework. Currently, no common or specific factor meets these criteria and can be considered an empirically validated working mechanism. Therefore, it is still unknown whether therapies work through common or specific factors, or both.
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Affiliation(s)
- Pim Cuijpers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
| | - Marcus J.H. Huibers
- Department of Clinical, Neuro-, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
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