1
|
Fusar-Poli L, Panariello F, Berry K, Rocchetti M, Casiraghi L, Malvezzi M, Starace F, Zamparini M, Zarbo C, de Girolamo G. Working alliance in treating staff and patients with Schizophrenia Spectrum Disorder living in Residential Facilities. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:156-177. [PMID: 38115200 DOI: 10.1111/bjc.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 11/15/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES Working Alliance (WA) is important in the care of patients with Schizophrenia Spectrum Disorders (SSD). This study aims to determine which sociodemographic and clinical factors are associated with WA, as assessed by patients and staff members in Residential Facilities (RFs), and may predict WA dyads' discrepancies. METHODS Three hundred and three SSD patients and 165 healthcare workers were recruited from 98 RFs and characterized for sociodemographic features. WA was rated by the Working Alliance Inventory (WAI) for patients (WAI-P) and staff members (WAI-T). SSD patients were assessed for the severity of psychopathology and psychosocial functioning. RESULTS Pearson's correlation revealed a positive correlation (ρ = .314; p < .001) between WAI-P and WAI-T ratings. Linear regression showed that patients with higher education reported lower WAI-P ratings (β = -.50, p = .044), while not being engaged in work or study was associated with lower WAI-T scores (β = -4.17, p = .015). A shorter lifetime hospitalization was associated with higher WAI-P ratings (β = 5.90, p = .008), while higher psychopathology severity negatively predicted WAI-T (β = -.10, p = .002) and WAI-P ratings (β = -.19, p < .001). Better functioning level positively foresaw WAI-T (β = .14, p < .001) and WAI-P ratings (β = .12, p < .001). Regarding discrepancies, staff members' age was associated with higher dyads discrepancy in Total scale and Agreement subscale scores, which were also associated with more severe negative symptoms, while patients' age was negatively correlated to Relationship subscale discrepancy. CONCLUSIONS This study provides insight into the factors that influence WA in SSD patients and health workers in RFs. The findings address interventions to improve WA and ultimately patient outcomes.
Collapse
Affiliation(s)
- Laura Fusar-Poli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Fabio Panariello
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - Katherine Berry
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Department of Research and Innovation, Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Matteo Rocchetti
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Letizia Casiraghi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Matteo Malvezzi
- Department of Biostatistics, University of Parma, Parma, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| |
Collapse
|
2
|
Faith LA, Hillis-Mascia JD, Wiesepape CN. How Does Individual Psychotherapy Promote Recovery for Persons with Psychosis? A Systematic Review of Qualitative Studies to Understand the Patient's Experience. Behav Sci (Basel) 2024; 14:460. [PMID: 38920792 PMCID: PMC11201174 DOI: 10.3390/bs14060460] [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: 01/31/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Psychotherapy for individuals with psychosis is an effective treatment that promotes recovery in various ways. While there is strong quantitative evidence across modalities, less is known from the patient's perspective. There are many varied forms of psychotherapy, and gaining the patient's perspective can improve understanding of salient elements of psychotherapy and increase engagement, ultimately improving recovery rates. The purpose of this review is to identify and integrate data from published studies of patient perspectives of psychotherapy for psychosis to understand essential elements across approaches, differences between approaches, and how psychotherapy impacts recovery. We aimed to understand further: what are the perceptions about individual psychotherapy from the perspective of individuals with psychosis? The current study was a systematic review using PRISMA guidelines of studies that included qualitative interviews with persons with experiences of psychosis who participated in psychotherapy. All three authors participated in the literature search using Pubmed, APA PsycInfo, and Psychiatry Online. We identified N = 33 studies. Studies included cognitive therapies, acceptance and mindfulness approaches, trauma therapies, metacognitive therapy, and music therapy. All studies reported participants' perceived benefit with the therapeutic relationship as especially salient. Participants described diverse aspects of objective (e.g., symptoms, functioning) and subjective (e.g., self-experience or quality of life) recovery improvements, with perceived mechanisms of change, and with music therapy having some unique benefits. Participants also reported challenges and suggestions for improvement. Study findings highlight the salient aspects of psychotherapy identified by patients that may help therapists to individualize and improve approaches to psychotherapy when working with individuals experiencing psychosis. Overall, findings support the potential for integrative psychotherapy approaches for maximal treatment personalization.
Collapse
Affiliation(s)
- Laura A. Faith
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indianapolis, IN 46202, USA
| | - Jaclyn D. Hillis-Mascia
- Psychosocial Rehabilitation and Recovery Center, Chillicothe VA Medical Center, Chillicothe, OH 45601, USA;
| | - Courtney N. Wiesepape
- Psychosocial Rehabilitation and Recovery Center, Austin VA Clinic, Austin, TX 78744, USA;
| |
Collapse
|
3
|
Finley BA, Shea KD, Gallagher SP, Taylor-Piliae R. Psychiatric mental health nurse practitioners experiencing therapeutic alliance while using tele-mental health: A phenomenological study. Arch Psychiatr Nurs 2024; 49:56-66. [PMID: 38734456 DOI: 10.1016/j.apnu.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/08/2023] [Accepted: 01/28/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND Psychiatric mental health nurse practitioners have rapidly adopted and implemented tele-mental health in their practice; however it is unclear how this modality of care affects the experiential quality of therapeutic alliance, simply defined as the interpersonal working bond between provider and patient. OBJECTIVE This study is the first to explore how psychiatric mental health nurse practitioners experience therapeutic alliance while using tele-mental health. DESIGN Husserlian phenomenological qualitative study. PARTICIPANTS A purposive, convenience sample of 17 American psychiatric mental health nurse practitioners who engaged in tele-mental health care were recruited online and interviewed. METHODS Phenomenological interview transcripts recorded and later thematically coded in the qualitative software MaxQDA. RESULTS From 1426 individual codes, five major themes and 16 subthemes were discovered. Overall, themes illuminated that psychiatric mental health nurse practitioners could build therapeutic alliance over tele-mental health using inherent interpersonal skills that had to be adapted to the technology. Adaptions included working with patient environmental factors, individual patient considerations, provider ambivalence, and technological observation shifting awareness and communication patterns. CONCLUSIONS When adapting for the tele-mental health environment, psychiatric mental health nurse practitioners experienced building and sustaining therapeutic alliance with most patients. Unparalleled aspects of tele-mental health allowed for a fuller clinical picture and logistical convenience to see patients more often with ease for both the provider and patient. However, experiential aspects of therapeutic alliance created during in-person care could not be replaced with tele-mental health. In conclusion, participants concluded that a hybrid care model would enhance therapeutic alliance for most patients.
Collapse
Affiliation(s)
- Brooke A Finley
- Owner & Provider, Finley Psychiatric Nurse Practitioner, PLLC, Canandaigua, NY, USA.
| | - Kimberly D Shea
- The University of Arizona College of Nursing, Tucson, AZ, USA
| | - Shawn P Gallagher
- The University of Arizona College of Nursing, Tucson, AZ, USA; International Society of Psychiatric-Mental Health Nurses (ISPN), USA
| | | |
Collapse
|
4
|
El-Abidi K, Moreno-Poyato AR, Cañabate-Ros M, Garcia-Sanchez JA, Lluch-Canut MT, Muñoz-Ruoco E, Pérez-Moreno JJ, Pita-De-La-Vega J, Puig-Llobet M, Rubia-Ruiz G, Santos-Pariente C, López AMR, Golmar LJ, López CE, Roldán-Merino JF. The therapeutic relationship from the perspective of patients and nurses in the first days of admission: A cross-sectional study in acute mental health units. Int J Ment Health Nurs 2024; 33:134-142. [PMID: 37743558 DOI: 10.1111/inm.13227] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/26/2023]
Abstract
The therapeutic relationship (TR) is essential in mental health nursing care and plays a fundamental role in the understanding and treatment of the patient's health status. Despite being a bidirectional construct, limited evidence is available to shed light on this issue in mental health units and even less so in the first days of admission. This study aimed to examine the association and differences between nurses' and patients' perspectives on the establishment of the therapeutic relationship in acute mental health units during the first days of hospitalization. A cross-sectional study was carried out in 12 Spanish mental health units. Data were collected from patients and nurses using the Working Alliance Inventory-Short (WAI-S) questionnaire. A total of 234 cases were analysed, including 234 patients and 58 nurses. The results showed a positive association between nurses' and patients' perspectives on the therapeutic relationship, but also revealed significant differences on each WAI-S dimension. Nurses assigned higher scores compared to patients on the perception of the quality of the therapeutic relationship. The dimensions with the greatest weight from the patients' perspective regarding the quality of the therapeutic relationship were the perception of greater agreement on goals and tasks among nurses. This study demonstrates the importance of establishing shared goals and tasks with nurses from the first days of hospitalization to improve the quality of the therapeutic relationship as perceived by patients. These findings underline the need to consider the different perspectives of both parties to promote a high-quality therapeutic relationship.
Collapse
Affiliation(s)
- Khadija El-Abidi
- Institut de Neuropisquiatria i Addiccions, Centre Fòrum, Hospital del Mar, Barcelona, Spain
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
- Grup de Recerca en Cures Infermeres de Salut Mental, Psicocials i de Complexitat, NURSEARCH - 2021 SGR 1083, Barcelona, Spain
| | - Montserrat Cañabate-Ros
- Universidad Católica de Valencia, San Vicente Mártir, Grupo de investigación MHG, Valencia, Spain
- Hospital Clínico Universitario de Valencia, Unidad de hospitalización de psiquiatría y toxicomanía, Valencia, Spain
| | - Juan A Garcia-Sanchez
- Department of Mental Health, Biomedical Research Institute of Malaga (IBIMA), University General Hospital of Málaga, Málaga, Spain
| | - M Teresa Lluch-Canut
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
- Grup de Recerca en Cures Infermeres de Salut Mental, Psicocials i de Complexitat, NURSEARCH - 2021 SGR 1083, Barcelona, Spain
| | - Estibaliz Muñoz-Ruoco
- Psychiatry Service, Galdakao-Usansolo Hospital, Osakidetza-Basque Health Service, Galdakao-Usansolo, Spain
| | - Juan J Pérez-Moreno
- Psychiatry Service, Galdakao-Usansolo Hospital, Osakidetza-Basque Health Service, Galdakao-Usansolo, Spain
| | - Javier Pita-De-La-Vega
- Children's Mental Health Centre, Department of Mental Health, Consorci Sanitari del Maresme, Mataró, Spain
| | - Montserrat Puig-Llobet
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
- Grup de Recerca en Cures Infermeres de Salut Mental, Psicocials i de Complexitat, NURSEARCH - 2021 SGR 1083, Barcelona, Spain
| | | | | | | | | | - Cristina Esquinas López
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Nursing School, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Juan F Roldán-Merino
- Campus Docent Sant Joan de Déu Fundació Privada, School of Nursing, University of Barcelona, Barcelona, Spain
| |
Collapse
|
5
|
Lavi-Rotenberg A, Kivity Y, Igra L, Atzil-Slonim D, Hasson-Ohayon I. A dyadic session-by-session assessment of therapeutic alliance and short-term outcome among clients with schizophrenia in comparison with clients with emotional disorders. Psychol Psychother 2023; 96:1029-1043. [PMID: 37665174 DOI: 10.1111/papt.12494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/27/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE Although the clinical significance of the therapeutic alliance (TA) is well documented, the literature regarding the establishment of TA and the relation between client-therapist agreement on it to short-term outcome among various diagnostic groups-and specifically among clients diagnosed with serious mental illness (SMI)-is sparse. The aim of the present study was to examine the effect of client diagnosis on the abovementioned TA characteristics. METHOD Dyadic analyses of session-by-session (SBS) data were used to compare clients diagnosed with schizophrenia and clients diagnosed with emotional disorders (based on a clinical interview) in their TA characteristics. RESULTS TA as initially rated by clients was stronger in the emotional disorders group than in the schizophrenia group. Higher TA ratings, regardless of whether these were provided by the therapist or the client, predicted better subsequent functioning in the emotional disorders group, whereas in the schizophrenia group, this association was observed only among good-outcome cases. CONCLUSIONS Establishing TA, having client-therapist agreement on it, and having clients derive therapeutic benefit from it might be more challenging with clients with schizophrenia than with clients with emotional disorders. Special attention should be given to specific challenges and needs regarding clients' diagnosis in order to enhance favourable therapy outcomes.
Collapse
Affiliation(s)
| | - Yogev Kivity
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Libby Igra
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | | | | |
Collapse
|
6
|
Mosavi NS, Ribeiro E, Sampaio A, Santos MF. Data mining techniques in psychotherapy: applications for studying therapeutic alliance. Sci Rep 2023; 13:16409. [PMID: 37775524 PMCID: PMC10541430 DOI: 10.1038/s41598-023-43366-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/22/2023] [Indexed: 10/01/2023] Open
Abstract
Therapeutic Alliance (TA) has been consistently reported as a robust predictor of therapy outcomes and is one of the most investigated therapy relational factors. Research on therapists' and clients' contributions to the alliance development and the alliance-outcome relationship had shown mixed results. The relation of the therapist's and client's biological markers with the alliance is an important and under-investigated topic. Taking advantage of data mining techniques, this exploratory study aimed to investigate the role of different therapist and client factors, including heart rate (HR) and electrodermal activity (EDA), in relation to TA. Twenty-two dyads with 6 therapists and 22 clients participated in the study. The Working Alliance Inventory (WAI) was used to evaluate the client's and therapist's perception of the alliance at the end of each session and through the therapy processes. The Cross-Industry Standard Process for Data Mining (CRISP-DM) was used to explore patterns that may contribute to TA. Machine Learning (ML) models have been employed to provide insights into the predictors and correlates of TA. Our results showed that Linear Regression (LR) was the best technique for predicting the therapist's TA, with client "Diagnostic" and therapy "Termination" being identified as significant predictors of the therapist's TA. In addition, for clients' TA, the Random Forest (RF) was shown to have the best performance. The therapist's TA and therapy "Outcome" were observed as the most influential predictors for the client's TA. In addition, while the Heart Rate (therapist) was negatively associated with the therapist's TA, EDA in the client was a physiological indicator related to the client's TA. Overall, these findings can assist in identifying key factors that therapists should focus on to enhance the quality of therapeutic alliance. Results are discussed in terms of their consistency with empirical literature, innovative and interdisciplinary research on the therapeutic alliance field, and, in particular, the use of the Data Mining approach in a psychotherapy context.
Collapse
Affiliation(s)
| | - Eugénia Ribeiro
- Psychotherapy and Psychopathology Research Lab, Centre for Research in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | - Adriana Sampaio
- Psychological Neuroscience Lab, Center for Research in Psychology (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | | |
Collapse
|
7
|
Huggett C, Gooding P, Haddock G, Quigley J, Pratt D. The relationship between the therapeutic alliance in psychotherapy and suicidal experiences: A systematic review. Clin Psychol Psychother 2022; 29:1203-1235. [PMID: 35168297 PMCID: PMC9546023 DOI: 10.1002/cpp.2726] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 01/10/2022] [Accepted: 02/10/2022] [Indexed: 11/10/2022]
Abstract
It is well established that there is a fundamental need to develop a robust therapeutic alliance to achieve positive outcomes in psychotherapy. However, little is known as to how this applies to psychotherapies which reduce suicidal experiences. The current narrative review summarizes the literature which investigates the relationship between the therapeutic alliance in psychotherapy and a range of suicidal experiences prior to, during and following psychotherapy. Systematic searches of MEDLINE, PsycINFO, Web of Science, EMBASE and British Nursing Index were conducted. The search returned 6472 studies, of which 19 studies were eligible for the present review. Findings failed to demonstrate a clear link between suicidal experiences prior to or during psychotherapy and the subsequent development and maintenance of the therapeutic alliance during psychotherapy. However, a robust therapeutic alliance reported early on in psychotherapy was related to a subsequent reduction in suicidal ideation and attempts. Study heterogeneity, varied sample sizes and inconsistent reporting may limit the generalizability of review findings. Several recommendations are made for future psychotherapy research studies. Training and supervision of therapists should not only highlight the importance of developing and maintaining the therapeutic alliance in psychotherapy when working with people with suicidal experiences but also attune to client perceptions of relationships and concerns about discussing suicidal experiences during therapy.
Collapse
Affiliation(s)
- Charlotte Huggett
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
| | - Patricia Gooding
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
| | - Jody Quigley
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Pennine Care NHS Foundation TrustAshton‐under‐LyneUK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science CentreUniversity of ManchesterManchesterUK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science CentreManchesterUK
| |
Collapse
|
8
|
Hasson‐Ohayon I, Jong S, Igra L, Carter SA, Faith LA, Lysaker P. Longitudinal changes in therapeutic alliance with people with psychosis: Relationship between client and therapist assessments. Clin Psychol Psychother 2021; 28:1243-1253. [DOI: 10.1002/cpp.2572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Libby Igra
- Department of Psychology Bar‐Ilan University Ramat‐Gan Israel
| | - Sarah A. Carter
- Utrecht University: University College Roosevelt Middelburg The Netherlands
| | - Laura A. Faith
- Department of Psychology University of Missouri‐Kansas City Kansas City Missouri USA
| | - Paul Lysaker
- Department of Psychiatry Roudebush VA Medical Center and the Indiana University School of Medicine Indianapolis Indiana USA
| |
Collapse
|