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In this short response to the papers appearing in this special issue (Technology, AI Bots and Psychotherapy After Covid), psychotherapist and author Aaron Balick draws on the variety of themes that have arisen within the contributed papers to reflect on the wider issue of computer mediated human relations. In it he makes a distinction between the papers that focus on the therapeutic process mediated by technology and those that look more broadly at the paradigm of therapy practice in this context. Framing technology as a tool, the author pulls together both strands to explore what psychotherapy research may say about the broader issues of societies mediated by technology and how therapeutic research may contribute to these larger social issues. [ABSTRACT FROM AUTHOR]

Purpose: This paper outlines the theoretical and empirical basis for compassion focused therapy (CFT) for psychosis, the gaps in the current knowledge and research, as well as some of the challenges for addressing gaps. It will guide the direction of future work and the steps needed to develop and advance this approach. Method: This paper reviews evidence of how evolutionary models such as social rank theory and attachment theory have greatly contributed to our understanding of psychosis and provide a clear rationale and evidence base for the mechanisms of change in CFT for psychosis. It reviews the evidence for outcomes of compassion training more generally, and early feasibility evaluations of CFT for psychosis. Results: The process evidence shows that people with psychosis have highly active social rank and threat systems, and the benefits of switching into attachment and care systems, which can support emotion regulation and integrative mind states. The outcomes evidence shows that compassion training impacts not only psychological outcomes, but also physiological outcomes such as neural circuits, immune system, and the autonomic nervous system. Within the psychosis field, outcomes research is still in the early days, but there are good indications of feasibility and a clear path forward for the next steps. Conclusions: CFT for psychosis is an approach that integrates biopsychosocial processes, an integration that's evidenced across each aspect of the model, from theoretical foundations (evolution‐informed) to interventions (e.g., body/breath training and relational techniques), to evaluation. Future RCTs are required to understand the effects on biopsychosocial outcomes for people with psychosis. [ABSTRACT FROM AUTHOR]

Idiographic patient‐reported outcome measures (I‐PROMs) are a growing set of individualized tools for use in routine outcome monitoring (ROM) in psychological therapies. This paper presents a position statement on their conceptualization, use, and analysis, based on contemporary evidence and clinical practice. Four problem‐based, and seven goal‐based, I‐PROMs, with some evidence of psychometric evaluation and use in psychotherapy, were identified. I‐PROMs may be particularly valuable to the evaluation of psychological therapies because of their clinical utility and their alignment with a patient‐centered approach. However, there are several challenges for I‐PROMs: how to generate items in a robust manner, their measurement model, methods for establishing their reliability and validity, and the meaning of an aggregated I‐PROM score. Based on the current state of the literature, we recommend that I‐PROMs are used to complement nomothetic measures. Research recommendations are also made regarding the most appropriate methods for analyzing I‐PROM data. [ABSTRACT FROM AUTHOR]

From many years, studies on psychoanalysis were built within a Newtonian framework. Today, with updated contemporary knowledge about quantum physics, we have the opportunity to bring a deeper appreciation to the study of psychoanalysis. Based on the contemporary development of quantum mechanics, I sought to demonstrate how these developments are compatible with psychoanalytic psychotherapy. By illustrating the supervised psychotherapy case below, I sketch a line of thought about a quantum-like modeling in psychoanalytic psychotherapy, specifically in the psychoanalytic listening. Finally, I have proposed ‘Quantum Listening’ eventually transmitting this quantum-like perspective of psychoanalytic listening to the rest of the psychoanalyst community and psychiatrist society in general. Through this paper, I hope to demonstrate how quantum physics is applicable to psychoanalysis. Although it is hard to know how much credence is given to the concept ‘Quantum Listening’, it does add motivation for a more comprehensive understanding of psychoanalytic listening. This short and basic paper is a preliminary to ‘Quantum Listening’ and further research will be carried out afterwards. [ABSTRACT FROM AUTHOR]

Background: There are presently a number of eating disorder treatment interventions that have a research-evidence base to support their effectiveness. However, rates of attrition and treatment outcomes demonstrate that there is no one-size fits all for the treatment of eating disorders. Narrative therapy is a promising, but under-researched, intervention for the treatment of eating disorders (EDs). The aim of this study was to conduct a narrative synthesis of the literature to explore the content and use of narrative therapy in the treatment of EDs. Method: Data were extracted from 33 eligible included studies following systematic search of five data bases. Data included aims and objectives, sample characteristics, treatment details and components of narrative therapy, which informed the narrative synthesis. The study is reported according to the Preferred Reporting items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Narrative therapy interventions for EDs consisted of several components including the narrative worldview; unpacking the problem story; finding, thickening the meaning and performance of stories hidden by the problem story; and safety considerations. A notable proportion of the extracted articles discussed components of unpacking problem stories, and finding and re-authoring openings (or unique outcomes) that were hidden by problematic stories. Relatively fewer papers discussed the processes by identity shifts were performed or lived out, including in the eating practices of those with a lived ED experience. Furthermore, few papers addressed how therapists established client safety within the narrative framework when working with EDs. Conclusion: This narrative synthesis found that narrative practitioners utilise a variety of narrative therapy techniques in working with individuals with a lived ED experience. The current literature has emphasis on specific narrative therapy techniques used in ED treatments, with some aspects of the narrative worldview and safety considerations left undiscussed. Additional research is needed to explore how identity shifts in narrative therapy are performed and lead to measurable behavioural changes, and to consider how safety considerations can be established within the narrative worldview. Plain English summary: There are a number of psychological therapies for eating disorders that have research evidence-base. These treatments, however, do not work for everyone as indicated by drop-out rates and eating disorders running a severe and enduring course for some people. Narrative therapy is a therapeutic intervention that has been reported as a promising intervention for people with an eating disorder. The focus of narrative therapy is to engage the person in finding identities hidden by problem-saturated identities and in the performance of these hidden identities. In this review, we have explored the use of narrative therapy for eating disorders to identify what aspects of this therapy are currently being used and which components are less referenced in the literature. Findings from this study support the need for further research into narrative therapy components in the treatment of eating disorders, particularly how hidden identities are performed and safety considerations are integrated into this therapeutic intervention. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to compare the effectiveness of Transference-focused Psychotherapy (TFP) and Acceptance and Commitment Therapy (ACT) on promoting the mental health and psychological capital of staff working in hospitals covered by social security in Tehran Province. Methods: The present study was a quasi-experimental research with pre-test and post-test. The statistical population of the present study was the personnel working in hospitals covered by social security in Tehran Province. A total of 120 personnel from three hospitals were randomly divided into two experimental groups and one control group (40 people in each group). All three groups answered the Mental Health Questionnaire (Symptom Checklist-90-R (SCL-90-R)) and Psychological Capital Questionnaire (PCQ) as a pre-test. Then, the transfer-oriented treatment group and the acceptance and commitment treatment group (during eight sessions) received the experimental intervention and the control group did not receive any kind of intervention. At the end of the sessions, all three groups answered the questions of the SCL-90-R and PCQ again. Multivariate analysis of covariance was used to analyze the colected data. Results: The results of the present study showed that both TFP and ACT were effective in promoting the mental health of staff working in hospitals covered by social security. There was also a difference between the effectiveness of TFP and ACT in promoting the mental health of staff working in hospitals covered by social security. Thus, in the TFP group, the components of anxiety, morbid fear, psychosis, and paranoia gained significantly lower scores compared to the ACT group. Regarding the components of psychological capital, the ACT group scored significantly lower than the TFP group. Conclusion: Both methods can be used by counselors and therapists to promote the mental health of staff working in hospitals covered by social security. [ABSTRACT FROM AUTHOR]

This paper reports follow-up findings for an Mentalization based treatment (MBT) parenting intervention delivered to a community mental health sample. Parents completed the 12-week version of the Lighthouse Parenting Program (LPP) and were evaluated on parenting practices, parent-child relationships, parental mental health indicators, and child problem behaviour levels. We evaluated the extent to which improvements in mentalizing at follow-up mediated changes in parenting, parental adjustment, mental health, and child outcomes. Results included a reduction in parental coercive behaviours and child problems, improved parent-child relationship, and better parental psychological adjustment and mental health. Improvement in self-focused mentalizing were observed. Self-focused mentalizing mediated the changes in most outcomes from baseline to 3-month follow-up. These results provide strong preliminary evidence that the LPP improves parent and child outcomes. [ABSTRACT FROM AUTHOR]

In this article the author outlines his understanding of self-psychology as an independent psychoanalytic treatment paradigm created by the late Heinz Kohut and initially geared toward the psychoanalytic treatment of narcissistic disorders. Since then, self-psychology theory and practice have been enriched by new theoretical and clinical considerations and have been introduced into other forms of psychotherapy, counseling, and education, for example. One important conceptual contribution to developmental theory was Heinz Kohut's differentiation of separate narcissistic and "object love" related developmental tasks. Today, new paradigms as i.e. relational analysis stress the value of human relationships and of the value of mutual recognition. This warrants a revisiting of the clinical value of the self-psychological understanding of narcissism. According to the author it lies in the nature of unattended narcissistic needs that when unattended they take primacy over relational aspects and demand adequate attention in order to open up the space for mutuality, reciprocity et cetera. [ABSTRACT FROM AUTHOR]

Two principal resources will be used to discuss Darren Haber's paper Simulated Selfhood, Authentic Dialogue: An Intersubjective Systems Look at Treating Addiction. They are Intersubjective Self Psychology: A Primer and Narcissus in Wonderland: The Self Psychology of Addiction and its Treatment. Both of these resources provide a different and more complete way of understanding this excellent case presentation. [ABSTRACT FROM AUTHOR]

Partnership and engagement are mediators of change in the efficient uptake of evidence-based patient-centered health interventions. We reflect on our process of engagement and preparation of peer mentors in the development of peer-led psychotherapy intervention for HIV infected adolescents in active care at the Comprehensive Care Centre (CCC) at Kenyatta National Hospital. The program was implemented in two phases, using a Consultation, Involve, Collaboration and Empowerment approach as stepping stones to guide our partnership and engagement process with stakeholders and ten peer mentors embedded in the CCC. Our partnership process promoted equity, power-and-resource sharing including making the peer mentors in-charge of the process and being led by them in manual development. This process of partnership and engagement demonstrated that engaging key stakeholders in projects lead to successful development, implementation, dissemination and sustainment of evidence-based interventions. Feedback and insights bridged the academic and clinical worlds of our research by helping us understand clinical, family, and real-life experiences of persons living with HIV that are often not visible in a research process. Our findings can be used to understand and design mentorship programs targeting lay health workers and peer mentors at community health care levels. [ABSTRACT FROM AUTHOR]

Emotionally-based school avoidance (EBSA) is an important driver of persistent school absenteeism and may have worsened in the context of COVID-19. This paper describes the development of a brief parent-focused psychosocial intervention with the goal to address the lack of accessible early interventions for EBSA. The developmental process used a person-based approach with two phases. In Phase 1, qualitative data were collected about intervention preferences and priorities from N = 10 parents and N = 7 practitioners in a series of co-design workshops. Phase 2 refined an intervention blueprint based on iterative consultations with N = 4 parents and N = 3 practitioners. Framework analysis was used to organise findings around key intervention parameters, including relevant mechanisms, content, and delivery methods needed to provide effective, acceptable and feasible support for families affected by EBSA. The resulting blueprint incorporates three online modules to be delivered over three weeks with each module consisting of psychoeducational videos, self-completed learning tasks and a corresponding coaching session. Respective module content includes: (i) self-care strategies to increase parent wellbeing and self-efficacy; (ii) parenting strategies to change behavioural patterns that maintain child distress and avoidance of school; and (iii) strategic communication strategies to increase the quality of home-school relationships. The blueprint has been developed into a full prototype for a forthcoming feasibility study. Plain language summary: Since the onset of the Covid-19 pandemic, there has been a noticeable increase in children missing school. One significant contributor to this rise in absences is Emotionally-Based School Avoidance (EBSA). EBSA refers to a situation where a child stays home from school due to feelings of anxiety and distress about attending. Accessing timely support for children with EBSA can be difficult due to lengthy waiting lists for child and adolescent mental health services. This paper outlines the creation of a new, brief psychosocial intervention aimed at helping parents support their child experiencing EBSA. The development process involved two phases. In the first phase, we collaborated with 10 parents and 7 practitioners to gather ideas about the kind of support families require, what should be included in the intervention, and how to make it practical for families to use. Based on these discussions, we formulated a plan for the new intervention. The second phase refined this plan of the intervention to ensure its suitability for families. The intervention is called ISAAC: Intervention for School Anxiety and Absenteeism in Children. ISAAC consists of three online modules to be completed by parents over a three-week period. Each module includes videos, reflection activities and homework tasks which help the parent learn a new skill or try a different way of responding to their child's anxiety about attending school. Parents are also supported by a coach. The first module encourages parents to take care of their own wellbeing and manage stress. The second module helps parents to learn new ways to respond to their child's distress related to school attendance, while the third module provides guidance on effective communication with the child's school. The next step for this intervention is to see whether it is agreeable to parents and practical to deliver in the real-world. [ABSTRACT FROM AUTHOR]

Background: According to the United Nations Commissioner for Refugees (UNHCR), children and adolescents represent 41% of all forcibly displaced individuals. They have to deal with conflicts, violence, and the many difficulties of flight and resettlement during a critical stage of their emotional, social, cognitive, and physical development. They are more likely to experience mental health problems during migration. Despite the several known risk factors, it is frequently challenging for refugees and asylum seekers to get mental health care. In this paper we review available studies on interventions aimed at promoting mental health and at preventing common mental disorders in immigrant adolescents and children. Methods: The relevant PubMed, Scopus, PsychINFO and Web of Science databases were searched for papers published until March 21, 2023, using ("immigrants" OR "migration" OR "asylum seekers" OR "refugees") AND ("promotion" OR "prevention") AND ("mental health" OR "mental disorders" OR "psych*") AND ("children" OR "adolescents" OR "young adults") as search string. Fourteen articles qualified for the detailed review. Results and Conclusions: The majority of available interventions, although highly heterogeneous in format and content, showed significant improvement in several psychopathological dimensions, including trauma-related symptoms, psychological stress, anxiety, depressive and cognitive symptoms. Available studies on interventions for the prevention of mental disorders and the promotion of mental health in refugees and asylum seekers children and adolescents indicate that provided interventions were associated with a global improvement for participants. Implementation strategies to improve their scalability are highly needed. [ABSTRACT FROM AUTHOR]

Objective: While co‐occurring mental health conditions are the norm in eating disorders, no testable protocol addresses management of these in psychotherapy. Method: The literature on managing mental health conditions that co‐occur with eating disorders is outlined and reviewed. Results: In the absence of clear evidence to inform managing co‐occurring mental health conditions, we advocate for use of an iterative, session‐by‐session measurement to guide practice and research. We identify three data‐driven treatment approaches (focus solely on the eating disorder; multiple sequential interventions either before or after the eating disorder is addressed; integrated interventions), and the indications for their use. Where a co‐occurring mental health condition/s impede effective treatment of the eating disorder, and an integrated intervention is required, we outline a four‐step protocol for three broad intervention approaches (alternate, modular, transdiagnostic). A research program is suggested to test the usefulness of the protocol. Discussion: Guidelines that provide a starting point to improving outcomes for people with eating disorders that can be evaluated/researched are offered in the current paper. These guidelines require further elaboration with reference to: (1) whether any difference in approach is required where the co‐occurring mental health condition is a comorbid symptom or condition; (2) the place of biological treatments within these guidelines; (3) precise guidelines for selecting among the three broad intervention approaches when adapting care for co‐occurring conditions; (4) optimal approaches to involving consumer input into identifying the most relevant co‐occurring conditions; (5) detailed specification on how to determine which adjuncts to add. Public significance: Most people with an eating disorder also have another diagnosis or an underlying trait (e.g., perfectionism). Currently no clear guidelines exist to guide treatment in this situation, which often results in a drift away from evidence‐based techniques. This paper outlines data‐driven strategies for treating eating disorders and the accompanying comorbid conditions and a research program that can test the usefulness of the different approaches suggested. [ABSTRACT FROM AUTHOR]

Complex and enduring mental health problems require greater treatment resources, usually in the form of multidisciplinary support, including providing psychological therapies. This paper reports on an NHS, tertiary-level specialist psychotherapy service offering Psychodynamic therapies with longer-term, exploratory transdiagnostic approaches to support complexity and sustained personality functioning. This paper adopts a naturalistic study design evaluating the effectiveness of Psychodynamic therapy using pre- and post-outcomes across a 10-year period. A total of n = 474 participants self-report pre- and post-outcome measures were used as the marker of effectiveness along with therapist assessments during intake and engagement. The findings showed that Psychodynamic therapy was effective in reducing psychological distress based on service-user self-report and therapist assessments. While intake scores varied by socio-demographic factors, the rate of change across most groups was similar. There were several limitations relating to data quality and completeness which reflect the naturalistic design. Despite the limits of a naturalistic design, this study provides evidence of support for the place of Psychodynamic therapies within NHS mental health care, catering to those with complex and enduring mental health problems. [ABSTRACT FROM AUTHOR]

The Journal of Analytical Psychology's latest issue features a variety of papers with academic and clinical relevance, as well as an interview with Warren Colman, a previous editor and regular contributor to the Journal. The papers cover topics such as the personal and transpersonal psyche, anima projection, embodied metaphors, and power dynamics in Jungian theory and practice. Additionally, the issue includes reviews of books and journal articles, as well as an announcement of the winner of the Michael Fordham Prize. The Journal also invites submissions from authors and plans to hold workshops on different topics. [Extracted from the article]

The very existence of truth, let alone its worth, is currently under attack from many quarters. In the wider culture, disinformation and other forms of misrepresenting the truth spread far and wide, as information conduits proliferate. This paper suggests some reasons for the "anti-truth" trend. Mainstream media have played a role, as have theoreticians from fields as diverse as philosophy, psychoanalysis, science, and literary criticism. "Anti-truth" trends are having a serious impact on psychological treatment, affecting its content and the conception of its goals. This paper suggests some problematic outcomes of this phenomenon for practitioners and patients in various forms of psychotherapy. [ABSTRACT FROM AUTHOR]

In 1993, the British Journal of Clinical Psychology published my paper titled ‘Defence and safety: Their function in social behaviour and psychopathology’. The paper highlights that to understand people's sensitivity to threat, we also need to understand their ability to identify what is safe. This paper offers an update on these concepts, highlighting distinctions that were implicit but not clearly defined at the time. Hence, the paper seeks to clarify distinctions between: (i) threat detection and response, (ii) safety and safety seeking, (iii) safeness and (iv) their social and non‐social functions and forms. Threat detection and response are to prevent or minimize harm (e.g., run from a predator or fire). Safety checking relates to monitoring for the absence and avoidance of threat, while safety seeking links to the destination of the defensive behaviour (e.g., running home). Safety seeking also relates to maintaining vigilance to the appearance of potential harms and doing things believed to avoid harm. Threat‐defending and safety checking and seeking are regulated primarily through evolved threat processing systems that monitor the nature, presence, controllability and/or absence of threat (e.g., amygdala and sympathetic nervous system). Safeness uses different monitoring systems via different psychophysiological systems (e.g., prefrontal cortex, parasympathetic system) for the presence of internal and external resources that support threat‐coping, risk‐taking, resource exploration. Creating brain states that recruit safeness processing can impact how standard evidence‐based therapies (e.g., exposure, distress tolerance and reappraisal) are experienced and produce long‐term change. [ABSTRACT FROM AUTHOR]

Within the UK a polarised and politicised discourse exists that attempts to pitch transgender identities in opposition to discourses on sexual orientations. This suggests that interventions assisting clients in their understanding of one, would be detrimental on exploration of the other i.e., to be affirming of gender identity is to cause conversion of sexuality and vice versa. This paper attempts to address some of the problems with this oppositional critique and solve some of the practical problems that the theorist and/or clinician may encounter while attempting to help their clients within the realm of psychological therapies. It does so through Deleuzian ontologies of difference, coupled with Bhaskarian critical realism. We aim to present a (re)consideration of the biopsychosocial model of Health. The recent publication of the International Classification of Diseases 11th Edition and its reclassification of trans aetiology as a Disorder of Sexual Development has presented a conceptual shift from gender dysphoria towards a gender incongruence model (WHO 2022). The aim of this article therefore is to develop practice by enhancing the conceptual toolbox of the clinician and therapist working with Gender Sex and Relationship Diversities (GSRD). Thereby enabling them to better approach a wider diversity of clients safely. This paper explores current conversations and ideas around the phenomenon of trans gender identities and minority orientations. It aims to present an ethical model which can inform the clinical practice of therapists and is underpinned by a critical realist interpretation of biological, psychological and sociological aspects of the mind and body. Overall, the paper acts as a call to action against conversion practices which aim to position trans experience and sexual attraction in opposition to each other. [ABSTRACT FROM AUTHOR]

The paper has a twofold aim. First, it describes the complex process of gaining consent retrospectively for the publication of clinical material after the institution, where therapy was taking place, had closed down. The clinical material was derived from the psychotherapeutic work with an autistic young boy and his family. Details of the complicated process of gaining consent to publish this material are provided. The second aim of this paper is to discuss the important role of 'trust' when asking or granting consent for publication of clinical material. It is argued that trust at different levels (and amongst various people) plays a pivotal role in gaining consent for publication. [ABSTRACT FROM AUTHOR]

Functional neurological disorder (FND), formerly called conversion disorder, is a condition characterized by neurological symptoms that lack an identifiable organic purpose. These signs, which can consist of motor, sensory, or cognitive disturbances, are not deliberately produced and often vary in severity. Its diagnosis is predicated on clinical evaluation and the exclusion of other medical or psychiatric situations. Its treatment typically involves a multidisciplinary technique addressing each of the neurological symptoms and underlying psychological factors via a mixture of medical management, psychotherapy, and supportive interventions. Recent advances in neuroimaging and a deeper exploration of its epidemiology, pathophysiology, and clinical presentation have shed new light on this disorder. This paper synthesizes the current knowledge on FND, focusing on its epidemiology and underlying mechanisms, neuroimaging insights, and the differentiation of FND from feigning or malingering. This review highlights the phenotypic heterogeneity of FND and the diagnostic challenges it presents. It also discusses the significant role of neuroimaging in unraveling the complex neural underpinnings of FND and its potential in predicting treatment response. This paper underscores the importance of a nuanced understanding of FND in informing clinical practice and guiding future research. With advancements in neuroimaging techniques and growing recognition of the disorder's multifaceted nature, the paper suggests a promising trajectory toward more effective, personalized treatment strategies and a better overall understanding of the disorder. [ABSTRACT FROM AUTHOR]

This paper explores the empathic nuances of the therapeutic process with a person experiencing ongoing psychosis associated with a diagnosis of schizophrenia, and with a history of severe relational trauma. Incorporating the self psychological principles of working with the therapist's and client's forward edge, utilizing experience-near empathic attunement, and the somatic psychotherapy essential for kinaesthetic conversation were essential elements for the ongoing integration of the client's self. This work demonstrates the development of a nuanced understanding of pathological accommodation with its internal self-organizing dynamics as well as offering examples of forward edge movement. Interweaving vignettes from a two-year period with the subjective and intersubjective somatically animated experiencing of the therapist, the puzzle of how to work with all parts of the client unfolds gently and carefully. This paper outlines how connections were made between the two participants, in a clinical sense and within the client, creating a sense-making structure within the nuclear self experience of the client. Real life clinical experiences of what somatic psychotherapy, undertaken within a relational, intersubjective psychodynamic process, looks and feels like are in short supply. The presentation of this case hopes to remedy that by demonstrating the body mind integration required to work this way. [ABSTRACT FROM AUTHOR]

Aim: We aimed to assess the impact of Tai Chi interventions on individuals with essential hypertension and to compare the effects of Tai Chi versus control in this population. Background: Tai Chi has been extensively utilized in the prevention of essential hypertension. Nevertheless, there is a lack of consensus regarding its benefits for treating essential hypertension. Design: A systematic review and meta‐analysis was conducted. Data Sources We conducted a systematic literature search of the Medline, Scholar, Elsevier, Wiley Online Library, Chinese Academic Journal (CNKI) and Wanfang databases from January 2003 to August 2023. Review Methods: Using the methods of the Cochrane Collaboration Handbook, a meta‐analysis was conducted to assess the collective impact of Tai Chi exercise in controlling hypertension. The primary outcomes measured included blood pressure and nitric oxide levels. Results: The participants consisted of adults with an average age of 57.1 years who had hypertension (mean ± standard deviation systolic blood pressure at 148.2 ± 12.1 mmHg and diastolic blood pressure at 89.2 ± 8.3 mmHg). Individuals who practiced Tai Chi experienced reductions in systolic blood pressure of 10.6 mmHg, diastolic blood pressure of 4.7 mmHg and an increase in nitric oxide levels. Conclusions: Tai Chi can be a viable lifestyle intervention for managing hypertension. Greater promotion of Tai Chi by medical professionals could extend these benefits to a larger patient population. Summary statement: What is already known about this topic? Hypertension is the primary risk factor for cardiovascular disease.Essential hypertension accounts for 90% of the overall prevalence of hypertension.Tai Chi has been employed for the prevention and treatment of essential hypertension. What this paper adds: The study reveals that the efficacy of 24‐style Tai Chi intervention in combating hypertension surpasses that of traditional aerobic exercises and conventional drug therapy.The statistical significance of anti‐hypertensive effects is notably higher when practicing middle‐intensity 24‐style Tai Chi for 1 h. Implications of this paper: The findings suggest that 24‐style Tai Chi holds clinical significance for patients, nurses and healthcare decision‐makers involved in the prevention and treatment of hypertension. [ABSTRACT FROM AUTHOR]

This paper raises and addresses issues to do with leadership and child psychotherapy, beginning with a report on a systematic review of papers about leadership in the Journal of Child Psychotherapy (JCP). The authors establish that leadership is expressed implicitly rather than as an important issue in its own right with relevance to clinical work, service development and the ongoing viability of psychoanalytic child psychotherapy. When reviewing the limited literature available, the authors classify them into five types of article: tribute to leaders past; clinical leadership; threat to survival and call to action; organisational leadership; and exemplary papers describing professional leadership. The authors query why the leadership literature is sparse and inexplicit and respond by using the theme of 'dual citizenship' to explore the issue from a psychoanalytic and organisational perspective. The psychoanalytic perspective explores tensions and barriers that may be profession-specific in relation to leadership. The organisational perspective explores the wider literature on leadership, starting with the concept of 'wicked problems and clumsy solutions'. The authors introduce and describe a 'leadership stance' that is compatible with psychoanalytic practice in context. This requires opening up leadership activity to the same scrutiny and reflective practice as clinical work, which provides ways of containing organisational and career anxieties and perplexing clinical problems. This paper is a call to action in regard to integrating leadership into the training and the profession. [ABSTRACT FROM AUTHOR]

Background and Objectives: The utilization of Between‐Session Homework (BSH) holds a longstanding tradition in the field of psychotherapy. Significantly, it serves as a pivotal catalyst for change within behavioral and cognitive‐behavioral therapies, and has also garnered endorsement within psychodynamic and humanistic‐experiential therapies. While our current conceptualization of BSH is characterized by assimilation and integration, diversity prevails in how BSH is incorporated into the treatment plan, spanning various therapy stages, thus necessitating a customized therapist‐client interpersonal dynamic. Far from being a panacea, the employment of BSH emerges as a highly sophisticated and intricate clinical methodology, demanding a high degree of therapist proficiency and competence to facilitate client engagement. Methods: In this introductory paper, we present an issue of the Journal of Clinical Psychology: In Session that exemplifies the diverse modalities through which BSH can be integrated into clinical practice across various client demographics and within distinct psychotherapeutic paradigms. We place specific emphasis on the pivotal role of BSH and its interplay with proposed mechanisms of change throughout the course of treatment. Results: Initially, we provide an overarching view of the subject and expound on empirical research substantiating the efficacy of BSH in psychotherapy. Subsequently, we delve into strategies for adeptly integrating and monitoring BSH within clinical practice. Conclusions: Our primary objectives encompass affording readers a more lucid comprehension of (1) the content and nature of homework; (2) the influence of BSH on treatment outcomes; and (3) the ways through which therapists can foster client engagement with BSH. Finally, we introduce the six papers comprising this issue. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a survey exploring people's understandings and experiences of Spiritual Abuse (SA) in a Christian faith context. The online survey was completed by 1591 individuals from the UK, 1002 of whom identified as having experienced SA. Inclusion criteria were: membership of the Christian faith, being or having been, a Church attender or member of a Christian organisation and having heard of the term SA. Participants detailed features of an effective response to disclosures of SA, many of these are directly relevant to counselling and psychotherapy practice. The findings echo calls in previous research for including discussions of religion and faith in training and CPD for counsellors and psychotherapists. Finally, the paper suggests the establishment of a network of counsellors with training and knowledge about SA. [ABSTRACT FROM AUTHOR]

Psychotherapy is widely used to treat different mental health disorders and emotional difficulties. The main objective of psychotherapy is to help clients become aware of and have control over their thoughts, moods, feelings and behaviours, as well as create healthy strategies to respond to challenging situations. Since the existing psychotherapy approaches and other methods of treatment are not always effective in treating mental health disorders, there is still space for new approaches to fill this gap. In this paper, we provide information about internal cohesion psychotherapy, which is a new integrative approach. This paper presents a new approach to eclectic psychotherapy, focussing on four detrimental aspects of human functioning through different time perspectives. [ABSTRACT FROM AUTHOR]

Purpose: In 2021, an opportunity arose to place four counselling and psychotherapy (C&P) students in three care homes across Greater Manchester as part of a 6‐week interprofessional education (IPE) care home scheme. Whilst, due to ethical concerns around confidentiality, the C&P students could not participate in interprofessional activities as intended, they still undertook their clinical placement in the home to provide accessible therapy support for care home staff. This paper aims at reporting on the varied factors that influenced the implementation of C&P student placements in care homes. Methods: At the start and end of their placement, four C&P students were interviewed about their experiences. We draw on data from these eight interviews and two reflective vignettes: one from a C&P student and the other from the C&P programme coordinator (C&PPC). Results: The data were thematically analysed, and two key themes and six subthemes were constructed. They broadly unpack the factors that facilitate and challenge the implementation of C&P student placements in care homes. Conclusion: This paper highlights the value of utilising care homes as placement sites for C&P students. We propose four key recommendations for future practice: (1) it is important to establish clear lines of communication, support and collaboration; (2) a dual‐space supervisory approach supports student learning in this "new" placement environment; (3) preplacement supportive frameworks are important to clarify initial role uncertainties within the care home; and (4) opportunities to provide therapy services should be well defined and referral processes put in place before the student arrives. [ABSTRACT FROM AUTHOR]

Acupuncture treatment (AT) of depressive insomnia by traditional Chinese medicine has the advantages of fewer side effects, quicker results, and lower prices compared to medication and psychological and cognitive therapy. Clinicians often select multiple acupoints, such as Bai Hui (GV20), San Yin Jiao (SP6), and Shen Men (HT7), for combined treatment in a single AT session to improve sleep quality. Since the ancient literature on AT often only records the general order of acupoints, there needs to be more discussion on the influence of the multiple acupoint sequence on the priority of efficacy for a specific disease. At the same time, determining the ranking of acupoints in-patient treatment in clinical practice is mainly dependent on the treatment experience of practitioners, and there is no transparent quantitative model or evaluation method for generating credible acupoint sequences from a small and limited scale of cases. Therefore, it is essential to explore the optimization of the order of multiple acupoints in treating depressive insomnia by Traditional Chinese Medicine acupuncture both for the symptom relief of depressive insomnia patients and for the efficient use of national health care resources. This paper proposes a reinforcement learning-based method for optimizing the acupoint sequence for depressive insomnia AT to address these issues. This paper provides a post-AT EEG signal prediction model with related interpretable models to construct a reinforcement learning framework to represent the state transfer of the AT environment and a quantitative EEG signal-based AT efficacy model to represent the reward function. Finally, 30 patients with depressive insomnia were recruited to collect EEG signals during AT for depressive insomnia, and the case data were used to quantify the efficacy of AT and to model the post-AT EEG signal prediction. The above two models were applied to optimize the acupoint sequence based on reinforcement learning. Satisfactory results were obtained, verifying the effectiveness and feasibility of the method proposed in this paper. [ABSTRACT FROM AUTHOR]

A comparison of the Boston Study Group and the Relationalist's theories of enactments in which I maintain that enactments can be viewed either as an unknowable past expressing itself in present action, or as a process shift coming out of incremental shifts in the fit in here and now interaction. Often, it is difficult to distinguish enactments from any ongoing analytic experience oscillating between defense and revelation on the part of the analyst, analysand, or both. Yet, I agree with Goldin that change is not simply moving along, fitting together better, and reaching a higher level of organization as in infancy. An analytic interchange cannot be understood "separately from the project of grasping experience into words." [ABSTRACT FROM AUTHOR]

This discussion compares interventions that are derived from reverie, bodily sensations, and dreams, with traditional transference interpretations. Using Seward's clinical vignettes, the author delineates subtle differences between projective identification, enactments, and the selfobject function. She suggests that body-mind-self experiences of the analyst bring the selfobject function to its most precise position. Furthermore, she argues that evocation of images, body sensations, and disclosed dreams are, in fact, interpretations and that such interventions do not strive to generate repetitions but to promote potential space and openness to disavowed areas of the mind. These interventions, says the author, are not better than traditional verbal interpretations or more correct but sometimes simply more useful to the patient. [ABSTRACT FROM AUTHOR]

This document introduces a special issue on technological applications in mental health and mental health services research. The advancements in computer technology have allowed for innovative applications in collecting and analyzing data related to mental health. The use of personal electronic devices and the internet provides a rich stream of data that can offer insights into individuals' mental health. The special issue includes papers on topics such as video therapy, measurements in daily life, and automated coding of psychotherapy sessions. These papers highlight the potential of technology in improving mental health outcomes and expanding the accessibility of mental health services. [Extracted from the article]

The classification of self-inflicted skin lesions proposed by the European Society for Dermatology and Psychiatry (ESDaP) group generated questions with regard to specific treatments that could be recommended for such cases. The therapeutic guidelines in the current paper integrate new psychotherapies and psychotropic drugs without forgetting the most important relational characteristics required for dealing with people with these disorders. The management of self-inflicted skin lesions necessitates empathy and a doctor-patient relationship based on trust and confidence. Cognitive behavioural therapy and/or psychodynamic and psychoanalytic psychotherapy (alone, or combined with the careful use of psychotropic drugs) seem to achieve the best results in the most difficult cases. Relatively new therapeutic techniques, such as habit reversal and mentalization-based psychotherapy, may be beneficial in the treatment of skin picking syndromes. [ABSTRACT FROM AUTHOR]

Aim: To determine the effectiveness of brief reminiscence‐based psychosocial interventions in alleviating psychological distress in cancer patients. Background: Cancer patients suffer tremendous psycho‐spiritual pain, which affects their quality of life. Brief reminiscence‐based psychosocial interventions have demonstrated positive effects on the mental health of cancer patients; however, the efficacy of these interventions has been inconsistent. Design: A systematic review and meta‐analysis. Methods: This review was conducted and reported in accordance with the PRISMA 2020 checklist provided by the EQUATOR network. The Cochrane Library, Web of Science, PsycINFO, PubMed, Embase, CINAHL and Scopus databases were systematically searched from inception to 27 November 2022 to identify randomised controlled trials (RCTs) published in English. Results: Twenty studies involving 1744 cancer participants were included. The meta‐analysis showed statistically significant effects of brief reminiscence‐based psychosocial interventions on hope, anxiety and depression at post‐intervention. A separate analysis revealed that brief reminiscence‐based psychosocial interventions had a sustainable effect on hope, spiritual well‐being, anxiety and depression at 1 month after the intervention. However, no statistically significant effect on quality of life was found in our study either immediately after the intervention or at 1 month. Conclusions: Brief reminiscence‐based psychosocial interventions can significantly reduce anxiety and depressive symptoms and improve hope and spiritual well‐being in cancer patients. Relevance to Clinical Practice: This study further supports that brief reminiscence‐based psychosocial interventions should be incorporated into the routine care of cancer patients to address their psychosocial distress. Patient or Public Contribution: All authors of this article contributed to the study conception and design. All authors of the included studies provided original data for this paper. [ABSTRACT FROM AUTHOR]

Depression, frequently associated with cancer, significantly impacts health outcomes, necessitating effective treatments. This systematic review and meta-analysis aim to synthesize and critically evaluate the evidence from randomized controlled trials (RCTs) for the efficacy of nurse-led psychological interventions in managing depression among adult cancer patients. It focuses on the unique contribution of these interventions to improving depression management in oncology care, an underrepresented area in the existing literature. We conducted a comprehensive search in databases including Scopus, Medline, CINAHL, and PsycINFO, applying strict criteria to select RCTs assessing nurse-led psychological interventions for depression in cancer patients. We used the Cochrane Risk of Bias 2 tool to assess study quality. Out of 425 screened abstracts, nine papers describing seven distinct interventions involving 1463 participants were selected. The overall effect size estimate of −0.75 (95% confidence interval: −1.23 to −0.27) indicates significant effectiveness of these interventions in reducing depression compared to treatment as usual. Additionally, the calculated prediction interval highlights the variability in effectiveness across different settings, suggesting that contextual factors play a crucial role in the success of these interventions. The findings advocate for the integration of nurse-led psychological interventions into standard cancer care, highlighting their efficacy in improving depressive symptoms in adult cancer patients. These interventions show promise but require further refinement and research to optimize their effectiveness across diverse patient groups and healthcare settings. This review underscores the potential of nurse-led psychological interventions in enriching oncology care and addresses a critical gap in the existing body of research. [ABSTRACT FROM AUTHOR]

Complex posttraumatic stress disorder (CPTSD) is a term representing the psychopathological implications of exposure to chronic, inter‐personal trauma. These include the main symptoms of PTSD, as well as changes in identity, emotion regulation, and inter‐personal relationships. Self‐harm and dissociation (i.e., disintegration of mental processes) are also quite common in CPTSD. Considering this complex and often severe clinical picture, mental health professionals often find it difficult to effectively treat CPTSD. In this paper, we present an integrative approach to the treatment of CPTSD based on a combination of techniques from several psychotherapy approaches. The case described here illustrates the need for therapeutic flexibility and eclecticism when treating individuals exposed to chronic trauma. We show the advantages of flexible therapeutic attunement, which enables the therapist to respond to the changing need of the patient, as well as her fluid clinical picture and symptom manifestation. The case also illustrates how interventions taken from psychodynamic therapy, Dialectical behavior therapy, and Eye Movement Desensitization and Reprocessing may be applicable in various stages of treatment, alleviating the patient's distress in several psychological and physical domains. [ABSTRACT FROM AUTHOR]

ObjectiveMethodResultsConclusionThe present paper focuses on therapist responsiveness during the initial therapy session with clients with borderline personality disorder (BPD), aiming to analyze therapist responsiveness at short intervals during the initial session and determine if it can predict therapeutic alliance from both therapist and client viewpoints.A sample of 47 clients participated in the study for 10 sessions of therapy. Therapeutic alliance from therapists’ and clients’ perspectives was rated after each session; external raters assessed therapist responsiveness during the initial session. Multiple linear regression models and linear mixed models with backward variable selection based on AIC were run to analyze whether specific therapist behaviors during session one predicted therapeutic alliance rated from therapists’ and clients’ perspectives.The results indicate that therapists normalizing and validating clients’ experiences during the first session are crucial for establishing therapeutic alliance for BPD clients; however, for therapists, the increase in variability of emotions verbalized by clients during the initial session negatively impacts therapeutic alliance.The study contributes to further understand the impact of therapists’ behavior at the beginning of therapy with BPD clients. Therapist responsiveness is crucial for therapy outcome but is methodologically challenging; therefore, efforts in this direction should be pursued. [ABSTRACT FROM AUTHOR]

Background: Technology improves accessibility of psychological interventions for youth. An ecological momentary intervention (EMI) is a digital intervention geared toward intervening in daily life to enhance the generalizability and ecological validity, and to be able to intervene in moments most needed. Identifying working mechanisms of the use of ecological momentary interventions might generate insights to improve interventions. Methods: The present study investigates the working mechanisms of the use and acceptability of an ecological momentary intervention, named SELFIE, targeting self-esteem in youth exposed to childhood trauma, and evaluates under what circumstances these mechanisms of use and acceptability do or do not come into play. A realist evaluation approach was used for developing initial program theories (data: expert interviews and a stakeholders focus group), and subsequently testing (data: 15 interviews with participants, a focus group with therapists, debriefing questionnaire), and refining them. Results: The SELFIE intervention is offered through a smartphone application enabling constant availability of the intervention and thereby increasing accessibility and feasibility. When the intervention was offered on their personal smartphone, this enhanced a sense of privacy and less hesitance in engaging with the app, leading to increased disclosure and active participation. Further, the smartphone application facilitates the practice of skills in daily life, supporting the repeated practice of exercises in different situations leading to the generalizability of the effect. Buffering against technical malfunction seemed important to decrease its possible negative effects. Conclusions: This study enhanced our understanding of possible working mechanisms in EMIs, such as the constant availability supporting increased accessibility and feasibility, for which the use of the personal smartphone was experienced as a facilitating context. Hereby, the current study contributes to relatively limited research in this field. For the field to move forward, mechanisms of use, and acceptability of EMIs need to be understood. It is strongly recommended that alongside efficacy trials of an EMI on specific target mechanisms, a process evaluation is conducted investigating the working mechanisms of use. Trial registration: The current paper reports on a realist evaluation within the SELFIE trial (Netherlands Trial Register NL7129 (NTR7475)). [ABSTRACT FROM AUTHOR]

This paper argues that the process of modeling in science and the process of encountering and working with a client in clinical psychotherapy overlap. In briefer terms: what makes a good therapist is much like what makes a good scientific modeler. Both modeling and psychotherapy are iterative processes, requiring careful observation, generation and testing of hypotheses. Both processes also face similar epistemic and pragmatic trade-offs. Heuristics and biases can shape both practices, for better and worse. Implications are considered for both training in clinical psychotherapy, and for larger debates concerning evidence-based methods in assessment of mental health care, and categorical v. dimensional approaches to diagnosis. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic caused concern regarding suicide risk mitigation while requiring many clinicians to transition to telehealth. We hypothesized that this transition would increase suicide intent, suicide desire, and depressive symptom ratings from pre-COVID-19 to peri-COVID-19. Patients at a southeastern US outpatient psychotherapy training clinic reported on suicide risk and depressive symptoms before and after the transition to telehealth treatment. Additionally, the effect of continuation of treatment on suicide risk was also analyzed. Suicide risk levels (n=39) and depressive symptoms (n=25) did not increase following the transition to telehealth. Self-reported suicide desire ratings significantly decreased from pre- to peri-pandemic assessments. Findings suggest that telehealth, among other sociocultural factors, became somewhat of a "port in a storm," such that it may have provided protections from exacerbations of mental health concerns and further vulnerabilities towards increased suicide risk. This paper concludes with relevant implications and suggestions for community health clinics. [ABSTRACT FROM AUTHOR]

Objective: Although Ireland has one of the highest levels of well‐being in Europe, having a health condition has been found to have a direct negative impact. The aim of this study is to evaluate the current situation and the experiences of patients with epidermolysis bullosa (EB), a rare genetic skin disease, and their relatives living in Ireland, with a focus on burdens and helpful practices. Methods and Measures: In a mixed‐methods design, a series of standardised questionnaires were combined with open‐ended questions. Via an online survey, data from n = 59 EB patients and relatives of EB patients living in Ireland were collected. Results: EB affects both the patients and their relatives. Burdens were found in relation to the visibility of EB, the degree of severity, the current health status, reduced mobility, the financial impact of EB, the psychosocial impact and personal and social resources. The paper also analyses existing resources and highlights opportunities for support and needs of improvement. Conclusion: Quality of life with EB is influenced by somatic symptoms and the psychosocial burden. Individual helpful practices in dealing with this rare disease can be considered as mediators, but they need to be supported by structural and healthcare improvements. Patient or Public Contribution: The perspective of EB patients, their relatives and EB experts were taken into account in the development of the study design via two feedback loops with the EB patient organisations DEBRA Ireland and DEBRA Austria. The design was adapted accordingly. Additionally, by including open‐ended questions, patients and relatives could contribute their individual perspectives and add insights into their lives with EB that might not have been captured with the structured online survey alone. [ABSTRACT FROM AUTHOR]

Background: Adolescence is a critical period for social emotional development. The need to focus on social emotional competencies is exacerbated by the COVID 19 pandemic. Objective: This systematic review paper provides a collective account of mindfulness interventions conducted exclusively with adolescent students in an educational setting (mean age 11 to 18) with the sole focus on social emotional and behavioral competencies primarily as outlined by the Collaborative for Academic, Social, and Emotional Learning (Safe and sound: an educational leader's guide to evidence-based social and emotional learning programs, Author, Chicago, IL, 2003, 2011). Method: Mindfulness literature in the past 15 years, i.e., Jan 2008–Feb 2023 was reviewed. Additionally, the type of intervention implemented, dosage, delivery, measures used, and targets of intervention were examined. All the articles were also assessed for their methodological quality using the EPHPP quality assessment tool for quantitative studies (Effective Public Health Practice Project in Quality assessment tool for quantitative studies, Effective Public Health Practice Project, Hamilton, ON, 1998. https://merst.ca/ephpp/). Results: With less than one third of the 30 included studies rated as strong, there appears to be moderate evidence for the effectiveness of MBIs on adolescent social emotional competencies. Overall, there appears to be mixed evidence for the effectiveness of MBIs on adolescents' self-awareness, social awareness, social skills, with relatively more consistent evidence that MBIs positively impact their self-management (e.g., emotional regulation). We classify broader characteristics of the MBIs that could help explain some of the differences in effectiveness into three categories: intervention implementation related (e.g., dosage), method related (e.g., psychometric properties), and participant related (e.g., age and gender). Conclusion: Future work on MBIs in schools needs to consider the quality of and factors known to impact effective implementation and resultant social emotional outcomes. [ABSTRACT FROM AUTHOR]

Meta-analytic research has suggested that, although there are two forms of power that can be problematic in a psychotherapy context, they are rarely considered in interaction. One form, cultural power, influences the ways clients, therapists, and systems interact in relation to social identities, communities, and ascribed cultural statuses, and the other, professional power, is held by therapists by virtue of their training and the authority ascribed to them. Both formsmay limit clients' ability to be empowered in therapy. As many feminist multicultural researchers and task forces have thoughtfully explicated strategies for responding to cultural power, this paper focuses predominantly on processes for addressing professional power, which have been less well explicated. Although there is a rich body of humanistic therapy literature on maximizing clients' agency, these core processes have rarely been framed in relation to concepts of power. This reframing contributes to prior work by feminist multicultural-humanistic therapy (FMHT) scholars by examining central humanistic principles to identify specific strategies that attenuate the misuse of this form of power. For instance, therapists teach clients to symbolize inchoate experiences (often resulting from cultural or interpersonal oppression eroding trust in oneself or one's community), to confidently self-reference (developing resistance to stigma), and to maximize their agency within the change process (empowering them to guide their own development). Integrating these humanistic therapy principles into FMHT enhances ethical practice and holds relevance across therapies, supporting therapists' competence, clients' agency, and a multidimensional understanding of power in therapy. [ABSTRACT FROM AUTHOR]

Aim: Routine outcome monitoring (ROM), including the use of feedback, has become a much vaunted method in psychological therapies but is little used in university/college counselling and mental health services, perhaps because its adoption raises questions for many practitioners and service leaders. There is a need for both clinical‐ and research‐based statements to clarify the reasoning and rationale for ROM. This paper aims to present and respond to common challenges of and reservations about using ROM in student counselling and/or mental health services. Method: The article poses 15 questions and issues about the adoption of ROM drawn from the literature on this topic and further refined by practitioner‐ and researcher‐members of a consortium comprising service leads, practitioners, and researchers working in the field of student counselling in the UK. The questions address nine themes: (1) the purpose and yield of ROM; (2) the burden of measurement; (3) the impact on clients and process of therapy; (4) consistency with therapeutic theory; (5) client groups and settings; (6) concern from practitioners; (7) equality, diversity, and inclusion; (8) implementation; and (9) relationship with the paradigm of practice‐based evidence. Findings: Responses to each of the 15 questions are provided from a methodological, evidence‐based, and clinical perspective. Conclusions: The responses provide practitioners with the necessary information to enable them to make informed decisions as to the value, or otherwise, of adopting ROM, including feedback, in the delivery of counselling interventions, and generating evidence created from clinical practice. [ABSTRACT FROM AUTHOR]