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Background: Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) are at increased risk of potentially traumatic events and may be at increased risk of post-traumatic stress disorder (PTSD). However, knowledge regarding identification of PTSD in this population is limited. The aim of this study was to investigate clinical experience regarding PTSD and trauma assessment in individuals with co-occurring ASD and ID. Method: Interpretative phenomenological analysis was used to explore experiences of identifying PTSD in this population among 18 mental health clinicians working with ASD and ID. Results: Informants viewed PTSD in individuals with ASD and ID as equivalent to PTSD in the general population, but with causes and expressions potentially differing. Several factors were described to contribute to challenges in identification. Conclusions: Trauma may have severe impact in individuals with ASD and ID. Multidimensional, individualized assessment strategies seem necessary to recognize PTSD or trauma-related symptoms in this population.

In this article we draw on literature from philosophy, history, and psychology to argue that empathy supports qualitative analysis of transcripts in several ways. We discuss examples of these processes both with data that we have co-created with our participants and data where we have not interacted with participants during data collection. What we suggest is not a new approach to analysis. Rather, we argue that the deliberate use of empathy bears potential to strengthen analysis across various analytical approaches. We explore five examples of how to access and harness our capacity for empathy as a resource in qualitative analysis: 1) Make time and room for prolonged engagement with data; 2) Use details and context actively when developing your understanding; 3) Practice decentering by actively seeking the perspective of the participants; 4) Attend to your own visceral experiences and body sensations; and 5) Utilize your capacity for imagination and creativity. [ABSTRACT FROM AUTHOR]

Influence from bias is unavoidable in clinical decision-making, and mental health assessment seems particularly vulnerable. Individuals with intellectual disabilities have increased risk of developing co-occurring mental disorder. Due to the inherent difficulties associated with intellectual disabilities, assessment of mental health in this population often relies on a different set of strategies, and it is unclear how these may affect risk of bias. In this theoretical paper, we apply recent conceptualisations of bias in clinical decision-making to the specific challenges and strategies in mental health assessment in intellectual disabilities. We suggest that clinical decision-making in these assessments is particularly vulnerable to bias, including sources of bias present in mental health assessment in the general population, as well as potential sources of bias which may be specific to assessments in this population. It follows that to manage potential bias, triangulating information from multi-informant, multi-method, interdisciplinary assessment strategies is likely to be necessary. [ABSTRACT FROM AUTHOR]

Background: Individuals with intellectual disability (ID) and autism spectrum disorder (ASD) are at increased risk of sexual abuse. However, little is known about facilitating detection and disclosure. One year after discharge from a specialised psychiatric ward, a young man with mild ID and ASD disclosed previously unknown sexual abuse. The aim of the present study was to explore clinicians' perceptions of their failure to detect abuse. Method: Interpretative phenomenological analysis was used to explore five staff members' perceptions, with data being collected through an individual, semi-structured interview. Results: Staff reported behaviours that, in retrospect, they understood as possible indicators of abuse and/or attempts by the patient to disclose. Factors contributing to non-detection included insufficient trauma sensitivity, lack of exploration, and diagnostic overshadowing. Conclusions: Symptoms of trauma should be routinely explored in individuals with ASD and ID referred for psychiatric assessment -- even in the absence of known trauma or abuse.

Introduction: Individuals with autism spectrum disorder (ASD) and intellectual disability (ID) seem to be at increased risk for post-traumatic stress disorder (PTSD), but knowledge is sparse regarding its identification in this population. Previous research indicates that certain symptoms of PTSD may be more easily recognized, and that identifying reexperiencing and avoidance is particularly challenging. Methods: Interpretative phenomenological analysis was used to explore 18 experienced clinicians' perceptions of PTSD symptom expression in ASD and ID through individual, qualitative interviews. Results: Informants provided examples from all symptom groups, but these differed in how frequently they were described. Recognition of reexperiencing may rely on knowledge about individuals' trauma experience. Avoidance may present in a wider range of ways. Conclusion: Development of reexperiencing and avoidance may follow different trajectories in this population, contributing to challenges in recognition. Reexperiencing may be more severe in ASD/ID. Implications are discussed in light of current diagnostic criteria.

Assessing and accommodating patient preferences is integral to evidence-based practice. This qualitative study sought to explore patient perspectives and experiences of preference work in psychotherapy. Participants were 13 UK-based patients who had completed up to 24 sessions of a collaborative–integrative psychotherapy. Ten participants identified as female and three as male. Interviews were conducted at endpoint and analyzed using a team-based, consensual qualitative research approach. Three superordinate domains were developed: Preferences Themselves, Process of Working with Preferences in Psychotherapy, and Effect of Preference Work (or its Absence). Patients typically wanted leadership, challenge, and input from their psychotherapist, and an affirming style. Patients attributed the origin of their preferences to personal history, characteristics, or circumstances; the present psychotherapy; or past episodes of psychotherapy. Some preferences changed over time. Preference work was described as having positive effects on the therapeutic relationship and patients' intrapersonal worlds; however, variantly, non-accommodation of preferences was also experienced as beneficial. Our findings provide in-depth answers to a range of novel questions on preference work—potential mechanisms by which preference work impacts outcomes, factors that may facilitate preference work, and origins of preferences—as well as nuancing previously-established quantitative findings. Implications for clinical training and practice are discussed. [ABSTRACT FROM AUTHOR]

This study investigated former patients' experiences with family-based inpatient treatment. Interviews of thirty-seven patients diagnosed with anorexia nervosa during the admissions were conducted to examine their post-treatment perspectives. The accounts were analyzed by utilizing an inductive thematic analytic approach. The analysis yielded 4 main themes, constituted by in all 8 subthemes. The main themes were; 1) Enabling new ways of understanding and relating, 2) Enhancing or maintaining negative power dynamics, 3) Vulnerable transitions, and 4) Sibling relationships and different ways of involvement. With its "insider focus," this study contributes to knowledge on how family-based inpatient treatment is perceived from a user perspective. The current study has value for both advancing the development of family-based inpatient treatment, and by adding patient perspectives to the ongoing effort of providing family-based approaches at higher levels of care. [ABSTRACT FROM AUTHOR]

Background: Individuals with intellectual disability (ID) and autism spectrum disorder (ASD) are at increased risk of sexual abuse. However, little is known about facilitating detection and disclosure. One year after discharge from a specialised psychiatric ward, a young man with mild ID and ASD disclosed previously unknown sexual abuse. The aim of the present study was to explore clinicians' perceptions of their failure to detect abuse. Method: Interpretative phenomenological analysis was used to explore five staff members' perceptions, with data being collected through an individual, semi-structured interview. Results: Staff reported behaviours that, in retrospect, they understood as possible indicators of abuse and/or attempts by the patient to disclose. Factors contributing to non-detection included insufficient trauma sensitivity, lack of exploration, and diagnostic overshadowing. Conclusions: Symptoms of trauma should be routinely explored in individuals with ASD and ID referred for psychiatric assessment – even in the absence of known trauma or abuse. [ABSTRACT FROM AUTHOR]

Studies have shown that many clinicians are skeptical about research and hesitant about participating in research. In the present study, we explored this issue by studying experienced therapists' reflections on their participation in practice-based research. Data were drawn from a practice-based research study at the University of Oslo, Norway. Twelve highly experienced therapists who had contributed to the study were invited to complete an open-ended questionnaire regarding their participation, and the text material was analyzed using a thematic analytic approach. Results indicated that research participation was experienced both as beneficial and demanding, and that being observed by others and following research procedures was experienced as affecting therapists' clinical work. We discuss these findings in relation to the distinction between "treatment as usual" versus "treatment in a research context", and offer suggestions for steps to increase the clinical relevance and the ecological validity of psychotherapy research. [ABSTRACT FROM AUTHOR]

Objective: Within a mixed methods program of research the present study aimed at expanding knowledge about interactions in the initial therapeutic collaboration by combining focus on client interpersonal style and therapist contribution. Method: The study involves in-depth analyses of therapist-client interactions in the initial two sessions of good and poor outcome therapies. Based on interpersonal theory and previous research, the Inventory of Interpersonal Problems (IIP-64-C) was used to define poor outcome cases, that is, low proactive agency cases. To compare good and poor outcome cases matched on this interpersonal pattern, cases were drawn from two different samples; nine poor outcome cases from a large multi-site outpatient clinic study and nine good outcome cases from a process-outcome study of highly experienced therapists. Results: Qualitative analysis of therapist behaviors resulted in 2 main categories, fostering client's proactive agentic involvement in change work and discouraging client's proactive agentic involvement in change work, 8 categories and 22 sub-categories. Conclusion: The findings revealed distinct and cohesive differences in therapist behaviors between the two outcome groups, and point to the particular therapist role of fostering client agency through engagement in a shared work on change when clients display strong unassertiveness and low readiness for change. Clinical or Methodological Significance Summary: The present analysis combines focus on client interpersonal style, therapist strategies/process and outcome. The categories generated from the present grounded theory analysis may serve as a foundation for identifying interactions that are associated with agentic involvement in future process research and practice, and hence we have formulated principles/strategies that were identified by the analysis. [ABSTRACT FROM AUTHOR]