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Background Methods Results Discussion The focus of this case study was to explore the development of the therapeutic alliance in relation to alliance rupture and resolution and the effect of motive‐focussed psychotherapeutic techniques on this process in the treatment of borderline personality disorder (BPD).Therapeutic alliance rupture and resolution processes were analysed in relation to outcomes over the course of a 10 week, short‐term generalist psychiatric treatment for BPD in two patients, hereby referred to as Clara and Rebecca. Clara received treatment in the form of good psychiatric management (GPM) with the addition of motive‐oriented therapeutic relationship (MOTR) techniques. Rebecca received treatment in the form of GPM.Both patients experienced a clinically significant reduction in symptoms. Ruptures and resolution processes occurred at low frequencies in Clara's treatment, while ruptures and resolution processes were numerous in Rebecca's treatment. The focus in Clara's treatment was on rupture prevention because of the added presence of MOTR techniques, while the focus in Rebecca's treatment was on rupture identification and resolution.Results support the hypothesis that symptom reduction was achieved through two distinct pathways of change as a function of the treatment condition, which suggests the potential presence of multiple effective psychotherapeutic techniques for alliance development. Limitations of this study and clinical implications for the treatment of BPD in psychotherapy, with a special focus on the therapeutic alliance, are discussed. [ABSTRACT FROM AUTHOR]

In this duet of two voices honoring Jeremy Safran's legacy, the authors celebrate some points of resonance between Sándor Ferenczi's groundbreaking relational interventions and Safran's approach to the therapeutic relationship as the heart of healing. Karen Starr first highlights Ferenczi's now well-known creative experimentation with technique and his emphasis on and care for the relational dimension of psychoanalytic treatment. Jill Bresler then links Safran's career-long dedication to the therapeutic alliance to Starr's introductory remarks, honoring Safran and Ferenczi's shared dedication to expanding options in clinical practice through focus on the relationship. Recalling Safran's naming Ferenczi as a key figure in psychotherapy integration's origin story, Bresler reflects on her own learning from Safran's groundbreaking transtheoretical research into the mutative aspects of psychotherapy and his translating a psychoanalytic focus on the therapeutic relationship to CBT researchers and practitioners. [ABSTRACT FROM AUTHOR]

Aim: To explore the benefits and challenges of a recently introduced Registered Undergraduate Student of Nursing workforce from the perspective of Nurses and Registered Undergraduate Students of Nursing, in a major metropolitan hospital in Australia in 2020. Design: A qualitative descriptive study was undertaken using individual interviews and focus groups. Methods: Purposively selected employed Registered Undergraduate Students of Nursing and nurses who worked with them were interviewed, using a semi‐structured format. Recordings were transcribed and coded using NVivo software. Reflexive thematic analysis using an inductive approach was undertaken. Results: Four major themes were revealed: (i) Navigating the programme, (ii) Belonging and integration; (iii) Patient care; and (iv) Continuing Development. Initial challenges were common, often related to clarifying the scope of practice for the new role. Ongoing issues were associated with gaps in understanding the role and lack of integration into the team. Mostly, nurses and Registered Undergraduate Students of Nursing built positive, professional relationships. Nurses valued the Registered Undergraduate Student of Nursing knowledge and skill level, reporting improved workload and work experiences when the Registered Undergraduate Student of Nursing was on shift. Nurses believed that the Registered Undergraduate Students of Nursing enhanced patient care. Registered Undergraduate Students of Nursing described positive, therapeutic relationships with patients. Registered Undergraduate Student of Nursing employment provided opportunities for new learning, leading to increased efficiency and confidence on clinical placement. Conclusions: This employment model benefited the Registered Undergraduate Students of Nursing and nurses who worked with them. In the absence of adequate training and support, challenges remained unresolved and negatively impacted the experience for nurses. In addition to university‐level education and clinical placement, the employment model can create a third space for student learning via on‐the‐job training. The study supports the ongoing employment of student nurses through the Registered Undergraduate Student of Nursing model. Implications for the Profession and/or Patient Care: Impact: This study contributes to the very small body of literature investigating Registered Undergraduate Student of Nursing workforces in Australian hospitals. It is the first to explore the experiences of both nurses and students working together in a major metropolitan setting and also the first in the context of the COVID‐19 pandemic.This study reflected a mostly positive experience for Registered Undergraduate Student of Nursing and the nurses who worked with them and highlighted the importance of adequate oversight and support in the implementation and maintenance of a Registered Undergraduate Student of Nursing workforce.Employed Registered Undergraduate Students of Nursing reported improved confidence, skills, and felt like they started clinical placement at an advantage, ready to step up and learn the Registered Nurse scope of practice.In addition to university‐level education and clinical placement, this employment model creates a third space for learning via on‐the‐job training. Reporting Method: COREQ guidelines were followed in the reporting of this study. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Objectives: This study explores therapists' perspectives on experiential learning, competencies, and training in ketamine-assisted therapy (KAT), a form of psychedelic-assisted therapy (PAT). We aim to understand how therapists' personal psychedelic experiences influence their self-perceived competency and therapeutic relationships regarding KAT. Methods: Licensed therapists from Numinus Wellness clinics in Canada and the USA who were trained in KAT were invited to participate in the study. Participation included a 60–90-minute semi-structured interview conducted remotely via secure videoconferencing. The interviews focused on the professional and personal impacts of providing KAT, its mechanisms, and the role of therapists' personal psychedelic experiences in delivering KAT. Data analysis utilized Interpretative Phenomenological Analysis (IPA) and a mix of deductive and inductive coding with Nvivo software. Results: Eight therapists (62.5% female, 37.5% male) were interviewed. All had formal training in KAT, with many also trained in other forms of PAT. All respondents endorsed the value of personal psychedelic experience for deepening understanding of clients' experiences and strengthening the therapeutic alliance. They all also expressed a desire for formal experiential training in KAT, which they viewed as a missing element in their training. Additional themes identified included the importance of relational safety and the therapeutic container, KAT's impact on professional development, competency, and purpose, and navigating risks and challenges in KAT, particularly with complex trauma clients. Conclusions: Our findings highlight the need for enhanced therapist training and evidence-based standardization of PAT programs that incorporate experiential learning. Such training has the potential to optimize safety and therapeutic outcomes. [ABSTRACT FROM AUTHOR]

In this study, we examined how four components of the therapeutic relationship—working alliance, real relationship, and positive and negative affective reactions of the patient toward their therapist—relate to each other and to the psychotherapy session outcome, from the patient’s point of view. Our simple comprised 700 adult patients in individual psychotherapy who were recruited and participated online. They underwent a baseline evaluation of their most recent therapy session, which encompassed a series of validated self-report measures focused on specific elements of the therapeutic relationship. The results revealed that, from the patient’s perspective, working alliance, real relationship, and positive affective reactions toward the therapist were positively correlated with session outcome, while negative affective reactions were negatively correlated. All components predicted session outcome when simultaneously included in a regression model. Collectively, these four components accounted for 30% of the variance in session outcome. Factor analysis revealed four distinct factors, underlying perceptions of the therapeutic relationship. Notably, the bond dimension of the alliance was sufficiently different from the task and goal dimensions, warranting consideration as a distinct construct. These findings, although cross-sectional, lay the groundwork for a more nuanced investigation of multiple dimensions of the therapeutic relationship. [ABSTRACT FROM AUTHOR]

Individuals diagnosed with Complex PTSD (C‐PTSD) have experienced repeated and often prolonged traumatic events. From a therapeutic perspective this can lead to difficulties in emotion regulation within‐session, challenges with patient‐therapist attunement, and impaired coregulation of emotions during therapeutic interactions. As a result, frequent therapeutic alliance ruptures can emerge, which in turn pose challenges for symptom‐focused work. We describe a case study involving a 38‐year‐old woman presenting with C‐PTSD, dissociation, anxiety and borderline and dependent personality disorder traits. We explore how difficulties in attunement and emotion regulation during therapy were mostly attributable to (i) maladaptive ideas regarding the self and others; and (ii) difficulties in recognizing both her own mental states and those of her therapist. For instance, the patient believed that the therapist was distant and critical; which she held to be fact rather than reflective of a mental state. We show how the therapist addressed these difficulties, incorporating repair of the therapeutic alliance, which enabled a return to symptom focused work. The case description offers guidance on how to maintain a dual focus on therapeutic alliance alongside symptoms when treating C‐PTSD (with or without comorbidity). [ABSTRACT FROM AUTHOR]

The relationship between patient and physiotherapist increases in complexity when patients experience chronic disability and require caregiver assistance at home. Since relatives often support therapeutic activities, they too play an important role that may significantly influence therapy success. This study reconstructs the therapeutic relationship triangle of patients, caregivers and physiotherapists in neurorehabilitation and seeks to examine how these relationships influence the rehabilitation process. A qualitative triangulation study consisting of participant observations and group discussions with long-term affected patients, their family caregivers and physiotherapists were realised. Data were analysed and triangulated using the documentary method. Two patient types were identified: the optimistic, success-motivated patient type and the pessimistic type. Regarding relatives, a confident, hopeless and a sceptical type emerged. The types differ in their expectations, hopes and desires in therapy. This fundamentally affects the therapeutic relationship triangle. Differing expectations of patients and their relatives should be recognised and taken into account by physiotherapists, as a successful triadic relationship is a prerequisite for effective therapeutic measures. The involvement of relatives in the therapy process plays an important role in achieving therapy goals. More attention should be placed within the triad, in future research and in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Pharmaceutical care is an essential component of mental healthcare. Objectives: The study assessed pharmacists' collaborations, barriers, perceptions on therapeutic relationships and attitudes toward pharmaceutical care to persons with mental illness. Methods: A questionnaire-based descriptive cross-sectional survey was conducted among 175 pharmacists in a Nigerian state via purposive sampling. Average mean score of >3 (±SD) was considered positive attitude toward pharmaceutical care, and positive for respondents' perception of pharmacists-patient relationship during consultations. Data were analyzed using SPSS version 25.0 for descriptive statistics. Results: A total of 140 (80.0%) respondents participated in the study. Access to patients' medical records 90 (64.3%) was the major barrier to the provision of pharmaceutical care to persons with mental illness. Almost half of the study participants 69 (49.3%) desired collaboration with only general practitioners and psychiatrists. Only 44 (31.4%) had full co-operation from their desired collaborators. Average score for respondents' attitude toward provision of pharmaceutical care to the patients, and perception of pharmacist-patient relationship were 4.5 (±0.7) and 3.8 (±0.9) respectively. Conclusions: Study participants' attitude toward pharmaceutical care, and perception on therapeutic relationship in persons with mental disorder were positive. Lack of access to patients' records mostly hindered provision of pharmaceutical care, and full collaboration with other mental health experts was mostly lacking. Appropriate policies are required to improve these vital components of mental healthcare for desired outcomes. [ABSTRACT FROM AUTHOR]

The scientific community's interest in psychedelic-assisted therapies (PAT) as a potential new therapeutic modality is growing, as evidence suggests that their use has a significant impact on the outcomes of patients with various conditions, including those with serious illnesses. In the context of PAT, the interpersonal bond established between patient and therapist is a vital factor for the positive results of this therapeutic approach. The aim of this article is to discuss the importance of these professionals adopting a compassionate care approach in the context of PAT in hospice and palliative care. This study starts with a brief review of the current literature on the therapeutic potential of PAT for people with serious diseases. Next, the definition of compassion and compassionate care in healthcare will be explored. Based on what the literature points out regarding the essential competencies for psychedelic therapists, it will address how compassionate care can contribute to the application of PAT in the hospice and palliative care context. Finally, the article will present implications for the research and practice of compassionate care in PAT, especially directed at people in hospice and palliative care. [ABSTRACT FROM AUTHOR]

Introduction: Patient feedback is relevant information for improvement of health care professionals' performance. Engaging patients in feedback conversations can help to harness patient feedback as a powerful tool for learning. However, health care settings may prevent patients and health care professionals to effectively engage in a feedback dialogue. To advance our understanding of how feedback conversations may support learning in and from practice, we sought to explore patients' and health care providers' perspectives on engaging patients in feedback conversations as informal learning opportunities. Methods: For this qualitative study, we used a pragmatic approach and conducted semi‐structured interviews with 12 health care providers and 10 patient consultants. We applied an inductive approach to thematic analysis to understand interviewees' perceptions regarding patient feedback for workplace learning. Results: Participants attributed importance to patient feedback and described how the feedback may improve treatment relationships, professionals' performance and care processes on the team level and the organisational level. Participants experienced conflicting roles as patient and educator or expert and learner, respectively. Changing relationships, feelings of vulnerability and perceived power dynamics in treatment relationships would affect participants' engagement in feedback conversations. Patients and professionals alike saw a role for themselves in giving or inviting feedback but often missed the tools for engaging in feedback conversations. Discussion: Patient feedback can contribute to professionals' practice‐based learning but requires navigating tensions around conflicting roles and power dynamics in the treatment relationship. Both patients and health care professionals need to embrace vulnerability and may need facilitation and guidance to use patient feedback effectively. Attention to power dynamics, if not a shift towards collaborative relationships, is however crucial to engage patients in feedback conversations, thereby capitalising the power patients posses. While feedback conversations can contribute to professionals' workplace learning, this study highlights how tensions around conflicting roles and power dynamics in the professional‐patient relationship must be navigated. [ABSTRACT FROM AUTHOR]

The nature and origins of addictions and of their adjunctive behaviors, as well as their chronicity, call for treatments that conceptualize and treat them as the long-term and complex processes that they are. Addictions are often comorbid with personality problems and with trauma histories. Patients suffering from these disorders often show poor engagement with treatment and high rates of relapse, possibly because available treatments have yet to address the patient suffering from addiction in a more integrated or holistic manner. In particular, comprehensive treatment models for addictive disorders - like treatments for personality disorders or trauma - are likely to require the integration of behavioral, cognitive, and emotion-focused interventions within a facilitative therapeutic relationship. However, most current treatment models, including ones which are highly effective in stabilization or behavioral change, lack one or more components of treatment that could sustain longer term recovery, wellness, and health for a higher percentage of patients. In this article, I propose approaching addictions and their treatment from the perspective of schema therapy, an integrative, developmental model with a strong track record of positive outcomes in addressing personality disorder symptoms and longstanding trauma histories, commonly comorbid with addictive disorders. In advancing this proposal, I begin by providing some background tying together addictions, attachment, and personality, suggesting they be treated simultaneously to achieve improved outcomes. Then, after briefly reviewing the leading approaches to the treatment of addictions, I introduce the idea that schema therapy is well-situated - both theoretically and practically - to address many of the shortcomings of existing treatment options. In particular, I note how addictive and co-occurring colluding behaviors are deeply intertwined with both early and continued frustration of core developmental needs. I illustrate how the addictive cycle is perpetuated through the process of schema reinforcement and through the operation of schema modes. I then demonstrate how these key terms (i.e., needs, schemas, and modes) inform the patient's assessment and case formulation, guiding treatment interventions from a strong therapeutic relationship that focuses on integrating recovery behavior change, healing dysfunctional schemas and modes, and preventing relapse. [ABSTRACT FROM AUTHOR]

This study investigated the role of a therapeutic presence in metaverse counseling, considering the growing interest in virtual reality psychotherapy. To examine the relationship between therapeutic presence and working alliance over time in metaverse counseling, we conducted a multilevel analysis with sessions at level 1, clients at level 2, and therapists at level 3. The dataset consisted of 75 sessions, nested within 25 clients and seven therapists. The study revealed that therapeutic presence positively affected the working alliance, at the between-sessions (within individual clients) and between-clients levels (across different clients). The findings also indicated that, during the early stages of treatment, a higher level of therapeutic presence in a session was associated with a stronger working alliance for that particular session. The final model explained approximately 45% of the working alliance variance. The implication for the potential influence of a therapeutic presence was discussed particularly during the initial sessions of metaverse counseling. [ABSTRACT FROM AUTHOR]

Introduction: Working with a person living with dementia over the years presents a significant challenge for the music therapist, particularly in determining the appropriate duration of intervention. This challenge is compounded by the evident deceleration process experienced by the person, necessitating a high degree of sensitivity and adaptability from the therapist. Method: This article draws on the author's extensive experience as a music therapist, spanning individual sessions lasting from 6 to 14 years with the same person. Insights gleaned from clinical moments over this duration highlight challenges inherent in long-term therapeutic interventions. Results: The therapeutic relationship developed over the years enables the music therapist to adjust the intervention progressively to the client's evolving needs and remain attuned despite challenges in interpreting the person's responses during severe dementia. Discussion: This reflection emphasizes the relevance of music therapy in providing continuous care for persons with severe dementia, acknowledging the inherent challenges of such interventions. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodsResultsConclusionReal relationship (RR) refers to a genuine human relationship between client and therapist, that has been found to be positively related to treatment outcome, and to predict unique variance in outcome over and above the working alliance. However, thus far, the measurement of RR has been limited to self-report. We aimed to develop an observer-rated version of the RR measure (RR-O) to assess RR in therapy sessions.We adapted items from the self-report measures to an observer rated measure, which was reviewed by RR experts. The final 24-item RR-O was rated in 540 session transcripts from 27 psychoanalytic treatments that already had existing process and outcome scores.The RR-O showed good internal consistency and good interrater reliability. In hierarchical EFA, items clustered into a general RR factor, and client realism, client genuineness, therapist genuineness, and therapist realism group factors. In addition, the RR-O was positively related to another RR measure and to the therapeutic alliance.The RR-O shows initial reliability and validity as an observer-rated measure of the RR to be used in post-hoc psychotherapy research. Future research should clarify the relation between RR-O and treatment outcome. [ABSTRACT FROM AUTHOR]

Accessible summary What is known on the subject? What the paper adds to existing knowledge? What are the implications for practice? Introduction Aim Method Results Discussion Implications for Practice Recovery‐oriented practices in community‐based mental health services are of increasing importance. The recovery journey of individuals with mental illness starts with a sense of agency, and a therapeutic relationship with the providers who support them is a prerequisite. In Japan, the construction of community‐based integrated care systems for individuals with mental illness is positioned as a priority health issue, with communication with familiar individuals being particularly important for recovery in Japanese and Asian cultures. This study is the first to examine effective communication factors for personal agency in the recovery of individuals with mental illness, focusing on addressing uncertainty about treatment choices and dissatisfaction with decision‐making, and considering the user's personal recovery journey. In recovery‐oriented practice, it is important to prioritize addressing the emotional aspects of decision‐making alongside the mental illness condition, supporting users' self‐determination in their unique recovery journeys. The findings emphasized the need to actively engage with users' perspectives and emotions, emphasize shared life planning, and foster a therapeutic relationship based on partnership. Providers should approach dialogue as carefully as medication prescriptions, prioritizing the establishment of an effective therapeutic relationship with the user. These characteristics are essential for developing a strong therapeutic relationship and effectively facilitating users' recovery. The findings are applicable not only to nurses but to all mental health service providers, contributing to the advancement of recovery‐oriented practice. Recovery‐oriented practice in community‐based mental health services is crucial for individuals with mental illness, with communication with familiar individuals being important for recovery in Japanese and Asian cultures.This study aimed to examine effective communication factors for personal agency in recovery by investigating the association between perceived support provided through communication and personal agency of individuals with mental illness.A cross‐sectional study was conducted among community‐dwelling Japanese mental health service users, assessing subjective agency, decisional conflict, staff support for personal recovery, activation for mental health self‐management, demographic variables and living difficulties. Multiple linear regression analysis identified factors predicting subjective agency, revealing characteristics of effective provider communication for recovery.Data from 222 users were analysed, revealing negative correlations between uncertainty about treatment choices and ineffective decision‐making with higher subjective agency, while staff support for personal recovery positively correlated with higher subjective agency.In recovery‐oriented practice, prioritizing users' emotional experiences during decision‐making and supporting their self‐determination in their unique recovery journeys is crucial.Providers should approach dialogue as carefully as medication prescriptions, prioritizing therapeutic partnerships with users. The findings extend beyond nursing to all mental health service providers, advancing the theory of recovery‐oriented practice. [ABSTRACT FROM AUTHOR]

Introduction: Outcome research in eating disorders (EDs) is commonly focused on psychopathological dysfunction. However, Ryff's model of psychological well-being (PWB) has shown promising--yet preliminary--results with ED patients. Additionally, despite substantial evidence highlighting the association between the therapeutic alliance and treatment outcome, findings in ED samples remain unclear. The present study aimed at exploring the direct effect of PWB dimensions and the early therapeutic alliance on ED patients' individual treatment responses, as well as the mediating role played by the early therapeutic alliance in the relationship between PWB dimensions and overall pre-post symptom change. Methods: A sample of N = 165 ED patients assigned female at birth, who were receiving treatment in a residential program, completed the Psychological Well-Being Scale at treatment intake and the Working Alliance Inventory after the first four psychotherapy sessions. Patients also completed the Outcome Questionnaire-45.2 at the same time point and during the week prior to discharge. Results: The PWB dimensions of autonomy, positive relations, and selfacceptance were associated with clinically significant change, while the dimensions of personal growth and self-acceptance were associated with reliable change. The early therapeutic alliance showed both direct and indirect effects on therapy outcome, predicting clinically significant and reliable symptom reduction. It also emerged as a significant mediator in the relationship between all PWB dimensions and overall symptomatic change. Conclusion: The identification of individual, adaptive characteristics in ED patients that might influence their development of an early therapeutic alliance may help therapists to predict relationship ruptures and tailor their interventions to enhance treatment effectiveness. [ABSTRACT FROM AUTHOR]

The real relationship and working alliance are considered sister concepts, because, even though they are distinct elements of the therapeutic relationship, they seem to be highly interrelated, especially regarding the bond element of the relationship. Both concepts are considered to contribute significantly to the therapy outcomes, but some questions remain regarding their relationship, similarities, and conceptual differences. The present study aimed to examine the association of real relationship and working alliance across studies and analyze their contribution to treatment success. For this purpose, we conducted a meta-analysis on these two constructs and performed a quantitative analysis to differentiate the contribution of real relationship and working alliance for psychotherapy outcomes. Results from the meta-analysis confirmed the theorized association between real relationship and working alliance, revealing an overall correlation of r =.66. Based on our quantitative analysis, real relationship seems to be as good a predictor as the working alliance, although both benefit from each other. The research findings underline the importance of considering the contribution of these two concepts for therapeutic outcomes. Therapists should pay attention to both real relationship and the working alliance as key factors that improve therapy success. [ABSTRACT FROM AUTHOR]

Background: Many transgender individuals experience stigmatisation, victimisation and discrimination and, as a result, have become reliant on counselling services. Previous research indicates that transgender clients have experienced a mixture of negative and positive experiences of counselling and their therapeutic relationships. However, there is limited research that specifically explores the components of therapeutic relationships and transgender clients' experiences of them. Aim: This study aimed to investigate how transgender clients experience their therapeutic relationship with their counsellor. Method: This study used semistructured interviews and interpretative phenomenological analysis (IPA). Three adult participants who identified as transgender and had at least three counselling sessions in the past were recruited. Findings: Key findings indicated positive impacts of the counsellors' congruence, the importance of counsellors having basic knowledge and awareness of the challenges that transgender people may face and how the clients' development of self‐awareness aided their evaluations and re‐evaluations of their experiences of their therapeutic relationships. Limitations: Due to the small sample size, the findings cannot be generalised to the wider transgender population. Implications for Policy: Further research is needed to support the development of affirmative counselling for transgender clients. Implications for Practice: Counsellors are encouraged to work to respond to the needs of their clients at whatever stage in their process, to acquire basic knowledge and awareness of the challenges that some transgender people may face and to engage with their personal development and reflexivity around gender and identity. Conclusion: Transgender clients reported both positive and negative experiences of their therapeutic relationships with reference to their own and their counsellors' contributions. Positive experiences were largely associated with the counsellors' use of congruence and working affirmatively, and negative experiences were largely associated with counsellors working nonaffirmatively. [ABSTRACT FROM AUTHOR]

Background: Chiropractic, osteopathy, and physiotherapy (COP) professionals regulated outside the United States traditionally incorporate hands-on procedures aligned with their historical principles to guide patient care. However, some authors in COP research advocate a pan-professional, evidence-informed, patient-centered approach to musculoskeletal care, emphasizing hands-off management of patients through education and exercise therapy. The extent to which non-Western sociocultural beliefs about body representations in health and disease, including Indigenous beliefs, could influence the patient–practitioner dyad and affect the interpretation of pillars of evidence-informed practice, such as patient-centered care and patient expectations, remains unknown. Methods: our perspective paper combines the best available evidence with expert insights and unique viewpoints to address gaps in the scientific literature and inform an interdisciplinary readership. Results: A COP pan-professional approach tends to marginalize approaches, such as prevention-oriented clinical scenarios traditionally advocated by osteopathic practitioners for patients with non-Western sociocultural health assumptions. The Cynefin framework was introduced as a decision-making tool to aid clinicians in managing complex clinical scenarios and promoting evidence-informed, patient-centered, and culturally sensitive care. Conclusion: Epistemological flexibility is historically rooted in osteopathic care, due to his Indigenous roots. It is imperative to reintroduce conceptual and operative clinical frameworks that better address contemporary health needs, promote inclusion and equality in healthcare, and enhance the quality of manual therapy services beyond COP's Western-centered perspective. [ABSTRACT FROM AUTHOR]

Background: Psychotherapists need effective tools to monitor changes in the patient's affective perception of the therapist and the therapeutic relationship during sessions to tailor therapeutic interventions and improve treatment outcomes. This study aims to evaluate the factor structure, reliability, and validity of the in-Session Patient Affective Reactions Questionnaire (SPARQ), a concise self-report measure designed for practical application in real-world psychotherapy settings. Methods: Validation data was gathered from (N = 700) adult patients in individual psychotherapy. These patients completed the SPARQ in conjunction with additional measures capturing sociodemographic details, characteristics of therapeutic interventions, individual personality traits, mental health symptom severity, elements of the therapeutic relationship, and session outcomes. This comprehensive approach was employed to assess the construct and criterionrelated validity of the SPARQ. Results: The SPARQ has a two-factor structure: Positive Affect (k = 4, ω total = .87) and Negative Affect (k = 4, ω total = .75). Bifactor confirmatory factor analysis (CFA) yielded the following fit indices: X²[df]=2.53, CFI = .99;TLI = .98;RMSEA=.05; and SRMR = .02. Multi-group CFAs demonstrated measurement invariance (i) across patients who attended psychotherapy sessions in person versus in remote mode, and (ii) across patients with and without psychiatric diagnoses confirmed metric invariance. Furthermore, the SPARQ showed meaningful correlations with concurrently administered measures. Discussion: The SPARQ proves to be a valuable instrument in clinical, training, and research contexts, adept at capturing patients' session-level affective responses towards their therapist and perceptions of the therapeutic alliance. Comprehensive descriptive statistics and a range of score precision indices have been reported, intended to serve as benchmarks for future research. [ABSTRACT FROM AUTHOR]

There is increasing interest in the potential role of eHealth interventions to support self-management in people with musculoskeletal disorders (MSDs). The COVID-19 pandemic appears to have been a significant catalyst for the implementation of eHealth modalities into routine practice, providing a unique opportunity for real-world evaluation of this underutilized method of delivering physiotherapy To explore the perceptions of eHealth-mediated supported self-management from the perspective of people with MSDs and physiotherapists who work in this clinical area. A qualitative interpretive descriptive approach was used. Semi-structured telephone interviews with 13 musculoskeletal physiotherapists and 13 people with musculoskeletal disorders were undertaken. Transcripts were analyzed using reflexive thematic analysis. Three main themes were identified: 1) Flexibility within a blended care model; 2) eHealth as a facilitator of self-management support; and 3) Technology: Getting it right. Participants expressed concerns about assessment and diagnosis, establishing a therapeutic relationship and felt eHealth should be reserved for follow-up purposes. There was a consistent view expressed that eHealth could facilitate aspects of self-management support. A lack of resources and suboptimal user experience remains a challenge. eHealth-mediated self-management support interventions were broadly acceptably, predominately as a follow-up option. [ABSTRACT FROM AUTHOR]

Does the empathy or personality of psychotherapists influence the way they do therapy? Is the therapeutic relationship the key to success? Questions such as these are commonly shared in Change Process Research (CPR) and outcome studies. However, these statements, posed in descriptive cross-sectional terms, often imply the use of strategies grounded in causal-linear explanatory models. The present study offers an alternative tool to measure elements of psychotherapy in dynamic, interactive, and interdependent terms. With nine observational categories defined under analytical-behavioral lens, the Acoveo System is an instrument designed to detect the potential functions of verbal exchanges that take place in the psychotherapeutic context from any theoretical orientation. A guide to its application is provided, and its usefulness is elaborated on two of the pivotal common factors in change process research: empathy and therapeutic alliance. [ABSTRACT FROM AUTHOR]

Introduction: A disturbed, negative sense of self is associated with various interpersonal difficulties and is characteristic of disorders such as borderline personality disorder (BPD). Negative self-views may affect an individuals' ability to build positive relationships, including a therapeutic relationship. However, it is not yet well understood how identity disturbances give rise to interpersonal difficulties. Using an experimental analogue design, we tested whether identity disturbances are associated with interpersonal difficulties. Methods: Participants were university students (N = 43, age M = 20.51 (SD = 3.08), women N = 32 (74.4%)) who reported moderate to high levels of BPD features, with 34.9% reporting significant BPD features as measured by the Borderline scale of the Personality Assessment Inventory (PAI-BOR). In a within-subject experimental paradigm using a Social Feedback Task, participants received negative, intermediate, and positive evaluations, supposedly from a panel. Using multilevel models, we tested whether negative self-views were associated with how much the participants liked, trusted, and felt close to each of the three panel members who provided either predominantly negative, intermediate, or positive feedback. Results: People with more negative self-views reported lower mood in response to positive feedback. In addition, where people with more positive self-views felt better when receiving feedback that was congruent with their self-views, people with more negative self-views did not report a better mood. Importantly, people with negative self-views felt lower desire to affiliate with the member who provided predominantly positive feedback. Affiliation was not affected when feedback was given by the negative member and intermediate member to those with negative self-views. Conclusions: The findings validated that those with more negative self-views anticipated and expected more negative responses from others. Negative self-views, as relevant for BPD, may explain how people relate differently to those giving different types of feedback. Pervasive negative self-views may interfere with building new relationships including the therapeutic alliance. It may be helpful for clinicians to be aware of the potential challenges around creating a supportive therapeutic relationship for patients with negative self-views. Overly positive affirmations made by clinicians may inadvertently lower the patient's mood and may impede alliance formation. [ABSTRACT FROM AUTHOR]

Introduction: High dropout rates are common in youth psychotherapy, including psychoanalytic psychotherapy, yet the reasons behind this trend remain obscure. A critical focus to enhance adolescent engagement could be the therapeutic alliance, particularly in resolving alliance ruptures. This study sought to clarify the complex relationships between the therapeutic alliance, encompassing alliance ruptures and resolutions, and dropout within the context of poor outcome. It investigated a single case of an adolescent with depression who dropped-out of Short-Term Psychoanalytic Psychotherapy, without showing clinical improvement. Method: Data was garnered from diverse sources, including questionnaires, interviews, and session recordings, and analyzed through a mixed-method longitudinal framework. This encompassed views from the adolescent, therapist, parents, and external evaluators. Results: The study identifies several factors impacting the decision to drop out, including initial profound distrust toward the therapist, a complex and difficult therapeutic relationship characterized by unresolved alliance ruptures, and sporadic attendance. External factors including minimal parental engagement with therapy were also seen as detrimental to the adolescent's involvement and progress. Discussion: The research underscores the challenges in engaging adolescents, especially when there may be distrust of professionals, and in the absence of parental involvement with treatment. [ABSTRACT FROM AUTHOR]

We examined if the therapeutic alliance between study participants and intervention facilitators in a psilocybin-assisted therapy (PAT) trial changed over time and whether there were relationships between alliance, acute psilocybin experiences, and depression outcomes. In a randomized, waiting list-controlled clinical trial for major depressive disorder in adults (N = 24), participants were randomized to an immediate (N = 13) or delayed (N = 11) condition with two oral doses of psilocybin (20mg/70kg and 30mg/70kg). Ratings of therapeutic alliance significantly increased from the final preparation session to one-week post-intervention (p =.03, d =.43). A stronger total alliance at the final preparation session predicted depression scores at 4 weeks (r = -.65, p =.002), 6 months (r = -.47, p =.036), and 12 months (r = -.54, p =.014) post-intervention. A stronger total alliance in the final preparation session was correlated with higher peak ratings of mystical experiences (r =.49, p =.027) and psychological insight (r =.52, p =.040), and peak ratings of mystical experience and psychological insight were correlated with depression scores at 4 weeks (r = -.45, p =.030 for mystical; r = -.75, p <.001 for insight). Stronger total alliance one week after the final psilocybin session predicted depression scores at 4 weeks (r = -.85, p <.001), 3 months (r = -.52, p =.010), 6 months (r = -.77, p <.001), and 12 months (r = -.61, p =.001) post-intervention. These findings highlight the importance of the therapeutic relationship in PAT. Future research should explore therapist and participant characteristics which maximize the therapeutic alliance and evaluate its relationship to treatment outcomes. Trial registration: Registration: Clinicaltrials.govNCT03181529. https://classic.clinicaltrials.gov/ct2/show/NCT03181529. [ABSTRACT FROM AUTHOR]

Objective: The aim of this review is to systematize and interpret results produced over one decade of Psychotherapy Process Research (2009–2019) in eight journals. Method: It is a Mixed Studies Review of quantitative as well as qualitative primary studies. The analysis of the results of these studies included a descriptive quantitative part and a qualitative part that followed the logic of Qualitative Meta Analysis, categorizing the main results of both types of studies in a bottom-up procedure that generates specific content categories that are synthesized in further steps of a higher level of abstraction, leading to an "interpretive synthesis" presented in a narrative way. Results: The review shows that psychotherapy process research uses a variety of qualitative and quantitative methods, often creating new procedures. Furthermore, the review indicates that the most commonly assessed macroprocess variables are ongoing change, therapeutic relationship (predominantly therapeutic alliance), and therapeutic intervention; while the most extensively studied microprocess variables are change events, difficult episodes (mainly ruptures), and therapeutic intervention. Macrolevel results reveal that the main contents of ongoing change are the building of new meanings and progressive psychological integration; underscore the association of the therapeutic alliance with ongoing change and outcome; and show the complexity of associating intervention with outcome, because different phases of therapy (and problems) need different assessments. Microlevel results indicate that change events impact on ongoing change and outcome; that for ruptures the key fact is their repair; and that therapist communication has an immediate influence on patient communication. Conclusion: Our knowledge regarding relevant aspects of psychotherapy is very fragmented; robust and replicated results are still scarce. Only a few variables have been found to consistently predict outcome across most therapies. Only in the field of alliance research it has been possible to perform meta-analyses that clearly demonstrate the impact of this factor on final outcomes. Despite these limitations, psychotherapy process research is a powerful tool for uncovering change mechanisms and is at present widely implemented. Our conclusion is that, in order to generate useful future knowledge, change mechanisms need to be linked to ongoing change; this, in turn, requires models of change, hopefully of a transtheoretical nature. [ABSTRACT FROM AUTHOR]

Objectives: Individuals with a diagnosis of FND report experiencing stigma in medical settings, however, there is a paucity of research exploring their experiences in psychological services. The aim of this research was to explore experiences of accessing UK psychological services, from the perspective of those with FND. Methods: This study utilised a qualitative approach with data collected from semi‐structured interviews (n = 15) and analysed using reflexive thematic analysis. Results: One superordinate theme, 'the stigmatised self within the therapeutic relationship', and five interrelated subthemes were identified: 'internalised stigma and self‐doubt', 'selective disclosure to professionals', 'perceptions of psychological explanations', 'having to educate the professionals' and 'attunement and trust within the therapeutic relationship'. Positive therapeutic relationships were perceived to mitigate the impact of these perceived barriers. The conceptualisation of FND and the perception of how this was responded to by services and professionals was a central tenet throughout the related themes. Conclusions: Intra‐personal, interpersonal and organisational stigma impact access and engagement to psychological treatment. The findings of this study highlight the need for increased training provision for practitioners with a focus on actively challenging FND stigma within services at both an individual and systemic level. [ABSTRACT FROM AUTHOR]

Objective: Studies indicate a significant challenge for therapists in forming a therapeutic alliance (TA) with patients coping with anorexia nervosa (AN). While TA is a significant predictor of treatment outcomes, and AN treatment has low success rates, little is known about factors that affect the formation of an alliance and its quality in the treatment of AN. This study aimed at examining the factors associated with alliance formation, as perceived by patient–therapist dyads throughout AN therapy. Methods: A total of 18 dyads of patients with AN and their therapists were recruited from an eating disorder unit. The semistructured interviews focussed on the TA between the therapist and patient and examined facilitators towards, and barriers to, TA formation. Data analysis followed a thematic approach. Results: The data analysis revealed an overarching theme: the mutual wish of the patient and therapist to form a close relationship and related challenges. This theme was divided into subthemes: (1) the role of self‐disclosure of affection; (2) the meaning of the therapeutic setting; (3) coping with relationship ruptures; and (4) the importance of empathic acknowledgements. Conclusion: A major barrier to TA formation between patients with AN and their therapists is patients' conflict between a need for meaningful relationships and fear of re‐experiencing disappointment and pain. Self‐disclosures of affection, flexible treatment setting, acknowledgement of therapists' empathic failures and ability to see things from patients' perspectives are perceived by therapists and patients to facilitate alliance formation. This study also presents practical implications derived from these themes. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Occupational Therapy is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

About two-thirds of patients have a trauma history, such as experiencing abuse or community violence. Clinicians must be knowledgeable about trauma because of its high prevalence and long-lasting effect on patients. The medical encounter can be triggering for patients with a history of trauma, especially when power differentials are intensified, such as during the physical examination. Clinicians can improve the interaction by incorporating simple traumainformed techniques, such as adjusting communication, positioning, and contact during the physical examination. These modifications foster a sense of patient safety and collaborative decision-making. This article describes the background of trauma-informed care and outlines traumainformed techniques for physical examinations. [ABSTRACT FROM AUTHOR]

Psychotherapy research identifies alliance ruptures and their resolutions as significant events in psychotherapy, influencing outcome. However, we know little about the process how such events influence outcomes, only assuming if clients stay in therapy that the rupture was resolved, and the outcome will be positive. The purpose of this paper is to problematize this assumption against the backdrop of self-determination theory, introducing motivation and relational positioning as relevant theoretical concepts for understanding rupture resolution and the effect on outcome. A therapeutic transcript demonstrating best practice for alliance rupture resolution in a brief integrative therapy is critically examined, calling the attention of both clinicians and researchers to the risk of prescribing and blindly following techniques during therapeutic impasses. Our analysis of metacommunication demonstrates how the therapist's use of a certain technique for resolving threats to the therapeutic alliance can lead to the client's external motivation and compliance, negatively influencing therapeutic outcome. Focusing on the therapist's relational positioning we present two alternative courses of therapeutic action, 'mindfulness in action' and 'embracing the patient's ambivalence', for supporting the client's autonomous motivation for the therapy process. [ABSTRACT FROM AUTHOR]

The study aimed to analyze patient–therapist convergence in therapeutic alliance ratings. The author also tested if increasing patient–therapist consensus on alliance quality during psychotherapy was related to better treatment outcomes. The study included 20 patients and one psychotherapist, who was a person other than the researcher in this study. The patients, suffering from adjustment disorders, were undergoing individual outpatient treatment in private practice. Three estimations of alliance and two estimations of treatment outcomes were performed. Psychotherapeutic processes, lasting nearly a year and a half, were examined from their commencement to their natural completion. The hypotheses were verified using difference tests. Two-dimensional correlations were computed, and the outcomes of psychotherapy were estimated using a clinical significance index. The results revealed systematic patient–therapist discrepancies in alliance quality ratings at specific time points and the psychotherapist's tendency to underrate alliance quality. Patient–therapist convergence in therapeutic alliance perceptions increased over the course of psychotherapy. The expected differences in treatment outcomes depending on convergence in alliance quality ratings were not found. Analysis results indicate that, in psychotherapy for patients with adjustment disorders, patient and therapist evaluations of alliance diverge, particularly in the early phases of treatment. Increasing consensus on alliance quality is observed. Similar convergence in alliance ratings was found in adjustment disorder patients with better and worse treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective: Increasing numbers of Canadians living with complex, life-limiting conditions demand high-quality palliative care. Timely access to palliative care can help to reduce stress, improve quality of life, and provide relief for patients and their families. The purpose of this study is to explore the experiences of family physicians (FPs) regarding the decision and process of introducing palliative care to patients with chronic diseases. Methods: Interpretive description methodology was used to guide the investigation of the research question. Thirteen Calgary Zone FPs participated in individual interviews. Data was collected iteratively and analyzed using constant comparative analysis. Results: Analysis of interviews identified the overarching themes of dignity and empowerment, which describe the experience of FPs introducing palliative care to chronically ill patients. Four subthemes were woven throughout, including the art of conversation, therapeutic relationships, timing, and preparation of the patient and family. Discussion: While the benefits of palliative conversations are widely accepted, a deeper understanding of how FPs can be supported in developing this aspect of their practice is needed. Understanding their experience provides knowledge that can serve as a framework for future education, mentorship, and competency development. [ABSTRACT FROM AUTHOR]

Palliative care clinicians enhance the illness experiences of patients and their families through building therapeutic relationships. Many psychological concepts underlie a clinician's approach to a specific patient. Through high-yield tips, this article highlights ten selected psychological elements that palliative care clinicians often use to support patients. As we all (both clinicians and patients) bring our own histories and unique biographies to the work of palliative care, a more explicit focus on the psychological aspects of this work can enhance our own experience and efficacy as providers. With a thoughtful focus on the psychological aspects of how we engage with patients, palliative care clinicians can offer a more meaningful therapeutic encounter. [ABSTRACT FROM AUTHOR]

Adolescent girls placed in residential care are often the victims of childhood experiences of maltreatment. Their history of relational trauma may subsequently limit their ability to establish and maintain positive relationships with others, a central component for their development and adaptation. The goal of the present study was to determine the nature and strength of associations between adolescent girls' relationship quality with their parents at admission to care and their perceptions, 3 months later, of the therapeutic alliance and group climate within their unit. The sample consisted of 156 adolescent girls between the ages of 12 and 18 living in residential care. Path analysis using structural equation modelling examined significant associations between variables. Results revealed that adolescent girls' perceptions of greater relationship quality with their mothers were associated with more positive perceptions of (a) their therapeutic alliance with their mentor, (b) their relationships with other care workers, and (c) the care practices of their unit. Perceptions of greater relationship quality with their fathers were associated with more positive perceptions of their relationships with the other girls in their unit. Relationship quality with parents as a significant factor to consider in the context of out‐of‐home care for adolescents is discussed. [ABSTRACT FROM AUTHOR]

In this study, we investigated the association between clients' initial outcome expectations and their subsequent perceptions of the expanded therapeutic alliance. Romantic partners (N = 252) who received at least four sessions of systemic couple therapy from thirty‐one therapists from the Marriage and Family Therapy Practice Research Network (Johnson et al., 2017; www.mft‐prn.net) completed an outcome expectation measure before session 1 and a therapeutic alliance measure before session 4. Results showed a strong association between expectations and alliance (r = 0.51). While fourteen per cent of the variability in session 4 alliance scores was uniquely attributable to therapists, 31.6 per cent of the variability in the expectations/alliance association was uniquely attributable to couples, with only 6.1 per cent uniquely attributable to individual clients. Taken together, these results suggest that, while some therapists are better at developing strong alliances, couple and client factors associated with expectations for therapy set the stage for how the expanded alliance develops. [ABSTRACT FROM AUTHOR]

Just as language is political, so too is the way we listen to people. Our listening shapes the way we witness and respond to others and the stories of life that are co‐constructed in the process. Co‐constructing resiliences includes returning the gaze on the political and social contexts in which harm to people takes place. In the process, we explore listening practices associated with therapeutic activism (D'Arrigo‐Patrick et al., 2017) and the generative potential offered by tuning into the meanings people attribute to their responses to violence and how people do resilience in their lives offers. We will demonstrate how our work with a family has led us to think about how we can all be jointly sustained in the work by making moments and practices of resistance and resilience visible. We will explore how these practices can enhance a sense of personal agency and create experiences of vicarious resilience (Hernandez‐Wolfe, 2018) that help people access more possibilities in their lives. [ABSTRACT FROM AUTHOR]

Background: MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasised within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes. Objective: Examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP. Method: Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomised (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (n = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised. Results: Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 and 9 (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons) and sessions 4 and 9 predicted postMDMA-AP self-reported PTSD severity. Conclusions: The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary [ABSTRACT FROM AUTHOR]

This case study focuses on a video telehealth consult to discuss genetic testing results. Participants include a Genetic Counselor (GC) and a Patient (P) previously diagnosed with ovarian cancer who is currently undergoing chemotherapy treatments. Utilizing conversation analysis (CA), attention is first given to a series of interactional dilemmas as GC delivers and P responds to negative, uncertain, and complex test results. Specific findings address practices employed by GC to structure the encounter and establish authority, impacts on P's participation and understandings, recurring and at times problematic orientations to "negative" findings, and inherent ambiguities faced by GC and P when attempting to discern good and bad news. Close examination of these moments provides a unique opportunity to identify, describe, and explain genetic counseling as a co-produced, interactional achievement. These findings are then integrated with patient's post-counseling survey (susceptibility, anxiety, uncertainty, fear, and hope), including reported experiences which broaden understandings of the interactional environment. Specific recommendations are raised for improving counseling skills, enhancing patients' understandings, and building therapeutic alliances addressing both patients' emotional circumstances and the complexities of genetic test results. [ABSTRACT FROM AUTHOR]

Objective: Developing good interpersonal relationships is one of the main impediments for people with an antisocial personality disorder (ASPD). However, in treatment of psychiatric disorders, establishing a strong therapeutic alliance (TA) is important for effective treatment. Nevertheless, there is little knowledge on how to establish this TA with this challenging patient group. This study investigates which factors are important in TA development. Method: For this study, a qualitative research methodology is applied. In‐depth interviews with therapists experienced in treating ASPD were conducted and analysed through thematic analysis. Results: The analysis revealed six themes important in alliance formation: the patient's needs, regulating interpersonal dynamics, connective attitude, connective skills, treatment process and treatment goals. Each theme is defined including aspects of the recommended therapeutic attitude and required skills for therapists working with patients with ASPD. Conclusions: This study determined that, for therapists working with patients with ASPD, several key factors are essential in establishing a strong TA. These factors include the ability to be firm, authentic, non‐judgmental and genuinely involved. An attentive presence is crucial, in which the therapist takes initiative in establishing contact and makes the patient feel that he is truly seen as an autonomous and equal person. In doing so, the therapist needs to provide clarity and structure while remaining perceptive to boundary violations. The therapist must be able to set limits using a clear yet kind tone of voice. Furthermore, it was notable that an intensive appeal is made to the therapist's reflective capacity in these treatments. [ABSTRACT FROM AUTHOR]

Purpose: The current review aimed to synthesise qualitative literature exploring adult refugees' and asylum seekers' experiences of individual psychological therapy. Methods: A comprehensive systematic search of the following databases led to the identification of eight studies for inclusion in this review: PsycINFO, PsycARTICLES, MEDLINE, EMBASE, CINAHL and Academic Search Ultimate. All selected studies used qualitative methodology to explore refugees' and asylum seekers' experiences of individual psychological therapy. Studies were appraised using an adapted version of the Critical Appraisal Skills Programme (CASP) Tool. The data from these selected studies were then synthesised using a meta‐ethnographic approach. Results: The synthesis of selected studies resulted in the development of five themes; (i) the importance of recognition and validation within therapy, (ii) building a human connection within the therapeutic relationship and the importance of cultural competency, (iii) revisiting trauma, managing difficult emotions from therapy and regaining hope, (iv) the value of practical interventions, (v) 'one should not wake up the djinns (demons)'—cultural stigma and accessing therapy. These themes illustrated the complexities of working therapeutically with asylum seekers and refugees and the vital role of building trust and safety within the therapeutic relationship prior to engagement in therapeutic work. The results also highlighted varied responses to engaging in trauma work ranging from participants finding the experience transformative to others finding it unhelpful, some participants preferred more practical interventions. Participants' cultural backgrounds and pre‐conceptions around therapy impacted on engagement and the therapist's cultural competency was a significant factor in therapeutic engagement. Conclusions: Working therapeutically with asylum seekers and refugees involves a number of factors for consideration. Forced migrants' socio‐political context was seen as central to their experiences of distress and recognition of these factors was imperative for positive therapeutic engagement. This review highlights a number of clinical implications to guide practitioners working therapeutically with this community. [ABSTRACT FROM AUTHOR]

In this clinical paper, the focus is on the use of questionnaires in family therapy practice. Psychotherapy research has indicated that the quality of the therapeutic relationship is the most robust predictor of therapeutic change. While the therapeutic relationship is even more important in family therapy than in individual therapy, it is also more complex. As will be illustrated in this paper, questionnaires can be useful in clinical practice to deal with the complex alliances in family therapy. In this paper, we will introduce two questionnaires: the Worries Questionnaire and the Dialogical Feedback Questionnaire. As illustrated in detailed case stories, we use these questionnaires in our practice as conversational tools rather than measuring instruments. They serve as the starting point for the therapist's reflection and for dialogues with family members. [ABSTRACT FROM AUTHOR]

"La Cura" is one of the tracks in Franco Battiato's L'Imboscata album (1996), the 19th published by the Italian composer and songwriter, who died 3 years ago. In the lyrics several references to psychiatric terminology appear. The purpose of this article is to consider the lyrics of the song from psychodynamic and mental health care perspectives and offer associations that reflect the process of forming a therapeutic alliance with patients. [ABSTRACT FROM AUTHOR]

We examined discrepancies in 81 patient‐therapist dyads' alliance ratings early in treatment (3rd or 4th session) in relation to Personality Assessment Inventory clinical scales, subscales and global psychopathology. Results indicated that PAI global psychopathology (mean clinical elevation) and the scales of Aggression [AGG], Somatization [SOM], and Anxiety‐Related Disorders [ARD] were significantly, negatively associated with an absolute difference of patient and therapist alliance ratings at Session 3. Higher initial scores on these clinical scales at treatment onset are associated with less difference (i.e., more convergence) in patient/ therapist ratings of alliance at Session 3. Correlations between PAI clinical subscales and absolute differences of patient and therapist alliance ratings at Session 3 also demonstrated statistically significant inverse relationships for several PAI subscales of Aggression‐ Attitude [AGG‐A], Aggression‐Physical [AGG‐P], Somatic‐ Health Concerns [SOM‐H], Anxiety‐Related Disorders‐Traumatic Stress [ARD‐T], Anxiety‐Related Disorders‐ Obsessive Compulsive [ARD‐O], Borderline Features‐Affective Instability [BOR‐A], Borderline‐ Self‐Harm [BOR‐S], Anxiety‐Physiological [ANX‐P], Depression‐Physiological [DEP‐P] and Antisocial‐Stimulus Seeking [ANT‐S]. Again, higher scores on these subscales at treatment onset are associated with less difference (i.e., more convergence) in patient/therapist ratings. We also examined group differences between patients rating alliance higher (Group 1) and therapists rating alliance higher (Group 2) and found that Group 1 had significantly lower scores on Mania‐Activity Level [MAN‐A]. Clinical implications of results are discussed. [ABSTRACT FROM AUTHOR]

Objective: The aim of this systematic review was to synthesise qualitative evidence on young people's conceptualisation, utilisation and experiences of the therapeutic alliance in individual psychotherapy or counselling and its role in bringing about change. Method: The thematic synthesis method was used to synthesise data. The methodological quality of included studies was assessed using the CASP checklist for qualitative research. Results: Four superordinate analytical themes were generated: (1) valuable therapist qualities, (2) conditions for the development and maintenance of the therapeutic alliance, (3) therapeutic processes and (4) barriers to the development of the therapeutic alliance. Findings indicate that young people appreciated the uniqueness of the therapeutic relationship that provided a sense of safety, choice and autonomy. Flexibility and accessibility were noted as important elements of therapeutic alliance building as they elicited a sense of agency. Young people emphasised the non‐linear nature of therapy and prioritised process variables such as improvement in self‐understanding, self‐efficacy and self‐worth. Conclusion: The current systematic review is a comprehensive overview of qualitative studies of experiences of therapy from young people's perspectives. Important practical implications derived from this review as the role of autonomy in the change process and the formation and maintenance of the therapeutic relationship were outlined as important elements in youth therapy. [ABSTRACT FROM AUTHOR]

Literature has shown the importance of therapeutic alliance in the psychotherapeutic process and seeks to understand factors that can interfere in its establishment, such as childhood trauma and parental bonding. As such, this study aims to evaluate therapeutic alliance in psychodynamic psychotherapy from the perspective of adult patients and the correlation between parental bonding and childhood trauma. A cross‐sectional and correlational study was carried out with 180 adult patients who started psychodynamic psychotherapy between May 2015 and May 2016 in a mental health clinic whereby Working Alliance Inventory, Parental Bonding Instrument and Childhood Trauma Questionnaire tools were used. The results show that there are correlations between the father's care and total alliance, as well as the dimensions of goal and bond, but those with mother did not reach statistical significance. The dimensions of emotional abuse and emotional neglect show an inverse correlation with the therapeutic alliance. These results point to the importance of experience of early relationships in establishing therapeutic alliance, relevance of the father figure in this process, and the need for clinicians to be aware of these attachment factors and patient childhood traumas to establish a strong therapeutic relationship. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Psicoterapia is the property of Revista de Psiquiatria y Psicologia Humanista, S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The purpose of the study was to explore the experiences of an individual navigating life in the first year after stroke, with attention to the influence of health professionals on adjustment. In-depth interviews were completed at regular intervals with an individual in rural Australia. This longitudinal approach supported the exploration of views over time. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory methods. Findings are presented as an instrumental case study. The experience of stroke was one of adjustment to a new reality and of an altered and evolving concept of self: captured within the themes of fragmentation, loss, and reconstruction. Self-efficacy emerged as a driver in the adjustment process. Interactions with health professionals influenced adjustment and impacted on conceptualisations of self and self-efficacy. Adjustment to stroke necessitated a reconceptualization of self. Relationships and interactions with others emerged as potential facilitators. For health professionals working with people after stroke, knowledge of the adjustment process and attention to practices that affirm personhood and enhance self-efficacy have the potential to facilitate long term outcomes. Processes linked to adjustment are represented visually to guide conceptual understandings and facilitative actions. All interactions with health professionals, including casual or ad hoc interactions, have the potential to influence adjustment after stroke. Health professionals who interact in ways that recognise personhood may have an especially positive influence on processes linked to adjustment. Giving time to listen to personal narratives and reflections may assist with sense-making and support the process of reconceptualising self after stroke. Through bidirectional sharing of experience and ideas, health professionals can facilitate the experience of self-efficacy. [ABSTRACT FROM AUTHOR]

Background: Enactivism and active inference are two important concepts in the field of osteopathy. While enactivism emphasizes the role of the body and the environment in shaping our experiences and understanding of the world, active inference emphasizes the role of action and perception in shaping our experiences and understanding of the world. Together, these frameworks provide a unique perspective on the practice of osteopathy, and how it can be used to facilitate positive change in patients. Since the neonatal period is a crucial time for development, osteopaths should aim to create a therapeutic relationship. Arguably, through participatory sense-making, osteopaths can help the baby build a generative model (with positive priors) to deal with stress and needs throughout their life. Aim: Since the literature considers that interactions with the environment, which enact the patients' experiences, depending on contextual factors and communication between patient and caregiver, this research explored whether there is a correspondence between the indications in the literature and clinical practice in the management of the mother/parent--child dyad during osteopathic care on children aged 0 to 2 years old. Methods: Semi-structured interviews were conducted with a purposive sample of nine osteopaths with experience in the field of pediatrics. Interviews were transcribed verbatim, and constructivist grounded theory was used to conceptualize, collect and analyze data. Codes and categories were actively constructed through an interpretive/constructionist paradigm. Results: The core category was the idea of the pediatric osteopath as a support for the family, not only for the child. Four additional categories were identified: (1) Preparing a safe environment for both children and parents, (2) Communication, (3) Attachment and synchrony, and (4) Synchronization. Conclusion: Through participatory sense-making, osteopaths manage contextual factors to establish an effective therapeutic alliance through the osteopathparent--child triad to facilitate the construction of the child's internal generative model to promote healthy development. The therapeutic encounter is considered an encounter between embodied subjects, occurring within a field of affordances (ecological niche) that allows the interlocutors to actively participate in creating new meanings through interpersonal synchronization. Participatory sensemaking and the establishment of a therapeutic alliance through the osteopathparent--child triad are crucial to promote healthy development in the child. [ABSTRACT FROM AUTHOR]

Background and Purpose: The therapeutic relationship is a central component for developing person‐centered care within physiotherapy services. However, it is necessary to understand how this relationship is perceived by both parties involved. The Person Centered Therapeutic Relationship‐Patient scale (PCTR‐PT) was constructed to identify patients' perceptions. No instruments are currently available to correlate patients' and physiotherapists' perceptions of the therapeutic relationship. This study sought to adapt the PCTR‐PT to develop a version for physiotherapists, the Person Centered Therapeutic Relationship Scale for Physiotherapists (PCTR‐PHYS) and to determine its psychometric properties. Methods: A three‐stage study was performed: (1) item generation, (2) pretesting of the questionnaire, (3) analysis of psychometric properties. Factor validity and psychometric properties were analyzed by confirmatory factor analysis (CFA). Convergent validity was calculated. Internal consistency was verified using the Cronbach's alpha coefficient. The intraclass correlation coefficient (ICC) was used to examine temporal stability. Results: Thirty‐three physiotherapists participated in two rounds of cognitive interviews and 343 participated in the analysis of psychometric properties. The CFA confirmed the four‐structure model. Reliability of the tool was confirmed by Cronbach's alpha (α = 0.863) for all four dimensions, as all were above 0.70, ranging from 0.704 (relational bond) and 0.898 (therapeutic communication). Test‐retest was performed with 2‐week intervals, indicating an appropriate stability for the scale (ICC = 0.908). Discussion: The Person Centered Therapeutic Relationship Scale for Physiotherapists is a useful, valid and applicable instrument to evaluate the person‐centered therapeutic relationship during physiotherapy interventions. It will enable the comparison of patients' and physiotherapists' perceptions. To provide person‐centered care in physiotherapy services, there is a clear need to incorporate specific resources into clinical practice to evaluate the quality of the therapeutic relationship from the perspective of both the persons being treated and the professionals providing care. [ABSTRACT FROM AUTHOR]