Search

Managing the Therapeutic Alliance is often complex when it comes to the treatment of borderline personality disorder (BPD), but the alliance is crucial for the success of the therapy. Combined individual and family interventions have been shown to be very useful in treating of these cases. This study has two objectives. First, to describe how the family therapeutic alliance facilitates therapeutic change through family psychotherapy for families with a member diagnosed with BPD. Second, to analyze how the therapeutic change achieved through combined individual and family systemic relational psychotherapy affects the individual functioning of the patient with BPD. This single case study used the System of Observation of Family Therapy Alliances (SOFTA‐o) to analyze the therapeutic alliance, along with two semi‐structured clinical interviews, one at the beginning and one at the end of therapy. Results show a dynamic and positive evolution of the therapeutic alliance throughout the therapeutic process and how this alliance facilitated therapeutic change, both reducing the symptomatology of the patient with BPD and improving family communication and functioning. Results contribute to highlighting the importance of including family therapy as an intervention unit in protocols for patients with BPD. [ABSTRACT FROM AUTHOR]

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]

Court-ordered treatment for offenders who suffer from psychiatric disorders or addiction has been the subject of controversy in all Western countries, but opposition in France has been more widespread than elsewhere. Based on 100 interviews, this article nonetheless reveals that healthcare professionals have gradually accepted court-ordered treatment, which they provide both inside and outside correctional facilities. We argue that, with few exceptions, they now agree that given offenders’ frequent unwillingness to seek treatment, constraint can lead to creating a therapeutic alliance, although it is a complex process that involves employing a variety of techniques. To overcome offenders’ suspicions that they are working with the courts, they claim to be complete outsiders who keep their distance from the judicial system and its expectations. We find that, despite greater acceptance of court-ordered treatment, these professionals perpetuate France’s distinctive system and fuel the growing criticism from prosecutors, judges, and corrections system personnel. [ABSTRACT FROM AUTHOR]

This article explores the use of artificial intelligence (AI) in mental healthcare, specifically focusing on its impact on the therapist-patient relationship. AI technologies, such as chatbots, have the potential to provide personalized support and improve access to mental health services. However, there are concerns about transference, where patients may project their feelings onto the AI. It is important to carefully manage transference dynamics to avoid harm and maintain ethical standards. The development of AI systems that can recognize and appropriately respond to transference is necessary, and collaboration between AI developers and mental health professionals is crucial. Additionally, regulatory frameworks and ethical guidelines should be implemented to ensure responsible and effective use of AI in mental healthcare. Interdisciplinary collaboration, cultural sensitivity, and continuous monitoring and evaluation of AI interactions are also emphasized. [Extracted from the article]

Previous reviews have examined empirical evidence of the relationship between therapists' internalized relational models, including therapists' attachment styles and Sullivan's notion of introject, and the therapeutic relationship. This review expands upon previous reviews by examining the effect of therapists' internalized relational models on the treatment process (e.g., therapeutic alliance and countertransference) and treatment outcomes (e.g., symptoms and functioning) more broadly. Our systematic search identified 42 empirical studies measuring therapist's internalized relational models, defined as therapist attachment style (i.e., the way the therapist relates to others) and/or introject (i.e., the way the therapist relates to themselves), in relation to therapy process and outcome, including 35 studies on attachment, nine studies on introject and two that examined both constructs. A rigorous quality assessment was conducted; two studies were rated as 'moderate', and 40 were rated as 'weak' in quality. Based on the study findings, it appears that more securely attached therapists may have stronger working alliances and more positive therapeutic processes with their patients. Contrary to expectations, therapist attachment security does not appear to impact treatment outcomes. Therapists who relate to themselves in a more affirming way may have stronger working alliances and better treatment outcomes, but very few studies have addressed this question thus far. More rigorous research, especially on the effect of therapists' introject, is needed. Therapists may consider the potential impact of their internalized relational models on the working alliance and other treatment processes that influence therapeutic outcomes. [ABSTRACT FROM AUTHOR]

This article introduces The CompanionshipModel as a template for conducting ethical and affirming assessment sessions for transgender and nonbinary youths (TNBY) and their guardians. The Companionship Model emphasizes proactive clinical companionship as TNBY and their guardians navigate access to gender-affirming care. The model offers specific action steps for establishing a therapeutic alliance and centers TNBY and their guardians' access to resources based on the informed consent/assent process. In this article, we provide sample session questions and illustrative clinical examples. [ABSTRACT FROM AUTHOR]

Working alliance is of particular importance in the treatment of hoarding due to high levels of stigma surrounding the diagnosis and low levels of insight in patients. Furthermore, clinician experiences of frustration when treating individuals with hoarding disorder may be a barrier to creating the necessary working alliance. However, evaluation of clinician experiences has been limited to self-reports or qualitative methods. Sentiment analysis of clinical case notes related to hoarding treatment may provide useful information on the relationship between clinician attitudes and patient outcomes. Sentiment analysis involves computerized scanning of text and subsequent ratings of emotional valence for each text string. The purpose of the current study was to use sentiment analysis to analyze clinical case notes from 41 participants who were enrolled in a clinical trial for hoarding disorder. When analyzed as a whole, sentiments spanned almost the entire possible range of values and showed insignificant changes over time, suggesting a stability in clinicians' overall sentiment towards patients. However, time emerged as a significant effect in specific categories, such that clinician sentiment became more negative across treatment sessions for notes relevant to barriers, successes, and concerns, and more positive for notes describing observations and assessments across sessions. The current study indicated that sentiment analysis of treatment notes is feasible; however, conclusions about working alliance are limited without additional input from clinicians (e.g., follow-up interviews). Future research should investigate which clinical interactions are reflected in clinical note sentiment, and whether change in clinician sentiment is associated with treatment outcomes. [ABSTRACT FROM AUTHOR]

Background: Little is known about delivering telehealth from a healthcare provider's perspective. Purpose: To investigate physiotherapists' (PTs) experiences in delivering live online exercise and education for people with knee osteoarthritis (OA). Methods: This was a qualitative individual interview study with a thematic analysis approach. The interviewees were six PTs delivering 8 weeks of supervised online exercise and education for people with knee OA in secondary public care in Denmark. Results: The three main themes were (1) From hands to words—on the transition from on‐site to on‐line physiotherapy, (2) Online selection—on the perceived barriers to managing a telehealth service and (3) Therapeutic relation under pressure—on the contextual difficulties in building relationships and alliances in online classes. Conclusion: The PTs in this study seemed to gradually come to terms with delivering first‐line OA care online, appreciating advantages and new possibilities. PTs' initial apprehension towards this new form of physiotherapy service may be rooted in the traditional conception of physiotherapy as a predominantly manual profession but also in a lack of formal training in physiotherapy telehealth services. This study underlines the growing need for better and more formalised training in physiotherapy telehealth services to meet growing demands. [ABSTRACT FROM AUTHOR]

Psychiatric nurses who work with people who are involved with the justice system experience ethical and moral tension arising from their dual role (care and control). This is known to significantly affect the development of a therapeutic relationship between nurses and patients. (a) better understand how justice system involvement affects people living with mental disorders and the nurses who work with them; (b) explore the influence of judiciarization on social interactions between these actors. Grounded theory (GT) was used as the qualitative methodology for this research. Semi-structured interviews were conducted with participants. The study was carried out in three different units of a psychiatric institution: Psychiatric Intensive Care Unit, Emergency Department, and Brief Intervention Unit. A sample of 10 patients and 9 psychiatric nurses was recruited (n = 19). Theoretical sampling was used to recruit participants. We followed the iterative steps of qualitative GT analysis (open coding, axial coding, constant comparison, and modelization). Three main themes emerged from the qualitative analysis: (a) Experience of Justice System Involvement, (b) Crisis, (c) Relational Aspects and Importance of the Approach. These results will inform nurses and healthcare providers about the impacts of justice system involvement on people living with mental illness and how clinical practices can be better adapted to this population with complex health needs. [ABSTRACT FROM AUTHOR]

This article challenges the assumptions made by Western leaders about the threat posed by Russia to NATO allies. It argues that Russia's military reconstitution does not necessarily tilt the balance of power in its favor and that NATO's deterrent is not weak. The article proposes a postwar strategy focused on preventing NATO-Russia conflict and stabilizing the security environment. It highlights the potential risks and pathways to a NATO-Russia conflict, emphasizing the importance of understanding leaders' statements and the unintended consequences of rhetoric. The article argues for a comprehensive strategy to minimize the risk of conflict, including reducing tensions, negotiating new arms control arrangements, and refraining from rapid moves towards Ukraine's NATO membership. [Extracted from the article]

Les exilés ont souvent vécu de multiples traumatismes et lorsqu'ils arrivent en France, ils restent en général dans une situation sociale précaire avec un certain nomadisme et un isolement important. L'offre de soins existante pour la santé mentale du public exilé n'est malheureusement pas suffisante actuellement ; aussi, multiplier les moyens et innover dans les prises en charge permettrait de soulager la pression de la demande. La présentation de l'État de Stress Post-Traumatique (ESPT) chez ce public est très fréquemment somatique, avec une errance diagnostique initiale fréquente. À travers trois vignettes cliniques, nous pouvons observer que le médecin généraliste formé, en tant que médecin de premier recours, peut déjà rétablir un lien de confiance qui est souvent rompu, redonner un certain sentiment de sécurité et apporter du soutien, ce qui est la base du soin dans le psychotrauma chez ces patients souvent déshumanisés, isolés et loin de leur environnement soutenant culturel. Il est possible pour le médecin de dépister, orienter, et prendre en charge selon ses compétences ces psychotraumatismes en étant une personne ressource et en utilisant une méthode complémentariste, tout en prenant en compte l'ensemble des symptômes présentés par les patients. Prendre en charge l'ESPT en situation transculturelle nécessite un décentrage indispensable et une prise en charge globale du patient, afin d'obtenir une alliance thérapeutique nécessaire à la qualité des soins. Or le travail en médecine générale est déjà dans cette démarche de raisonnement. Enfin, la continuité des soins dans la durée permet d'éviter les ruptures de soins qui peuvent alors être traumatogènes pour ces patients. Le travail du médecin généraliste permettra alors d'améliorer l'accès aux soins psychiques des exilés et développer des structures spécialisées dans le psychotrauma des personnes migrantes, tout en innovant dans la prise en charge. Exiles have often experienced multiple traumas, and when they arrive in France, they generally find themselves in precarious social situations, often with a certain level of nomadism and significant isolation. Unfortunately, the existing mental health care services available for exiles are currently inadequate, and more resources and innovative approaches to providing care would help alleviate the pressure of demand. The presentation of Post-Traumatic Stress Disorder (PTSD) in this population is often somatic, with frequent initial misdiagnoses. Through the study of three clinical vignettes, we are able to substantiate that a trained general practitioner, as the primary care physician, can readily establish a bond of trust that has often been broken, restore a sense of security, and provide support, which is at the core of trauma care for these patients who are often dehumanized and isolated, far from their supportive cultural environment. The general practitioner can screen, refer, and manage these psycho-traumas according to their competence, serving as a resource person and using a complementary approach while taking into account all the symptoms presented by the patients. Addressing PTSD in a transcultural context requires essential decentralization and comprehensive patient care to establish a therapeutic alliance necessary for quality care. This approach is increasingly being used in general medical practice. Additionally, the continuity of care over time helps prevent breaks in treatment, which can be traumatic for these patients. The treatment provided by the general practitioner will help to improve access to mental healthcare for refugees and to develop structures specialized in treating psychotrauma in migrant populations, while at the same time being innovative in patient care. [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]

Service users living with Obsessive compulsive disorder (OCD) often delay or avoid seeking diagnosis or treatment because of a fear of judgement or feelings of shame associated with their obsessions and compulsions. They may feel that their behaviour defies societal norms, which can lead to social isolation, and in turn, further contribute to health inequality. When such individuals present with physical illness and are seen by district nurses, it is imperative that behaviours are understood and approached appropriately. It is important to develop therapeutic relationships and consider their holistic wellbeing. Developing a close working relationship with the mental health team as a multidisciplinary team and using the team as a resource may contribute to the overall health outcome of service users with OCD. [ABSTRACT FROM AUTHOR]

This article discusses the use of long-acting injectables (LAIs) as a treatment option for adolescents diagnosed with bipolar disorder. The study focuses on four adolescent patients with similar symptoms of bipolar disorder who underwent treatment with a LAI antipsychotic. The results showed positive responses to the treatment, with a decline in symptoms over time. The article emphasizes the importance of medication adherence in managing bipolar disorder and highlights the benefits of LAIs in promoting stability and reducing the impact of the illness on daily life. It also emphasizes the need for comprehensive measures, such as education, family support, and regular monitoring, to effectively manage bipolar disorder in adolescents. [Extracted from the article]

This article focuses on the definition and application of empathy in psychotherapy to strengthen clinical social work's understanding of the concept and improve consistency in how it is applied in clinical practice, psychotherapy, and research. We conducted a critical review of the conceptual and empirical literature to understand the meaning of empathy and its relation to other components of the helping relationship. Based on this review, we identified that there was lack of consensus regarding how empathy is defined and how it has been operationalized in research. This review also indicated the need to delineate empathy from closely related constructs (e.g., the therapeutic alliance) and focus on frequently overlooked empathy subdomains (e.g., fantasy) to enhance clinical social work practice. [ABSTRACT FROM AUTHOR]

Purpose: Since the COVID-19 pandemic, psycho-oncological care has increasingly been provided virtually and/or telephonically. We examined whether patients' therapeutic alliance (TA) – an essential processual outcome – differs due to altered modes of care delivery (MOCD) and assessed, if MOCD impacts patients' care satisfaction and patient reported outcomes. Methods: Survey and documentation data from newly diagnosed cancer patients that were cared for in the new form of care 'isPO' in Germany, were analyzed. Patients were surveyed after completing the one-year psycho-oncological care program. MOCD was operationalized by the ratio of patients' face-to-face, telephonic or video-based consultations to all their consultations. Regression analyzes were conducted to determine a possible relationship between MOCD and TA, between MOCD and patients' care satisfaction ('subjective effectiveness' and 'satisfaction and needs-orientation') and patient reported outcomes (anxiety and depression, sense of coherence, global health status). Findings: MOCD does not significantly influence TA. Regression models on the possible effect on subjective effectiveness and satisfaction and needs-orientation do not show statistical significance with only MOCD as the predictor. MOCD does not predict any of the patient reported outcomes. Conclusions: During the pandemic, neither TA, care satisfaction nor patient reported outcomes were affected by the MOCD in the new form of care 'isPO'. Therefore, the MOCD didn't negatively affect quality of care, which indicates that telephone or video consultations seem to be useful alternatives for psycho-oncological care in Germany. [ABSTRACT FROM AUTHOR]

Background: Therapeutic alliance has been found to play an influential role in predicting outcomes for adults and adolescents in psychotherapy. However, thus far, the information concerning the impact of therapeutic alliance on outcomes for adolescents in treatment for substance misuse has not yet been critically synthesised. Methods: In accordance with PRISMA guidelines, the current review aimed to systematically collate published research investigating the association between alliance and outcomes for adolescents undergoing substance misuse treatment. Database searching produced 1083 records, with 16 studies meeting eligibility criteria. Results: Twelve out of the 16 studies (75%) reported significant alliance–outcome relationships, whereby higher alliance ratings predicted better treatment outcomes, as well as improved engagement and retention in treatment. In addition, the review explored the conditions whereby alliances better predict outcomes, with reference to the alliance rater, the timing of the alliance rating and comorbid diagnoses. These results, however, largely remain inconclusive. Conclusions: The evidence as it stands demonstrates the importance of the therapeutic alliance in predicting outcomes for adolescents in substance misuse treatments. The implications of the review's findings and recommendations for future research are discussed. [ABSTRACT FROM AUTHOR]

As the Ministry of Justice looks to develop a 'new generation' of programmes to reduce reoffending, we reflect on what can be learnt from the only accredited domestic abuse programme in England and Wales, Building Better Relationships (BBR). Findings from an ethnographic study of BBR are situated within the Probation Inspectorate's recent inspection of domestic abuse work within the newly unified Probation Service which revealed a fractured and overstretched workforce. Our central argument is that if we are to avoid making matters worse, practitioners must be equipped with the time, supervision and skill needed to maintain something akin to a 'therapeutic alliance', that will endure in moments of crisis in their own lives as well as those of their clients. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsConclusionsDiscussionThis exploratory study examined the prevalence and determinants of the use of the title ‘doctor’ among the United States (U.S.) licensed Doctors of Physical Therapy (DPTs) during patient-provider introductions.A cross-sectional analysis of DPTs across eight states was conducted. Binary logistic regression analyzed demographic and experience-related factors influencing title use, including years of experience, board certification status, and clinical instructor (CI) experience. Stepwise logistic regression with forward selection identified significant predictors. Beliefs influencing title use were evaluated through descriptive statistics from multiple choice questions with an option for open-ended responses for additional opinions.Of the 1,311 participants who met the inclusion criteria, 19.9% reported using ‘doctor’ during patient-provider introductions. The odds of using the title increased with age and was higher among males, with age controlled for. Completion of a residency program and not being a CI were also associated with greater odds of title use, with age and sex controlled for. Beliefs about demonstrating expertise, having earned the title, and advancing the profession were primary reasons for using the title, while concerns about patient confusion and therapeutic alliance were reasons for not using it. Both DPTs who did and did not report using the title ‘doctor’ commonly cited the impact on therapeutic alliance as justificationA minority of our sample of U.S. DPTs use the title ‘doctor’ during patient-provider introductions, with significant variation across age, gender, and professional experience. Deciding whether to use the title was primarily based on their perceived effects on patient beliefs.This is the first study to formally investigate how DPTs refer to themselves during patient-provider introductions. Understanding title use in healthcare can inform best practices during patient interactions. This study provides a foundation for future research on the impact of DPTs mentioning their doctoral title on patient experiences and outcomes. [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: In psychotherapy, clients and therapists work together to forge a path towards better mental health. Key to this process is genuine and honest communication. However, much previous research suggests that clients are not always fully truthful with their therapists. In this study, we make a preliminary examination of the relationship between client deception in therapy, the quality of the therapeutic relationship and therapeutic outcomes. Methods: Participants who had been involved in psychotherapy completed a variety of measures that assessed their use of dishonesty in therapy. They also completed measures of the quality of the client–therapist relationship and measures of their perceived therapeutic outcomes. We hypothesised that client dishonesty would negatively correlate with the perceived quality of the therapeutic relationship and the therapeutic outcomes. Furthermore, we predicted that the quality of the therapeutic relationship would mediate the relationship between client dishonesty and perceived therapeutic outcomes. Results: The results of correlation and mediation analyses supported these hypotheses. Client dishonesty was associated with poorer therapeutic relationships and worse perceived therapeutic outcomes. Additionally, therapeutic relationship quality partially mediated the relationship between client dishonesty and therapeutic outcomes. Conclusions: This initial study provides important tentative insights into the possible negative correlates of client dishonesty in the therapeutic environment. [ABSTRACT FROM AUTHOR]

The present study investigated the differences in movement synchrony and therapeutic alliance between solution-focused and problem-focused counseling. Thirty-four participants each attended two counseling sessions with different counselors, one with a solution-focus and one with a problem-focus, in randomized order. The sessions consisted of three consecutive parts: problem description, standardized intervention and free intervention. Movement synchrony, including leading and pacing synchrony, was measured using Motion Energy Analysis (MEA) and windowed cross-lagged correlation (WCLC) based on video recordings of the sessions. The Helping Alliance Questionnaire (HAQ) was used to assess therapeutic alliance. Results showed that movement synchrony was significantly higher in solution-focused than in problem-focused counseling, driven by differences in the problem description part. This difference may be explained by the allegiance of the counselors to the solution-focused approach, as we observed more leading synchrony during the problem description part in solution-focused sessions. There was no significant difference in therapeutic alliance between the two conditions. This study expands the understanding of counseling approaches in the field of movement synchrony and contributes valuable insights for practitioners and researchers alike. [ABSTRACT FROM AUTHOR]

Objectives: Developing mental health services which are accessible and acceptable to those from minority backgrounds continues to be a priority. In the United Kingdom, individuals who identify with a religion are underrepresented in Talking Therapies services as compared to those with no religion. This necessitates an understanding of how therapy is perceived. This online study explored the impact of explicitly acknowledging religion on anticipated alliance, treatment credibility and expectations of therapy in a non‐clinical sample of British Muslims. Methods: A video‐vignette experimental design was used in which participants who self‐reported as either high or low in religiosity were randomly allocated to receiving information about cognitive behavioural therapy either with or without an explicit mention of religion as a value in the therapeutic process. Results: One hundred twenty‐nine British Muslim adults aged 18–70+ years from various ethnic backgrounds participated in the study. Between‐subjects ANOVAs showed that scores on the perceived credibility of therapy and treatment expectations were significantly higher when religion was explicitly mentioned by the 'therapist', but that acknowledging religion did not impact upon anticipated alliance. Conclusions: These findings suggest that mentioning religion as a value to be considered in therapy has some positive impacts upon how therapy is perceived by British Muslims. Although video vignettes do not provide insight into the complexity of actual therapeutic encounters, acknowledging religion in mental health services more broadly remains an important consideration for improving equity of access and may bear relevance to other minoritized groups. [ABSTRACT FROM AUTHOR]

The United States Census Bureau suggests that the number of non-English speakers is on the rise, and thus, music therapists may be faced with working with patients who speak different languages, necessitating the need for language interpretation (Dietrich & Hernandez, 2022). In efforts to explore and better understand music therapists' experiences of delivering music therapy services with language interpreters, five music therapists were interviewed in a semi-structured format. Interviews were conducted and analyzed using interpretative phenomenological analysis. Five domains emerged from the data: (a) benefits of working with interpreters, (b) drawbacks of working with interpreters, (c) feelings associated when working with interpreters, (d) potential reasons why music therapists may not work with interpreters, and (e) considerations for music therapists working with interpreters. The findings provide a greater understanding of how music therapists currently work with interpreters, as well as indicate the need for increased education and awareness. [ABSTRACT FROM AUTHOR]

By championing the strengths, resources, and resilience of service users and increasing treatment access while limiting costs, single-session therapy (SST) represents a collaborative, direct, and transparent approach to providing treatment. In SST, service users have active and empowered roles in determining the focus, solutions, and extent of the therapy. SST practitioners note that all circumstances, settings, and contexts are unique and thus provide service users with autonomy to help them address the concerns that brought them to seek treatment. In Part II, I describe various ways to implement SST for music therapy clinicians in acute mental health settings. As Carr et al. (2013) noted a need for a music therapy model in acute mental health settings, I highlight Soo-Hoo's (2018) Strength-Based Multicultural Integrative Therapy model as a potential therapeutic framework. To help music therapists apply aspects of SST to their clinical practice, I also provide questions for therapists to use in SST, describe how to conclude SST, provide suggestions for single-session group music therapy and other applications of single-session therapy in music therapy, and conclude with a critical reflection of SST. [ABSTRACT FROM AUTHOR]

Copyright of Revista Electrónica de Psicología Iztacala is the property of Facultad de Estudios Superiores Iztacala 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.)

Psychoanalysis brings some specific aspects of treatment technique to the field of mental health practice today, such as highlighting the dynamics within therapeutic relationship (especially regarding emotional and unconscious elements), the role of defense mechanisms etc. Moreover, by means of taking a particular therapeutic stance, psychoanalysis offers some shared mental space for patients. The present paper argues that this stance is characterized by the capacity to "not act", that is: by passive receptivity. To view this as some specific "negative skill" in psychotherapy in general means to align common elements of effective psychotherapy with the capacity to explore the uncommon, unfamiliar or unforeseen in particular psychotherapeutic processes. The paper sketches how this can be employed in psychotherapy training as well as in psychotherapy integration. [ABSTRACT FROM AUTHOR]

Abstract Objective The therapeutic alliance is central to psychotherapy. However, research on the relationship between alliance and suicidality is scarce. We examined whether pretreatment suicidality is associated with an impaired alliance formation in brief cognitive behavioral therapy (CBT) and whether the therapeutic alliance is associated with change in suicidal ideation (difference between pretreatment and posttreatment assessment). Methods N = 643 outpatients (64% female; age: M[SD] = 37.09[13.15], range: 18–73 years), received 12 sessions of manual-based short-term CBT for primary diagnosis treatment. Using self-report questionnaires, suicidal ideation and behavior were assessed before and after therapy, patient-rated therapeutic alliance was assessed after the fourth session and posttreatment. We performed correlation analyses and two hierarchical linear regressions, unadjusted and adjusted for possible confounding variables (age, gender, lifetime suicide attempts and depression). Results Pretreatment suicidal ideation was not predictive of the quality of the early alliance. In addition, the therapeutic alliance was not predictive of change in suicidal ideation. Conclusions In the outpatient setting, no association was found between therapeutic alliance and suicidality. Future studies should investigate therapeutic alliance as a predictor of prospective suicidal behavior in different clinical settings.

Abstract Objective This systematic review examines the literature regarding perceived clinician stigma and treatment experiences of adult patients with eating disorders, emphasising lived experience perspectives. Method A systematic search was conducted across MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials [CENTRAL] to identify studies published from 1 January 2000 until 24 March 2024 that explored patient experiences of clinician attitudes and behaviours in eating disorder treatment. Eligible studies included those reporting on perceived clinician stigma and impacts on treatment outcomes. Results There were 11 studies that met the eligibility criteria. The studies encompassed various diagnoses, locations, and healthcare settings, reflecting a broad spectrum of experiences and contexts within treatment of eating disorders. Four key themes emerged across the studies: treatment engagement, where perceived clinician stigma led to reduced patient involvement; therapeutic alliances, with stigma compromising relationships between patients and healthcare providers; barriers to treatment and care, where stigma heightened obstacles to accessing support; and weight stigma. Discussion Despite the overall scarcity of evidence, these qualitative studies provide evidence of impacts of perceived clinician stigma on patient experiences in eating disorder treatment. These findings provide an initial understanding of negative effects of clinician attitudes such as dismissiveness and invalidation, which may hinder treatment adherence and therapeutic outcomes. Beyond addressing stigma, future research should explore how clinician behaviours can foster positive treatment experiences, such as patients feeling heard, respected, and understood. Clinicians’ reflective practices should focus on improving therapeutic alliances and fostering more inclusive, patient-centred care. Future studies should prioritise mixed-methods approaches to investigate how clinician stigma and positive care experiences influence treatment engagement, recovery trajectories, and long-term outcomes.

Abstract Background Attrition continues to be a major hurdle for addiction treatment. Through the prism of the attachment theory, this phenomenon can be understood as a manifestation of the patient’s insecure attachment style, needing a highly-responsive care delivery. We developed an electronic health mobile application, co-designed with patients, aimed at helping healthcare teams respond to their patients’ needs, and fostering adherence to care. This acceptability study evaluated patients everyday use of the application for eight weeks, assessing their satisfaction with the system, and its integration within professionals’ current practice in our center. Methods This single-center, prospective study was conducted between January 2022 and December 2022. 24 adult patients with any type of addiction were included. They were granted access to the application for eight weeks, and were invited to complete the System Usability Scale questionnaire regarding their satisfaction with application’s usability at the end of the study. The application uses active self-reports, which are later discussed with the healthcare team, and foster both the working alliance and the decision-making process. Results 17 patients out of 24 reached the primary endpoint. On average, over the eight-weeks period, patients logged in the application 38.2 times, and sent 5.9 messages to the healthcare team. Interestingly, 64.3% of the user logins were recorded outside of our center’s working hours (either from 5 p.m. to 9 a.m., or during week-ends and bank holidays), and 70.8% of the patients logged into the application at least one time between 10 p.m. and 8 a.m. 18 patients completed the System Usability Scale questionnaire, which averaged a score of 81.8 out of 100. Healthcare professionals logged in the application’s messaging system 4.5 times a day on average. Conclusions This preliminary study shows promising results, as patients engaged well with various components of the application. It was moreover possible for healthcare workers in our center to integrate this tool in their daily activities. More work is needed to better understand the various patients’ needs regarding the application, further strengthen their adherence to the intervention, and understand professionals’ motivations to use the application. Trial registration ClinicalTrials.gov, Identifier: NCT04659954. Registered 09 December 2020, https://clinicaltrials.gov/study/NCT04659954 .

Structural equation modeling using the Partial Least Square-Structural Equation Modeling algorithm (PLS-SEM) is a statistical technique that has gained attention recently due to its flexibility and predictive power. However, there is a scarcity of guidance on applying this technique in the field of social sciences, especially education and psychology research. Therefore, this study aimed to apply the PLS-SEM algorithm as an advanced approach to structural equation modeling, highlight the justifications for its use and compare it to structural modeling using the variance method. PLS-SEM was applied using the SmartPLS program to a proposed structural model of the causal relationships between artificial intelligence use, therapeutic alliance, and job engagement. The descriptive approach was applied. The study sample consisted of (127) mental health service providers in the Kingdom of Saudi Arabia, including 58 males and 69 females aged 25-50 years. (36.32±6.43), the artificial intelligence questionnaire, therapeutic alliance scale, and job engagement scale were applied to them, all prepared by the researcher. The results found there were median levels of artificial intelligence use, therapeutic alliance, and job engagement, and also showed that the proposed structural model of artificial intelligence use and the therapeutic alliance has a good ability to predict job engagement and explain the interrelationships between them compared to the indicators model and the linear model. The results also revealed a strong overall positive effect statistically significant (p< 0.05) for the variable of attitude towards using artificial intelligence in the therapeutic alliance (0.941) and job engagement (0.930), and a moderate overall positive effect statistically significant (p< 0.05) for the therapeutic alliance in job engagement (0.694). These findings indicate the importance of integrating training of mental health providers on the skills of using artificial intelligence and generative artificial intelligence techniques into professional practice to develop their ability to build a therapeutic alliance with beneficiaries and enhance their sense of the importance of the profession and their well-being in it.

ObjectivesThe therapeutic alliance (TA) has been shown to be a predictor of psychotherapy treatment success. In the case of psychotherapy with children, there is a dearth of information on TA's role. The aims of the paper are: (1) To estimate the therapist effects on children TA; (2) to investigate if therapists' TA predicts children's TA; (3) to analyze if children's age and sex predict children's TA; (4) to evaluate if the therapist's characteristics predict children's TA.MethodsThe sample consisted of 77 children undergoing psychotherapy in Argentina, and the therapists (N = 29) providing services to those children. The assessment tools utilized for the study included the Therapy Alliance Scale for Children and the Personal Style of the Therapist Questionnaire (PST-Q).ResultsFindings indicated that 2% of the children's TA was explained by the therapists (ICC = 0.02), while 17% of the therapists' TA was explained by the therapists (ICC = 0.17). Therapists' TA predicted children's TA. Children's age and sex did not have an effect on their own TA. Moreover, therapists with more experience achieved higher scores of children's TA. Finally, the Operative dimension of the PST had a negative effect on children's TA (i.e., therapists who prefer more spontaneous interventions over structured ones may experience higher levels of therapeutic alliance with child patients).ConclusionWe found a positive effect of the therapist's TA on children's TA, especially in the preference for using more spontaneous intervention techniques. We discuss the implications of the findings on the training of psychotherapists who provide services to children.

This study examined the development of the therapy alliance over the first six sessions of couple therapy using a dyadic latent growth curve. The role of relationship adjustment, symptom distress, and attachment to alliance development were also examined. Participants were 165 couples in a treatment-as-usual setting. The alliance increased over the first six therapy sessions for males and females with males following a curvilinear pattern of growth. Additionally, female relationship adjustment was related to initial alliance levels for females while symptom distress was related to female alliance development. Male attachment avoidance and female attachment anxiety were related to male initial alliance. Couple therapists need to pay attention to intake level of female adjustment, symptom distress, and attachment—along with male attachment, as these are related to alliance development. Therapists should also be mindful that female and male alliance follow a different developmental trajectory. [ABSTRACT FROM AUTHOR]

Background: The rising demand for psychotherapy exceeds therapist availability, often due to financial or physical proximity constraints. Artificial intelligence (AI), particularly through chatbots, presents a promising solution, having shown efficacy in enhancing mental health. Aims: This study investigated the psychotherapeutic relationship in the context of using chatbots for psychotherapy, in which the intimate and emotionally involving nature of the relationship might render the need for human interaction a strong deterrent to people's acceptance of anthropomorphised chatbots. Methods: This study included four hundred ninety‐four participants, aged 15 to 69 years (M = 22.77; SD = 8.43); 75.1% of them were females. They completed scales that measure attitudes towards the use of chatbots in psychotherapy, AI and seeking professional psychological help, need for human interaction in psychotherapy, importance of anthropomorphic qualities and intentions to use chatbots in psychotherapy. Results: Individuals' engagement in using chatbots in psychotherapy is related to their attitudes towards chatbots and towards AI in general, not only to the importance that they place on chatbots having anthropomorphic traits, but also to the strength of their needs for human interaction in the psychotherapeutic relationship. Conclusion: Technology can enhance the psychotherapeutic process, but should not replace therapists entirely for people who seek psychological assistance. [ABSTRACT FROM AUTHOR]

Introduction: Recent reports from the World Health Organization and the American Psychological Association have highlighted the gap between the growing need for mental health services and available resources. Even with additional funding, however, the high proportion of clients who drop out after only a few sessions presents a significant obstacle to providing effective help. Methods: Using archival data from the Research Consortium of Counseling and Psychological Services in Higher Education, this study examined relations between client attendance and two constructs of the early therapeutic environment model, working alliance and client distress. Results: Session count evidenced a floor effect, with the mean of the distribution (4.45) <1 standard deviation (SD; 4.11) from the lowest possible score. In contrast, clients' alliance scores (measured with the Working Alliance Inventory) displayed a ceiling effect, with the mean 1.48 SD units from the highest possible score. Analyses indicated that alliance and distress (measured via the Outcome Questionnaire—45) scores exhibit different nonlinear relations with session count. Working alliance scores exhibited a power function indicating that rapid increases in alliance scores during initial sessions were associated with larger session counts. In contrast, distress scores formed a funnel shape with session count such that moderate initial distress was associated with greater attendance. Clients whose alliance scores evidenced a ceiling effect accounted for most of the observed change on the distress measure. Conclusion: To enhance attendance, study findings suggest that, as early as possible, therapists should maximise the client–therapist alliance and moderate the level of client distress. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to determine the trajectories of therapeutic alliance development in individual systemic psychotherapy for adults with adaptation disorders and the differences in alliance development between groups with different treatment outcomes. Method: The longitudinal quasi‐experiment included 20 patients undergoing individual outpatient psychotherapy treatment in private practice for over a year. Therapeutic alliance was evaluated three times, by the psychotherapist and the patient simultaneously. Treatment outcomes were estimated twice based on patient ratings. Their clinical significance was assessed using the Reliable Change Index, analysis of variance for independent groups and trend analysis. The analyses concerned global therapeutic alliance and its three dimensions: goals, tasks and bonds. Results: The study supported the hypothesised linear trend. It also confirmed a greater increase in alliance quality over the course of treatment in patients whose therapy was more successful. Conclusion: The results indicate that, in patients with adaptation disorders, alliance development in systemic therapy follows a stable linear trend. The linear change observed for global therapeutic alliance is paralleled by similar trends in goals, tasks and bonds. Strong alliance correlates with better treatment outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Mental health suffered during the COVID‐19 pandemic lockdown in Scotland. While there was limited availability for face‐to‐face counselling, online counselling was available via telephone, videoconference, email, one‐to‐one chat and group basis. Existing research has failed to examine inter‐modality comparisons of client experiences of online counselling during the COVID‐19 pandemic. Methods: Scottish participants (n = 94) who received online counselling during the COVID‐19 pandemic completed an online survey using quantitative methodology, which explored their experiences of one of five online counselling modalities measured by two reliable scales: the Working Alliance Inventory‐Short Revised and factor one of the Satisfaction with Therapy and Therapist Scale. Additional exploratory analysis investigated whether age, gender, choice of online counselling modality and pre‐COVID‐19 pandemic familiarity with online counselling affected these outcomes. Results: Working alliance and satisfaction outcomes were positively correlated. No significant differences between working alliance and satisfaction scores were found between the five modalities. Female participants, and those who received their preferred choice of counselling modality, had significantly greater working alliance than those who did not. Conclusion: These findings provide insights to clients and practitioners about the variety of synchronous and asynchronous online platforms that can facilitate good therapeutic outcomes. The importance of participant choice of counselling modality was reiterated. The broader implications of the findings and the future direction of a hybrid online and face‐to‐face counselling model were discussed. [ABSTRACT FROM AUTHOR]

Background: Adolescents often drop out of psychotherapy, with research indicating that almost half of adolescents abandon therapy prematurely. Authors have recommended that, in order to increase engagement and prevent dropout, it is important for clinicians to manage and maintain the therapeutic setting and the relationship. Objective: This study was designed to investigate the impact of events that hinder the therapeutic alliance in psychotherapy with adolescents, with attention to the adolescents' experiences of these events, how such events were managed within the therapeutic relationship and consequences for the course of treatment. Methods: Semi‐structured interviews were conducted with adolescents and young adults who experienced negative events during their treatment. Results: Following a structured thematic analysis, four main domains of hindering events were identified: (a) the nature of problems; (b) subjective experience; (c) response to the events; and (d) consequences of these events. Conclusion: While there were some similarities between hindering events in adult psychotherapy and that undertaken with adolescents, findings indicate that working with adolescents presents specific challenges associated with limited independence that is typical of this stage of life, and this has implications for clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: This is the first of two articles that examine the psychometric properties and treatment outcomes associated with measures of the therapeutic alliance collected in naturalistic settings rather than clinical trials. These articles break new ground in understanding the relationship between measures of alliance and treatment outcome by performing detailed item analyses in order to assess the psychometric properties of each individual item, its propensity to change from session to session and its utility in predicting change in the outcome measure. Methods: Data were taken from the ACORN database for adults attending for psychotherapy treatment in naturalistic settings (N = 147,399). The sample, the largest to date, included only those completing both an alliance measure and an outcome measure at every session. Two sets of three different alliance items are used across three different treatment populations: general outpatient, substance use, and severe and persistent mental health difficulties. To investigate this possibility, the psychometric properties of each item were evaluated, including factor analysis, likelihood of change over time in treatment and correlations between changes in alliance and magnitude of client‐reported improvement in therapy. The predictive validity of each individual item is compared with the predictive validity of their respective three‐item measures. The problem of alliance scores being heavily skewed in a positive direction and the resulting lack of variability from session to session is addressed by categorising change in alliance as same, better or worse, regardless of the magnitude of change. Results: Findings tended to differ from those in clinical trials, with the last alliance score being most predictive of outcome. In this data set, the alliance accounted for, at most, 2% of the variance in outcomes. Measures of the therapeutic alliance demonstrate ceiling effects, and the alliance–outcome correlation is far from linear. Change in alliance score, rather than a single assessment, is more predictive of outcome, regardless of the magnitude of change in the alliance measure, with effect sizes of up to 50% more for those who rated the alliance as worse than for those rating it as no change or better. Conclusion: Therapists using therapeutic alliance questionnaires will benefit from being aware of how the psychometric properties of alliance measures impact outcomes. Even the smallest drop in alliance is predictive of significant clinically meaningful differences. Implications for practice, training and research are considered. [ABSTRACT FROM AUTHOR]

Objectives: There is evidence of a significant role for therapeutic alliance (TA) in psycho‐oncology care. This review aims to provide an overview by systematically identifying key characteristics of TA in this setting and exploring related concepts. Methods: PubMed, PsycInfo and Web of Science were systematically searched for empirical studies on adult cancer patients receiving psycho‐oncological care considering TA. Quality assessment was undertaken using the Mixed Methods Appraisal Tool. A narrative synthesis was conducted. Results: Of the 4647 identified publications, 24 quantitative, qualitative and mixed‐methods studies were included. Characteristics of studies, interventions and samples were heterogenic. Patients consistently reported high TA scores. Favourable associations of TA with distress and well‐being and mixed results for further outcomes and compliance were detected. Associations between the patient's and therapist's characteristics yielded mixed results. Qualitative evidence pointed to a unique nature of TA in psycho‐oncology, for example, patients experiencing it in the context of other patient–provider relationships occurring in the context of the disease. Conclusion: The review displays a unique synopsis of a heterogenic, quickly developing research field. First hints towards the efficacy and particularity of TA in psycho‐oncology are delivered. Results encourage further focus on TA, both in psycho‐oncological research and in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Videoconferencing psychotherapy (VCP) delivers treatment to individuals with limited access to face-to-face mental healthcare. VCP's effectiveness has been demonstrated for various disorders and therapeutic interventions. However, there is contradictory evidence regarding the therapeutic alliance in VCP as compared to psychotherapy in person (PIP). This meta-analysis examines whether therapeutic alliance differs by psychotherapy's delivery format, namely VCP versus PIP. Methods: We searched five databases for trials comparing the therapeutic alliance in VCP and PIP, wherein the therapeutic alliance was rated by either patients or therapists or both. Eighteen publications were included, and the difference between VCP and PIP was assessed. Furthermore, we tested possible moderators of the difference in therapeutic alliance between VCP and PIP by meta-regression, and we assessed the risk of bias of this meta-analysis. Results: The meta-analysis revealed no statistically significant difference in the therapeutic alliance between VCP and PIP for alliance ratings by patients (SMD = −0.09; 95% CI = −0.26; 0.07) as well as by therapists (SMD = 0.04; 95% CI = −0.17; 0.25). No significant moderators were found. Discussion: In this meta-analysis, VCP and PIP did not differ with respect to the therapeutic alliance as rated by either patients or therapists. Further research is required into mechanisms driving the therapeutic alliance in VCP and PIP. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is characterized by a pathognomonic instability of interpersonal relationships. Therefore, a good working alliance in the treatment of BPD may go beyond qualitative aspects like agreement on goals and mutual trust, and in particular depend on a balancing of instability. Yet, little is known about working alliance dynamics in the treatment of BPD. Using daily ratings of the Therapy Process Questionnaire, we retrospectively investigated assessments of the stability of the therapeutic alliance during inpatient treatment in 51 patients with BPD and 66 patients with major depressive disorder. Regression analyses were used to investigate whether working alliance was more unstable in patients with BPD and how it was associated to outcome. The working alliance was found to be significantly more unstable in patients with BPD. Yet, a high dynamic complexity of the working alliance was found to be linked to better outcomes in BPD, possibly hinting at the importance of rupture and repair. [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]

This article explores the origins and dynamics of the ANZUS alliance between the United States, Australia, and New Zealand. It acknowledges that the alliance has endured due to shared threat perceptions and interests, but notes that in the early Cold War era, Australia and the United States had differing views on potential threats, with Australia still wary of Japan. The article also addresses the belief that Australia's involvement in U.S. conflicts increased the likelihood of a defense commitment from the United States, but states that there is no empirical evidence to support this claim. The text suggests that the ANZUS alliance has been strengthened by the growing threats from China, and emphasizes the importance of understanding the political dynamics behind the alliance for predicting its future. [Extracted from the article]

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]

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]