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Every year, the US Department of Defense (DOD) invests billions to engage in numerous cooperative activities with partner nation security forces and officials, solidifying its partnerships. The DOD's Regional Defense Fellowship Program (RDFP) and the Department of State's International Military Education and Training (IMET) program offer education and training to foreign military and civilian personnel, fostering international military relationships, exchanging military systems information, promoting military professionalism, and instilling human rights and democratic values. This qualitative evaluation reports findings from interviews with security cooperation officers and civilian employees from Colombia, Ethiopia, Georgia, Mexico, and Thailand, directly involved in in-country security cooperation tasks. Data show RDFP and IMET activities span technical training, English language instruction, seminars, workshops, and professional military education, including undergraduate and graduate education. Returns on Investment can be short- or long-term, with short-term outcomes being tangible and long-term outcomes intangible, potentially taking decades to manifest. Recommendations for program enhancement are provided. [ABSTRACT FROM AUTHOR]

Purpose: Sensory modulation intervention involves using calming and grounding sensory stimuli to support coping with distress and intense emotions. Evaluating the impact of sensory modulation is challenging in inpatient settings due to the numerous variables influencing outcomes in ward environments. This study aims to determine the impact of sensory modulation across all organisational levels including service users, staff confidence and attitudes, ward climate and seclusion events. Design/methodology/approach: Organisational case studies were conducted in two Aotearoa New Zealand inpatient mental health services, using qualitative and quantitative data to explore the effects of a sensory modulation programme. Findings: Results showed that sensory modulation enhanced staff knowledge and confidence in fostering therapeutic relationships and reducing restrictive practices, positively impacted ward climate and provided service users with sensory strategies to use in everyday life. Practical implications: The findings captured the complexity of implementation and impact of sensory modulation programmes at individual, group and organisational levels. It is important to recognise the influencing factors and impact of sensory modulation across all levels of service delivery. Originality/value: Organisational case study methodology offered a unique approach to evaluating the impact of sensory modulation within inpatient mental health services. Data analysis suggests that in addition to managing acute service user distress, sensory modulation impacts broader staff, team and service level outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: Research suggests that various psychosocial factors influence chronic pain, with psychotherapies like cognitive behavioral therapy proving effective. However, the limited availability and accessibility have prolonged suffering among patients with chronic pain. This challenge has led to a growing demand for accessible online interventions. We developed an online cognitive behavioral group therapy (CBGT) program, building upon our existing face‐to‐face CBGT program. We compared the scores obtained by patients during the treatment‐as‐usual (TAU) period with those collected at the beginning and at the end of the intervention. Methods: Patients with chronic pain (N = 22) agreed to participate in the online CBGT program, which was conducted once a week for 12 sessions. The sample size was decided based on the effect sizes of our past face‐to‐face CBGT. We assessed pain intensity [Visual Analogue Scale (VAS)], pain catastrophizing [pain catastrophizing scale (PCS)] and psychiatric assessment [Beck Depression Inventory‐Second Edition (BDI)‐II], State‐Trait‐Anxiety Inventory (STAI), and Short Form Health Survey (SF‐36) at three points: entry, pretreatment, and posttreatment. We also evaluated the participants' therapeutic alliance with the treatment staff [short‐form version of the Working Alliance Inventory (WAI‐S)]. We utilized analyses of variance, Friedman test, paired t‐tests, Wilcoxon signed‐rank test, and Pearson correlation analysis for data evaluation. Results: Results indicated a significant posttreatment improvement in VAS, PCS, and BDI‐II scores compared to the TAU period. Furthermore, posttreatment WAI‐S scores increased significantly compared to pretreatment scores. Also, positive correlations were observed among pre‐ and posttreatment changes in WAI‐S, pain intensity, and pain catastrophizing scores. Conclusion: There is a possibility that a therapeutic alliance can be established, and therapeutic effects achieved through an online CBGT intervention; however, additional research is required to substantiate this potential. We have registered this clinical trial in UMIN‐CTR on 04/21/2021 with the number UMIN000043982. [ABSTRACT FROM AUTHOR]

The global impact of the SARS‐COV‐2 pandemic necessitated a rapid shift to online/teletherapy psychotherapy services. While research suggests the feasibility and efficacy of teletherapy, there is limited investigation into couple teletherapy's impact on satisfaction and therapeutic alliance. This study aimed to address this gap by examining changes in couple satisfaction during tele‐ and in‐person therapy sessions over 12 sessions and exploring whether therapeutic alliance development mediates these changes. Using growth curve modeling in a sample of 416 couples, it found that teletherapy participants initially reported higher couple satisfaction, but improvement in this domain was slower than in‐person therapy recipients. The development of the therapeutic alliance mediated this effect via two indirect paths. Implications include the need for focused attention on alliance development in teletherapy and more empirically‐informed approaches in couple teletherapy. [ABSTRACT FROM AUTHOR]

Background: Clinicians working with patients at risk of suicide often experience high stress, which can result in negative emotional responses (NERs). Such negative emotional responses may lead to less empathic communication (EC) and unintentional rejection of the patient, potentially damaging the therapeutic alliance and adversely impacting suicidal outcomes. Therefore, clinicians need training to effectively manage negative emotions toward suicidal patients to improve suicidal outcomes. Methods: This study investigated the impact of virtual human interaction (VHI) training on clinicians' self-awareness of their negative emotional responses, assessed by the Therapist Response Questionnaire Suicide Form, clinicians' verbal empathic communication assessed by the Empathic Communication and Coding System, and clinical efficacy (CE). Clinical efficacy was assessed by the likelihood of subsequent appointments, perceived helpfulness, and overall interaction satisfaction as rated by individuals with lived experience of suicide attempts. Two conditions of virtual human interactions were used: one with instructions on verbal empathic communication and reminders to report negative emotional responses during the interaction (scaffolded); and the other with no such instructions or reminders (non-scaffolded). Both conditions provided pre-interaction instructions and post-interaction feedback aimed at improving clinicians' empathic communication and management of negative emotions. Sixty-two clinicians participated in three virtual human interaction sessions under one of the two conditions. Linear mixed models were utilized to evaluate the impact on clinicians' negative emotional responses, verbal empathic communication, and clinical efficacy; and to determine changes in these outcomes over time, as moderated by the training conditions. Results: Clinician participants' negative emotional responses decreased after two training sessions with virtual human interactions in both conditions. Participants in the scaffolded condition exhibited enhanced empathic communication after one training session, while two sessions were required for participants in the non-scaffolded condition. Surprisingly, after two training sessions, clinical efficacy was improved in the non-scaffolded group, while no similar improvements were observed in the scaffolded group. Conclusion: Lower clinical efficacy after virtual human interaction training in clinicians with higher verbal empathic communication suggests that nonverbal expressions of empathy are critical when interacting with suicidal patients. Future work should explore virtual human interaction training in both nonverbal and verbal empathic communication. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodsResultsConclusionPrevious qualitative research has listed trust as a component of the therapeutic alliance in physical therapy.Quantitatively correlate trust and therapeutic alliance in physical therapy care for patients with chronic low back pain. The secondary aim was to investigate the relation of trust and therapeutic alliance with outcomes over the course of treatment.The Primary Care Assessment Survey was used to measure trust and the Working Alliance Inventory-Short Revised tool measured therapeutic alliance. The patient recorded these measures after the initial visit and at discharge. Self-report patient outcome measures for pain, function, and global rating of change were also measured at the same time points.A strong correlation (rs = 0.747 and rs = 0.801) was found between trust scores and therapeutic alliance measures post-initial visit and at discharge, respectively. In addition, there were moderate to strong correlations between trust and therapeutic alliance scores with the various improved outcome measures of pain, function, and global rating of change.There appears to be a connection between trust and therapeutic alliance along with improved patient outcomes related to higher trust and therapeutic alliance scores in a cohort with chronic low back pain. [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic alliance (TA), or the extent to which patients feel a sense of caring and trust with their physician, may have an impact on health care utilization. We sought to determine if TA is associated with: (1) emergency department (ED) visits within 30 days of death and (2) hospice enrollment. Methods and Materials: This is a secondary analysis of data from a randomized clinical trial. We used restricted cubic splines to assess the relationship between TA scores and health care utilization. Results: Six hundred seventy-two patients were enrolled in the study, with 331 (49.3%) dying within 12 months. Patients with higher TA were less likely to have an ED visit in the last 30 days of life, but there was no evidence of a relationship between TA and enrollment in hospice. Conclusions: Higher TA was associated with decreased ED visits within 30 days of death. There was no association between TA and rates of hospice enrollment. Clinical Registration Number: NCT02712229. [ABSTRACT FROM AUTHOR]

The practice of clinical medicine is imbued with uncertainty. The ways in which clinicians and patients think about, communicate about, and act within situations of heightened uncertainty can have significant implications for the therapeutic alliance and for the trajectory and outcomes of clinical care. Despite this, there is limited guidance about the best methods for physicians to recognize, acknowledge, communicate about, and manage uncertainty in clinical settings. In this paper, we propose a structured approach for discussing and managing uncertainty within the context of a clinician-patient relationship. The approach involves four steps: Recognize, Acknowledge, Partner, and Seek Support (i.e., the RAPS framework). The approach is guided by existing literature on uncertainty as well as our own experience as clinicians working at different stages of career. We define each component of the approach and present sample language and actions for how to implement it in practice. Our aim is to empower clinicians to regard situations of high uncertainty as an opportunity to deepen the therapeutic alliance with the patient, and simultaneously to grow and learn as practitioners. [ABSTRACT FROM AUTHOR]

Mental health nurses undertake difficult and complex roles. Therapeutic relationships and engagement between mental health nurses and people experiencing severe mental ill‐health provide the core purpose and rationale for such mental health care. These relationships are influenced by factors outside of frontline mental health nurses control. They are difficult to define or describe with clarity, have limited 'quantitative' evidence of effectiveness and are frequently not experienced as therapeutic. This paper presents some initial ideas regarding 'everyday ordinariness' using psychologist Daniel Kahneman's two systems of thinking as a focus for understanding and potentially improving mental health nurse practice, and therapeutic relationships and engagement. [ABSTRACT FROM AUTHOR]

The Mental State Examination (MSE) is an assessment framework used to facilitate the collection of subjective and objective data about a person's current mental state. There is a lack of understanding of nurses' experiences when conducting the MSE. The aim of this scoping review is to identify, examine and summarize the available literature relating to nurses' experiences when conducting the MSE. A scoping review was conducted using Arksey and O'Malley (2005) framework to review, examine and synthesize the available literature on nurses' experiences with the MSE. A PRISMA flow diagram was used to describe the systematic literature search. Six databases (APA PsycInfo, CINAHL, MEDLINE, PubMed, ProQuest, and Scopus) were searched including reference lists of eligible sources. Google Scholar, Trove and Proquest Dissertation and Thesis were searched for grey literature. Twelve articles included in this scoping review considered nurses experiences when conducting the MSE. The principles of thematic analysis were used to synthesize the studies. Three distinct themes were identified from the literature: (i) Nurses' role and the MSE, (ii) Nurses' competence and knowledge when conducting the MSE, and (iii) Nurses' confidence when conducting the MSE. The results of this scoping review identified the MSE as a component of the mental health nursing role and a core competency of mental health telephone triage services. The MSE was used by nurses in the Emergency department (ED), acute in‐patient and community mental health settings, including mental health telephone triage services. Nurses working in EDs and acute in‐patient mental health settings experienced a lack of confidence and competence, including a knowledge deficit in conducting the MSE in comparison to nurses working in community mental health settings. Community mental health nurses identified the importance of conducting an MSE higher than acute in‐patient mental health nurses. This review identified the need for evidence‐based research related to the MSE and its application in nursing practice. Evidence‐based research will inform the development of MSE guidelines and policies, thus, enhance mental health nursing practice related to the MSE, including improving and strengthening consumer‐nurse therapeutic alliance in acute in‐patient mental health settings. [ABSTRACT FROM AUTHOR]

Anorexia nervosa has a high mortality rate and is often treated in the inpatient setting, where close monitoring and medical support are available. Consistent with objective biomedical benchmarks, conventional inpatient treatment is often focussed on weight gain. Consumers report that clinicians provide care focussed on weight and physical restoration without adequate consideration of their full spectrum of needs. The aim of this study was to explore consumers' perspectives of the biomedical focus on weight gain in the inpatient care of anorexia nervosa. This study employed a qualitative approach, involving semistructured interviews, and participants were recruited from relevant social media communities. This study was ethically approved by a university ethics committee and the COREQ checklist ensured ethical reporting. Ten women participated in interviews. Participants reported that the biomedical imperative of weight gain is focussed on at the exclusion of other relevant determinants of well‐being, and the narrow focus on weight gain does not suitably prepare consumers for discharge. The conflict between clinicians' biomedical focus and consumers' broader unmet needs leads to harmful interpersonal dynamics and feelings of invalidation. The inpatient care of anorexia nervosa needs to develop beyond biomedically driven objectives and incorporate the merits of an approach that substantively integrates person‐centred care, therapeutic relationships and trauma‐informed principles. [ABSTRACT FROM AUTHOR]

Therapists' in-session feelings in psychotherapy can be seen as indications of the development of the therapeutic relationship and the therapeutic process. To manage them appropriately, it is important to know to what extent they may be influenced by patients' pretreatment characteristics. This study aims to improve the understanding of therapists' emotional reactions in the psychotherapeutic setting by investigating if patients' pretreatment mentalization ability and attachment style predicted therapist in-session feelings. In a sample of 87 therapy dyads treated with interpersonal psychotherapy and cognitive behavioral therapy for depression, patient attachment was measured using self-reported Experiences in Close Relationships (ECR) and mentalization using Reflective Functioning (RF). ECR and RF were hypothesized to predict therapist feelings measured by the Feeling Word Checklist–24 at different treatment phases over the full course of treatment. Treatment method, patient age, gender, and pretreatment depression were evaluated as potential confounders. Multilevel modeling was used to analyze the data. Lower RF in patients predicted more negative therapist feelings in the mid- to late-treatment phases and less positive feelings in the late-treatment phase. Self-reported attachment anxiety or avoidance did not predict therapist feelings. Findings indicate that patients' ability to mentalize is important to consider when conducting psychotherapy, as it can influence therapists' feelings in the therapeutic process. Limitations of the present study's approach are discussed, and directions for future research are considered. Public Significance Statement: This study indicates that therapists treating depressed patients with less developed mentalizing capacity feel less positive and more negative feelings in sessions as treatment gets closer to its end compared to when treating patients with better mentalizing ability. However, patient self-reported attachment showed no relationship to therapist in-session feelings. [ABSTRACT FROM AUTHOR]

Research suggests that a client's achievement goal orientation and alliance are important for positive treatment outcomes. However, it is currently unknown how a member's goal orientation and alliance in tandem relate to members' improvement in group therapy, despite conceptual wisdom regarding the additive effect of a high alliance and a mastery or approach goal orientation. Therefore, this study sought to examine the congruence between members' goal orientation and the member–group alliance on members' perceived improvement in group therapy. Data for this study came from 99 clients across 10 interpersonal process groups. Polynomial regression and response surface analysis were used to test the congruent and discrepant effects of members' goal orientation (i.e., approach-performance, avoidance-performance, and mastery orientation) and group alliance on their perceived improvement in group therapy. As hypothesized, members who reported congruent high group alliance and high mastery orientation or approach orientation compared to congruent low alliance and low mastery or approach orientation reported high levels of improvement in group therapy. Regarding discrepant effects, discrepant high alliance and low avoidance orientation compared to low alliance and high avoidance was positively related to improvement in group therapy, and discrepant high alliance and low approach orientation compared to low alliance and high approach was positively related to improvement in group therapy. Last, discrepant high alliance and low mastery and low alliance and high mastery were positively related to improvement in group therapy, suggesting a compensatory effect between mastery orientation and alliance on improvement. Public Significance Statement: This study sought to examine if various levels of a group member's alliance to the group and their goal orientation (mastery orientation, performance-approach orientation, and performance-avoidance orientation) related to their perceived improvement in group therapy. Results indicated that a high alliance to the group and high mastery goal orientation or high approach goal orientation was related to high levels of improvement. Additionally, a low avoidance orientation and high alliance to the group was related to high levels of improvement. This study advances the group alliance literature by studying an understudied yet related construct, members' goal orientation. [ABSTRACT FROM AUTHOR]

This article explores the use of between-session homework (BSH) in psychotherapy and its effectiveness in promoting positive outcomes for clients. The authors present six case studies that demonstrate how BSH can be applied in different treatment modalities and for various disorders. They emphasize the importance of tailoring BSH to each individual client's needs and strengths, and stress the need for collaboration between therapists and clients in selecting and reviewing BSH. The article advocates for the integration of BSH into clients' daily lives to promote symptom improvement and personal growth. [Extracted from the article]

In order to effectively treat individuals suffering from Narcissistic Personality Disorder (NPD), it is crucial to establish therapeutic goals and identify tasks to achieve them. However, this is a challenging process with NPD patients because they often struggle to find meaningful goals beyond the pursuit of status. Moreover, in order to change Furthermore, to promote change, they must confront painful emotions such as shame, guilt, or fear, which they habitually try to avoid. Additionally, they face difficulties in forming a positive perception of their therapists and cooperating towards mutually agreed‐upon goals and tasks. As a consequence, NPD patients ask for change but hardly engage themselves in the work necessary to achieve it. Therapists therefore need to pay the uttermost attention to drafting, negotiating and continuously updating a reasonable and realistic therapeutic contract. In this paper we describe the story of a man in his thirties with NPD who was ridden with depression, guilt, envy and anger and did not find ways to pursue the healthy and adaptive behaviors he would need to pursue in order to leave a richer social life. The therapist overcame ruptures in the therapeutic alliance and then involved the patient in a process where they set the steps to follow, making sure the patient was convinced they made sense. After a contract was reached progress became possible. Implications for the role of the therapeutic contract in NPD treatment are discussed. [ABSTRACT FROM AUTHOR]

This article examines the challenges and potential for treating individuals with Narcissistic Personality Disorder (NPD). It acknowledges historical beliefs that NPD was difficult to treat, but presents more recent clinical observations that suggest treatment is possible. The article discusses the specific challenges therapists face when working with NPD patients, such as high dropout rates and slow progress, and emphasizes the importance of understanding the co-creation of treatment difficulties. It also explores different approaches to treatment development for NPD, aiming to provide clinicians with insights into effective interventions and promote a more hopeful approach to treatment. [Extracted from the article]

Many pioneering family therapists exuded exemplary personal characteristics that at many instances were incorporated into their clinical work and theoretical approaches to psychotherapy. While such therapist effects have been traditionally less researched compared with the vast literature on the efficacy of techniques, they are of increased empirical attention, especially given the common factors of psychotherapy change and related process research. To explicate these therapist effects, empirical studies within the fields of marriage and family therapy specifically and psychotherapy more broadly are reviewed concerning those personal characteristics that are linked to or are postulated to be associated with therapeutic success. Following a brief synthesis of this literature, two family therapy pioneers, Carl Whitaker and Salvador Minuchin, are reviewed, concerning their personality attributes and characteristics that were highlights of their approaches and their personal and professional lives. Following a comparison of these two therapists, the manuscript closes with reflections for future psychotherapy research, for training initiatives, and for clinicians. [ABSTRACT FROM AUTHOR]

Debates on allies' contributions to alliances focus mainly on the material dimension. Accordingly, smaller partners are often belittled for failing to contribute their fair share to their defensive alliances with more powerful allies. While acknowledging that junior partners' contributions do not match the same level of material capabilities provided by a more significant power like the United States, this study highlights the importance of other intangible contributions. We argue that defensive alliances during peacetime require a crucial, albeit overlooked, ideational contribution by all allies. We examine the US–Japan and ANZUS alliances to explore the process through which junior partners advance the interests of an alliance through ideational contributions. Our findings reveal that Japan and Australia contribute to their respective alliances with the United States by mobilizing fundamental ideas and norms that sustain and promote a specific global order and security vision. We maintain that such intangible contributions are necessary for alliance success. [ABSTRACT FROM AUTHOR]

The present paper focuses on the recall of childhood experiences of adults who had at least one parent misusing alcohol and/or drugs. The study aims to gain an in-depth understanding of the recall of these experiences in adulthood and their effect on relationships with significant others. Twelve (12) adults, who had experienced as children in their family's drug and alcohol misuse were interviewed and their interviews were analyzed using thematic analysis. The findings of the qualitative study suggest that adults recall in their childhood the reversal of family roles and traumas that seem to affect their current relationships. The research findings indicate the necessity of supporting early enough children who grow up in families where alcohol and drug misuse are part of daily life and to create a therapeutic alliance in adult life in order to advance in their relationship with self and others. [ABSTRACT FROM AUTHOR]

Defining psychiatric and mental health nursing has been a challenge for decades, and it is still difficult to find a comprehensive definition. We have identified a possibility to clarify psychiatric and mental health nursing based on humanistic philosophy in a general psychiatric care context. The aim was therefore to identify and synthesize the theoretical frameworks from which psychiatric and mental health nursing models are developed. We systematically collected and evaluated articles based on Grounded Theory (GT) methodology regarding psychiatric or mental health nursing. The PRISMA statement for systematic reviews was used and the formal process of synthesis, as a three-step process of identifying first -, second - and third-order themes following the examples of Howell Major and Savin-Baden. The synthesis resulted in a model describing five core elements of psychiatric and mental health nursing: 'professional nursing', 'therapeutic relationships' and 'honest engagement', with time as the all-encompassing theme, including the patients' 'lifetime perspective'. Psychiatric and mental health nursing is a caring support towards recovery, where the patient's lifetime perspective must be in focus during the caring process with a relationship built on an honest engagement. Time is therefore essential for psychiatric and mental health nursing. [ABSTRACT FROM AUTHOR]

Introduction: Previous research shows a dearth of literature relating to the therapeutic experiences of the consensually non-monogamous (CNM) population. Research Question and Aims: We aim to understand the experiences of CNM clients in mental healthcare with a view to improving services. Method: This is an online, questionnaire-based qualitative study. Participants (n = 19) were CNM individuals who had accessed mental healthcare in the UK and disclosed being a part of CNM to their practitioner. They were recruited through social media and internet forums. Some ethical considerations included the vulnerability of this population and concerns over anonymity. Thematic analysis of the data was conducted. Findings: Three main themes were identified, these were 'stigma', 'pathologisation' and 'barriers to openness within the therapeutic alliance'. Conclusion: It is theorized that societal mononormativity impacts both clients and practitioners within mental healthcare. For clients this compounds minority stress and results in experiences of fear of disclosure in anticipation of stigma. For practitioners, this mononormativity manifests in stigmatizing assumptions and the pathologisation of CNM in clients. Taken together, this culminates in a lack of openness and damage to the therapeutic alliance. This means care is ineffective and potentially harmful. Ways of mitigating this, including education and the development of meta skills, are explored. [ABSTRACT FROM AUTHOR]

Currently, individuals with personal or familial histories of psychopathological experiences of psychosis, psychotic spectrum disorders, bipolar disorder, and similar conditions are excluded from most psychedelic clinical trials, studies, and treatment programs. This study sought to determine why such an exclusion exists, what the implications of the exclusion criteria are, and if there was agreement in expert opinion. In-depth interviews with 12 experts in the fields of psychiatry, clinical psychology, medicine, and the effects of psychedelics were conducted in an expert consultation format. Interviews were transcribed, and themes were produced using an interpretative phenomenological analysis (IPA) approach. We found that while the exclusion criteria may be justified for psychedelic protocols that provide minimal psychological support for participants, experts agreed that psychedelic-, ketamine-, and MDMA-assisted psychotherapy are not necessarily contraindicated for all individuals within this group. Rather, results suggest that psychedelic-assisted psychotherapy as well as therapy with MDMA and ketamine, which include high levels of support, may be of benefit to some individuals experiencing said conditions and symptoms. Potentially relevant factors for predicting treatment outcomes include specific symptom endorsement, illness duration, symptom severity, quality of therapeutic alliance, role of trauma in symptom etiology and perpetuation, and the level of other supports in the client's life. An analysis of expert opinions revealed that psychedelic-assisted psychotherapy can potentially benefit people with psychopathological psychosis and psychotic conditions under the right conditions. However, more research needs to be carried out to determine the risks and develop a protocol specific to this population. [ABSTRACT FROM AUTHOR]

Marginalized populations have been historically underrepresented in eating disorder (ED) research. A more robust, culturally responsive framework is needed to bridge ED research and counseling practice gaps. Therefore, we propose an integrative approach using Relational Cultural Therapy and self-compassion principles to provide a strengths-based and socially just conceptualization of ED clients with marginalized identities. We conclude with a case illustration, implications for counselors, and future research directions. [ABSTRACT FROM AUTHOR]

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Psychiatric mental health nurse practitioners have rapidly adopted and implemented tele-mental health in their practice; however it is unclear how this modality of care affects the experiential quality of therapeutic alliance, simply defined as the interpersonal working bond between provider and patient. This study is the first to explore how psychiatric mental health nurse practitioners experience therapeutic alliance while using tele-mental health. Husserlian phenomenological qualitative study. A purposive, convenience sample of 17 American psychiatric mental health nurse practitioners who engaged in tele-mental health care were recruited online and interviewed. Phenomenological interview transcripts recorded and later thematically coded in the qualitative software MaxQDA. From 1426 individual codes, five major themes and 16 subthemes were discovered. Overall, themes illuminated that psychiatric mental health nurse practitioners could build therapeutic alliance over tele-mental health using inherent interpersonal skills that had to be adapted to the technology. Adaptions included working with patient environmental factors, individual patient considerations, provider ambivalence, and technological observation shifting awareness and communication patterns. When adapting for the tele-mental health environment, psychiatric mental health nurse practitioners experienced building and sustaining therapeutic alliance with most patients. Unparalleled aspects of tele-mental health allowed for a fuller clinical picture and logistical convenience to see patients more often with ease for both the provider and patient. However, experiential aspects of therapeutic alliance created during in-person care could not be replaced with tele-mental health. In conclusion, participants concluded that a hybrid care model would enhance therapeutic alliance for most patients. • This study is the first to explore how psychiatric mental health nurse practitioners (PMHNPs) experience therapeutic alliance while using tele-mental health • Findings indicate that PMHNP facilitated therapeutic alliance using foundational practices of inherent interpersonal skills that were adapted to virtual care. • Collectively, PMHNPs felt that a hybrid care model would enhance holistic therapeutic alliance for most patients. [ABSTRACT FROM AUTHOR]

This scoping review provides an overview of empirical studies investigating therapeutic relationships between speech-language pathologists (SLPs), clients, and caregivers across all ages and clinical areas, and identifies areas of future research. The Joanna Briggs Institute's (JBI) scoping review method was employed. Systematic searches were conducted across seven databases and four grey literature databases. Research published in English and German until 3 August 2020 was included. Data were extracted for the primary aim, terminology and theoretical foundations, research design, and focus. Central findings concerning the input-, process-, outcome-, and output-level of speech-language pathology were categorised. Of 5479 articles, 44 articles were included in the analysis. Psychotherapy was the leading discipline for the theoretical foundation and measurement of relationship quality. Most findings focused on therapeutic attitudes, qualities, and relational actions to build the basis of a positive therapeutic relationship. A small number of studies indicated connections between clinical outcomes and the quality of the relationships. Future research needs to address precision of terminology, expansion of qualitative and quantitative research methods, development and psychometric examination of measuring instruments specific to SLPs and the development and evaluation of concepts to support professional relationship building in speech-language pathology training and everyday work. [ABSTRACT FROM AUTHOR]

Telepsychology is a new perspective of professional help for mental health. Increased use of technology became a preferred medium to provide mental health services and made it easier to reach the larger population. In the underserved regions, the services of mental health have been reached to manage and prevent mental disorders. It requires proficiency, competency, and encouragement to improve skills and services. The purpose of the article is to explore and identify the scope and to link the concept with application and challenges in different mental health conditions. [ABSTRACT FROM AUTHOR]

The article is a book review of the "Routledge Handbook of Evidence-Based Criminal Justice Practices." The book aims to provide concrete and actionable solutions to address the major questions in today's criminal justice system. The editors and contributors come from diverse backgrounds, including academics, practitioners, and students, with a range of disciplines such as criminology, psychology, and sociology. The book covers a wide variety of topics, divided into seven parts, including crime prevention, juvenile justice, policing, and corrections. The review focuses on the introduction and conclusion by the editors, as well as chapters related to the Corrections section. It highlights the importance of evidence-based practices in criminal justice and the challenges of implementing them in real-world settings. [Extracted from the article]

Purpose: The purpose of this clinical focus article is to highlight the significance of the therapeutic alliance (TA) and how it relates to speech and language therapy practice. We define the components of the TA through the Rehabilitation Treatment Specification System (RTSS) framework in an effort to increase clinician understanding and implementation of the components of TA. Method: With the introduction of the RTSS, there have been ongoing efforts to increase specificity in describing and outlining rehabilitation treatments to better understand, research, and translate knowledge across the field. However, the inclusion of representations and volitional ingredients is often missing from current literature or limited to certain patient populations. We map the ingredients of the TA as intentional clinician actions to provide increased specification of volition components, with the goal of shaping and enhancing the patients' mental representations and offer insights for direct application in clinical practice. Conclusions: Ongoing efforts to educate and train speech-language pathologists on the invaluable contribution of mental representations and TA are imperative. Embedding this education within the RTSS framework may serve to underscore its equal contribution to the patient experience and associated outcomes. Ongoing research and efforts to further delineate volitional ingredients into therapeutic practice is essential to maximize patient engagement and outcomes. [ABSTRACT FROM AUTHOR]

This article explores the 'ways of being' (Pawl, 1994) that promote an alliance between the parent and provider and illuminates the concept of 'parallel process', otherwise known in Infant Mental Health (IMH) work as the platinum rule, 'Do unto others as you would have others do unto others' (Pawl, 1994:23). Parallel process illuminates the interconnected nature of providing for a parent what we hope parents can provide for their infant (Weatherston & Ribaudo, 2020). Often, parents who struggle the most to provide for their infant's emotional and relational needs have not had reliable experiences of their own needs being met. By offering emotional containment and care, practitioners across a spectrum of perinatal services can be a source of healing and, thus, therapeutic. [ABSTRACT FROM AUTHOR]

The future of telemedicine for substance use treatment hangs by a thread, as the United States awaits approval of proposed regulations and laws to increase care access in light of the 2022 Centers for Medicare and Medicaid Services revisions allowing for audio-only care. Telemedicine improves patient care access and outcomes. Audio-only telemedicine can be an effective and viable modality for individuals without technology resources (devices, internet services, and literacy), those with reduced telehealth service utilization (Black individuals or those with unstable housing, who are older, with low income, or with low education), and those living in rural locations. Studies suggest that telephone visits for buprenorphine treatment are well-accepted by patients and providers, making telephone visits essential in care access to reduce disparities. Telephone counseling for patients in substance use treatment is convenient, flexible, and empowering and can augment therapeutic alliances and treatment goals. Both providers and patients advocate for patient-centered hybrid care to include telephone-only treatment, which enhances service productivity and care access; reduces no-show rates, costs, and stigma; and is sustainable. Numerous solutions can expand technology access, proficiency, assimilation, and trust. Despite being "old" technology, the telephone remains an essential resource for substance use treatment. [ABSTRACT FROM AUTHOR]

The article highlights the urgent need to establish an evidence base for deflection programs, which aim to connect individuals with substance use disorders with services and resources. Topics discussed include the challenges in developing this evidence base, including the complexity of program design, the need to define clear outcomes, and the difficulties in measuring program effectiveness.

This review identifes the factors influencing the relationship between physicians and patients that can lead to patients' dissatisfaction and medical complaints. Utilizing a systemic approach 92 studies were retrieved which included quantitative, qualitative, and mixed method studies. Through a thematic analysis of the literature, we identified three interrelated main themes that can influence the relationship between physicians and patients, patients' satisfaction, and the decision to file a medico‐legal complaint. The main themes include patient and physician characteristics; the interpersonal relationship between physicians and patients; and the health care system and policies, with relevant subthemes. These themes are demonstrated in a descriptive model. The review suggests areas of focus for physicians who may wish to increase their awareness around the potential sources of relational problems with their patients. Identifying these issues may assist in improvements in the therapeutic relationship with patients, can reduce their medico‐legal risk, and enhance the quality of their clinical practice. The findings can also be utilized to support andragogical principles for medical learners. The article can serve as a structured framework to identify potential problems and gaps to design and test effective interventions to mitigate these potential relational problems between physician‐patient. [ABSTRACT FROM AUTHOR]

This study assessed changes in therapeutic alliance and group cohesion among parents/primary caregivers enrolled in Connecting and Reflecting Experience (CARE), a short-term, group-based, mentalizing-focused parenting program designed to support a diverse community facing socioeconomic and health disparities. Caregivers (N = 44) experiencing parenting stress or parent-child relational challenges were recruited from their children's outpatient psychiatry clinic to participate in one of nine 12-session telehealth CARE groups. Caregivers completed the Working Alliance Inventory-Short Revised and the Therapeutic Factors Inventory Cohesiveness subscale after CARE Sessions 1 and 12. Ratings of group cohesion and therapeutic bond with facilitators increased significantly across treatment. Findings indicate that caregivers from underserved families with high levels of parenting stress experienced an increase in group cohesion and therapeutic alliance throughout a telehealth adaptation of CARE. [ABSTRACT FROM AUTHOR]

Civilian cooperation with armed actors has been widely studied by conflict scholars. However, one aspect remains conceptually overlooked: instances where civilian communities cooperate while retaining their autonomy. This article proposes alliance as the core concept to understand cooperative relationships between communities and armed groups, while communities maintain autonomous self-governance. The article introduces a descriptive typology of alliances and provides a theoretical framework explaining how civilian positions and types of territory shape the various forms that alliances take. Drawing on field-based original empirical material from three rural communities in Colombia, the article illustrates how community-combatant alliances work on the ground. [ABSTRACT FROM AUTHOR]

Background: Hospitalization can be an extremely distressing experience for seriously ill and injured children. Art therapy has a well-established clinical history, and recent research has begun to demonstrate its effectiveness in somatic pediatric wards. Descriptive and statistical research indicates that art therapy can alleviate anxiety and fear, improve mood, and enhance communication among children, parents, and healthcare professionals. This study aims to enhance our understanding of the specific elements of art therapy that facilitate a connection with the healthier aspects of the self. Method: A total of 12 hospitalized children, aged 4-12, participated in an art therapy session led by a certified art therapist. Verbalizations during the sessions were recorded, and subsequent observations were synchronized with verbatim transcriptions of audio recordings. A reflexive thematic analysis was conducted to identify relevant patterns of meaning. Findings: The study identified four significant dimensions of the children's experiences during art therapy: (1) The child feels safe, (2) The child becomes a competent artist, bursting with creativity, (3) The healthy child emerges, and (4) The child achieves something beyond its limits - a triumph. Discussion: The active ingredients contributing to effective art therapy include the stimulation of creativity, guided art-making with scaffolding support, task variation, granting children control over the artistic process, encouragement of free expression, and the display of positive regard. This study also delves into the therapeutic alliance, emphasizing its role in facilitating children's learning, self-expression, concentration, and the creation of work they take pride in. Additionally, certain psychotherapy-like interactions, such as control-mastery dynamics, were observed. Nevertheless, more extensive research with larger sample sizes is required to draw broader conclusions. [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]

Background: The clinician-patient relationship has consistently been found to predict treatment success in both physical and mental health settings. This relationship has been operationalised in the literature as "Working Alliance," which consists of three key components: patient-clinician agreement on the goals of care, agreement on the tasks required to achieve those goals, and the establishment of a strong bond. While research has demonstrated the impact of working alliance in physical health settings, it often measures working alliance early in patients' care journeys. However, no primary research has investigated how early working alliance develops between patients and chiropractors. Evidence suggests that musculoskeletal practitioners may require further training to feel confident in establishing working alliance. Therefore, this study aims to explore the development of working alliance in the early stages of chiropractic care from the patients' perspective to inform evidence-based practice. Methods: Participants for this qualitative study were recruited from a teaching clinic at a specialised healthcare professions training university in the United Kingdom between September 2022 and April 2023. A total of 25 adult patients completed semi-structured interviews during the early stages of their care. The interview transcripts were analysed using Reflexive Thematic Analysis, from a critical realist stance. Results: The findings highlight that an early working alliance entails the gradual development of patients' confidence in their decision to seek help from trainee chiropractors to alleviate their symptoms. The four themes describe the impact of the clinical context on patients' expectations, the trainee chiropractors' qualities that participants considered important for early working alliance, the role of explanations, and the interplay between pain and early working alliance. Conclusions: Establishing an early trainee chiropractor-patient working alliance involves a process of building patients' confidence in the trainee chiropractors' expertise, identifying the correct goals of care, and recognising the value of the proposed treatment plan. Factors shaping this process include the context of the care journey, patients' perceptions of trainee chiropractors' qualities, their bodily sensations, their expectations, their past experiences, and their satisfaction with trainee chiropractors' explanations. [ABSTRACT FROM AUTHOR]

Background: While most studies assessing psychotherapy efficacy are randomized-controlled trials conducted in research institutions or short clinical treatments, the understanding of psychotherapy effectiveness under regular, clinically representative conditions, particularly in outpatient practice, remains limited. Representative data examining the effectiveness of psychotherapy under real-world conditions in Austria is lacking. Aims and Methods: This paper introduces a naturalistic observational combined process- and outcome study, implementing a dual-perspective approach through standardised pre- and post-treatment questionnaires and evaluating changes in the therapeutic alliance after each session. Further, semi-structured qualitative interviews aim to illuminate the personal experiences of patients and therapists. The primary objective of the presented study is to discern whether symptoms markedly decrease following therapy. A significant secondary goal is to trace the therapeutic alliance's evolution from both patient and therapist viewpoints, emphasising the alliance-outcome association and gender dynamics within the pairs. This paper discusses the project's feasibility after three years and shares key insights. Discussion: Recruitment for this study has posed substantial challenges due to psychotherapists' concerns regarding data protection, extensive documentation, and philosophical reservations about the study design. Consequently, we recruited fewer participants than initially planned. Despite these hurdles, qualitative data collection has shown notable success. Given psychotherapists' busy schedules and reluctance to participate, more potent external incentives or a legal obligation may be necessary to encourage participation in future studies. [ABSTRACT FROM AUTHOR]

Background: The Cultural Formulation Interview (CFI) is designed to improve understanding of patients’ mental health care needs. The lack of empirical evidence on the impact and effectiveness of CFI use in clarifying people’s perspectives, experiences, context, and identity, and in preventing cultural misunderstandings between migrant patients and clinicians, inspired this study. The objective is to examine the effect of the CFI on the strength of therapeutic working alliances, and the potential mediating or moderating role of perceived empathy. Materials and methods: A multicenter randomized controlled trial will be conducted, involving migrant patients, their confidants, and clinicians. The CFI will be administered in the intervention group, but not in the control group. Validated questionnaires will be used to assess therapeutic working alliances and perceived empathy. T-tests and linear regression analyses will be conducted to investigate between-group differences and possible mediating or moderating effects. Results: This study will indicate whether or not the CFI strengthens the therapeutic working alliance between patients and clinicians, as moderated and/or mediated by perceived empathy. Discussion: Research on the effect and impact of using the CFI in mental health care for migrant patients is important to clarify whether its use strengthens the therapeutic working alliance with clinicians. This can lead to a reduction in cultural misunderstandings and improve mental health care for migrant patients. The results may also be important for the implementation of the CFI as a standard of care. Ethics and dissemination: This research protocol was tailored to the needs of patients in collaboration with experts by experience. It was approved by the Ethical Review Board of the Tilburg Law School and registered in the Clinical Trials Register under number NCT05788315. Positive results may stimulate further implementation of the CFI in clinical practice, and contribute to improving the impact of the CFI on the therapeutic working alliances. [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]

Background: While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic–androgenic steroid (AAS) consumers. Objective: This study aimed to triangulate the attitudes and experiences of AAS consumers and community pharmacist's regarding AAS harm reduction. Methods: Semi-structured interviews were conducted with AAS consumers (n = 8) and community pharmacists (n = 15) between December 2022 and August 2023 in Australia. Interview data were analysed using reflexive thematic analysis. Results: While consumers emphasised easy access to pharmacies, particularly in urban areas, challenges were noted in rural regions. AAS consumers expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with AAS consumers. Similarly, pharmacists expressed receptivity to providing harm reduction information but acknowledged knowledge gaps, suggesting a need for tailored education programs to support AAS consumers effectively. Conclusions: Community pharmacies can be an important environment for AAS harm reduction. Strategies include utilising private spaces for open discussions with AAS consumers and enhancing pharmacists' understanding of AAS to foster trust and support. Further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers. [ABSTRACT FROM AUTHOR]

Objective:Method:Results:Conclusion:To investigate associations between common factors (alliance, insight, problem solving) and therapists’ techniques. We expected a positive association between (1) supportive techniques and the alliance, (2) interpretative techniques and insight, and (3) a stronger association between interpretative techniques and insight for patients with more severe baseline symptoms. Other associations were analyzed in an exploratory way.Sixty sessions from 15 adult female patients diagnosed with personality disorder were analyzed using the Psychodynamic Interventions List (verbal techniques, observer-rated transcripts), and the Session Questionnaire for General and Differential Individual Psychotherapy (common factors, patient-rated after each session). Multilevel modeling was applied.A greater use of supportive techniques was related to a higher therapeutic alliance (b = .28, 95% CI: .01–.55, p = .042). Neither the positive association between interpretative techniques and insight nor the moderating effect of baseline symptom severity could be confirmed. Exploratory analyses revealed associations between problem-solving and different verbal techniques.Therapists’ use of supportive techniques seems to influence the therapeutic alliance positively in patients with personality disorders. The effect of interpretative techniques might depend on other factors like patient characteristics. In general, there seem to be differential and specific associations between different therapists’ verbal techniques and common factors. [ABSTRACT FROM AUTHOR]

Introduction: Therapeutic alliance is a relevant aspect of healthcare and may influence patient outcomes. So far, little is known about the therapeutic alliance in telerehabilitation. Purpose: To identify and describe central elements of therapeutic alliance in the setting of telerehabilitation and compare it to those in conventional rehabilitation. Methods: In this qualitative study, a literature search and in-depth semi-structured interviews with rehabilitation and telerehabilitation experts were conducted from 15.5.-10.8.2020 on elements influencing the therapeutic alliance in rehabilitation and telerehabilitation. Using a combined deductive and inductive approach, qualitative content analysis was used to identify categories and derive central themes. Results: The elements bond, communication, agreement on goals and tasks and external factors were identified in the literature search and informed the development of the interview guide. Twelve purposively sampled experts from the fields of physiotherapy, occupational therapy, speech and language therapy, psychology, general medicine, sports science and telerehabilitation software development participated in the interviews. We identified three central themes: building effective communication; nurturing a mutual relationship of trust and respect; and agreement on goals and tasks and drivers of motivation. Conclusions: In this qualitative study, key elements of therapeutic alliance in rehabilitation confirmed those reported in the literature, with additional elements in telerehabilitation comprising support from others for ensuring physical safety and technical connectedness, caregivers acting as co-therapists and applying professional touch, and promoting patient autonomy and motivation using specific strategies. [ABSTRACT FROM AUTHOR]

AbstractObjective: Aspects of our emotional state are constantly being broadcast via our facial expressions. Psychotherapeutic theories highlight the importance of emotional dynamics between patients and therapists for an effective therapeutic relationship. Two emotional dynamics suggested by the literature are emotional reactivity (i.e., when one person is reacting to the other) and emotional stability (i.e., when a person has a tendency to remain in a given emotional state). Yet, little is known empirically about the association between these dynamics and the therapeutic alliance. This study investigates the association between the therapeutic alliance and the emotional dynamics of reactivity and stability, as manifested in the facial expressions of patients and therapists within the session. Methods: Ninety-four patients with major depressive disorder underwent short-term treatment for depression (N = 1256 sessions). Results: Both therapist reactivity and stability were associated with the alliance, across all time spans. Patient reactivity was associated with the alliance only in a short time span (1 s). Conclusions: These findings may potentially guide therapists in the field to attenuate not only their emotional reaction to their patients, but also their own unique presence in the therapy room. [ABSTRACT FROM AUTHOR]

COVID-19 has been defined as one of the biggest collective traumas faced by the human population worldwide. Thus, there is a need for trauma-focused psychotherapy during the pandemic. Due to the highly transmissive virus, the safest and most realistic option for conducting trauma-focused psychotherapy was through online platforms, since then online psychotherapy has been one of the most preferred ways of conducting psychotherapy. The current article reviewed available literature, to illustrate different potential challenges and obstacles mental-health practitioners face when providing trauma-focused online psychotherapy in Malaysia. These challenges are categorized into (a) ethical issues, (b) therapeutic relationships and environment, (c) techniques, and (d) psychotherapists' self-care. Practical research-driven suggestions were provided to tackle these challenges. [ABSTRACT FROM AUTHOR]

Working alliance is a key predictor of therapy outcomes, and observer ratings offer an objective perspective. This study adapted the Working Alliance Inventory-Observer Form (WAI-O) for Bahasa Indonesia psychotherapy settings. It involved 15 therapist-patient dyads and three expert observers. The study correlated third-session WAI-O scores with sixth-session therapist-rated improvements for predictive validity and with WAI-client and WAI-therapist scores for construct validity. The Indonesian WAI-O demonstrated moderate predictive validity, no significant convergent validity, and excellent reliability, with a Cronbach's alpha of 0.994 and an ICC of 0.628. Preliminary evidence supports the Indonesian WAI-O's reliability and potential validity for predicting overall clinical improvement, but further research with a larger sample size is suggested to fully establish its validity. [ABSTRACT FROM AUTHOR]

Therapists' experience with teletherapy pre-pandemic differed widely across countries. We explored potential differences in teletherapy use in therapists in China and the USA in 2020. Results showed that pre-pandemic, therapists in China had more teletherapy training and experience, and they also had more positive views about teletherapy. During the pandemic, both groups reported more positive views on the effectiveness of teletherapy. Unlike the therapists in China, therapists in the USA reported an increase in their use of self-disclosure. Therapists reported similar experience with the therapeutic relationship. These findings highlight general similarities along with specific differences between the groups, and future research is needed to examine teletherapy experiences and to develop effective therapist trainings, outside of the pandemic context. [ABSTRACT FROM AUTHOR]

Analysing transitional justice mechanisms in the non-liberal transition of post-revolutionary Egypt, from the overthrow of Hosni Mubarak to the election of 'Abd al-Fattah al-Sisi, this article seeks to enhance the understanding of the character of the transition period and the re-establishment of authoritarianism in Egypt, but also to shed light on the implications of the manipulation of transitional justice in order to bolster repressive structures in non-liberal transitions. Based on analysing transitional justice as a contested process whose mechanism and outcomes are shaped according to specific domestic power structures and coalitions, the article argues that the ability of Egypt's elites, led by the military, to control the transitional justice process and to manipulate it to enhance their power and interests depended on their coercive capacity but was also a product of their ability to utilise the deep gaps among political forces, which had different interests and perceptions regarding transitional justice (reformative or revolutionary) in order to create shifting alliances and agreements on the boundaries of transitional justice and hence affect its outcomes. [ABSTRACT FROM AUTHOR]