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Anxiety is highly prevalent, but undertreated, in primary care. Brief, non-pharmacological interventions are needed. Modular Anxiety Skills Training (MAST), a cognitive-behavioral anxiety intervention, was developed for primary care and tailored for a Veteran sample (MAST-V). The purpose of this mixed methods pilot study was to evaluate MAST-V's feasibility, acceptability, and implementation potential, and preliminarily examine its effectiveness compared to Primary Care Behavioral Health (PCBH) usual care. This hybrid I randomized controlled trial (conducted 2019–2021) assigned 35 primary care patients (M age = 47, 17 % female, 27 % racial/ethnic minority) with clinically significant anxiety symptoms to receive MAST-V or PCBH usual care. Participants completed validated measures of anxiety symptoms and functional impairment at 0, 4, 8, 12, and 16 weeks. Participants attended more sessions in MAST-V than usual care. After necessary adjustments to reduce session duration, MAST-V will likely fit within PCBH practice parameters. Participants in both conditions valued treatment, but treatment satisfaction, credibility, and therapeutic alliance were higher for MAST-V. Study therapists achieved high treatment fidelity and rated MAST-V as highly feasible, acceptable, and appropriate for PCBH. They identified ways to address potential barriers to implementation. MAST-V was more effective than usual care in reducing anxiety symptoms and impairment. This was a small pilot study at a single site using study therapists. Results should be considered preliminary until replicated in a full-scale clinical trial. This brief modular anxiety intervention, which was designed with implementation in mind, may help to address the anxiety treatment gap in primary care. • Brief nonpharmacological anxiety interventions feasible in primary care are needed. • We conducted a pilot RCT of a modular cognitive-behavioral anxiety intervention. • The intervention was feasible and highly acceptable for patients and therapists. • Clinical outcomes improved more than with usual care (primarily supportive therapy). • The intervention's potential for implementation in routine primary care is high. [ABSTRACT FROM AUTHOR]

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 discusses the prevalence of depression and delirium among surgical patients, particularly older adults. It highlights the importance of screening for depression in peri-operative settings and the increased risk of postoperative delirium for patients with depression. The article suggests that depression may serve as a predictor of delirium and an opportunity for diagnosis and treatment. It also discusses the evolving focus of perioperative care, which now includes interventions aimed at improving patients' quality of life after surgery. The article emphasizes the need for further research to determine the efficacy and safety of perioperative mental health interventions. [Extracted from the article]

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]

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]

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]

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

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

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]

Objectives: While medical education requires frequent interactions with attending physicians and supervisors, little research has explored the role of supervisory alliance in the learning process. In other learning environments, supervisory alliance, or the bond between a supervisor and trainee, is considered a key ingredient of effective supervision. Medical educators or attending physicians who aim to enhance learning and engagement in medical education may benefit from understanding specific factors that increase or decrease engagement and how those might intersect within a context that requires learning through supervision. This cross-sectional study examined associations between supervisory alliance and (a) program satisfaction, (b) educational engagement, (c) and career purpose. Methods: Participants were medical trainees from the rural Northeast (n = 108, response rate = 81%) who completed an electronic and anonymous survey. Results: Multiple linear regression was used to examine whether total supervisory alliance independently predicted behavioral and emotional engagement in learning while controlling for hours slept, hours worked, and burnout. Supervisory alliance predicted trainees' career purpose, program satisfaction, and emotional engagement in learning. Conclusions: Findings from this study lay groundwork for consideration of the role of supervisory alliance in medical learning processes. Future research might explore whether targeted mentorship programs or faculty enhancement training that focuses on the supervisory relationship might positively impact learning outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To provide pragmatic guidance for acute rehabilitation management and implementation of early mobility for individuals with critical illness due to COVID-19. Methods: Clinical perspective developed through reflective clinical practice and narrative review of best available evidence. Results: Current clinical practice guidelines do not provide guidance for implementation of early mobility interventions for individuals with critical illness due to COVID-19 who require enhanced ventilatory support or support of inhaled pulmonary artery vasodilators. Many individuals who may benefit from implementation of early mobility interventions are excluded by strict interpretation of current guidelines. Conclusions: Risk vs benefit of implementing early mobility interventions in individuals with critical illness due to COVID-19 can be mitigated through coordinated efforts of interdisciplinary teams to promote shared decision-making through therapeutic alliances with patients and their families. Clinicians must clearly define the goals of care, understand the limitations of monitoring equipment in the intensive care unit, prepare to titrate levels of oxygen based on an individual's physiologic response to mobility interventions, and help individuals maintain external goal-directed focus of attention to optimize outcomes of early mobility interventions. IMPLICATIONS FOR REHABILITATION: Current clinical practice guidelines do not provide guidance for implementation of early mobility interventions for individuals with critical illness due to COVID-19 who require enhanced ventilatory support or support of inhaled pulmonary artery vasodilators. Risk vs benefit of implementing early mobility interventions in individuals with critical illness due to COVID-19 can be mitigated through coordinated efforts of interdisciplinary teams to promote shared decision-making through therapeutic alliances with patients and their families. Clinicians must clearly define the goals of care, understand the limitations of monitoring equipment in the intensive care unit, prepare to titrate levels of oxygen based on an individual's physiologic response to mobility interventions, and help individuals maintain external goal-directed focus of attention to optimize outcomes of early mobility interventions. [ABSTRACT FROM AUTHOR]

Background: Patient-centered care aims to prevent disease and promote well-being by actively involving patients in treatment and decision-making that is based on respecting the patients and their families. However, no scales have been developed to assess patient-centered care from the nurse's perspective. This study aimed to develop a scale to measure nurses' level of patient-centered communication and confirm its validity and reliability. Methods: A methodological cross-sectional study was adopted to develop and validate the Patient-Centered Communication Scale (PCCS). The items were developed through a literature review and online interviews with nurses. Content validity was assessed by experts and the content validity index was calculated. A pretest of the questionnaire was conducted with 10 clinical nurses. To evaluate the factor structure and internal consistency reliability, the PCCS was administered online to 325 nurses in South Korea. Data were analyzed using descriptive statistics, explanatory factor analysis (EFA), and confirmatory factor analysis (CFA). Results: The final instrument consisted of 12 items and three factors: (1) information sharing, (2) patient-as-person, and (3) therapeutic alliance. EFA revealed a distinct three-factor structure, explaining 59.0% of the total variance. CFA confirmed the adequacy of the model fit and validated the inclusion of the final items. The Cronbach's alpha values ranged from 0.60 to 0.77, indicating acceptable internal consistency. Convergent validity was evidenced by the correlation between the PCCS and a measure of interpersonal communication competence. Conclusions: The 12-item PCCS showed good reliability, construct validity, and convergent validity. The scale has utility for measuring the level of patient-centered communication skills in nurses. [ABSTRACT FROM AUTHOR]

AbstractObjective: Although therapists are encouraged to balance emotionally involving work on the patient’s problems with need satisfaction in therapy sessions, effects of this balance have rarely been studied empirically. Hence, we examined congruence effects between problem-related affective and need-satisfying experiences in cognitive–behavioral therapy (CBT). Method: 165 distressed family caregivers rated problem-related affective experiences, need-satisfying experiences comprising self-esteem, positive interpersonal, and control experiences, as well as coping experiences after 12 CBT sessions. We examined within-person congruence effects of problem-related affective and need-satisfying experiences on subsequent coping in multilevel response surface analysis. Further, we included between-person problem-related affective and need-satisfying experiences and pretreatment depression and anxiety as moderators of within-person effects. Results: A slight predominance of self-esteem over problem-related affective experiences as well as exact correspondence between problem-related affective and both interpersonal and control experiences was most predictive of coping. Between-person moderators supported a cross-level balance heuristic of problem-related affective and self-esteem experiences. Finally, a stronger emphasis on self-esteem and interpersonal over problem-related affective experiences proved more beneficial for patients with high anxiety and low depression. Conclusions: The findings highlight the importance of balancing problem-related affective and need-satisfying experiences in CBT and provide insights into how balancing may be tailored to specific patients. [ABSTRACT FROM AUTHOR]

Background: Most patients with cervical radiculopathy improve within the first months without treatment or with non-surgical treatment. A systematic review concluded that these patients improve, regardless of their intervention. Still, many patients are offered surgery, despite limited evidence regarding the indications for surgical treatments. The aim of this article is to describe the intervention that is going to be followed in the non-surgical treatment arm of a randomised controlled trial (RCT) comparing the effectiveness of surgical and non-surgical treatment for patients with cervical radiculopathy. Methods: The non-surgical intervention is a functional intervention within a cognitive approach founded on previous experiences, and current recommendations for best practice care of musculoskeletal pain and cervical radiculopathy. It is based on the biopsychosocial rather than a biomedical perspective, comprises an interdisciplinary approach (physicians, physiotherapy specialists), and includes brief intervention and graded activities. The intervention consists of 6 sessions over 12 weeks. The primary goals are first, to validate the patients´ symptoms and build a therapeutic alliance, second, to explore the understanding and promote alternatives, and third, to explore problems and opportunities based on patients´ symptoms and function. Motivational factors toward self-management are challenging. We will attempt shared decision-making in planning progress for the individual patient and emphasise learning of practical self-help strategies and encouragement to stay active (reinforcing the positive natural course). General physical activities such as walking will be promoted along with simple functional exercises for the neck- and shoulder region. We will also explore social activity, comorbidities, pain location, sleep, and work-related factors. The health providers will set individualised goals together with each patient. Discussion: The aim of the intervention is to describe a functional intervention within a cognitive approach for patients with chronic cervical radiculopathy. The effectiveness of the present program will be compared to surgery in a randomised controlled trial. [ABSTRACT FROM AUTHOR]

Our model extends the joint-products models to allow for two types of defence inputs used to produce both an alliance-wide public defence output and a country-specific private output. Distinguishing different defence inputs is particularly appropriate in the case of the North American Aerospace Defense Command (NORAD), as the alliance-wide defence output is produced with two inputs – military technology in the form of sensors and radars and land. These two inputs are complements in the production of the alliance-wide public output. At the same time, the military technology has country-specific private benefits as this can be used by the civilian economy. Our analysis shows that distinguishing between defence inputs may change the predictions of the joint-products model. We derive conditions under which an ally responds to an increase in the defence input by other allies by increasing or decreasing its own contribution of both or only one of the defence inputs. [ABSTRACT FROM AUTHOR]

The struggle to distinguish a clear professional identity has been an ongoing issue for counselling psychology. In Australia, this struggle has been associated with discrepancies between the definition and competencies of counselling psychologists. This is further exacerbated by the overlap between clinical and counselling psychologists' scopes of practice. This research contributes to the ongoing discussion surrounding the similarities and differences between clinical and counselling psychology. A web-based survey was distributed to Australian counselling psychologists (n = 290) seeking information regarding respondents' demographics and their perceptions of the similarities and differences between clinical and counselling psychology. Reflexive thematic analysis generated three key themes: 1) overlap in the scope of practice and competencies of clinical and counselling psychologists; 2) the philosophy of counselling psychology; and 3) the negative impact of the Better Access scheme on counselling psychology. These findings indicated that despite overlap across core competencies, counselling psychologists perceive they are a distinct area of practice to clinical psychology. In identifying counselling psychologists' perceptions of the similarities and differences between the two areas of practice endorsement, this study has the potential to clarify scopes of practice and perceived competencies. What is already known about this topic: Professional identity has been identified as an issue for Australian counselling psychologists. A lack of clarity exists over counselling psychology's similarities and differences with clinical psychology. No prior comparisons of similarities and differences between the two areas of practice endorsement have been published with Australian psychologists. What this topic adds: Participants perceive an overlap in the competencies and scope of practice of clinical and counselling psychologists. Counselling psychologists perceive a unique philosophy and orientation to practice. External factors, such as funding schemes, have negatively impacted on public understanding and recognition of counselling psychology. [ABSTRACT FROM AUTHOR]

This was a mixed methods cross-sectional study evaluating OPD EERSS services in London. This included whether engagement with EERSS improved service participants' well-being and relationships with others, and reduced risk. Participants completed self-reported measures on working alliance, psychological distress, and well-being; and at different time points of service participation, were compared on outcomes including risk and attendance at statutory appointments. EERSS were compared to two control groups; the Intensive Intervention Risk Management Service (IIRMS) group, and a 'no-intervention' OPD screened-in group. A subsample of EERSS participants took part in qualitative interviews. Findings highlighted the positive impact of EERSS and IIRMS; in particular, that participants in those services improved their attendance at statutory probation appointments, compared to controls. There was a positive indication of improvement in well-being and risk. Qualitative findings identified aspects of the therapeutic alliance which improved well-being and engagement with probation. In conclusion, EERSS added value to the OPD pathway and may be deserving of wider rollout. [ABSTRACT FROM AUTHOR]

Palliative care (PC) clinicians are well poised to help people with disabilities (PWD) live well in the context of serious illness. PC prioritizes person-centered care with a focus on function, autonomy, and quality of life. This approach aligns with principles of high-quality care for PWD. An understanding of the unique experiences and needs of PWD can advance the delivery of comprehensive, equitable PC for this population. In this article, we provide 10 tips to help PC clinicians develop an informed disability lens in their approach to care. [ABSTRACT FROM AUTHOR]

Therapeutic relationships play a central role in maintaining a positive social climate in forensic settings. The interpersonal difficulties characteristic of Borderline Personality Disorder, alongside the secure environment of forensic wards, can make developing positive therapeutic relationships with this patient group challenging. Qualitative interviews aimed to explore how ward staff understand and experience the interaction of interpersonal relationships and social climate when caring for patients with Borderline Personality Disorder on forensic wards. Interviews with 11 staff members working across UK forensic inpatient settings were analysed using Reflexive Thematic Analysis and reported following COREQ guidelines. Six interrelated themes were generated; three describe relational cycles that occur between ward staff and patients with Borderline Personality Disorder and three describe systemic factors that influence the context in which ward staff operate. From these themes, an integrative model was developed to summarise how factors in the wider forensic system and the interpersonal relationships between staff and patients with Borderline Personality Disorder in forensic wards influence one another, affecting staff experiences of the social climate of forensic settings. The model illustrates how complex cycles within the therapeutic relationships with staff and patients with Borderline Personality Disorder can interact with systemic influences in the wider forensic context to influence staff experiences of forensic settings. Clinical implications of the model are discussed, offering recommendations for improving therapeutic relationships and the social climate on forensic wards caring for patients with Borderline Personality Disorder, to better support staff and patient wellbeing. [ABSTRACT FROM AUTHOR]

The number of Australians subject to coercive interventions in community mental health services continues to increase. This is in the context of a growing awareness of the harms from coercion, increasing concerns about potential breaches of human rights and an ongoing uncertainty regarding the clinical benefits of community treatment orders, the primary instrument of legislated coercion in community mental health services. Nurses in community mental health services are on the frontline with regard to coercion. They police the requirements of the community treatment order, administer medication to people in community settings without their consent and facilitate re‐hospitalisation if indicated. Coercive practice contradicts the person‐centred, recovery‐oriented and trauma‐informed care principles that inform contemporary mental health nursing. This contradiction may generate ethical challenges for nurses and result in ethical distress. The aim of this scoping review was to map the research literature on how nurses in community mental health settings recognise and manage the harm associated with the administration of coercive interventions and consider the ethical challenges that may arise within this practice. The search strategy yielded 562 studies with author consensus determining a total of three articles as meeting the inclusion criteria. The resulting literature identified three themes: (1) maintaining the therapeutic relationship, (2) promoting autonomy and (3) using subtle forms of control. This review demonstrated that there is minimal research that has considered the ethical challenges related to the use of coercion by nurses in community mental health settings. [ABSTRACT FROM AUTHOR]

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

Research shows that, in mental healthcare, empathy and active listening skills play a fundamental role in the therapeutic relationship. Despite this, clinicians receive little training in cultivating these qualities, and there is a dearth of training in therapeutic relationships and relational care in this field more generally. In response to this paucity of training, a new intensive three-day training programme has been developed called Compassionate and Relational Enquiry (CARE). The CARE training programme has recently been delivered to a number of mental health teams in different boroughs of an NHS Trust and has undergone several rounds of redevelopment. This paper outlines the CARE training programme's objectives and mode of delivery, and subsequently presents questionnaire results from recent CARE trainees regarding their experience of the nature and utility of the training. Four main themes emerged from responses to the question of the utility of the training, these were 'A shift towards more person-centred care', 'Strengthens the therapeutic relationship', 'Facilitates more collaborative care with patients and their families' and 'Development of new skills and therapeutic techniques'. The paper concludes by discussing the potential of this training to help forge a substantial shift in the culture of mental health services in a systemic way. [ABSTRACT FROM AUTHOR]

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

BACKGROUND: The oncology care environment includes a wide range of traumatic physical and emotional experiences that can be challenging for patients and healthcare providers. OBJECTIVES: This article aims to establish a knowledge base about the trauma-informed care (TIC) approach in oncology care. METHODS: This article provides a literature-based overview of TIC as a model of care for patients with cancer, informed by definitions of trauma, post-traumatic stress disorder, and adverse childhood experiences. This review is based on clinical studies, expertise, and evidence-based guidelines. FINDINGS: Based on a foundation of care for patients with cancer, nurses can apply TIC to clinical oncology practice. To illustrate TIC in practice, this article includes a case study, nursing approaches, implications, the TIC model of care, and resources. When applied to care, TIC benefits patients, staff, and organizations. [ABSTRACT FROM AUTHOR]

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

Impaired ability to develop trusting relationships, self-dysregulation, poor emotional regulation, poor self valuation, and relational sensitivity are key challenges for survivors of Childhood Sexual Abuse. These increase the risk of ruptures in the therapeutic relationship and dropouts. Nevertheless, there is little evidence of the role of therapeutic trust in CSA. We collectively present the findings of a 15-year research journey into CSA recovering. Central to recovering was the establishment and maintenance of trust. Trust was also key for client satisfaction and facilitating the recovering process. Trust mediated regulation of threat responses, facilitated empathy, and enabled accurate symbolisation and re-contextualisation of traumatic narratives. In an increasingly traumatogenic world, more clinicians will be called to respond to disclosures of abuse and maintain engagement. Given the lack of effective interventions for CSA/complex trauma, trust-based person-centred psychotherapies are a promising alternative for managing dropouts, supporting the therapeutic relationship, and facilitating change. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodResultsConclusionTherapeutic alliance has been little investigated in infant and toddler therapy, with no tools specifically adapted to this population. However, we have developed the Infant-Toddler Working Alliance Inventory-Short form (IT-WAI-S) which is based on the Working Alliance Inventory. The aim of this study was to assess the psychometric properties of this original French tool, in its two versions: for parent (IT-WAI-SP) and for therapist (IT-WAI-STh).This study included 227 families consulting with their 18–48-month-old child for emotional or behavioral disorders. The scales were filled in at the first three therapy sessions. The IT-WAI-S acceptability, internal validity, reliability and predictive validity (association with child and mother’s outcomes) were evaluated.Confirmatory then exploratory factor analyses revealed a three-factor structure for the both scales: Negative Experience of Care Relationship, Positive Alliance and Alliance with the Child. Acceptability, reproducibility and construct validity were satisfactory for both versions. The two versions predicted the child's outcome. The IT-WAI-SP predicted also the mother’s outcome. The IT-WAI-STh gave more reproducible results, whereas the IT-WAI-SP was a better predictor of the child's progress.The two IT-WAI-S versions showed good psychometric properties and could be used to study the therapeutic alliance in young children. [ABSTRACT FROM AUTHOR]

Overnight observations of mental health inpatients have been criticised for interrupting inpatients' sleep and potentially undermining recovery. No studies have examined the perceptions of mental health nurses who complete overnight observations, limiting key information necessary to guide improvements. This study aims to understand mental health nurses' perceptions on overnight observations and views on practice re-evaluations, as well as assess whether nurses' perceptions align with inpatients as reported in previous research. To fulfil the aims ten mental health nurses working on mental health inpatient units engaged in semi-structured interviews which were analysed using Content Analysis. Nine themes were identified and grouped into three categories: (1) staff and inpatient experiences, (2) impacts on treatment, recovery, and risk management, and (3) opinions on change. Majority of participants were critical of overnight observations, describing their negative impacts on inpatients' sleep and wellbeing. This aligns with previously reported inpatient views. There is scope for reassessment on how overnight observations are conducted to promote inpatients' sleep, recovery, and safety. [ABSTRACT FROM AUTHOR]

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

Background: Therapeutic alliance and decreases in negative cognitions may play an important role in the outcomes of child trauma-focused cognitive behavioral therapy. However, understanding alliance from multiple perspectives (i.e., therapist, parent, and child) and if changes in negative cognitions differ by type of delivery is limited. Objective: The current study examined therapist, parent and child therapeutic alliance and child negative cognition changes over time and as potential mediators of outcomes between Step One, a parent-led therapist-assisted cognitive behavioral therapy (CBT), and therapist-led Trauma-Focused CBT (TF-CBT). Methods: Therapist, parent and child therapeutic alliance, child negative cognitions, child posttraumatic stress symptoms (PTSS) and impairment were assessed at the first session, mid-treatment and near the end of treatment among child-parent dyads in Step One (n = 43) and TF-CBT (n = 71). Child PTSS and impairment were also assessed at post-treatment. Results: The rate of change in therapist and parent therapeutic alliance within Step One and TF-CBT did not significantly differ. Changes over time in child alliance ratings differed with a convex curve for Step One and a concave curve for TF-CBT children. Similar decreases in negative cognitions in Step One and TF-CBT children occurred. Neither therapeutic alliance (therapist, parent, and child) nor negative cognitions were mediators of PTSS and impairment outcomes. Therapist therapeutic alliance over time, across treatments was a predictor of child PTSS. Conclusions: Change rates in child therapeutic alliance differs with a parent-led therapist-assisted treatment versus TF-CBT. Therapist alliance may influence child PTSS outcomes in a parent-led and therapist-led CBT treatment. Clinical Trial Registration Information: Stepped Care for Children after Trauma: Optimizing Treatment: https://clinicaltrials.gov: NCT02537678. [ABSTRACT FROM AUTHOR]

To investigate clinimetric properties of 2 surveys used to evaluate common factors in the patient-provider relation and present screener options for the assessment of common factors and report their correlation with pain and functional outcomes. Observational cohort. Outpatient physical therapy. 100 individuals (58% women, mean age=34, SD=15; N=100) presenting to physical therapy with musculoskeletal pain in the following regions: 44% lower extremity, 36% spine, 19% upper extremity, 1% undetermined. Not applicable. Participants completed the Working Alliance Inventory (WAI) and the Credibility and Expectancy Questionnaire (CEQ). Exploratory factor analysis (EFA) explored factor structure of the WAI and CEQ. Internal consistency was evaluated for scales derived from items retained based on factor loadings. Finally, options for screener tools were proposed and assessed based on their correlation to original surveys as well as pain and functional outcomes. The data supported a 4-factor structure for the surveys. Some WAI items were excluded due to cross-loading. The derived four-factor scales demonstrated strong correlations with the original surveys (r =.89-.99) and exhibited good internal consistency (α=.824-.875). Two screening options were suggested: 1 retaining 11 of the original 18 items and the other comprising just 3 items. Both screening tools correlated with the original surveys and showed associations with improvements in pain and functional outcomes (r =-.21-.34). The proposed screeners provide concise measurement options to facilitate use in clinical practice. These tools can aid in facilitating patient communication specifically addressing patient expectation and understanding the tasks required to enact behavior change. [ABSTRACT FROM AUTHOR]

This evidence-based opinion piece explores the totalising risk averse nature of secure and forensic mental health services and associated iatrogenic harms in England and Wales. Drawing on the research literature I consider the various influences, both external and internal which impact on the provision of such services and how both the therapeutic alliance and recovery potential for patients may be improved. Especial attention is paid to the deployment of restrictive practise, practitioner attitudes, the potential for non-thinking, and how these may impact on decision-making and the care and treatment of mentally disordered offenders. [ABSTRACT FROM AUTHOR]

Transgender and nonbinary (TGNB) people report experiencing discrimination from therapists. A step to reducing these microaggressions is for therapists to be able to identify them. Psychological trainees and psychologists (n = 105) were randomly assigned to watch a video vignette therapy session: a session with (a) blatant therapist microaggressions (nonaffirming), (b) therapist-led transition focus (transition affirming), and (c) gender exploration focus (nonbinary affirming). There was no difference in microaggression detection between the two affirming conditions. The microaggression condition of participants had a negative effect on ratings of therapist multicultural orientation (MCO). Additionally, attitudes towards transgender people moderated the relationship between microaggression conditions and ratings of therapist's cultural humility for the affirming conditions; participants in the nonbinary affirming condition rated the therapist more culturally humble as their positive attitudes towards TGNB people increased, and participants rated the therapist as less culturally humble as TGNB attitudes increased in the transition affirming condition. [ABSTRACT FROM AUTHOR]

The central aim of the current study is to further the understanding of how therapists identify and understand erotic transference in therapy, and how they perceive it to influence the therapeutic processes and alliance. Answers were analyzed thematically using an open-coding analysis. A total of 116 therapists participated in the study reflecting on how erotic transference is experienced in the therapeutic setting. Data analysis yielded three main themes: (1) threat; (2) boundaries; and (3) growth. The threat theme included two subthemes: Threat to the therapeutic process and threat to the therapist’s professional-esteem. Growth also consisted of two subthemes: development of the therapist and opportunity for insight (into the inner world of the patient). The present study subscribes to the idea that erotic transference is a significant aspect of the therapeutic setting and, if addressed appropriately and more comprehensively, can have a great impact on the patient’s healing process. [ABSTRACT FROM AUTHOR]

IntroductionObjectiveMethodResultsConclusionDigital options for osteoarthritis (OA) treatment are increasingly available with high patient satisfaction and acceptability. Little is, however, known about physical therapists’ (PT) perception of this treatment modality.To investigate PT’s experience of delivering digital treatment for hip and knee OA using a smart-phone application.Nine PTs (mean age 36 years, women n = 5) with 3–24 months experience of delivering digital OA treatment were interviewed using a semi-structured interview guide. The interviews were transcribed verbatim and analyzed using content analysis.Four main categories arose; 1) A feeling of being part of the future, 2) Making an osteoarthritis diagnosis in a digital setting, 3) Facilitators and barriers of digital OA management and 4) Where to go from here? PTs were in general positive for digital treatment delivery but felt that a lack of visual assessments and physical examinations to enhance exercise evaluations and diagnosis accuracy was sometimes a disadvantage.Digital treatment delivery was in general perceived as a time-efficient way of providing high-quality care that may increase patient motivation and adherence without violating the therapeutic alliance. Future implementations of digital OA treatment programs should consider the possibility of including real-time video calls for visual assessment. [ABSTRACT FROM AUTHOR]

Background: Hybrid models that integrate both in-person and remote health services are increasingly recognized as a promising approach. Nevertheless, research that defines and characterizes these models in children and young people is scarce and essential for establishing guidelines for implementation of hybrid allied health services. This scoping review evaluates four key aspects of hybrid allied health services in children and young people: 1. definitions, 2. service characteristics, 3. outcome measures, and 4. results of hybrid allied health services. Methods: Six databases were searched: Medline (Ovid), Embase, CINHAL, Psycinfo, Cochrane CENTRAL, and Web of Science. Of the 9,868 studies potentially meeting the inclusion criteria, 49 studies focused on children and young people. Following full-text review, n = 21 studies were included. Results: Terminology used for hybrid allied health services varied across studies which targeted diverse clinical populations and varied in study design, type and frequency of remote and in-person treatments. Over 75% of cases used custom-written software, limiting scalability. All interventions started in-person, possibly to establish a therapeutic alliance and solve technological issues. Most hybrid allied health services (67%) were in mental health, while only a minority involved physical, occupational or speech therapy. The most common outcomes were feasibility and satisfaction, but tools used to measure them were inconsistent. Although 57% of studies demonstrated effectiveness of hybrid allied health services, none measured cost-effectiveness. Discussion: Despite the potential of hybrid allied health services for children and young people, the literature remains at a preliminary stage. Standardization of definitions and outcome measures, and clearer reporting of service characteristics and results would likely promote consolidation of hybrid allied health services in children and young people into clinical practice. [ABSTRACT FROM AUTHOR]