Client Change Research Articles

미술치료 전공 학부생의 임상실습, 수퍼비전, 학부과정 경험에 대한 질적 연구

Objectives The purpose of this study is to explore through qualitative research the experiences of undergraduate students majoring in art therapy in clinical practice, supervision, and undergraduate courses, and to analyze the intrinsic meaning of these experiences. Methods Data were collected through two in-depth interviews with six undergraduate students majoring in alco-hol treatment. The interviews used a semi-structured questionnaire to encourage undergraduate students to talk freely about their experiences in clinical practice, supervision, and undergraduate courses. The collected data were analyzed using open coding according to qualitative research methodology, and themes were derived inductively. Through this, the main themes and subcategories experienced by the participants were identified and the research results were derived. Results As a result of the analysis, 6 main areas, 14 categories, and 37 subcategories were derived. In clinical practice, external factors such as conditions of the practice institution, workload, communication between thera-pists, and changes in clients, and internal factors such as self-criticism, tension while performing roles, and sense of accomplishment after practice were identified. The supervision experience consisted of process aspects such as close supervision and shared experiences with colleagues, as well as academic and emotional support from the supervisor. During the bachelor's course, self-exploration, anxiety and burden about art work, and interaction with classmates served as factors that promoted improved future vision and psychological growth. Conclusions These findings provide significant implications for establishing criteria for selecting clinical practice institutions, improving supervision education, and enhancing the role of school education in undergraduate pro-grams aimed at training art therapists.

음주 문제가 있는 두 청년 내담자의 가족치료 사례연구

Objective: The purpose of this study is to examine factors influencing clients’ drinking problems and changes in clients and their families depending on intervention methods of therapists, focusing on two family therapy cases involving conflicts due to children’s drinking problems. Methods: The study utilized a case study method, allowing for an in-depth examination of the cases. Results: This study found that the factors influencing the children’s drinking problems included personal factors, family factors, and socio-cultural factors. Personal factors were high anxiety and avoidant tendencies. Family factors included issues stemming from the parents’ families of origin, negative parenting styles, dysfunctional communication methods, and a family culture tolerant of drinking. Socio-cultural factors included patriarchal culture and a preference for sons. Conclusions: The findings of this study show a multifaceted analysis of the factors influencing children’s drinking problems and elucidate the cyclic nature of these factors. Additionally, this study is meaningful in providing practical techniques based on family therapeutic interventions for families with children’s drinking problems.

What do clients think about amplifying positivity? Client change perspectives following a cognitive and behavioural positive activity intervention for anxiety and depression

AbstractBackgroundThe positive valence system (PVS) is increasingly recognised as an important target in facilitating recovery from anxiety and depression. Amplification of positivity (AMP), a cognitive and behavioural intervention, targets the PVS through repeated and intentional activities (e.g. savouring positive experiences, gratitude and acts of kindness). Initial data demonstrate that AMP engages positive valence targets (e.g. positive affect) and outcomes (e.g. social connectedness) in people seeking treatment for anxiety or depression; however, client perspectives on AMP are not well understood. This study aimed to qualitatively explore clients' experiences to better understand post‐treatment client changes and advance the development and effectiveness of AMP and other emerging positive valence‐focussed interventions.MethodsTranscripts were analysed from 11 participants who completed an optional qualitative interview after completing AMP treatment in a randomised controlled trial (NCT04945239).ResultsTwo superordinate themes with several subthemes emerged. The first theme, Changes in Self, revealed common changes consistent with the core targets of AMP, as well as changes less explicitly targeted by AMP. The second theme, The Positivity Pivot, uncovered clients' perceptions on the emphasis of positive emotions in treatment. Overall, clients enjoyed and reaped benefits from amplifying positivity; some clients also reported wanting more time and space to discuss negative valence symptoms.ConclusionPeople seeking treatment for anxiety or depression are receptive to amplifying positivity and experience the mental and social benefits of doing so. Positive valence‐centred treatments may therefore be valuable for some clients. Treatment protocols that integrate positive valence‐ and negative valence‐targeted approaches may be preferred by some clients.

An initial validation of a new measure of client change in a correctional sample

ABSTRACT Ideally, when an individual enters the Criminal Justice System there is the goal and expectation that they will, over time and through intervention, change from the individual who perpetrated the crime(s) toward adopting a non-criminal identity. However, there are currently few measures of change with established validity for predicting post-program or post-release outcomes with correctional samples. The Client Change Scale [CCS; Serin & Lloyd, 2018] was developed to address this gap to provide an empirically grounded systematic measure of factors relevant for change. This study was the first to assess the psychometric properties of the CCS with post-release outcomes and to predict recidivism outcomes with a Canadian release cohort using archival data. The sample included 390 adult males under community supervision by the Correctional Service of Canada (CSC) between 2015 and 2017. Overall, the CCS reflected acceptable psychometric properties. Additionally, an exploratory factor analysis revealed that all 16 items of the CCS should be retained and provided evidence for separate but correlated consideration of internal and external change factors. These initial findings suggest the CCS has the potential to improve decision-making throughout an individual’s time in the criminal justice system by utilizing a person-centered approach in support of improving client success and subsequent public safety.

상담사의 범죄경력 가족 상담 경험에 대한 질적 연구

This study was conducted to examine the counseling experiences of professional counselors who participated in the Family Psychological Support Project conducted by the Gyeonggi Branch of the Korea Legal Protection and Welfare Corporation from 2022 to 2023, and to explore improvements and complementary points of the project from the perspective of professional counselors. The study was conducted among six counselors, five of whom were affiliated with Gyeonggi National University, and aimed to help provide more suitable and efficient programs and practical institutional support for criminal offenders and their families. The research method used a phenomenological research method that can reflectively analyze participants' experiences in terms of structure and subjectivity, and in the data analysis, iterative comparative analysis was applied to deeply explore the inner experience and define the meaning of a total of 633 consultations in 28 cases from 2022 to 2023. As a result of the research analysis, 57 semantic units were derived, which were grouped into 12 components, which were further categorized into 5 categories. Category 1. 'Feelings before participating in counseling' consisted of two components, 'Worry and curiosity about clients with special needs' and 'Challenging new types of clients', with three and two semantic units, respectively. Category 2. 'Difficulties and obstacles' consisted of four components: 'Limitations faced in the counseling process', 'Clients' insincere attitude to participate in counseling', 'Lack of family cooperation and support', and 'Difficulties due to the situation faced by the client', with seven, three, five, and three meaning units respectively. Category 3. 'Emotions felt while participating in the project' consisted of three components: 'Emotions felt in the counseling scene', 'Gratitude and regret for institutional support', and 'Activeness of support from the industrial complex', with 9, 2, and 4 meaning units, respectively. Category 4. 'Positive outcomes' consisted of two components, 'Positive changes in clients through counseling' and 'Capacity enhancement of counselors', with 7 and 3 meaning units, respectively. Category 5. 'Effective improvement direction of business' is 'business and counseling support area', which has a total of 1 component and 7 meaning units. Based on these findings, we discussed the improvements and deficiencies of the Family Psychological Support Project and made recommendations to provide more suitable and efficient programmes and practical institutional support for criminal offenders and their families.

The person behind the therapist: a recall study on significant events that contribute to therapists' personal and professional development.

This study explores the interconnexion between personal and professional development in therapist growth. This research examines a self-integrated perspective on training, by looking at the equal importance of nurturing personal development alongside professional skills cultivation. The study uses the concept of Significant Events (SE) which was originally developed to understand client change processes and applies the concept to investigate the development of the person-of-the-therapist. SE is events that are experienced in the therapy process and that are experienced by the client as being helpful or hindering for therapeutic change. Similar to the process of therapy, professional development is not a linear process of acquiring skills and knowledge but a discontinuous process that is driven by SE. The goal is to explore transformative moments in therapists' development. 281 participants completed an online questionnaire, evaluating: i) ) personal events (physical and mental health, interpersonal relationships, exploring the world, losses and deaths), ii) professional events (training, clinical experiences, relationship with colleagues, challenges due to work position), and iii) hybrid events where personal and professional aspects intertwine (personal therapy and societal context inducing insecurity). Findings suggest a more integrated self in personal and professional development. The study contributes to ongoing discussions on professional development, revealing the interplay between personal and professional spheres of therapists.

Variations and Claims in International Construction Projects in the MENA Region from the Last Decade

This study delves into the dynamics of ‘Variations’ and ‘Claims’ in construction projects. This study aims to identify, categorize, and devise mitigation strategies for critical types of variations and claims that are aligned with the contract’s FIDIC conditions. The research draws on input from construction industry professionals, including contract administrators and project managers, and focuses on the MENA region. The region’s extensive adoption of FIDIC standards and the rapidly growing construction sector drive this choice. Data collection encompassed a questionnaire distributed to 80 industry experts, predominantly through interviews focused on countries such as Saudi Arabia, the UAE, Kuwait, and Egypt. Utilizing SPSS-V.25 for statistical analysis, this study uncovers the most prevalent and impactful causes of variations and claims, highlighting the critical need for managerial intervention. A key feature is the integration of scientometric analysis into a quantitative finding. Implementing a k-means clustering analysis is a significant addition to the methodology. The survey had high internal consistency with a Cronbach’s alpha of 0.97, and the respondents reported frequent and significant claims such as delayed drawings, ambiguous documents, and client changes. The results showed that effective claims management requires clear communication and balanced contracts, while poor design and contract documentation cause variations and claims. The correlation analysis showed strong positive correlations between claim types and causes. To reduce claims and address these factors, most respondents said the survey could predict and reduce claims.

Automated Behavioral Coding to Enhance the Effectiveness of Motivational Interviewing in a Chat-Based Suicide Prevention Helpline: Secondary Analysis of a Clinical Trial.

With the rise of computer science and artificial intelligence, analyzing large data sets promises enormous potential in gaining insights for developing and improving evidence-based health interventions. One such intervention is the counseling strategy motivational interviewing (MI), which has been found effective in improving a wide range of health-related behaviors. Despite the simplicity of its principles, MI can be a challenging skill to learn and requires expertise to apply effectively. This study aims to investigate the performance of artificial intelligence models in classifying MI behavior and explore the feasibility of using these models in online helplines for mental health as an automated support tool for counselors in clinical practice. We used a coded data set of 253 MI counseling chat sessions from the 113 Suicide Prevention helpline. With 23,982 messages coded with the MI Sequential Code for Observing Process Exchanges codebook, we trained and evaluated 4 machine learning models and 1 deep learning model to classify client- and counselor MI behavior based on language use. The deep learning model BERTje outperformed all machine learning models, accurately predicting counselor behavior (accuracy=0.72, area under the curve [AUC]=0.95, Cohen κ=0.69). It differentiated MI congruent and incongruent counselor behavior (AUC=0.92, κ=0.65) and evocative and nonevocative language (AUC=0.92, κ=0.66). For client behavior, the model achieved an accuracy of 0.70 (AUC=0.89, κ=0.55). The model's interpretable predictions discerned client change talk and sustain talk, counselor affirmations, and reflection types, facilitating valuable counselor feedback. The results of this study demonstrate that artificial intelligence techniques can accurately classify MI behavior, indicating their potential as a valuable tool for enhancing MI proficiency in online helplines for mental health. Provided that the data set size is sufficiently large with enough training samples for each behavioral code, these methods can be trained and applied to other domains and languages, offering a scalable and cost-effective way to evaluate MI adherence, accelerate behavioral coding, and provide therapists with personalized, quick, and objective feedback.

Connecting Auditory-Perceptual Prompts Used in Voice Therapy to Anatomy and Physiology: Application to the Estill Voice Model and the Rehabilitation Treatment Specification System

PurposeThis clinical tutorial will present the concept of applying auditory-perceptual prompts (implicit instruction) typically used in voice therapy to anatomy and physiology of the voice production system (explicit instruction) via the Estill Voice Model (EVM) and the Rehabilitation Treatment Specification System (RTSS). MethodsEVM offers an integrated implicit-explicit instructional approach to voice training allowing for isolated practice of vocal structures (explicit) that interact to produce functional voice qualities (implicit) such as modal speech and louder projected voice qualities. In EVM, voice quality is correlated with the specific anatomy and physiologic adjustments via 13 Estill Figures and options (e.g., Larynx Figure has three options: High, Mid, and Low). RTSS provides a framework to connect client change in functioning (i.e., target) with clinician action (i.e., ingredients). Mechanisms of action connect the target to the ingredients by hypothesizing how the treatment is expected to work. ResultsEvidence is provided for connecting auditory-perpetual voice prompts with anatomy and physiology of voice and supporting an integrated implicit-explicit approach to voice therapy. The concept of linking commonly used implicit auditory-perceptual prompts used in voice therapy (e.g., humming, loud “aahh”) to explicit anatomy and physiology training (e.g., 13 Estill Figures and options) is demonstrated using EVM and the RTSS framework with case studies and video examples. ConclusionsClinicians may choose to use anatomy and physiology of voice to define and provide explicit instruction for typically used implicit auditory-perceptual prompts. Future research is warranted to test the concept applied to voice therapy models in the literature across prevention and treatment of voice disorders.

Who is the Expert in Change? Exploring the Role of Therapists in Client Change Processes: A Systemic Therapy Case Study

ABSTRACT This case study focuses on the therapeutic change process, highlighting the crucial role of therapists in facilitating it. Rooted in constructivist epistemology, we employed an integrative systemic model. Our exploration centers on the presence or absence of system restructuring within the therapeutic process. We delve into the differing perceptions of change between the therapist and the client, particularly regarding the criteria for therapy discharge. A significant aspect of our analysis is the discussion on the authenticity of change. We examine the dual role of therapists as expert observers and participants in the therapy, navigating between “objective” and subjective perspectives in their interventions. This includes assessing various levels of change, first and second order. We highlight the client’s autonomy in defining the reality and authenticity of change, advocating for a balance between the therapist’s guidance and the client’s agency. Additionally, we emphasize the therapist’s need for self-reflection and adherence to ethical practices. Our study contributes to systemic therapy literature by demonstrating the effective application of an integrative approach. It reinforces the importance of collaboration in therapeutic change, offering insights into how therapists can navigate complex therapeutic dynamics.

Group Radical Openness: Participants' attributions of change

AbstractBackgroundGroup Radical Openness (GRO) has been shown to be a feasible and acceptable intervention for individuals who struggle with costly overcontrol. This paper explores participants' reports of attributions of change following the engagement in GRO.MethodFourteen participants took part in qualitative interviews. An adapted version of ‘The Revised Client Change Interview Schedule: Version 5’ was used to capture the experiences of change following the intervention (Elliott & Rodgers, 2008). Research participants were outpatients of a psychiatric hospital who attended GRO. The sample consisted of 14 participants (6 females: 8 males); mean age 44.4 years; and age range 18–58. All participants attended 26, 3‐h group sessions. Reflexive thematic analysis was used to identify the specific aspects of the group therapy to which clients attributed change.ResultsThe analysis identified three superordinate themes, each with two subthemes. These included Safety and Connection (Safety and Tribe; Open and Genuine Facilitation); Understanding Overcontrol (Awareness of Overcontrol; The GRO Approach); and Carrying GRO Forward (Increased Awareness and Capacity to Reflect; Internalising GRO).ConclusionGroup Radical Openness was shown to be an acceptable group therapy treatment for people with an overcontrolled coping style. This paper further clarifies the participants' experiences of GRO and what aspects led to change from their perspective.

Psychotherapists' Experience with In-Session Use of Routine Outcome Monitoring: A Qualitative Meta-analysis.

Routine outcome monitoring (ROM) has become an increasingly utilized tool in therapeutic practice that has the potential to improve therapy outcomes. This study aimed to synthesize the findings of existing qualitative studies investigating how clinicians use ROM in their work with clients. A systematic search of qualitative studies on clinicians' experience with the use of ROM in mental health services was conducted via PsycInfo, PsycArticles, Medline, Web of Science, and Scopus databases. Qualitative meta-analysis was used to synthesize the finding of the primary studies. Forty-seven studies met the inclusion criteria. The analysis resulted in 21 meta-categories organized into six clusters, namely (1) obtaining clinically relevant information, (2) adapting treatment, (3) facilitating communication, (4) enhancing the therapeutic relationship, (5) facilitating change in clients, and (6) personalized usage of ROM. The meta-analysis revealed that clinicians utilized ROM in diverse ways, including both informational and communicational functions. From the clinicians' perspective, ROM was an element that, on the one hand, introduced additional structure and standardization in treatment and, on the other hand, allowed for greater flexibility and tailoring of treatment.

Leveraging natural language processing to study emotional coherence in psychotherapy.

The association between emotional experience and expression, known as emotional coherence, is considered important for individual functioning. Recent advances in natural language processing (NLP) make it possible to automatically recognize verbally expressed emotions in psychotherapy dialogues and to explore emotional coherence with larger samples and finer granularity than previously. The present study used state-of-the-art emotion recognition models to automatically label clients' emotions at the utterance level, employed these labeled data to examine the coherence between verbally expressed emotions and self-reported emotions, and examined the associations between emotional coherence and clients' improvement in functioning throughout treatment. The data comprised 872 transcribed sessions from 68 clients. Clients self-reported their functioning before each session and their emotions after each. A subsample of 196 sessions were manually coded. A transformer-based approach was used to automatically label the remaining data for a total of 139,061 utterances. Multilevel modeling was used to assess emotional coherence and determine whether it was associated with changes in clients' functioning throughout treatment. The emotion recognition model demonstrated moderate performance. The findings indicated a significant association between verbally expressed emotions and self-reported emotions. Coherence in clients' negative emotions was associated with improvement in functioning. The results suggest an association between clients' subjective experience and their verbal expression of emotions and underscore the importance of this coherence to functioning. NLP may uncover crucial emotional processes in psychotherapy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effectiveness of Capacity-Building and Quality Improvement Interventions to Improve Day-of-Birth Care in Kinshasa, Democratic Republic of the Congo.

In sub-Saharan African settings like the Democratic Republic of the Congo, high-quality care during childbirth and the immediate postpartum period is lacking in public facilities, necessitating multipronged interventions to improve care. We used a pre-post design to examine the effectiveness of a low-dose, high-frequency capacity-building and quality improvement (QI) intervention to improve care for women and newborns around the day of birth in 16 health facilities in Kinshasa, Democratic Republic of the Congo. Effectiveness was assessed based on changes in provider skills, key health indicators, and beneficiary satisfaction. To assess changes in the competency of the 188 providers participating in the intervention, we conducted objective structured clinical examinations on care for mothers and newborns on the day of birth, immediate postpartum family planning (PPFP) counseling and method provision, and postabortion care before and after implementation of training and at 6 and 12 months after training. Interrupted time series (ITS) analysis techniques were used to analyze routine health service data for changes in select maternal, newborn, and postpartum outcomes before and after the intervention. To assess changes in clients' perceptions of care, 2 rounds of telephone surveys were administered. Before the intervention, less than 2% of participating providers demonstrated competency in skills. Immediately after training, more than 80% demonstrated competency, and 70% retained competency after 12 months. ITS analyses show the risk of early neonatal death declined significantly by 9% (95% confidence interval [CI]=4%, 13%, P<.001), and likelihood of immediate PPFP uptake increased significantly by 72% (95% CI=53%, 92%, P<.001). Client satisfaction improved by 58% over the life of the project. These findings build on previous studies documenting the effectiveness of clinical capacity-building and QI approaches. If implemented at scale, this approach has the potential to substantively contribute to improving maternal and perinatal health in similar settings.

Action recommendations review in community-based therapy and depression and anxiety outcomes: a machine learning approach

BackgroundWhile the positive impact of homework completion on symptom alleviation is well-established, the pivotal role of therapists in reviewing these assignments has been under-investigated. This study examined therapists' practice of assigning and reviewing action recommendations in therapy sessions, and how it correlates with patients’ depression and anxiety outcomes.MethodsWe analyzed 2,444 therapy sessions from community-based behavioral health programs. Machine learning models and natural language processing techniques were deployed to discern action recommendations and their subsequent reviews. The extent of the review was quantified by measuring the proportion of session dialogues reviewing action recommendations, a metric we refer to as “review percentage”. Using Generalized Estimating Equations modeling, we evaluated the correlation between this metric and changes in clients' depression and anxiety scores.ResultsOur models achieved 76% precision in capturing action recommendations and 71.1% in reviewing them. Using these models, we found that therapists typically provided clients with one to eight action recommendations per session to engage in outside therapy. However, only half of the sessions included a review of previously assigned action recommendations. We identified a significant interaction between the initial depression score and the review percentage (p = 0.045). When adjusting for this relationship, the review percentage was positively and significantly associated with a reduction in depression score (p = 0.032). This suggests that more frequent review of action recommendations in therapy relates to greater improvement in depression symptoms. Further analyses highlighted this association for mild depression (p = 0.024), but not for anxiety or moderate to severe depression.ConclusionsAn observed positive association exists between therapists’ review of previous sessions’ action recommendations and improved treatment outcomes among clients with mild depression, highlighting the possible advantages of consistently revisiting therapeutic homework in real-world therapy settings. Results underscore the importance of developing effective strategies to help therapists maintain continuity between therapy sessions, potentially enhancing the impact of therapy.

Improved self‐ and relational regulation: The relationship with the client changes the therapist

AbstractObjectivesSeveral contemporary models of psychotherapy demand psychotherapists and counsellors to navigate an intensely personal involvement with clients. This study considers how this personal involvement impacts the clinician as a person.DesignWe interviewed practitioners about how working with clients in a one‐on‐one therapeutic setting changed them.MethodsA grounded theory analysis of interviews with behavioural and cognitive therapists (N = 14; 9 women, 5 men) was carried out.ResultsWorking with clients may improve practitioners' self‐regulation by generating a clearer view of themselves, providing strategies for effective living and facilitating self‐compassion. These changes are often either clinical work's unavoidable effects or gains from accidental exposure to clients' contents. Clinical work may also improve practitioners' relationships by demonstrating the value of and providing strategies for managing one's input in crucial relationships and non‐judgemental acceptance. Improved relational regulation often occurs as unavoidable learning or results from intentional emulation. Both self‐regulation and relational regulation may contribute to clinical competency. Professionals can also unintentionally reproduce client quirks and accidentally learn practical tips. Possible implications are discussed.ConclusionClients' influence on counsellors and psychotherapists deserves attention in psychotherapy research, training and supervision.

Coaching as an Implementation Strategy: The Perceived Alliance Between a Coach and Teachers Predicts Proactive Classroom Management Strategy Use

Building an alliance is a well-documented and critical therapeutic process. Considerable evidence has established a significant relationship between the quality of the alliance among a therapist and their client and changes in clients’ behavior. Like the therapeutic alliance, school-based coaches and teachers navigate their working relationship with the goal of modifying or altering practices in the classroom to promote youth’s healthy functioning. Yet, little is known about the coach-teacher alliance. Using data from two randomized controlled trials examining the efficacy of classroom management coaching interventions, this study explored whether the alliance between teachers and the coach in the studies predicted teachers’ implementation of classroom management strategies. Results from 83 teachers working with one coach indicated that the coach, but not teachers’, report of the overall quality of the alliance significantly predicted teachers’ use of proactive classroom management practices. The findings add to the existing literature on the importance of the coach-teacher alliance in the coaching process. Limitations of the study and implications for research and practice are discussed. Impact Statement Coaching is a commonly used in schools to support teachers’ implementation of new practices. This study found that the alliance between one coach and teachers during coaching for classroom management significantly predicted teachers’ use of effective strategies. This study highlights the importance of focusing on relationships when school-based coaches (e.g., school psychologists, school personnel) are working with educators to adopt and use interventions.

Technical and relational process in MI sessions with a sample of Hispanic/Latinx adults who engage in heavy drinking: A latent growth mediation model

The current study tests the Motivational Interviewing (MI) technical and relational hypotheses in a sample of Hispanic/Latinx adults (N = 276) who engage in heavy alcohol consumption. MI causal theory hypothesizes that therapist use of MI consistent skills (i.e., technical hypothesis) and embodiment of the MI Spirit (i.e., relational hypothesis) will elicit client change talk, which is a putative mechanism of positive client outcome after the session. We tested these associations in a rigorous parallel process latent growth curve mediation modeling framework. The data are from a completed randomized clinical trial of a culturally-adapted (CAMI) versus un-adapted MI targeting hazardous alcohol use and consequences. Results. The unconditional growth models for the mediator (i.e., proportion of change talk relative to sustain talk) and two study outcomes (i.e., percent of heavy drinking days; alcohol-related consequences) showed a linear effect over a 12-month period with a slower rate of growth at later timepoints. Contrary to expectations, the latent growth mediation models did not show relationships between MI-consistent skills (i.e., technical predictor) or latent MI Spirit (i.e., relational indicator) and the slope factor for proportion change talk. The slope factor for proportion change talk was also not associated with the slope factors for percent heavy drinking and consequences over follow-up. Conclusions. In this novel population for MI process analysis, the technical and relational hypotheses were not supported. Studies that are exploratory may be needed to further investigate the causal model in populations that are not often represented in MI process research.

The Causal Relationship Between Early Maladaptive Schemas and Attachment Styles with Attitudes Toward Marital Infidelity Among Married Men and Women

Objective: The present study aimed to develop a causal model of the relationship between early maladaptive schemas and attachment styles with attitudes toward marital infidelity among married men and women attending counseling centers in Tonekabon. Methods and Materials: This research is applied in terms of purpose and descriptive-analytical in terms of methodology, conducted as a survey using the statistical method of structural equation modeling. A total of 75 individuals, both men and women attending counseling centers in Tonekabon, were selected using simple random sampling to test the hypotheses and model fit. Data were collected using the Young Early Maladaptive Schema Questionnaire (1998), the Hazan and Shaver Attachment Styles Questionnaire (1998), and the Mark Whitley Marital Infidelity Questionnaire (2009). Data were analyzed using SPSS22 and SmartPLS3 software. The Kolmogorov-Smirnov test was used to assess the normality of data, confirmatory factor analysis was employed to validate the questions and identify key factors of each component, and structural equation modeling was used to evaluate the fit of the research model. Findings: Based on the results, the causal relationship model of the aforementioned variables exhibited an acceptable fit. The results indicated that all fitness indices showed the model's alignment with the data. Overall, in the proposed research model, all paths were significant, thus confirming the hypotheses related to these paths. Additionally, the findings revealed that early maladaptive schemas had a significant positive effect on attitudes toward marital infidelity (β = 3.338), secure attachment styles on attitudes toward marital infidelity (β = 4.048), avoidant attachment styles on attitudes toward marital infidelity (β = 2.946), and ambivalent attachment styles on attitudes toward marital infidelity (β = 3.925), all of which are greater than the value of 1.96, indicating a significant positive effect at a 95% confidence level. Attachment styles, through early maladaptive schemas, had a significant indirect effect on attitudes toward marital infidelity among married men and women attending counseling centers in Tonekabon. Conclusion: The findings suggest that as the level of early maladaptive schemas and attachment styles change in clients, their attitudes toward marital infidelity increase correspondingly.

Training Australian Dietitians in Behavior Change Techniques Through Educational Workshops: Protocol for a Randomized Controlled Trial.

The use of education alone as a technique to change behavior in interventions is usually insufficient, particularly in health interventions. Behavior change techniques have been shown to be effective in fostering positive changes in health behaviors such as diet and physical activity. The upskilling of health professionals can increase perceived capability and motivation toward eliciting change in clients' behaviors. However, to date, dietitians have received limited training in behavior change and have expressed a need for continuous professional development. The study objectives are to (1) develop and evaluate the effectiveness and acceptability of two 2-hour behavior change workshops on changing dietitians behavior (ie, range of behavior change techniques used and frequency of use) across 3 time points; (2) determine if participation in these workshops will elicit changes in dietitians' perceived capability, opportunity, and motivation toward using behavior change techniques; and (3) determine the acceptability of the training and its application in practice by dietitians. We will recruit registered dietitians (N=140) in Australia to participate in this randomized controlled trial. Participants will be randomly assigned to either the intervention or 3-month waitlist control condition and complete outcome measures at 3 time points: baseline, after the workshop, and follow-up at 3 months. Both groups will complete 2 workshops on behavior change that are guided by the COM-B (Capability, Opportunity, Motivation, and Behavior) Model and embedded with behavior change techniques. The primary outcome is changes in behavior, (ie, the range of behavior change techniques used and their frequency of use). Secondary outcomes include changes in perceived capability, opportunity, motivation, and preparedness as a health professional toward delivering behavior change techniques. The acceptability of the workshops will also be assessed after the workshop through the postworkshop survey and semistructured interviews. A series of 2-way repeated measures ANOVAs and regressions will be used. Qualitative data will be analyzed using thematic analysis. Participant recruitment commenced in June 2023. The results of the study are expected to be published in November 2024. The results will allow us to assess comparisons between the intervention and waitlist control groups, as well as changes in perceived capability, opportunity, motivation, and preparedness over a 3-month period. It will also provide an understanding of the acceptability of the training as a form of continuous professional development for dietitians. If found to be effective, the results of this 2-arm randomized controlled trial will guide future training and continuous professional development for health professionals in changing behavior in practice. Our findings will contribute to our understanding of the application of behavior change techniques in practice with clients and identify components of COM-B where dietitians may need future support. ACTRN12623000525684; https://www.anzctr.org.au/ACTRN12623000525684.aspx. PRR1-10.2196/49723.