Positive Therapeutic Relationship Research Articles

Adolescent engagement in a stepped care, transdiagnostic mental health intervention delivered in Indian schools

Given the relationship between poor engagement and worse treatment outcomes, improving engagement has been the focus of attention in recent years. Engagement is a particular challenge among minoritized and otherwise challenged youth, such as those from socioeconomically disadvantaged groups, including youth in low- and middle-income countries (LMICs), where they face lower levels of access to resources, including mental health treatment. The present study describes engagement challenges that arose in an uncontrolled pre-post evaluation of a school-based, modular, multi-problem, stepped-care intervention delivered in urban Indian communities. Specifically, the study aimed to (1) characterize barriers and facilitators of youth treatment engagement; and (2) evaluate treatment acceptability and fit of treatment from the youth perspective. Youth participants completed semi-structured interviews, which were transcribed and coded using thematic analysis. Participants described numerous facilitators to engagement (e.g., positive therapeutic relationship) and reported high overall satisfaction with the intervention, while also identifying barriers to engagement (e.g., concerns about confidentiality) and offering suggestions to increase fit and acceptability (e.g., more visually appealing treatment materials). Findings highlight ways in which engagement can be enhanced and implementation supports improved to maximize treatment effectiveness among minoritized and disadvantaged youth in LMICs.

'A ward full of emotional, aggressive people': Social climate and interpersonal relationships in forensic settings caring for patients with borderline personality disorder.

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.

Psychotherapist perceptions of engagement-building behaviours with youth clients across developmental levels.

Building a positive therapeutic relationship is a challenging, yet critical, first step in conducting youth psychotherapy. A number of studies in the youth treatment literature have indicated that a positive therapeutic alliance is related to increased treatment attendance, participation, and outcome. Some research has examined therapist behaviours for engaging therapy clients; however, developmental differences in alliance formation have had limited exploration. The current study surveyed clinicians about their use of specific engagement strategies and the developmental stage of their youth clients. It was hypothesised that participants would differentially rate the importance of different aspects of therapeutic engagement based upon a youth client's developmental stage and that these would correspond with differences in specific engagement strategies. A total of 64 clinicians with experience treating youth completed the study. The participants completed a questionnaire administered online that asked them to rate the importance of developmental differences to forming a therapeutic relationship and provide example client behaviours from their clinical experience for each developmental stage. Results showed clinicians felt the relative importance of collaboration, advocacy, and trustworthiness increased with age. These differences were also evidenced in the specific strategies clinicians endorsed in relation to each engagement factor across developmental stages. This program of research will eventually aid in the development of new guidelines for engaging clients in youth psychotherapy. In addition, the results may be used to enhance psychotherapy training for those working with children and adolescents.

Individual counseling practice with solution-focused brief counseling in cross-cultural counseling

Cross-cultural counseling refers to a therapeutic process that occurs between counselors and clients who originate from diverse backgrounds and cultural contexts. Hence, it is imperative for counselors to possess proficiency in the domain of cross-cultural counseling in their professional endeavors. This research employed a qualitative descriptive methodology to examine the cross-cultural counseling process using the solution-focused brief counseling approach. The study focused on a seventh-grade student from one of the public schools in Nusa Tenggara Timur Indonesia who belonged to a distinct cultural background from the counselor. The primary objective was to investigate the effectiveness and outcomes of the cross-cultural counseling process when implementing the solution-focused brief counseling approach. The study's findings indicate that individual counseling using the Focused Solution Brief Counseling technique encompasses several key components. These include the construction of a positive therapeutic relationship, goal setting, the identification of issues, the development and implementation of solutions, and the termination of the counseling session. The study additionally demonstrates that within the realm of cross-cultural counseling, the solution-focused brief counseling approach has the capacity to effectively address the challenges faced by students. Therefore, solution-focused brief counseling may serve as an effective strategy for school counselors that can help students resolve their problems.

Functional neurological disorder: A qualitative study exploring individuals' experiences of psychological services.

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

The Impact of the Transformation Toward Small-Scale Residential Youth Care Facilities on Professionals: A Qualitative Study

ABSTRACT In the last decade, living groups in residential youth care facilities in The Netherlands have gradually grown in size with eight to twelve adolescents per group, which is related to an increase in workload and overburdened personnel. Research suggests that a smaller group size of up to six adolescents can have a positive impact on the living and working environment, and therefore small-scale facilities are advocated as a an alternative for regular residential youth care. Little is known about the experiences of residential care personnel working in these small-scale facilities. The aim of this study is to examine the impact of the transformation toward small-scale facilities from the perspective of residential care personnel. The results show, in line with previous studies, that professionals working in small-scale facilities experience a safer and more positive group climate and that they are more able to invest in a positive therapeutic relationship with the adolescents, than working on regular residential groups. Moreover, working on a group with fewer adolescents affects the working climate in a positive way. Recommendations for practice and further research are proposed.

Non-clinically trained facilitators' experiences of remote psychosocial interventions for older adults with memory loss and their family carers.

Dementia is the seventh leading cause of global mortality, with cases increasing. Psychosocial interventions might help prevent dementia and improve quality of life. Although it is cost-effective for non-clinically trained staff to deliver these, concerns are raised and little is known about the resulting impact on staff, especially for remote interventions. To explore how non-clinically trained facilitators experienced delivering remote, one-to-one and group-based psychosocial interventions with older adults with memory loss and their family carers, under training and supervision. We conducted a secondary thematic analysis of interviews with non-clinically trained facilitators, employed by universities, the National Health Service and third-sector organisations, who facilitated either of two manualised interventions: the APPLE-Tree group dementia prevention for people with mild memory loss or the NIDUS-Family one-to-one dyadic intervention for people living with dementia and their family carers. The overarching theme of building confidence in developing therapeutic relationships was explained with subthemes that described the roles of positioning expertise (subtheme 1), developing clinical skills (subtheme 2), peer support (subtheme 3) in enabling this process and remote delivery as a potential barrier to it (subtheme 4). Non-clinically trained facilitators can have positive experiences delivering remote psychosocial interventions with older adults. Differences in life experience could compound initial fears of being 'in at the deep end' and 'exposed' as lacking expertise. Fears were allayed by experiencing positive therapeutic relationships and outcomes, and by growing confidence. For this to happen, appropriate training and supervision is needed, alongside accounting for the challenges of remote delivery.

Comprehensive geriatric assessment delivered by advanced nursing practitioners within primary care setting: a mixed-methods pilot feasibility randomised controlled trial

BackgroundComprehensive Geriatric Assessment (CGA)is a widely accepted intervention for frailty and can be cost-effective within a primary care setting.ObjectiveTo explore the feasibility of identifying older adults with frailty and assess the subsequent implementation of a tailored CGA with care and support plan by Advanced Nursing Practitioners (ANPs).MethodsA mixed-method parallel randomised controlled trial was conducted. Participants were recruited from two General Practice (GP) centres between January and June 2019. Older adults with confirmed frailty, as assessed by practice nurses, were randomised, using a web service, to the intervention or treatment-as-usual (TAU) groups for six months with an interim and a final review. Data were collected on feasibility, health service usage, function, quality of life, loneliness, and participants' experience and perception of the intervention. Non-parametric tests were used to analyse within and between-group differences. P-values were adjusted to account for type I error. Thematic analysis of qualitative data was conducted.ResultsOne hundred sixty four older adults were invited to participate, of which 44.5% (n = 72) were randomised to either the TAU (n = 37) or intervention (n = 35) groups. All participants in the intervention group were given the baseline, interim and final reviews. Eight participants in each group were lost to post-intervention outcome assessment. The health service use (i.e. hospital admissions, GP/emergency calls and GP/Accident Emergency attendance) was slightly higher in the TAU group; however, none of the outcome data showed statistical significance between-group differences. The TAU group showed a deterioration in the total functional independence and its motor and cognition components post-intervention (p < .05), though the role limitation due to physical function and pain outcomes improved (p < .05). The qualitative findings indicate that participants appreciated the consistency of care provided by ANPs, experienced positive therapeutic relationship and were connected to wider services.DiscussionFrailty identification and intervention delivery in the community by ANPs were feasible. The study shows that older adults with frailty living in the community might benefit from intervention delivered by ANPs. It is suggested to examine the cost-effectiveness of the intervention in sufficiently powered future research.Trial registrationsThe protocol is available at clinicaltirals.gov, ID: NCT03394534; 09/01/2018.

“Friendly, local and welcoming” – evaluation of a community mental health early intervention service

PurposeHalf of adulthood mental health challenges begin by the age of 14-years-old, making the need for early-intervention clear. This study aims to evaluate a new service model that promotes early-intervention through a community based low-intensity Hub.Design/methodology/approachClinical data from 2,384 young people were analysed through within-group, pre- and post-comparisons and qualitative survey, and interview data was analysed through content analysis.FindingsOverall, participants reported that they were highly satisfied with the Hub and the low-intensity brief interventions met their needs. Participants reported that learning new skills, having a place to talk and positive therapeutic relationships were beneficial. The Hub appeared to be less successful for young people with complex mental health difficulties. As a service, the adoption of the Hub model reduced waiting list times by more than half.Research limitations/implicationsThe quantitative data demonstrated that engaging with the Hub reduced symptoms of psychological distress. Qualitative analyses suggest that access to local, community, welcoming and “less clinical” support was beneficial, and the type of brief interventions offered was less important than therapeutic relationships.Originality/valueThis is the first study of a novel “Hub” model for low-intensity brief interventions in a socio-economically deprived area of England. Local knowledge, community integrated support, therapeutic relationships and a welcoming environment were viewed as more beneficial than the type of brief interventions offered. Consequently, community spaces can be created to be therapeutic and beneficial for mental health outside of a traditional conceptualisation of clinical support.

A qualitative interview study of patient experiences of receiving motivational enhancement therapy in a Swedish addiction specialist treatment setting

BackgroundMotivational enhancement therapy (MET) has shown to be efficacious as treatment of alcohol use disorder (AUD), in reducing alcohol consumption and related consequences. However, qualitative research on how patients perceive this treatment is lacking. The aim of this study was to explore how patients experience MET as a treatment for AUD.MethodsFifteen patients (8/7 female/male) participated in semi-structured interviews after receiving MET at a specialized addiction outpatient clinic in Sweden. Data were analyzed by thematic analysis.ResultsFive themes were identified: the therapist conveyed the MI-spirit, the therapist did not guide on how to reach the goal, participants were committed to change before starting treatment, participants were uncertain if treatment was enough to maintain change, and significant others were not wanted in sessions. Participants appreciated the supportive relationship with their therapist, but some experienced therapy as overly positive, with no room to talk about failure. Further, they experienced a low level of guidance in goal-setting. For some, this was empowering, while others requested more direction and advice. Participants perceived their motivational process to have started before treatment. MET was considered to be too brief. None of the participants brought a significant other to a session.ConclusionsTherapist behaviors in line with MI spirit were emphasized as key to the development of a positive therapeutic relationship. More specific advice on goal-setting may be effective for supporting change in some patients. Longer treatment is requested among patients to support the patient’s self-efficacy for change. Significant others can support change without necessarily being present in sessions.Trial registration: The current trial was retrospectively registered at isrtcn.com (14539251).

Support Provided by Stop-Smoking Practitioners to Co-users of Tobacco and Cannabis: A Qualitative Study.

Co-use of tobacco and cannabis is highly prevalent among cannabis users and is associated with poorer tobacco cessation outcomes. This study explored the barriers and enablers influencing stop-smoking practitioners' ability to provide optimal support to co-users. Online semi-structured interviews were audio recorded. Interviewees (n = 20) were UK-based certified stop-smoking practitioners. An interview schedule informed by the "capability", "opportunity", "motivation" (COM-B) model was designed to explore participants' perceived barriers and enablers in better supporting co-users to achieve abstinence of both substances or tobacco harm reduction. The transcripts were analyzed using framework analysis. Capability: Practitioners' lack of knowledge and skills undermines their delivery of smoking cessation interventions to co-users. Interestingly, when cannabis is used for medicinal reasons, practitioners feel unable to provide adequate support. Opportunity: Service recording systems play an important role in screening for co-use and supporting co-users. When responding to clients' specific needs and practitioners' uncertainties, a positive therapeutic relationship and a support network of peers and other healthcare professionals are needed. Motivation: supporting co-users is generally perceived as part of practitioners' roles but there are concerns that co-users are less likely to successfully stop smoking. Practitioners are willing to support co-users, but their lack of knowledge and access to an appropriate recording system are barriers to doing so. Having a supportive team and a positive therapeutic relationship is perceived as important. Identified barriers can be mostly addressed with further training to improve tobacco cessation outcomes for co-users.

“I literally had no support”: barriers and facilitators to supporting the psychosocial wellbeing of young people with mental illness in Tasmania, Australia

BackgroundThere has been limited focus on understanding the barriers and facilitators to meeting the broader psychosocial needs of young people with mental illness from the perspectives of young people. This is required to advance the local evidence base and inform service design and development. The aim of this qualitative study was to explore young people’s (10–25 years) and carers’ experiences of mental health services, focusing on barriers and facilitators to services supporting young people’s psychosocial functioning.MethodsThis study was conducted throughout 2022 in Tasmania, Australia. Young people with lived experience of mental illness were involved in all stages of this research. Semi-structured interviews were conducted with 32 young people aged 10–25 years with experience of mental illness, and 29 carers (n = 12 parent–child dyads). Qualitative analysis was guided by the Social-Ecological Framework to identify barriers and facilitators at the individual (young person/carer level), interpersonal, and service/systemic level.ResultsYoung people and carers identified eight barriers and six facilitators across the various levels of the Social-Ecological Framework. Barriers included, at the individual level: (1) the complexity of young people’s psychosocial needs and (2) lack of awareness/knowledge of services available; at the interpersonal level: (3) negative experiences with adults and (4) fragmented communication between services and family; and at the systemic level: (5) lack of services; (6) long waiting periods; (7) limited service accessibility; and (8) the missing middle. Facilitators included, at the individual level: (1) education for carers; at the interpersonal level: (2) positive therapeutic relationships and (3) carer advocacy/support; and at the systemic level: (4) flexible or responsive services, (5) services that address the psychosocial factors; and (6) safe service environments.ConclusionsThis study identified key barriers and facilitators to accessing and utilising mental health services that may inform service design, development, policy and practice. To enhance their psychosocial functioning, young people and carers want lived-experience workers to provide practical wrap-around support, and mental health services that integrate health and social care, and are flexible, responsive and safe. These findings will inform the co-design of a community-based psychosocial service to support young people experiencing severe mental illness.

Therapeutic Relationship in mTBI Rehabilitation: The Disparity Between the Illness Experience and Clinical Definitions.

A positive therapeutic relationship is characterized by trust and mutually perceived genuineness. It is positively associated with patients' adherence to treatment, satisfaction, and health outcomes. When service members with a history of mild traumatic brain injury (mTBI) present to rehabilitation clinics with nonspecific symptoms, a disparity between their experience of disability and clinical expectations of mTBI may disrupt the establishment of a positive therapeutic relationship between patients and providers. The objectives of this study are to (1) explore disparities between military service members and rehabilitation clinicians about the clinical diagnosis and illness experience of mTBI and (2) identify barriers to the establishment of a positive therapeutic relationship. This is a qualitative descriptive study of military service members with prior mTBI (n = 18) and clinicians (n = 16) who participated in interviews and focus groups. Data were analyzed thematically using Kleinman's framing of illness experience and clinical diagnosis. Three themes reflected the potential breakdowns in the therapeutic relationship. The first theme, clinical expectations for post-injury recovery versus patients' experience of ongoing disability, reflects the inconsistency between clinicians' expectations of symptom resolution within 90 days following mTBI and service members' experiences of symptoms that worsened over several months or years. The second theme, symptom attribution to mental health conditions versus tissue injury, describes the difficulty in attributing symptoms to the physical impact of the mTBI or mental health diagnoses that may also stem from the injury event. The third theme, suspected malingering versus valid disability, describes clinicians' reports of frustration with cases in which they suspected malingering for secondary gains in contrast with service members' feelings that their problems were not taken seriously by clinicians. This study extended previous research on therapeutic relationships by examining the situation of mTBI rehabilitation services for military service members. The findings reinforce the best practice recommendations of acknowledging patients' experiences, addressing the presenting symptoms and problems, and encouraging progressive return to activity following mTBI. Acknowledgment of and attention to patients' illness experience by rehabilitation clinicians is necessary and important for supporting a positive therapeutic relationship and ultimately to optimize patients' health outcomes and reduce disability.

Physiological and neural synchrony in emotional and neutral stimulus processing: A study protocol.

As psychotherapy involves at least two individuals, it is essential to include the interaction perspective research. During interaction, synchrony, i.e., the occurrence of simultaneous responses, can be observed at the physiological, neural, and behavioral level. Physiological responses include heart rate and electrodermal activity; neural markers can be measured using electroencephalogram. Emotionally arousing stimuli are allocated more attentional resources (motivated attention), which is reflected in physiological activation and brain potentials. Here we present a protocol for a pilot study implementing a new research methodology, and replication of the motivated attention to emotion effect in in dyads. There is evidence that higher synchrony is associated with more positive (therapeutic) relationships. Thus, the secondary outcome will be the association between physiological and neural synchrony and subjective ratings. Individuals (18-30 years) will participate in same-sex pairs in two experiments. In the first experiment (triadic interaction), both participants attentively watch unpleasant, neutral and pleasant pictures, and read/listen to standardized scripts (unpleasant, neutral, and pleasant, respectively) for the imagination task. In the second experiment, participants will read out three scripts (unpleasant, neutral, pleasant) to each other, followed by a joint imagination period. Stimuli will be presented in counterbalanced orders. After each picture and imagination, participants rate their subjective arousal and valence. In the beginning and in the end of the procedure, dyads rate their relationship, sympathy, and bonds (Working Alliance Inventory subscale). Heart rate, electrodermal activity and electroencephalogram will be continuously measured during both experiments using portable devices (EcgMove4 and EdaMove4, nine-channel B-Alert X-Series mobile-wireless EEG). Synchrony analyses will include the dual electroencephalography analysis pipeline, correlational analyses and Actor-Partner Interdependence Models. The present study protocol provides an experimental approach to investigate interpersonal synchrony during emotion processing, allowing for the establishment of research methods in a pilot study, which can later be translated into real-life psychotherapy research. In the future, fundamental understanding of such mechanisms in dyadic interactions is essential in order to promote therapeutic relationships, and thus, treatment effectiveness and efficiency.

"Where have you been in this world?" a qualitative study of clients' curiosity about their psychotherapists.

Curiosity is widely seen as a basic human drive, important to the development of relationships as well as to the process of change in psychotherapy. Less attention, however, has been directed toward examining curiosity in the client-therapist relationship. In particular, we lack a comprehensive understanding of what occurs for clients when they become curious about their therapists. As a result, we aimed to explore clients' experiences of curiosity about their therapists. Using a consensual qualitative research approach, we analyzed data from ten current and former adult psychotherapy clients. Results were organized in six domains that captured different facets of participants' experiences of curiosity about their therapists: the content of the curiosity, motivation(s) for the curiosity, triggers of the curiosity, expressions of curiosity, influences on the curiosity, and consequences of the curiosity. More specifically, results revealed participants experienced curiosity that (a) concerned the therapist's professional and personal life, (b) was motivated by concerns over the therapist's ability to understand or relate, and (c) was triggered by therapist behavior (e.g., disclosures). For some participants, having a positive therapeutic relationship led to greater curiosity; by the same token, participants' desire for professional boundaries at times quelled this curiosity. Moreover, although some participants described positive relational outcomes, others disclosed feelings of shame or discomfort resulting from their curiosity. Several cultural factors were also found to influence participants' curiosity. Implications for research and practice are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Opportunities for fostering a positive therapeutic relationship in an Internet‐based cognitive behavioural therapy for dementia caregivers

AbstractObjectiveResearch has shown that therapists can develop a positive therapeutic relationship in the Internet setting and that the therapeutic relationship plays a role in treatment outcome. However, little is known about how therapists foster a positive therapeutic relationship in the Internet setting. Therefore, the current study assesses the extent to which therapists apply techniques that are recommended in the face‐to‐face setting when communicating with participants of an Internet‐based cognitive behavioural therapy (iCBT) intervention.MethodQualitative content analysis was conducted to analyse therapists' messages sent to clients during the course of an asynchronous, text‐based iCBT intervention for caregivers of people with dementia. A total of 216 written messages from four therapists to 27 participants were analysed. Based on the motivational attunement framework of therapist behaviour, a deductive coding system was developed, and the intercoder reliability was satisfactory.ResultsThrough qualitative content analysis, a variety of techniques were found in the therapeutic messages: 12 main categories and six subcategories of therapeutic techniques that satisfy the four basic needs according to Grawe were identified. Therapists most frequently addressed the need for attachment (41%), followed by orientation and control (28%), self‐esteem (24%) and pleasure (7%).ConclusionsThe results indicated that online therapists implemented many of the techniques that are recommended and applied in the face‐to‐face setting to foster a positive therapeutic relationship. Results can be used to develop training for online therapists and manuals for Internet interventions.

The Impact of Music Therapists’ Perspectives on Quality of Life in Building Relationships with Older Adults with Chronic Illness

Older adults with chronic illnesses have diminished qualities of life (QoL) due to physical and mental decline. To promote their QoL, music therapists create meaningful shared music experiences and positive therapeutic relationships to address their psychosocial needs. However, within this relationship-building process, healthcare professionals, staff, and even caregivers appear to project their own perceptions and expectations of what positive QoL of older adults should be. This misapprehension may challenge therapists to meet older adults' actual QoL needs adequately. To date, no studies have explored music therapists' perspectives on QoL in building relationships with older adults experiencing chronic illness. Eleven music therapists participated in online, semi-structured phenomenological interviews that were thematically analyzed. Three themes emerged: participants gained an increased awareness of unconscious biases, a deepened understanding of older adults' QoL, and a purposeful alignment with older adults' QoL. These highlighted the significance of therapists' consistent self-reflection within the relationship-building process. Identifying their shared commonalities with older adults guided therapists to engage with clients more salutogenically and empathically. Additionally, recognizing their own biases being projected onto older adults empowered therapists to be more intentional to reconcile their perceptual discrepancies while prioritizing older adults' authentic voices and capable selves.

Connecting and Healing: The Role of Existential Isolation in Mediating the Impact of the Therapeutic Relationship on Canadian Men's Mental Health Outcomes.

The therapeutic relationship has emerged as one of the most important components of successful treatment outcomes, regardless of the specific form of therapy. Research has now turned its attention to better understanding how the therapeutic relationship contributes to patient improvement. Extant literature contends that a strong therapeutic relationship may help reduce a patient's sense of existential isolation (i.e., a sense of not feeling understood by others). Research indicates that existential isolation might be especially problematic for men, potentially increasing their risk for suicidality. This study investigated the association between strength of the therapeutic relationship and psychological distress and suicidality among men who received psychotherapy, and whether existential isolation mediated this association. A total of 204 Canadian men who had previously attended psychotherapy participated in a cross-sectional survey, completing measures of the quality of their most recent therapeutic relationship, existential isolation, depression and anxiety symptoms, and suicidality. Regression with mediation analysis was conducted. Two models were tested; one with depression/anxiety symptoms as the dependent variable and the other with suicidality as the dependent variable. Both mediation models emerged as significant, indicating an indirect effect for quality of the therapeutic relationship on symptoms of anxiety/depression and suicidality through existential isolation. The findings suggest that a positive therapeutic relationship can contribute to men feeling less isolated in their experiences in life (i.e., less existentially isolated), thereby helping mitigate psychological distress and suicidality.

Managing emotional labour in the provision of psychotherapy – what matters most

ABSTRACT Objective The current study sought to explore holistic factors perceived to be key in managing emotional labour effectively in psychologists providing psychotherapy. Identifying applicable factors in this occupational group is vital to understand how psychologists manage emotional labour and related constructs. The study aimed to contribute to a burgeoning conversation around the topic of emotional labour in psychologists and examined the following research question: How do psychologists providing psychotherapy manage emotional labour? Method Reflexive thematic analysis of data collected from 24 semi-structured interviews with psychologists who provide individual psychotherapy was conducted. This method enabled broad themes relating to the research question to be identified. Results Key factors for managing emotional labour were found and summarised by key themes of effective in-session regulation, effective post-session regulation, positive therapeutic relationships with clients, general lifestyle factors, evaluating therapeutic effectiveness, personal predispositions, and career experience. Conclusions Analysis of the findings found that novel factors including psychological flexibility, self-compassion, self-reflection, and career experience are important for effectively managing emotional labour. Researchers and clinicians would benefit from integrating the study’s findings into their respective practices.

The therapeutic relationship as a change mechanism in child psychotherapy: a qualitative study of children, parents’, and therapists’ views in different moments of the process (La relación terapéutica como un mecanismo de cambio en la psicoterapia infantil: un estudio cualitativo de las perspectivas de niño/as, padres, y terapeutas en diferentes momentos del proceso)

ABSTRACT The therapeutic relationship is organized triadically between children, therapists and parents, yet little research focuses on its evolution as a change mechanism integrating these perspectives. Develop a comprehensive model of the therapeutic relationship as a change mechanism in different phases of psychotherapy, from the perspective of children, parents and therapists. A grounded theory analysis integrated findings from a retrospective and a qualitative longitudinal study of the therapeutic relationship with children and parents as change factors based on semi-structured interviews and children’s drawings. Initially, therapists’ close, flexible attitude improved children’s and parents’ motivation for psychotherapy. Later, a child-centred, playful relationship fostered children’s affection and trust in the therapists, promoting emotional and socio-affective changes. Lastly, as a greater bond developed, children internalized the therapist as a significant figure, and deeper changes emerged. Parents’ changes were eased by further trust and collaboration in the relationship with the therapist, and changes in the child-parent relationship emerged. Constructing positive therapeutic relationships requires participants’ evolving dispositions. These relationships shape progressive changes in children and their parents.