Therapist Orientation Research Articles

Internet-delivered therapy for alcohol misuse: engagement, satisfaction, and outcomes when patients select their preference for therapist- or self-guided treatment

BackgroundAlcohol misuse is common and causes substantial harm. Internet-delivered cognitive behaviour therapy (ICBT) is effective in reducing alcohol misuse; however, the literature investigating how treatment outcomes are impacted by patients’ preferences for therapist- versus self-guided ICBT for alcohol misuse is sparse.MethodsIn this preference trial, 74 eligible patients (who reported ≥ 14 drinks in the previous week and obtained scores suggesting hazardous or harmful drinking) chose between enrolling in either therapist- or self-guided ICBT for alcohol misuse. We investigated whether those who chose therapist- versus self-guided ICBT differed in their (a) drinking outcomes—as measured by Timeline Follow-Back (TLFB) and heavy drinking days (HDD) at post-treatment and 3-month follow-up—and (b) post-treatment ICBT engagement and satisfaction.ResultsThe majority (81.1%) of eligible patients chose therapist-guided ICBT. These patients reported higher psychotropic medication use, drinking difficulties, and anxiety symptoms. For both the therapist- and self-guided patients, a modified intention-to-treat analysis revealed large within-group treatment effects for TLFB (β = − 2.64, SE 0.66; p < 0.001) and HDD (β = − 0.34, SE 0.07; p < 0.001), with large pre-to-post-treatment Cohen’s effect sizes of d = 0.97 (95% CI [0.49, 1.45]) for TLFB and d = 1.19 (95% CI [0.69, 1.68]) for HDD. The interaction comparing the effects of therapist- to self-guided ICBT over time was not significant for TLFB (p = 0.34) or HDD (p = 0.06). With treatment, for both therapist- and self-guided patients, there was a significant improvement in drinking difficulties, cravings, and confidence with controlling cravings, as well as in anxiety, depression, and functional impairment. Further, the majority (75.7%) of patients completed five or more lessons, as well as reported overall satisfaction with the treatment (88.9%) and increased confidence in managing their symptoms (86.7%); these outcomes also did not differ between therapist- and self-guided patients.ConclusionsThe current study shows that ICBT for alcohol misuse is associated with reduced drinking and comorbid mental health difficulties over time, irrespective of whether patients chose to complete the course on their own or with therapist guidance.Trial registration number: NCT04611854 (https://clinicaltrials.gov/ct2/show/NCT04611854).

The relationship between occupational therapists’ organizational commitment, perceived organizational support, and entrepreneurial orientations

Introduction: Entrepreneurial orientation is a critical factor in the success of an organization and encourages higher performance. Individual entrepreneurial orientation can be influenced by organizational commitment and perceived organizational support. The study aimed to examine the relationship between occupational therapists’ organizational commitment, perceived organizational support levels, and their individual entrepreneurial orientation. Method: Using an online form, a cross-sectional survey study was conducted with 88 occupational therapists aged between 22 and 28. Occupational therapists completed a socio-demographic information form, the Organizational Commitment Scale, the Perceived Organizational Support Scale, and the Individual Entrepreneurial Orientation Scale. Data were analyzed using descriptive statistics and correlation analysis. Results: Significant positive correlations were found between occupational therapists’ individual entrepreneurial orientations and organizational commitment ( p = 0.015; r = 0.260) and perceived organizational support ( p = 0.045; r = 0.214). Conclusion: This study indicates that occupational therapists’ individual entrepreneurial orientation increases when their levels of organizational commitment and perceived organizational support increase. Therefore, organizations should strive to maintain high levels of organizational commitment and the support provided by the organization to enhance the entrepreneurial orientation of occupational therapists, which is important for their creativity and innovation.

Customized GRASP for rehabilitation therapy scheduling with appointment priorities and accounting for therapist satisfaction

Physical therapy in acute care hospitals plays an important role in the rehabilitation of patients. Nevertheless, the profession must deal with staff shortages caused by a lack of potential employees and absenteeism which are results of high physical and mental workloads. The therapist shortage negatively affects the total number of daily appointments the department can fulfill. For appointments that can be successfully scheduled, continuity of care with the same therapist cannot be guaranteed for individual patients. Lack of continuity of care negatively influences the therapist's satisfaction. Therapist preferences for individual appointments in general cannot always be guaranteed when designing schedules, which also hurts satisfaction. This paper develops a multi-criteria model for the daily therapy appointment-scheduling problem. The primary objective is to minimize the total sum of priority violations for unscheduled appointments. To improve therapist satisfaction, we consider therapist preferences including continuity of care as a secondary objective. Here, our integer programming formulation aims to minimize the total sum of preference violations for scheduled appointments. We are dealing with an operational planning problem with a daily planning horizon. The operational objective is to achieve therapist schedules in at most two hours. The therapists’ schedules together need to include several hundred appointments for a planning day. Due to intractability, the developed integer program cannot provide schedules for such problem sizes. Therefore, we develop a customized Greedy Randomized Adaptive Search Procedure (GRASP) with six innovative local search operations to improve an initially constructed solution. We test the heuristic algorithm on realistic data instances. The metaheuristic provides high-quality schedules for various problem sizes in short runtimes, i.e., within minutes. Comparisons with the optimal solutions for small problem instances show very good results of the GRASP with a similar number of scheduled appointments and good adherence to continuity of care and therapist preference requirements.

Les distorsions cognitives des victimes : symptômes et levier thérapeutique

Cognitive distortions are mental processes that affect individuals and partially govern their relationship with the world. They manifest themselves at a very early age and are directly influenced by an individual's early life experiences, from which implicit learning about the world and oneself occurs. This acquisition is personal and biased, leading to the formation of cognitive filters that individuals reinforce in a self-perpetuating cycle. The information selected depends on these filters, and the processing of this information depends on the subject's distortions. These mental processes are present in everyone; however, certain populations, such as individuals with anxiety or depressive symptoms, victims, or those with post-traumatic stress disorder, exhibit specificities based on their life experiences. In light of the various therapeutic approaches and treatments related to the cognitive dimension, we propose a syllogistic model for understanding how victims from different social backgrounds and with a victim status perceive and confront the world. Two clinical vignettes are provided to illustrate this model. This approach is rooted in philosophy and cognitive psychopathology but is intended to be trans-theoretical and applicable regardless of the therapist's orientation.

Comparison of Physical Therapy Field Preferences of Students and Physical Therapists

Comparison of Physical Therapy Field Preferences of Students and Physical Therapists

Validation of the Cooper–Norcross Inventory of Preferences (C-NIP) in Chinese lay clients and mental health professionals: Factor structure, measurement invariance, and scale differences.

The Cooper-Norcross Inventory of Preferences (C-NIP) is one of the most widely used measures of psychotherapy preferences. However, its psychometric properties have not been examined in non-Western samples. Research on disparities between the preferences of mental health professionals and their clients is also limited. We evaluated the C-NIP's psychometric properties and measurement invariance in Chinese lay clients and mental health professionals and evaluated the latent mean differences between clients' and professionals' scores on the C-NIP's four scales (preference for therapist vs. client directiveness, emotional intensity vs. emotional reserve, past vs. present orientation, and warm support vs. focused challenge). This cross-sectional investigation involved 301 lay clients and 856 mental health professionals who completed the Chinese version of the C-NIP. Confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were used to examine the factor structure of the C-NIP. ESEM provided stronger evidence than CFA for the four-factor model in both samples. The four scales had adequate internal consistency in both the lay clients (αs = .68-.89) and the mental health professionals (αs = .70-.80). Partial scalar invariance was established across these two populations. Chinese mental health professionals preferred less therapist directiveness, past orientation, and warm support-but more emotional intensity-than Chinese lay clients (ds = 0.25-0.90). Culture-specific cutoff values (norms) to identify strong therapy preferences were established. This study supports the application of the C-NIP to non-Western populations and suggests that discrepancies between the preferences of lay clients and mental health professionals are a cross-cultural phenomenon. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Remote or in-person cancer support? Therapist and service user preferences

Background/Aims Remote service delivery became a key method of providing therapy for psychological oncology services during the COVID-19 pandemic and beyond. This study aimed to understand the experiences and preferences of both patients and therapists who undertook remote psychological therapy in a cancer support service, with a view to informing ongoing service provision. Methods A total of 99 out of 152 invited patients completed an online mixed-methods (quantitative and qualitative) audit survey. All patient participants had accessed therapy with the psycho-oncology support team at Guy's Cancer Centre in London. Of the 12 therapists and four trainee therapists working in this service, 11 and two from each group (respectively) completed a corresponding survey about their experiences as therapists. For quantitative data, descriptive statistics were collated. Results Patients rated their experience of remote therapy as positive, reporting that they felt respected, understood and confident during therapy, and acknowledged the associated advantages of increased accessibility and infection control. Despite this, 87% of patients and 100% of therapists expressed a preference to access or deliver therapy in person, with patients identifying human connection and relationship building as key reasons for choosing in-person delivery. Therapists valued the relational aspects of in-person psychological support and reported that remote delivery had negatively affected the quality of therapy delivered. Conclusions Understanding the needs and preferences of patients and therapists is important in informing ongoing psychological service delivery. The results highlight the importance of retaining provision for in-person service delivery and offering choice to patients in how they access psychological support, in line with personalised care recommendations made by the NHS Long Term Plan.

Therapist dishonesty across theoretical orientations

ABSTRACT To examine whether and how therapy orientation is associated with psychotherapists’ perceived reasons for, feelings about, and regrets around their own dishonesty in therapy. A sample of 255 psychodynamic (n= 81), cognitive-behavior (n= 92), integrative (n= 64), and humanistic (n= 18) therapists who reported having been “less than completely honest” to a client provided open-text responses regarding this occurrence. A bricoleur approach was used to identify themes among responses, and Fisher’s exact test analyses were used to compare responses across theoretical orientations. The most frequent reason offered for instances of less than complete honesty was “treatment strategy” (i.e. it was deemed necessary for treatment). The most common feeling reported was discomfort, including anxiety. Most respondents reported that, in retrospect, they would not have handled the situation differently. Therapist orientation was not significantly associated to any pattern of responses to these questions. While therapist dishonesty is perceived as occurring primarily in the service of the client and tends to evoke similar reactions among therapists across theoretical orientations, most therapists report experiencing negative feelings after acting somewhat dishonestly. Training programs should encourage greater discussion about the potential benefits and consequences of therapeutic dishonesty, including instances of therapeutic tact.

Physical rehabilitation for Parkinson’s disease: assessment and treatment preferences of physical therapists

IntroductionPatients with Parkinson’s disease are often prescribed physical therapy. Physiotherapists often assist Parkinson’s disease patients with assessment and treatment, but little is known about the assessment tools and interventions they use. Additionally, physical therapists do not consistently integrate standard outcome measures and treatment procedures into their practices. Consequently, this study was carried out to determine physical therapists’ preferences for assessment and treatment of Parkinson’s disease.MethodsFive hundred questionnaires were distributed to physiotherapists working in clinical settings. Overall, 446 physiotherapists responded to the survey and returned the questionnaires. Questionnaires with incomplete information were excluded from the survey. In total, 418 physiotherapists participated in the study, of whom 324 saw PD patients in their clinical practice.ResultsOverall, 446 physiotherapists responded to the survey and returned the questionnaires. Questionnaires with incomplete information were excluded from the survey. In total, 418 physiotherapists participated in the study, of whom 324 saw PD patients in their clinical practice. Study participants included 43.8% male PTs and 56.2% female PTs with an average age of 30.02 ± 5.38 years. The Berg balance scale for balance assessment was preferred by 220 (67.9%), the Mini Mental State Examination for cognitive assessment was preferred by 317 (97.8%), and the Unified Parkinson’s Disease Rating Scale was preferred by 168 (51.85%) PTs. Neurological PTs employed PNF (proprioceptive neuromuscular facilitation) to decrease stiffness, and exercise and task-focused training for functional training. Virtual Reality and Motor Imagery were also known by 56.6% and 62.4% of PTs, respectively, although only 4.8% and 1.85% used them.ConclusionsStudy results revealed that most physiotherapists follow routine assessment and treatment protocols and do not implement innovative technology in the physical rehabilitation of patients with Parkinson’s disease.

Formality in psychotherapy: How are therapists' and clients' use of discourse particles related to therapist empathy?

Previous studies explored the preferences for therapists' attire and office setting based on initial impressions as a reference for the formality in psychotherapy. This study examines the formality of psychotherapy by investigating therapists' and clients' use of discourse particles, the linguistic marker and quantifier of the formality in speech, in relation to therapist empathy in different stages of psychotherapy. Four psychotherapy sessions (representing early, mid, and late stages) each from 39 therapist-client dyads were analyzed. Trained observers rated therapist empathy in each session using the Therapist Empathy Scale. Results of multilevel modeling show that synchrony in particle usage, hence synchrony in formality, between clients and therapists is not associated with therapist empathy. Therapists' use of particles (i.e., absolute formality of therapists) was also not associated with therapist empathy. In contrast, the relative formality of therapists plays significant roles: therapist empathy is generally observed when therapists are relatively more formal than the clients (i.e., lower relative usage of particles by the therapists when compared to the clients). However, for clients who speak formally with few particles, therapist casualness (i.e., higher relative usage of particles than the clients) at the beginning of therapy may be interpreted as therapist empathy as therapists help these clients ease into the therapeutic relationships. Our results suggest that the examination of therapists' and clients' use of particles across different stages of treatment may illuminate dynamic interactional styles that facilitate or hinder the psychotherapy process.

Examining Expectations Among Polynesian Americans About Seeking Psychotherapy.

Research on culturally diverse clients has investigated expectations about psychotherapy and intention to seek counseling. However, few studies have investigated how these factors may be linked to specific client expectations, such as advice-seeking (the client expecting the therapist to give advice) and audience-seeking (the client expecting to lead the sessions) behaviors, particularly for U.S. racial-ethnic minority populations. This study used a survey to investigate 593 Polynesian Americans' gender and ethnic preferences for therapists, as well as the mediating effects of advice- and audience-seeking behaviors and their associations with intention to seek counseling and expectations about psychotherapy. Results indicated that audience-seeking behavior mediated the association between expectations about the psychotherapy process and intention to seek counseling for psychological and interpersonal concerns and between expectations about psychotherapy outcomes and intention to seek counseling for academic concerns. Culturally competent counseling for Polynesian Americans, a fast-growing yet understudied population in the United States, is needed, particularly by psychotherapists working with these individuals. Expectations about the process of therapy, such as audience-seeking behavior, may be important to consider in working with this population.

Understanding User Needs for Digital Aphasia Therapy: Experiences and Preferences of Speech and Language Therapists

ABSTRACT Background Aphasia therapy software applications (apps) can help achieve recommendations regarding aphasia treatment intensity and duration. However, we currently know very little about speech and language therapists’ (SLTs) preferences with regards to these apps. This may be problematic, as clinician acceptance of novel treatments and technology are a key factor for successful translation from research evidence to practice. Aim This research aimed to increase our understanding of clinicians’ experiences with aphasia therapy apps and their perceived barriers and facilitators to the use of aphasia apps. Furthermore, we wanted to explore the influence of some demographic factors (age, country, and SLT availability in the client’s hometown) on SLTs’ attitudes towards these apps. Method & Procedures 35 Dutch and 29 Australian SLTs completed an online survey. The survey contained 9 closed-ended questions and 3 open-ended questions. Responses to the closed-ended questions were summarised through the use of descriptive statistics. The responses to the open questions were analysed and coded into recurring themes that were derived from the data. Logistic regression analyses were performed to explore the relationship between the demographic variables and the responses to the closed-ended questions. Outcomes & results Participants were overwhelmingly positive about aphasia therapy apps and saw the potential for their clients to use apps independently. As facilitators of app use, participants reported accessibility and inclusion of different language modalities, while high costs, absence of a compatible device, and clients’ potential computer illiteracy were listed as barriers. None of the analysed demographic factors consistently influenced differences in participants’ attitudes towards aphasia therapy apps. Conclusions The positive, extensive and insightful feedback from speech and language therapists is both useful and encouraging for app developers and aphasia researchers, and should facilitate the development of appropriate, high-quality therapy apps.

Therapists' Views of Mechanisms of Change in Psychotherapy: A Mixed-Method Approach.

The question of what works in psychotherapy has been a subject of debate in the recent years, occupying both clinicians and researchers. In this study, we aimed to assess the current perspectives held by clinicians regarding the processes which produce changes in psychotherapy, as well as the predictors of specific views. Licensed therapists (n = 107), consisting mainly of psychodynamically and integratively oriented psychologists, were asked to write in their own words what they think works in psychotherapy. Thematic analysis was employed to assess the main mechanisms of change as perceived by the therapists. Differences in the prevalence of specific themes were assessed using Friedman and Wilcoxon signed-rank tests. Univariate logistic regressions were employed to assess the factors that predict the probability of reporting a specific mechanism of change. The results indicated that the therapeutic bond was the most highly reported mechanism of change, followed by theory-driven mechanisms of change, therapist characteristics, therapist professionalism, and client motivation. Male therapists were more likely to indicate the professionalism as a mechanism of change compared to female therapists. Higher education was associated with lower reports of therapists’ characteristics as the mechanisms of change. These results suggest that therapists acknowledge the importance of the working alliance, and that the perception of the mechanism of change is associated with various factors which comprise therapist orientation. Limitations and directions for future research are discussed.

Treatment Preferences of Physical Therapists in Management of Carpal Tunnel Syndrome: A Cross Sectional Survey

Background: Carpal tunnel syndrome affects one out of ten people throughout their lives, and repetitive work related conditions affecting wrist and hand are the most common cause of prolonged absenteeism from work and limited functional ability. Multiple physical therapy interventions have been used by physical therapists for reducing pain severity, increasing range of motion and decreasing functional limitations in carpal tunnel syndrome.Methods: A cross-sectional survey was conducted among 196 physical therapists in Karachi, Pakistan. Demographic data of physical therapists was obtained, as well as information regarding carpal tunnel syndrome and its intervention techniques used.Conclusion: There existed variability among the treatment preferences of physical therapists regarding the management of carpal tunnel syndrome. A majority of respondents (72.4%) used nerve mobilization techniques, and therapeutic ultrasound was given by 66.3%. The least common intervention used was myofascial release (28.1%). Different approaches had been given in combination as well, which showed that physical therapists are also aware about the recent approaches and their effects for the management of CTS.

Preferences of speech and language therapists for telepractice in the COVID-19 pandemic and factors affecting their acceptance of the delivery model

Objectives: With the COVID-19 pandemic, telepractice became a great option in speech-language therapy services, as in many healthcare utilities. However, the transition to this service model did not occur at a similar rate for every clinician. Therefore, this study aimed to determine the experiences, preferences and factors affecting the acceptance of speech-language therapists (SLT) regarding telepractice in Turkey. Methods: Sixty-seven SLTs were presented with a questionnaire that addressed the professional tendencies, experiences and views on telepractice of them. Descriptive statistics regarding the preferences and experiences of SLTs were calculated. Moreover, factors that might be related to the number of sessions they held at the pandemic were examined with the Chi-squared test. Results: The speech-language disorders that SLTs find the most suitable for telepractice were fluency disorders, voice disorders and speech sound disorders. Groups that SLTs deemed most suitable for receiving telepractice in terms of age were 12-21, 22-64 and 7-11, respectively. A significant relationship was found between the frequency of online meetings and telepractice sessions before the pandemic and the number of sessions during the pandemic. Furthermore, a significant relationship also was found between satisfaction with using clinician skills in telepractice and the number of telepractice sessions during the pandemic. Conclusions: The importance of the first experiences of SLTs in the acceptance of the delivery method emerged. The necessity of in-service trainings and exemplary models to improve attitudes emerged. With these trainings, ensuring security, standardizing practices and increasing qualified services will be provided as well.

Improving the Quality of Children\u2019s Mental Health Care with Progress Measures: A Mixed-Methods Study of PCIT Therapist Attitudes

Progress measures are an evidence-based technique for improving the quality of mental health care, however, clinicians rarely incorporate them into treatment. Research into how measure type impacts clinician preference has been recommended to help improve measure implementation. Parent–Child Interaction Therapy (PCIT) is an assessment-driven treatment that serves as an ideal intervention through which to investigate measure preferences given its routine use of two types of assessments, a behavioral observation (the Dyadic Parent–Child Interaction Coding System) and a parent-report measure (the Eyberg Child Behavior Inventory). This study investigated PCIT therapist attitudes towards progress measures used within PCIT and children’s mental health treatment generally. A mixed-method (QUAN + QUAL) study design examined PCIT therapist attitudes towards two types of progress measures and measures used in two contexts (PCIT and general practice). Multi-level modeling of a survey distributed to 324 PCIT therapists identified predictors of therapist attitudes towards measures, while qualitative interviews with 23 therapists expanded and clarified the rationale for differing perceptions. PCIT therapists reported more positive attitudes towards a behavioral observation measure, the DPICS, than a parent-report measure, the ECBI, and towards measures used in PCIT than in general practice. Clinician race/ethnicity was significantly related to measure-specific attitudes. Qualitative interviews highlighted how perceptions of measure reliability, type of data offered, ease of use, utility in guiding sessions and motivating clients, and embeddedness in treatment protocol impact therapist preferences. Efforts to implement progress monitoring should consider preferences for particular types of measures, as well as how therapists are trained to embed measures in treatment.

Therapeutic Preferences of Arts Therapists in Educational Environments - A Cross-Sectional Study in the Czech Republic

Therapeutic Preferences of Arts Therapists in Educational Environments - A Cross-Sectional Study in the Czech Republic

Professional development training preferences of occupational therapists working with older adults in Australia: A discrete choice experiment.

Members of the public expect occupational therapists to provide evidence-based practice. Participation in professional development activities is essential to update knowledge and acquire skills to enable delivery of evidence-based assessment and intervention. Therapists commonly choose to participate in professional development through attending training workshops. Little is known about occupational therapists' preference of how continuing professional development training programmes should be designed and delivered. An online quantitative survey of occupational therapists working with older people in Australia, conducted June to September 2018, incorporated a discrete choice experiment to elicit and estimate preferences for professional development training when acquiring skills in delivering an evidence-based intervention. A series of questions asked participants to choose one of two options for training, each differing in terms of attributes (level of recognition, mode of learning, follow-up post-training and cost to establish willingness to pay). Statistical analyses were conducted according to recommended practice in the field of choice-modelling. A total of 108 responses were received from occupational therapists practicing around Australia. Therapists reported a strong preference for receiving post-training support to implement their new skills in practice and would be willing to pay an additional A$200 for training that included this option. They also highly regarded achieving 'certification' in their new skill (willing to pay an additional A$100) and having the opportunity to become a 'Master Trainer' in the future (willing to pay an additional A$200). This study generates new knowledge about aspects of a professional development training programme that occupational therapists' value and aspects that they are willing to compromise on when acquiring new skills that they intend to use in their practice. These findings can influence the training programme design utilised by those working in implementation research and providers of continuing professional development for health professionals.

Assessment of in-hand manipulation by occupational therapists in paediatric practices in South Africa

ABSTRACT INTRODUCTION: Assessment of in-hand manipulation is fundamental to guide treatment for children with fine motor delays. Limited literature is available on how South African occupational therapists assess in-hand manipulation. This study aimed to describe which current in-hand manipulation assessment methods are used and what the preferences of occupational therapists in all areas of paediatric practices are regarding a suitable instrument METHODS: Quantitative cross-sectional study design with a non-probability purposive sampling method was used. Participants completed an EvaSys survey system online questionnaire RESULTS: Two-hundred-and-ninety-two (n=292) occupational therapists registered with the HPCSA participated. Limited familiarity (n=50; 17.1 %) with the formal assessment instruments described in literature was reported. The informal assessment methods most commonly used were subjective observation of tasks (n=287; 98.3%) of scholastic tasks (n=261; 89.4%) and play tasks (n=255; 87.3%) for children between the ages of five to six years (n=273; 93.5%). Preferences supported a descriptive instrument accompanied by a user manual that is administered under 15 minutes, in multiple languages, and with attention to the quality of movements and compensatory techniques used by the child CONCLUSION: Results showed that the current and preferred assessment methods used by occupational therapists might provide guidance for the future development of a contextual, relevant in-hand manipulation instrument for paediatric practices in South Africa Keywords: in-hand manipulation; assessment methods; paediatric practice

Psychotherapeutic Considerations for Patients With Terminal Illness

Dignity has gained increasing attention as a vital component of quality of life and quality of end-of-life care. This article reviews psychological, spiritual, existential, and physical issues facing patients at the end of life as well as practical considerations in providing therapy for this population. The authors reviewed several evidence-based treatments for enhancing end-of-life experience and mitigating suffering, including a primary focus on dignity therapy and an additional review of meaning-centered psychotherapy, acceptance and commitment therapy, and cognitive-behavioral therapy. Each of these therapies has an emerging evidence base, but they have not been compared to each other in trials. Thus, the choice of psychotherapy for patients at the end of life will reflect patient characteristics, therapist orientation and expertise with various approaches, and feasibility within the care context. Future research is needed to directly compare the efficacy and feasibility of these interventions to determine optimal care delivery.