Psychotherapeutic Sessions Research Articles

Enhancing Psychotherapy Outcomes by Encouraging Patients to Regularly Self-Monitor, Reflect on, and Share Their Affective Responses Toward Their Therapist: Protocol for a Randomized Controlled Trial.

The quality of the therapeutic relationship is pivotal in determining psychotherapy outcomes. However, facilitating patients' self-awareness, reflection on, and sharing of their affective responses toward their therapist remains underexplored as a potential tool for enhancing this relationship and subsequent treatment outcomes. The primary objective of this study is to examine whether and how the patients' regular self-monitoring and self-reflection (fostered by the systematic compilation of a brief postsession battery) on their affective reactions toward the psychotherapist impact the quality of the therapeutic relationship and treatment outcomes in individual psychotherapy. Secondary objectives are to (1) explore whether and how the characteristics of the patient, the therapist, and the process moderate the effect of regular self-monitoring on the therapeutic relationship and outcomes; (2) examine the relationships between the affective response of the patient, the alliance, and the result of the therapy session outcome; and (3) explore how the affective responses of the patient unfold or change throughout the course of the therapy. We conducted a 1:1 randomized controlled trial of adults in individual psychotherapy versus individual psychotherapy plus self-monitoring. Participants will be enrolled through the web-based recruitment platforms "ResearchMatch" and "Research for Me," and data will be collected through web-based surveys. Participants in the control group will receive only their regular individual psychotherapy (treatment as usual) and will not complete postsession questionnaires. Participants in the intervention group will continue their regular individual psychotherapy sessions and complete the "in-Session Patient Affective Reactions Questionnaire" and the "Rift In-Session Questionnaire" following each therapy session in the 10 weeks of the trial. Additionally, after completion of the postsession battery, they will receive general written feedback encouraging them to discuss their feelings and reflections with their therapist. Participants in both groups will complete a comprehensive psychological assessment at baseline, midtrial (week 5), and end-of-trial (week 10). The primary outcome measure of the trial is the "Clinical Outcomes in Routine Evaluation-Outcome Measure," while the secondary outcomes are the "Real Relationship Inventory-Client-Short Form," the "Working Alliance Inventory-Short Revised," and the number of scheduled therapy sessions that the patient has missed or canceled. The trial was approved by the institutional review board of the University of North Carolina at Chapel Hill. Recruitment started in September 2023. A total of 475 individuals completed the baseline assessment. Data collection was completed in February 2024. The results are expected to be published in the autumn of 2024. This study could reveal key information on how regular self-monitoring and introspection can influence both the therapeutic relationship and treatment outcomes. Findings have the potential to shape interventions, enhance the efficacy of psychotherapeutic sessions, and possibly offer a cost-effective strategy for improving patients' well-being. ClinicalTrials.gov NCT06038747; https://classic.clinicaltrials.gov/ct2/show/NCT06038747. DERR1-10.2196/55369.

(In)visibilité dans la clinique de l’AVC du sujet âgé : effets intrapsychiques et intersubjectifs de l’utilisation de l’IRM

ContextThis paper illustrates a psychodynamic analysis of the intrapsychic and intersubjective effects of the use of MRI in a Neurovascular Unit (NVU) for elderly post-stroke patients, in mainland France. The sudden onset of the stroke and the shift from independence to dependence are juxtaposed with the reality of normal and pathological aging in the elderly, making the boundaries around these two issues difficult to determine. ObjectivesThe aim of this paper is to propose a reflection about the intrapsychic and intersubjective effects of the almost automatic use of the MRI results during the hospitalization of elderly post-stroke patients. MethodThis is a theoretical-clinical elaboration based on clinical cases derived from clinical psychotherapeutic sessions with post-stroke hospitalized patients, institutional observations during staff meetings, and transdisciplinary interviews with the patients and their families. ResultsWe can conclude, through the cases studied and the theoretical analysis that a more personalized use of MRI is essential, because it may help the patient to visualize his or her stroke, to organize what has been psychologically and physically disorganized, and to create a link with the healthcare professional. However, an automated and mechanized way of showing these results may lead the patient into a psychological impasse, accentuate the psycho-corporal disorganization, and complexify the relationship with others. InterpretationsMRI is nowadays the main tool for diagnosing strokes, allowing in vivo exploration of the human brain. Despite its relatively recent appearance, MRI seems to be essential in the treatment and monitoring of stroke patients. However, the use of showing the MRI results to the elderly patients in a stroke unit, their families, and the healthcare professionals does not seem to have been thought through, or at the very least, reflected upon consciously.

Assessment of Basic Benefits of Positive and Transcultural Psychotherapy in Working with a Group of Multicultural Students

This research was done with a group of multicultural students who were pursuing their studies in Turkey. The aim of the research is to evaluate the benefits of Positive and Transcultural Psychotherapy in working with groups of multicultural students. The research data are based on the therapeutic process, which was used in ten psychotherapeutic sessions by applying Positive and Transcultural Psychotherapy, with the methods and techniques, such as: the concept of positum, the principle of hope, the balance model, stories and the psychotherapeutic process, all made within the five phases of therapy. The participants in the group therapy were six females from different national backgrounds. All participants expressed complaints about the adaptation process in the new environment. The research results are based on oral data from participants’ feedback at the end of each session and at the end of the therapeutic process.

Comparative analysis of the use of original and standard methods of rehabilitation treatment of dorsopathy

Introduction. The increase in the number of requests for medical help for pain in dorsopathy determines the relevance of this problem. Among all the conditions included in the Health Expenditure Survey, non-specific musculoskeletal back pain ranks first in the world. A special place belongs to cervicothoracic dorsopathy (CТD), which are the most common in developed countries and are characterized by a variety of clinical forms. There is a need to develop safe and effective complexes for the medical rehabilitation of patients with СТD. The complex method of СТD treating with the obligatory use of drug and non-drug methods of treatment prescribed together or sequentially in one complex, in our opinion, is the most optimal.Aim. To conduct a comparative evaluation of the therapeutic efficacy of restorative treatment methods in patients with cervicothoracic dorsopathy.Materials and methods. Patients with cervicothoracic dorsopathy (n = 220), stratified into 2 comparable groups, were studied, to whom the original (n = 155) and standard (n = 65) methods of restorative treatment were applied. The original method of treatment assumed a combined therapeutic effect with the use of drug therapy and a rehabilitation complex of physiotherapeutic and psychotherapeutic sessions. Statistical analysis included a comparative assessment of the intensity of the pain syndrome, static-dynamic and reflex disorders before and after the therapy.Results. The original and standard methods used in the course of the study statistically significantly (p < 0.05) reduced the intensity of the pain syndrome and reduced the frequency of reflex disorders. At the same time, the use of the original method of therapy was more effective (p < 0.05) in reducing the severity of the pain syndrome and reducing the frequency of reflex disorders in subgroups of patients, both with uncomplicated and complicated forms of cervicothoracic dorsopathy. The use of a standard method of therapeutic effect significantly reduced the frequency of manifestation of static-dynamic disorders in the group with uncomplicated forms of dorsopathy, while in patients with complicated forms of cervicothoracic dorsopathy, no therapeutic effect was achieved.Conclusions. The original method of therapy has confirmed its effectiveness, which indicates the need and justification for the use of combined restorative treatment of patients with cervicothoracic dorsopathy.

Dance as Rehabilitation and Therapy For Breast Cancer Survivors in Kuala Lumpur

How can dance become a useful medium for rehabilitation and alternative therapy for post-clinical populations is the primary concern of this paper. This study examines the ways in which dance/movement can purposefully aid breast cancer survivors in promoting health wellbeing, post-treatment. The first group, Candy Girls Breast Cancer Survivors, advocates dance for healing and sustenance of healthy living. The second group, breast cancer survivors from the National Cancer Society Malaysia participated in a series of psychotherapeutic sessions centred around dance activities and explored dance as a promising strategy to integrate mind, body, and emotion. This ethnographic study draws data from observations, participations, and interviews with women who have survived breast cancer and who have actively participated in various dance activities.

Machine Learning Facial Emotion Classifiers in Psychotherapy Research: A Proof-of-Concept Study

Background: New advances in the field of machine learning make it possible to track facial emotional expression with high resolution, including micro-expressions. These advances have promising applications for psychotherapy research, since manual coding (e.g., the Facial Action Coding System), is time-consuming. Purpose: We tested whether this technology can reliably identify in-session emotional expression in a naturalistic treatment setting, and how these measures relate to the outcome of psychotherapy. Method: We applied a machine learning emotion classifier to video material from 389 psychotherapy sessions of 23 patients with borderline personality pathology. We validated the findings with human ratings according to the Clients Emotional Arousal Scale (CEAS) and explored associations with treatment outcomes. Results: Overall, machine learning ratings showed significant agreement with human ratings. Machine learning emotion classifiers, particularly the display of positive emotions (smiling and happiness), showed medium effect size on median-split treatment outcome (d = 0.3) as well as continuous improvement (r = 0.49, p < 0.05). Patients who dropped out form psychotherapy, showed significantly more neutral expressions, and generally less social smiling, particularly at the beginning of psychotherapeutic sessions. Conclusions: Machine learning classifiers are a highly promising resource for research in psychotherapy. The results highlight differential associations of displayed positive and negative feelings with treatment outcomes. Machine learning emotion recognition may be used for the early identification of drop-out risks and clinically relevant interactions in psychotherapy.

Complex Psychological Comorbidity and Chronic Pain

This study investigates the effectiveness of Multimodal Pain Management (MMST) in patients with complex psychological comorbidity and chronic pain, especially in patients with trauma. Based on expert interviews, it is emphasized that the success of MMST depends heavily on a comprehensive psychological diagnosis to detect and treat potential trauma at an early stage. In addition, it is emphasized that specific treatment approaches, such as longer therapy times and a higher frequency of psychotherapeutic sessions, are required for this patient group. The research draws on various psychological models to represent the interactions between pain and trauma. It highlights the need to identify the factors contributing to maintaining post-traumatic pain. Despite potential limitations, such as limited sample size and lack of control groups, the study highlights the urgent need for further research to develop and optimize effective treatment strategies for this specific patient population.

EFFICACY OF INTEGRATIVE SELF-REFLECTION INTERVENTIONS ON THE SELF-COMPASSION OF ADULTS WITH SYMPTOMS OF DEPRESSION

Objective: The purpose of the research was to explore the impact of an integrated approach to self-reflections by combining the interventions from Naikan Therapy and Expressive Arts therapy on adults with symptoms of depression. It was hypothesized that after the successful completion of ten bi-weekly psychotherapeutic sessions over a period of 7 weeks (including pre and post assessment), participants would have increased levels of self-compassion compared to the pre-test levels. Research Design: The present research is a quasi-experimental research design. A total of eleven participants within the age range of 18-40 were included in the research using purposive sampling. Place and Duration of the Study: 1 year, at Bahria University, Karachi Campus Participants and Methods: Only participants who were experiencing symptoms of depression, between the age range of 18-40 and at least a 12th grade education level was included in the research. In addition to the Informed Consent Form, Demographic Information Form, Siddiqui Shah Scale of Depression (Siddiqui and Shah, 1997) and Self Compassion Scale (Neff, 2003) were used to assess the level of depressive symptoms and self-compassion of the participants before and after the intervention. Statistical Package for Social Science (SPSS) 22.0 was used for analysis and a paired sample t-test was conducted to see the differences between the pretest and posttest of the participants. Results: Results indicated a significant increase in the levels of self-compassion from pretest (M=57, SD=6.67) to posttest (M=102, SD=10.09) conditions; t (10) = -1.45, P&lt;0.05. Conclusion: Integrative psychotherapies have been found to be effective in increasing awareness, improving self-awareness, improving mindfulness, and reducing self-critical thinking. Overall, these potential implications suggest that it may be an integrative form of therapy for individuals struggling with depression.

Psychotherapy displayed as an ongoing meaning-making dialogue

Individuals psychologically process their experiences while involved in dialogue in daily situations. In psychotherapeutic sessions, we can appreciate the ongoing process of constructing meaning when focusing on a microgenetic level during the exchange of child and therapist. We examine an excerpt from a therapeutic process with a sexually abused child from a socio-genetic perspective, with a focus on the display of semiotic fields, meaning growth and balancing tension and as a mean to deal with the painful consequences. Self-regulatory mechanisms are displayed in dialogical chains, providing insight into processing strategies to cope with a traumatic experience. Ambivalence and tension are essential to elaborate new meanings as well as a therapist willing to accompany the child.

Empathy, working alliance, treatment expectancy and credibility in video and face-to-face psychotherapeutic first contact

Objective Video-based therapy has been used increasingly since the onset of the COVID-19 pandemic. Yet, video-based initial psychotherapeutic contact can be problematic due to the limitations of computer-mediated communication. At present, little is known about the effects of video first contact on important psychotherapeutic processes. Method: Forty-three individuals (n video = 18, n face-to-face = 25) were recruited via an outpatient clinic waiting list and were randomly assigned to video or face-to-face initial psychotherapeutic sessions. Participants rated treatment expectancy before and after the session, and the therapist’s empathy, working alliance, and credibility after the session and several days later. Results: Empathy and working alliance ratings of patients and therapists were high and did not differ between the two communication conditions after the appointment or at follow-up. Treatment expectancy increased to a similar extent for the video and face-to-face modalities from pre to post. Willingness to continue with video-based therapy increased in participants who had video contact, but not in those with face-to-face contact. Conclusion: This study indicates that crucial processes related to the therapeutic relationship can be initiated via video, without prior face-to-face contact. Given the limited nonverbal communication cues in video appointments, it remains unclear as to how such processes evolve. Trial registration: German Clinical Trials Register identifier: DRKS00031262..

Expression and interpretation of emotions in multilingual psychotherapy: A literature review

AbstractThis review aimed at presenting the findings of 19 original studies that were published in the period from 2000 to 2022 in order to outline the current state of the art in the field of emotion communication (i.e., expressing and interpreting emotions) in multilingual psychotherapy. This analysis involves in particular the studies that investigate multilingual phenomena (e.g., code‐switching and language‐mixing) that occur during psychotherapeutic sessions when client and therapist can speak more than one language, as well as the articles that research emotion communication in this multilingual setting. With this in mind, the articles selected for this review are divided into two main categories: linguistic phenomena in multilingual psychotherapy and emotion communication in multilingual psychotherapy. Results of the studies in the current analysis reveal that code‐switching remains one of the main linguistic phenomena that arises in the area of multilingual psychotherapy. Switching languages in therapy tends to be considered as beneficial for both client and therapist. Besides, findings suggest a connection between speaking L1/LX and one's identity (e.g., feeling different depending on the language). Additionally, studies that investigate emotion communication in multilingual psychotherapy show that an individual's first language (L1) is predominantly viewed as more emotionally charged than their language(s) learned later in life (LX). However, some studies also demonstrate that the relationship between L1 and LX is more fluid and context‐dependent than it has traditionally been regarded. Propositions are given for future research in the field of emotion communication in multilingual psychotherapy.

POST -PANDEMIC SCENARIO FOR MEDICINE AND PEOPLE

The novel coronavirus disease (COVID-19), first reported in China, quickly reached global proportions, which triggered a wave of compulsory confinements imposed by governments in order to ease the pandemic. In this scenario, patients, health workers and the general population are under insurmountable psychological pressure, which can lead to mental health problems, such as depression, anxiety, insomnia. In Brazil, the largest number of cases of the disease were notified in the city of São Paulo. With this in mind, an observational study of individuals participating in the Longitudinal Study of Adult Health (ELSA-Brasil) was proposed, which seeks to analyze and monitor the mental health of 4150 patients during the period of social isolation and restricted commuting, as well as registering their evolution when submitted to psychoeducation and psychotherapy, looking for prevalences of associated psychiatric symptoms. In this study, individuals who sought psychological assistance, who scored with higher levels of severity and had significant worsening in the depression scale will be submitted to online psychotherapeutic sessions, guided by professionals in the fields of Psychiatry and Psychology. Based on this proposal, the possibility of using Telemedicine follows, more specifically, Telepsychiatry and Telepsychology, whose use underwent new revisions in March and April by CFM and CFP, respectively, which involved their exceptional release during the COVID-19 pandemic. With this, the broader use of these means for the follow-up of ELSA patients is sought, through the exploration of new platforms and their application to the exposed context.

Mental Health Promotion for Internally Displaced Persons Using Drama Therapy in Makurdi Area, North Central Nigeria

Trends in contemporary global arts practice have shown that experts in the field of mental health have long tapped into visual arts and music to help treat developmental disabilities and several other mental issues, including depression, anxiety, borderline personality disorder, as well as schizophrenia and bipolar spectrum. Today, therapists are finding great benefit from another art form; drama.” However, the paradox in Nigeria, especially in the northern part is that drama technique as a psychotherapeutic practice does not exist in the protocol of mental health facilities. In retrospect, it is obvious that the poor status of mental health care in northern Nigeria is due mainly to lack of facilities, un-affordability and inaccessibility to health facilities. Against this backdrop of increasing mental health issues, especially post-traumatic-stress-disorder (PTSD); resulting from insurgency attacks, communal clashes, herdsmen carnage, road accident and flood, which have given rise to various internally displaced persons (IDPs) camps vis-à-vis their psychological implication in the north. The need for the availability of drama therapy technique becomes highly imperative for affordable, accessible and effective mental healthcare promotion. The paper discusses the concept and practice of drama and theatre therapy techniques, and how they can be applied in psychotherapeutic sessions both at individual and group therapy levels. The improvisational approach which keys into various expressive art techniques shall be utilized. The approach is used to create believable characters out of IDPs themselves, through storytelling, songs, music, dance, etc., to enable them to get emotionally involved to establish a recall of the experience that brought about their disadvantaged psychological condition. This leads to clinical discussions that will facilitate the way forward in making individual and collective choices and decisions that will bring about not just mental health, but holistic well-being.

Patients and psychotherapists using concessive counter‐argumentation: Co‐constructing new framings

AbstractShifting point of view and imagining alternative scenarios can be considered crucial goals of every therapeutic path. Reframing is aimed at stimulating other hypotheses and new viewpoints of the same situation and at adding complexity to one's own and to the others' world images. An interesting aspect to be investigated is the linguistic mechanisms through which this reframing can be enacted. Our work has an interdisciplinary focus and can be staged in between theories and techniques of psychotherapy on the one side and argumentation theory on the other side. The aim of this contribution was to explore the potential role that concessive counter‐argumentation plays in amplifying and redefining patients' framing. Our study consists of an in‐depth single‐case analysis based on two psychotherapeutic sessions. The analysis comprises different steps: first, we identified the concessive sentences in the transcriptions of the psychotherapy sessions and we considered them as counter‐argumentations; second, we identified the two parts of the concessive counter‐argumentations; third, we identified the inferences that could be drawn from these two parts; and finally, we reconstructed the contextual framing that was enacted and endorsed by both the patient and the therapist. The findings show that both the therapist's and the patient's concessive counter‐argumentations help in detecting key passages of sessions that open new, previously unimagined scenarios, thereby also contributing to clinical theory.

Validation of the Working Alliance Inventory- Short Form for Patient (WAI-S-P) in Peruvian Adults.

Although the importance of the therapeutic alliance in the treatment process and health outcomes is recognized, so far, there has been no evaluation in the Peruvian context that considers possible individual differences that could influence this assessment. This study assessed the psychometric properties of the WAI-S-P in a sample of individuals from Peru who are receiving psychological therapy. Furthermore, a network analysis was conducted to investigate the direct relationships between the therapeutic alliance and several relevant sociodemographic variables. The short version of the Working Alliance Inventory was used in a sample of 241 participants (Mage=32.58, SD=12.67) that had attended less than 6 sessions. Three models were considered, including a three-factor and a two-factor correlated model, as well as a bifactor model. In addition, a network of partial associations was created including the overall therapeutic alliance, sex, age, and number of psychotherapeutic sessions. The bifactor model, with an overall therapeutic alliance factor and two specific factors ("contact" and "contract"), better fit the data. Invariance of the structure by sex and age showed equitable measurement. On the other hand, network analysis revealed a positive correlation between total session attendance and therapeutic alliance. Men reported higher therapeutic alliance, while women had higher total session attendance. The results of this study suggest that the therapeutic alliance is better represented by a bifactor model and demonstrates invariance across sex and age in Peruvian adults. Additionally, findings indicate that differences in life experiences and the sex of patients may need to be verified in future studies to better understand nuanced needs in forming therapeutic alliances at least in the early stages of session attendance.

Accompagner l’orthorexie dans les troubles des conduites alimentaires : création et évaluation d’un programme psychothérapeutique

ObjectiveOrthorexia, defined as an obsession with healthy eating, is an emerging phenomenon. More and more researchers are interested in the topic but to date no therapeutic program exists to help those who suffer from this disorder. The aim of this study is to test an intervention program for patients suffering from eating disorders who present orthorexic symptoms: the ORTO-ED program. MethodThis program includes five collective psychotherapeutic sessions. Inspired by brief therapies, it is based on an integrative approach. Self-reported questionnaires were used to evaluate the program. Participants (n=5) completed in test-retest the French Orthorexia Scale (FOS-12), the Body Esteem Scale (BES), the Acceptance and Action Questionnaire (AAQ-II), and the Clinical Scale of Mediated Therapies (CSMT-16) at the final session. ResultsQuantitative analyses did not objectify significant differences for the level of orthorexia, body esteem, and psychological flexibility. However, the qualitative analyses showed that the participants expressed positive feedback about their experience of the program. They felt an improvement; they appropriated the tools properly; and they found the program pleasant and useful. DiscussionThis experimental research can be considered more as a feasibility and acceptability study in an open context than as an evaluation of a psychotherapeutic program in terms of impact. It also raises some methodological limitations (such as the absence of a control group). Furthermore, the content of the program could be improved by other methods (mediatised therapies, cognitive approach, etc.). ConclusionThis experimental therapeutic program represents a major clinical progress for the treatment of orthorexic symptoms in eating disorders. The ORTO-ED program has produced interesting results and can be considered a serious treatment approach for orthorexia.

Brief presential and online psychodynamic psychotherapy: patients' perception

In the last decade, different types of online activities have been growing exponentially and online psychotherapy is moving in the same direction. It is crucial to recognize this line of work as a facilitator for people in the contemporary world, especially after the COVID-19 pandemic in 2020. The purpose of this study was to compare the perception of patients who underwent brief face-to-face psychodynamic psychotherapy and online psychotherapy by a single therapist. The study had a quantitative-qualitative approach, exploratory and comparative, which used the clinical methodology. The appointments were systematic and respective, consisting of six daily face-to-face sessions, on consecutive days, except on Sundays; and six online appointments, using the same process for data collection; the extent of each session was between 40 to 50 minutes. For the data collection regarding the perception of patients on the brief psychodynamic psychotherapy care in person versus online, were tested the Inventory of Therapeutic Alliance (Working Alliance Inventory) with questions about the therapeutic relationship, after the end of 6 online sessions, and the Questionnaire Session Evaluation Questionnaire right after the end of each psychotherapeutic session, both in face-to-face and online situations. The results obtained demonstrated that there is equivalence in face-to-face and online care, regarding the therapeutic relationship built in both moments.

Heart rate variability predicts outcome of short-term psychotherapy at the workplace.

The bio-psycho-social model highlights intra-individual and inter-individual interactions, including psychotherapy. The processing of these interactions within a person takes place, among others, in the central autonomic network (CAN). The CAN's autonomic output to the periphery can be indexed by heart rate variability (HRV), representing individual adaptive capacity. Further, the CAN influences the hypothalamus-pituitary-adrenal axis with its product cortisol. The aim consisted in investigating HRV and cortisol as well as their relation to symptom course in response to short-term psychotherapy. A single-arm, uncontrolled, explorative study was conducted at an outpatient psychotherapeutic consultation in the workplace offered to employees with mental or psychosomatic complaints. Questionnaires included symptoms of depression, irritation and functional impairment. Circadian profile of HRV and salivary cortisol concentrations collected pre and post short-term psychotherapeutic intervention (4-12 sessions) were assessed. Multilevel-linear mixed regressions were calculated. Out of 29 participants (mean age 42; 72% female), 24% were on sick leave from work. Cortisol concentrations were neither affected by intervention nor by symptom course. The proportion of individuals showing a vagally mediated HRV in the range of the lowest quartile assessed for age- and sex-matched healthy controls was reduced at follow-up (pre 34%, post 22%; p=.017). Higher vagally mediated HRV at baseline predicted lower symptom burden at follow-up. Thus, the results support the assumption that HRV reflects the capability of an organism to adapt and recover. Patients with reduced HRV might need additional psychotherapeutic sessions to achieve the same symptom improvements than patients with retained HRV.

Early Diagnosis and Counseling in Adolescents With Subclinical Psychotic Symptoms

Psychosis is a condition characterized on current diagnostic tests by impairment and may include severe disturbances of cognition, thinking, behaviour, and emotion. The need for early diagnosis and prevention of psychotic episodes in adolescents challenges traditional models of counselling, diagnosis, and treatment. The aim of the present study is to derive the main themes and psychological manifestations in the first psychotic episode in adolescents and to deepen knowledge and raise questions around the specific experiences of psychotic adolescents in order to help the clinical psychologist and psychotherapist in diagnostic and therapeutic counselling. This thus goes beyond the visible behaviour and the medical model that pays little attention to the causal relationships in psychosis and its unconscious components. Thirty-six adolescents (27 girls) with subclinical and clinical psychotic symptoms and 30 adolescents (16 girls) with neurotic symptoms were interviewed. A clinical approach was used – clinical psychological interview followed by psychotherapeutic work. Findings and statements can be found showing that early psychotic signs may change into a more severe adolescent crisis, as well as indications of the nature of anger towards parents, unstable mood and aggressivity. Leading themes in interviews and psychotherapeutic sessions may relate to feelings of insignificance in the world around them, unclear sexual identification, too close a relationship with their mothers, and anxiety about real or symbolic absence such as their mothers’ working away from home for long periods of time. In 79% of the interviews with adolescents with psychotic symptoms, we see a lack of real symbolic play in childhood. suitable for non-psychotic adolescents, in this case to change in the first psychotic episode.****What does this last sentence mean? The importance of early diagnosis is recognized and the known psychotherapeutic techniques must be used. Keywords: early psychosis, adolescent, positive psychotherapy, counselling

Immersive virtual reality in anxiety psychotherapy and ocular rehabilitation. A transdisciplinary approach

Immersive virtual reality (iVR) can be used not only as a guideline intervention in certain anxiety disorders but also as a brain stimulating interface, triggering neuroplasticity mechanisms and facilitating the rehabilitation of sensorimotor disorders. iVR’s potential was recently harnessed in treating or diagnosing amblyopia or in remote measuring of patient-related outcomes. We present the case of Mr. L.A., a 69-year-old man, a former academic, political and civic movement figure, currently performing successful writing. His right eye had posterior chamber pseudophakia and was treated for glaucoma, and his left eye had an evolving cataract. The right eye’s optical coherence tomography (OCT) revealed the impact of glaucoma and also the loss of nerve fibers and cells impairing signal conduction, while the combined results explained the high level of impairment of binocular vision. The impaired vision caused a very high level of concurring anxiety derived from the inability to perform daily tasks, directing him toward psychotherapy. The personalized iVR approach was preceded by cybersickness evaluation using VRQTest (Vectorush Studio). For relaxation, we used an artificial intelligence massage chair with body scanning mimicking Jacobson progressive relaxation and a specific pranayama yoga already familiar to the patient. Every session used a different iVR software for further distractibility and immersivity. The best-tolerated visual rehabilitation software was Vision Therapy, developed by Cerverum INC. The hardware used consisted of an Oculus Rift virtual reality headset and a Dell Alienware 17 R4 laptop. The patient was able to conduct daily tasks after the nineth session. The tolerance was associated with a massive improvement in eyesight of the left eye, from a visual acuity of 0.2 to 0.6 measured after the 20th psychotherapeutic session. To our knowledge, this is the first reported case of using this type of consecutive dual approach to anxiety and ocular rehabilitation.