Strong Therapeutic Alliance Research Articles

Telehealth Social Rhythm Therapy to Reduce Mood Symptoms and Suicide Risk Among Adolescents and Young Adults With Bipolar Disorder.

Social rhythm irregularities are associated with increased bipolar disorder symptoms and suicide risk. This study was the first to examine the feasibility and acceptability of a 12-week social rhythm therapy (SRT) delivered predominantly via telehealth (three in-person sessions, nine via video teleconferencing) to adolescents and young adults with bipolar disorder. The primary aim was to determine the feasibility and acceptability of SRT delivered predominantly via telehealth. Secondary aims were to explore the intervention's impacts on social rhythm regularity, mood symptoms, and suicide propensity. Thirteen adolescents and young adults with bipolar disorder received a modified SRT called Brain Emotion circuitry-targeted Self-Monitoring And Regulation Therapy for Daily Rhythms (BE-SMART-DR) administered mostly remotely, adjunctive to treatment as usual. Retention rates, client satisfaction, therapeutic alliance, and pre- to postintervention changes in social rhythm regularity, mood symptoms, and suicide propensity were assessed. BE-SMART-DR was associated with high retention rates (77%), high mean±SD scores on the Client Satisfaction Questionnaire (29.4±2.7), and high participant global scores on the Working Alliance Inventory (231.3±8.1), indicative of strong therapeutic alliance. Secondary outcome measures on social rhythm irregularities, mood symptoms, and suicide propensity decreased from pre- to posttherapy. Increased social rhythm regularity was associated with reduced suicide propensity after analyses were controlled for reductions in mood symptoms. These preliminary results indicate that SRT delivered largely by telemedicine is feasible and acceptable. The intervention appeared to reduce mood symptoms, and suicide propensity independent of mood symptoms, among adolescents and young adults with bipolar disorder.

\u201cSex isn\u2019t everything\u201d: views of people with experience of psychosis on intimate relationships and implications for mental health services

BackgroundThe experience of psychosis and associated discrimination can be a barrier to forming and maintaining romantic relationships. Sexual health interventions within mental health services often focus on contraception and reducing risk. There are no known studies that seek to understand what support, if any, people who experience psychosis want regarding psychosocial aspects of intimate relationships.MethodsTo address this gap in the literature, qualitative data was collected to investigate how people with experience of psychosis conceptualise romantic relationships and what support they would like in this area of their lives. Semi-structured interviews were conducted with 10 mental health service users (four women, six men) with experience of psychosis. Interviews were analysed from a critical realist social constructionism perspective using thematic analysis.ResultsStigma was a prominent theme, described as impacting numerous aspects of romantic relationships. Power imbalance within services meant participants were wary of having conversations about relationships with professionals and identified a therapeutic alliance as a prerequisite. However, abusive relationships were highlighted as a needed area for support by services.ConclusionServices should be trauma-informed and help those in abusive relationships. The power and autonomy of people with experience of psychosis should be maintained in any discussions or interventions regarding intimate relationships. A strong therapeutic alliance is essential for any work in this area.

Stronger therapeutic alliance is associated with better quality of life among patients with advanced cancer.

Patient-oncologist therapeutic alliance is a foundation of quality cancer care, although there is limited research demonstrating its relationship with patient outcomes. We investigated the relationship between therapeutic alliance and patient quality of life with a secondary goal of determining whether the association varied by patients' baseline level of psychological distress. Cross-sectional analysis of baseline data from a randomized clinical trial of 672 patients with advanced cancer participating in a primary palliative care intervention trial. Patients completed baseline self-reported measures of therapeutic alliance (The Human Connection Scale, range: 16-64), overall quality of life (Functional Assessment of Cancer Therapy-Palliative Care, range: 0-184), and psychological distress (Hospital Anxiety and Depression Scale, range: 0-42). First, we determined the relationship between therapeutic alliance and quality of life using multivariable regression adjusting for confounders. We then examined if psychological distress was an effect modifier in this relationship by adding interaction effects of depression and anxiety symptoms on therapeutic alliance into the regression model. Patients reported high levels of therapeutic alliance (56.4±7.4) and moderate quality of life (130.3±25.5). Stronger therapeutic alliance was associated with better quality of life after adjusting for other confounding factors (β=3.7, 95% confidence interval=2.1, 5.3, p<0.01). The relationship between therapeutic alliance and quality of life was generally consistent regardless of psychological distress. Collaborative, trusting relationships between patients with advanced cancer and their oncologists are associated with better patient quality of life. Future research should investigate the causal, longitudinal nature of these relationships.

The abrupt transition from face-to-face to online treatment for eating disorders: a pilot examination of patients\u2019 perspectives during the COVID-19 lockdown

BackgroundStudies investigating patients’ perspectives towards an abrupt transition from face-to-face to online treatment in eating disorders (EDs) are scarce. The current study aimed to (1) conduct a preliminary assessment of patients’ perspectives regarding this transition, and (2) explore potential demographic, clinical, and treatment-related factors associated with these perspectives.MethodsSixty-three patients with EDs whose treatment was moved to an online format, were surveyed during the COVID-19 lockdown (April–May 2020). A 6-item measure was developed to examine their perspectives toward this transition. Exploratory factor analyses (EFAs) were conducted to confirm the rational-theoretical structure of the measure (Eigenvalue = 3.745, explaining 62.4% of variance). The Cronbach’s alpha value was excellent (α = 0.878). Validated questionnaires were used to measure ED symptoms, general psychopathology, therapeutic alliance, and pandemic anxiety, and their associations with our transition-focused scale and telemedicine satisfaction were examined.ResultsMixed views were found regarding the transition, with the majority (68%) stating that they would not choose to continue online therapy given the option. Longer duration of treatment (r = 0.291, p = 0.022), stronger therapeutic alliance (r = 0.293, p = 0.028), and higher COVID-19 anxiety (r = 0.276, p = 0.029) were linked with more positive views towards the transition.ConclusionsAnalyses suggest that patients’ perspectives towards the transition can be measured using a Likert-type 6-item scale. Findings highlight the various responses to online treatment and indicate a need to identify patients who may face difficulties in the transition to this newly ubiquitous treatment mode. Clinicians should be cognizant of these potential difficulties and consider appropriate modes of treatment in the ongoing pandemic situation.

Psychodynamic technique and therapeutic alliance in prediction of outcome in psychodynamic child psychotherapy.

This study is the first to investigate the effect of psychodynamic technique (PT), therapeutic alliance, and their interactions with outcome in psychodynamic child psychotherapy. The sample comprised 79 Turkish children (mean age = 6.86 years, 38% girls) with discrete internalizing (22%), discrete externalizing (11%) and comorbid internalizing and externalizing (67%) problems. Independent raters coded 359 sessions from different phases of treatment using the Child Psychotherapy Process Q-Sort for PT and Therapy Process Observational Coding System-Alliance Scale. Problem-assessment measures were collected at intake and every 10th session in treatment using the Children's Behavior Checklist and Brief Problem Monitor. Multilevel modeling analyses indicated that the PT and therapeutic alliance interacted such that more use of the PT in the context of high therapeutic alliance predicted less problem behaviors, whereas in the context of low therapeutic alliance PT predicted more problem behaviors. This relationship was moderated by problem comorbidity such that for children with comorbid problems, though a strong therapeutic alliance was indicated, an increase in PT use did not have a significant effect. Findings suggest that the use of psychodynamic interventions is indicated in the context of a strong therapeutic alliance, especially for children with noncomorbid problems. Psychodynamic interventions may have an adverse effect if a therapeutic alliance is not established. For children with comorbid problems, keeping the relationship strong is important. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Brief Mindfulness Therapy and Mental Health in People Exposed to a Recent Stressful Event: A Study of Multiple Cases with Follow-Up

Stressful events have important consequences for mental health, among the most frequent are posttraumatic and depressive symptoms. Brief mindfulness-based interventions are currently of great research interest as preventive interventions. In this sense, the objective of this research was to evaluate the effectiveness of a four-sessions mindfulness program in reducing posttraumatic and depressive symptoms, in people that have been exposed to a recent stressful event. A mixed qualitative-quantitative design was used. Qualitatively, a phenomenological method was used. On the other hand, an A-B type intra-subject case study was carried out with pre-intervention, post-intervention and follow-up measurements. Four patients and four therapists participated, semi-structured interviews were used, complemented by measurement scales to evaluate posttraumatic and depressive symptoms, posttraumatic growth and satisfaction with life. A decrease tendency in depressive and posttraumatic symptoms and an increase tendency in posttraumatic growth and life satisfaction were observed. After the intervention, patients said that they felt gratified and better prepared for daily life. They developed a strong therapeutic alliance, and quantitative indicators of positive change were present.

An Open Trial of Metacognitive Remediation Therapy and Pharmacotherapy to Promote Smoking Cessation among Individuals with Psychotic-Spectrum Disorders.

Introduction Individuals with psychotic-spectrum disorders may smoke due to the ameliorating effect of nicotine on the cognitive deficits that accompany these illnesses. Metacognitive remediation therapy (MCR) has been shown to produce improvements in cognitive functioning among individuals with psychotic-spectrum disorders and provides a foundation for a novel smoking cessation intervention for this population. Aims To complete an open investigation of pharmacotherapy and a modified version of MCR [MCR to Quit (MCR-Q)] in promoting smoking cessation among individuals with psychotic-spectrum disorders. Methods Forty-nine individuals with a psychotic-spectrum disorder and who currently smoke cigarettes participated in MCR-Q while also receiving evidence-based smoking cessation pharmacotherapy. Tobacco use was assessed as follows: (i) prior to MCR-Q, (ii) immediately after completing MCR-Q, and (iii) six weeks after completion of MCR-Q. Results/Findings. During participation in MCR-Q, nearly 80% of participants made a 24-hour quit attempt. Following the completion of MCR-Q, participants experienced reductions in level of nicotine dependency and exhaled carbon monoxide, with reductions in nicotine dependency sustained six weeks after completion of MCR-Q. Over the course of their participation in MCR-Q, participants reported strong therapeutic alliance with their MCR-Q therapist and high levels of intrinsic motivation with regard to completing MCR-Q exercises. Conclusions The results from the current study suggest cautious optimism with regard to the use of MCR-Q in combination with medication for individuals with psychotic-spectrum disorders who want to quit smoking.

Cultural adaptations of cognitive behaviour therapy for the Orthodox Jewish community: a qualitative study of therapists’ perspectives

Abstract Cultural factors are influential in the prevalence, diagnosis and treatment efficacy of mental health conditions. Although the literature has advanced substantially towards the development of cultural adaptations of cognitive behavioural therapy (CBT) for various minority cultural groups, research into cultural adaptations of CBT for the Orthodox Jewish community has been scarce. This qualitative study interviewed five CBT therapists about their experiences working with clients from the London Orthodox Jewish community and uncovered several key practical implications for the clinical practice of CBT with this client group. This study indicates that CBT is a culturally appropriate psychological treatment for this client group that accords with Orthodox Jewish teachings and religious beliefs. CBT therapists are encouraged to become familiar with Orthodox Jewish cultural practices and beliefs and adopt a culturally sensitive approach to treatment. Despite the reduced mental health stigma within the community, this study recommends that CBT therapists normalise mental health conditions and therapy with Orthodox Jewish clients. Due to the close-knit nature of the community, it is suggested that CBT therapists display heightened confidentiality with this client group. To overcome the mistrust of their Orthodox Jewish clients, CBT therapists are advised to display cultural sensitivity and genuine respect for the Orthodox Jewish way of life, in addition to building a strong therapeutic alliance. Further qualitative research exploring different perspectives is necessary to produce evidence-based guidelines for the cultural adaptation of CBT for the Orthodox Jewish community. Key learning aims (1) To explore how CBT therapists work with the religious beliefs and practices of Orthodox Jewish clients. (2) To discover the challenges faced by Orthodox Jewish clients when accessing psychological treatment. (3) To consider the ways in which CBT can be culturally adapted to meet the needs of the Orthodox Jewish community.

Patients’ conceptions of undergoing physiotherapy for persistent low back pain delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in cognitive functional therapy

Purpose To explore the conceptions of patients with persistent low back pain (LBP) of undergoing physiotherapy delivered in Finnish primary healthcare by physiotherapists who had participated in brief training in Cognitive Functional Therapy (CFT). Methods As part of a feasibility implementation study exploring CFT in management of LBP in the Finnish primary healthcare system, we interviewed nine patients from four geographical areas in Finland after receiving care. We used a phenomenographic approach to explore the variation in their conceptions. Results The analysis revealed four descriptive categories: “hung out to dry,” “stuck,” “making sense and taking control,” and “holistic approach to care and living,” that varied based on six themes. Conclusions Although the participants accepted this approach to care well, there was significant variation in patients’ conceptions. Restricted access to care within the healthcare system and a lack of social support led some of them to feel they had been left alone to suffer with their pain. On the other hand, based on the results of this study, positive experiences of physiotherapy and good collaboration with the physiotherapist, wider social support outside of physiotherapy, a better understanding of the multidimensional nature of pain and the acquisition of self-management skills were reported as positive aspects of undergoing physiotherapy that may be related to positive treatment outcomes. Implications for rehabilitation The participants of this study saw undergoing physiotherapy delivered within biopsychosocial framework as different from their previous physiotherapy experiences and for some the process ended with feeling empty-handed and for others it could be a turning point in their lives. This study encourages the health care providers to create flexible care pathways and ongoing support for more vulnerable individuals so that they don’t feel abandoned by the system. Professionals could also pay attention to building strong therapeutic alliance, help patients understand pain in biopsychosocial framework, take into consideration social support networks of the patients, and support patients toward effective self-management strategies.

Technology-assisted methods to assess the quality of the therapeutic alliance between health care providers and patients: a scoping review protocol.

The goal of this review is to identify and summarize technology-assisted methods that are being used in clinical, research, or educational settings to assess non-verbal behaviors that have been identified as contributors to the quality of the therapeutic alliance between health care providers and patients. A strong therapeutic alliance is a critical component of positive patient outcomes. A health care provider's non-verbal behaviors help build a strong therapeutic alliance, but practice with expert feedback is often required to develop desirable non-verbal behaviors. Advances in technology have been harnessed to assess and provide feedback to health care providers, but the technological tools can be difficult to find and compare. Technology-assisted feedback has the potential to help health care providers hone important clinical skills without requiring highly trained instructors, improving medical care overall. This review will consider quantitative and qualitative studies, as well as review articles. Participants must be health care providers (or students) who routinely conduct appointments with patients. Included studies must incorporate technology-assisted methods that are being used to collect or analyze information regarding at least one behavior associated with the therapeutic alliance in a clinical, research, or educational setting. Any type of patient encounter, whether actual, actor-based, virtual reality, or simulation-based, will be included. Five bibliographic databases will be searched, with results limited to English-language articles published from 2010 to the present. The search strategy yielded 404 results in PubMed. The proposed methodology follows the JBI methodology for scoping reviews.

‘My Child is Anxious Because We Might Get Deported’: Brief Therapy from MRI with an Immigrant Family in the United States

As we go to press in a COVID‐19 world, the topic of anxiety is foremost on our minds. While each situation has to be considered in its own context, how to manage different anxieties has common denominators. There is currently a sharp increase in forced migration around the globe so mental health professionals must develop effective skills, like the ability to adapt services to different contexts and cultures, to manage the needs of immigrant people. Problem‐Solving Brief Therapy, as developed at the Mental Research Institute in Palo Alto, is a systemic model of therapy, which aims at promoting change in the complaint the presenting client (the ‘talker’) cares about. The model’s roots in Constructivism foster integrating the clients’ beliefs and values into therapy to allow the therapists to adapt to the clients’ particular needs. This paper is the analysis of a single case where the therapist worked with an immigrant family because their child suffered from severe anxiety related to the parents’ threatened deportation. The paper focuses on premises and strategies that allowed minimising cultural barriers between therapists and family members, thus facilitating a strong therapeutic alliance conducive to improvement.

Group Therapy for Patients With Medical Illness.

This article aims to review the expanding role of group psychotherapy in the treatment of individuals with medical illnesses, an area that has expanded dramatically during the past 30 years. The fundamental principles of adaptation of group therapies for specialized clinical populations are articulated. Clarity of goals and thoughtful alignment with patient interests and needs are at the heart of building a strong therapeutic alliance and potentiate the effectiveness of group therapy. This article also discusses the conceptual underpinnings of group therapies and the ways in which group therapeutic factors gain expression with these clinical populations. This article also focuses on breast cancer, in light of its clinical prominence and the development of group therapies for individuals with the disease. These therapies address clinical concerns for women along the continuum of the disease, including familial and genetic predisposition, primary breast cancer, adaptation to illness and its treatment, metastatic disease, and dealing with mortal illness.

Rethinking Interpreter Functions in Mental Health Services.

Interpreters improve access to care for patients with limited English proficiency (LEP), but some studies have reported poorer cultural understanding, relationship quality, and patient satisfaction than with language-concordant care. Use of interpreter roles beyond linguistic conversion (clarifier, cultural broker, or advocate/mediator) may enhance interpreter-mediated care by improving cultural understanding and the therapeutic alliance. As reported in this column, pilot data on interpreter-mediated evaluations of 25 psychiatric outpatients with LEP support this position. The authors found that clarification of the interpreter's role and the session structure improved provider-interpreter collaboration, with two perceived benefits: improved assessment through elicitation of clinically relevant information and stronger therapeutic alliance through "emotion work." Strategies for effectively enhancing provider-interpreter collaboration are discussed.

Portrait of an Exhibitionist.

Exhibitionism has been viewed through many lenses, from the perspectives of sexual deviance, forensic psychiatry, psychopathology, psychological dynamics, feminism, behaviorism, and psychopharmacology. Starting from the description of one psychotherapy patient, the aim of this paper is to synthesize this disparate literature. The findings of the synthesis include an estimate of the lifetime male prevalence of exhibitionism, 2-4%, peaking in late adolescence. Insecure attachment, sexual abuse in childhood, substance abuse, and sexual dysfunction are acknowledged risk factors. Motives behind the act of genital exposure remain obscure, constructed of both sexual and non-sexual impulses. The usual response of women victims is alarm and disgust. Successful treatment relies on a strong therapeutic alliance with specific psychological and psychopharmacological interventions - comparative effectiveness not yet determined. In conclusion, precedents for exhibitionism vary. The frequency of the behavior usually wanes with age and, while exhibitionists may pose a risk to others, they usually do not. There is, as yet, no gold standard treatment; the recommendation for therapists is to respond to individual facets of the patient's circumstances and history.

Reconnecting Homeless Adolescents and Their Families: Correlates of Participation in a Family Intervention.

Behavioral family interventions are an effective way to intervene to prevent negative developmental outcomes for adolescents. Participation in family interventions encompasses behavioral and cognitive/attitudinal dimensions, among others, indicated by retention and engagement, respectively. Two dimensions of participation, retention and engagement, in a family intervention were examined in a sample of newly homeless adolescents and their parents or guardians. Correlates of participation included parents with more income and less perceived family conflict and adolescents with higher endorsement of depression, anxiety, somatization, obsessive-compulsive, phobic, and psychotic symptoms on the Brief Symptom Inventory (BSI). Stronger therapeutic alliance was correlated with being more distressed (i.e., lower income, more hostility), being a female adolescent participant, and having greater comfort discussing sex with parents. Furthermore, parents and adolescents with greater distress and thus greater need were more apt to finish the intervention. The finding that families who were experiencing more distress had higher alliance scores suggests that there is an additional need for development of interventions for families in crisis. Both participant and provider perceptions are also important in development of a strong therapeutic alliance. This study's findings have implications for further exploration of the development of cultural humility and improving mental health literacy among facilitators of behavioral interventions.

Profiles of medical services use and health status in sex therapy clients: Associations with therapeutic alliance, attachment and trauma

Adults with sexual difficulties tend to report poorer health and higher health services utilization than individuals from community samples. Several correlates are related to greater use of health services, such as childhood interpersonal traumas, insecure attachment and level of therapeutic alliance. Although it is documented that clients presenting sexual difficulties and seeking sex therapy are likely to present these risk factors, health status and medical services use have not yet been empirically examined in this population. A total of 220 clients seeking sex therapy completed self-report questionnaires assessing childhood interpersonal traumas, attachment representations, therapeutic alliance, and sexual satisfaction. Five variables were used to identify their health status and medical services use: 1) annual number of medical consultations; 2) annual number of emergency room visits; 3) presence of chronic health problems; 4) frequency of medication intake; and 5) health status self-assessment. Hierarchical clustering analyses were conducted and three distinct profiles were identified according to the clients’ health status and medical services use. The first profile ( n = 106) was characterized by a good health and low use of medication and medical services. Compared to the other profiles, these clients report more secure attachment, stronger therapeutic alliance, and fewer traumas. The second profile ( n = 73) showed the highest frequency of medical and emergency room consultations. These clients all reported a chronic health problem and a high rate of trauma. The third profile ( n = 41) included clients using the most medication, but reporting a globally good health. These clients reported low levels of therapeutic alliance. Results provide a better understanding of the associations between sexual difficulties and health problems.

What Influences Patient Satisfaction after TKA? A Qualitative Investigation.

Patient satisfaction is a common measure of the success of an orthopaedic intervention. However, there is poor understanding of what satisfaction means to patients or what influences it. Using qualitative study methodology in patients undergoing TKA, we asked: (1) What does it mean to be satisfied after TKA? (2) What factors influence satisfaction levels after TKA? People in a hospital registry who had completed 12-month follow-up questionnaires and were not more than 18 months post-TKA at the time of sampling were eligible (n = 121). To recruit a sample that provided insight into a range of TKA experiences, we divided eligible candidates on the registry into quadrants based on their responder status and satisfaction level. A responder was an individual who experienced a clinically meaningful change in pain and/or function on the WOMAC according to the Outcome Measures in Rheumatology-Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria. Individuals were considered satisfied unless they indicated somewhat dissatisfied or very dissatisfied for one or more of the four items on the Self-Administered Patient Satisfaction Scale. From the resulting quadrants: responder satisfied, nonresponder satisfied, nonresponder dissatisfied, responder dissatisfied, we identified men and women with a range of ages and invited them to participate (n = 85). The final sample (n = 40), consisted of 10 responder satisfied, nine nonresponder satisfied, eight nonresponder dissatisfied, and 13 responder dissatisfied; 71% were women, with a mean age of 71 ± 7 years and a mean time since TKA surgery of 17 ± 2 months (range 13 to 25 months). Interview transcripts were analyzed by looking for factors in the participants' narrative that appeared to underscore their level of satisfaction and attaching inductive (data-derived, rather than a priori derived) codes to relevant sections of text. Coded data from participants who reported high and low levels of satisfaction were compared/contrasted and emerging patterns were mapped into a conceptual model. Recruitment continued until no new information was uncovered in data analysis of subsequent interviews, signalling to the researchers that further interviews would not change the key themes identified and data collection could cease. In those with high satisfaction levels, satisfaction was conceptualized as an improvement in pain and function. In those with low satisfaction levels, rather than an improvement, satisfaction was conceptualized as completely resolving all symptoms and functional limitations. In addition, we identified three pathways through which participants reached different levels of low and high satisfaction: (1) The full-glass pathway, characterized by no or minimal ongoing symptoms and functional deficits, which consistently led to high levels of satisfaction; (2) the glass-half-full pathway, characterized by ongoing symptoms and functional limitations, which led to high satisfaction; and (3) the glass-half-empty pathway, also characterized by ongoing symptoms and functional limitations, which led to low satisfaction levels. The latter two pathways were mediated by three core mechanisms (recalibration, reframing valued activities, and reconceptualization) influenced either positively or negatively by (1) a persons' thoughts and feelings such as optimism, self-efficacy, pain catastrophizing, external locus of control; and (2) social and contextual factors such as fulfilment of social roles, therapeutic alliance, lack of family/social support. This qualitative study suggests that for preoperative patients in whom unrealistically high hopes for complete symptom resolution and restoration of functional capacity persists, it may be appropriate to direct them away from TKA due to the risk of low satisfaction. For postoperative patients troubled by ongoing symptoms or functional limitations, clinicians may improve levels of satisfaction by targeting the three core mechanisms (recalibration, reframing valued activities, and reconceptualization) through addressing modifiable negative thoughts and feelings in interventions such as psychology or psychotherapy; and negative social and contextual factors by promoting a strong therapeutic alliance and engagement in community activities. Given that these factors may be identifiable preoperatively, future research is needed to explore if and how addressing them preoperatively may improve satisfaction post-TKA. Level IV, therapeutic study.

Parent–Child Interaction Therapy: Findings from an exploratory qualitative study with practitioners and foster parents

This exploratory study examines practitioners’ and foster parents’ perceptions on use of Parent–Child Interaction Therapy in child welfare. Focus groups were completed with Parent–Child Interaction Therapy practitioners and foster parents. Thematic analysis was employed, and four main themes were analyzed. First, practitioners and foster parents identified implementation barriers. Second, practitioners and foster parents identified factors that facilitate implementation. While practitioners perceived benefits from on-going consultation, foster parents favored treatment flexibility and a strong therapeutic alliance with practitioners. Third, practitioners and foster parents found that the integration of trauma principles into Parent–Child Interaction Therapy helped to meet the needs of the child welfare population. Finally, the translation of Parent–Child Interaction Therapy into child welfare may be facilitated by model adaptations, such as brief treatments, and integrating Parent–Child Interaction Therapy into pre-service foster parent trainings. Findings are discussed within the context of the relevant literature, and recommendations for future areas of study are proposed.

Therapists' behaviors and youths' therapeutic alliance during trauma-focused cognitive behavioral therapy.

Trauma-focused cognitive-behavioral therapy (TF-CBT) is a recommended treatment for posttraumatic stress (PTS) in youth, and a strong therapeutic alliance predicts reductions of PTS in TF-CBT. However, little is known of how therapists can build a strong alliance. This study seeks to understand which therapist behaviors are associated with the strength of alliance in TF-CBT. Participants were 65 youth (M age = 15.1, SD = 2.19; 77% girls) engaged in TF-CBT and their therapists (n = 24). The alliance was assessed midtreatment using the Therapeutic Alliance Scale for Children-revised. Therapists' behaviors were coded using the Adolescent Alliance-Building Scale-revised, and youth engagement behavior was coded using the Behavioral Index of Disengagement Scale. Linear mixed-effects models were used to evaluate clients' and therapists' in-session behaviors as predictors of the alliance, in addition to assessing the potential moderating effects of youth behaviors. Rapport-building behaviors were significantly predictive of higher alliance scores (Est. = 1.81, 95% CI [0.11, 3.52], p = .038), whereas there was no predictive effect of treatment socialization or trauma-focusing behavior on alliance scores. Initial youth behavior significantly moderated the effect of trauma-focusing on the alliance (p = .007); greater focus on trauma was associated with higher alliance scores among passively disengaged youth (Est. = 4.92, 95% CI [1.80, 8.05], p = .003). Rapport-building behaviors are associated with a stronger alliance in TF-CBT. Gradual exposure through initial trauma-eliciting does not appear to undermine alliance formation but is rather associated with higher alliance-scores among passively disengaged youth. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

La guidance interactive : utilisation du vidéo feed-back dans une thérapie conjointe parent–bébé. Illustration par deux cas cliniques

Interactive guidance is a parent-child psychotherapy technique, which was initially developed by Susan Mc Donough in the United States to support parental alliance in high-risk families. Later the Geneva Group Study showed its effectiveness in dyads whose babies had functional disorders. This technique chooses as a gateway in the parent–child interaction the interpersonal dimension, and the reading of the Interactive behaviors, to then approach thoughts, cognitions, and emotions related to the symptom of the child or of the dyad. The viewing of free play sequences is at the heart of the therapeutic device allowing a co-construction of the interaction reading between the therapist and the concerned parent. We propose a main principles description of this technique and its illustration by two clinical cases. The first one describes an interaction whose reading was a key moment in a mother–baby therapy with a mother suffering from perinatal depression. The second illustrates the creation of a strong therapeutic alliance in a situation of high-risk parenting through the description and support of parenting skills by means of viewing positive moments of interaction. These situations illustrate the therapeutic process and the links that arise between the maternal symptomatology and the synchrony of the interaction. We will discuss this technique in conceptual contrast to some other interventions using video feedback.