Therapeutic Bond Research Articles

Cancer patients’ sense of coherence – psycho-oncological consultations and therapeutic alliance as salutogenic factors

BackgroundSense of coherence (SoC), a key concept in the theory of salutogenesis, influences the pathway to promote or maintain health. Utilising psycho-oncological care (PC) can be allocated to the dimension of ‘tension management’ within this theo-ry. We aimed to evaluate tension management and SoC in the context of PC by analysing whether PC consultations and therapeutic alliance influenced patients’ SoC over time.Participants and procedurePatients who received PC were surveyed twice (after 3 and 12 months) about their care experiences, including therapeutic alliance and SoC. Survey data were matched to care documentation data, which contain consultation dates and sociodemo-graphics. Four stepwise regression analyses were conducted with overall SoC and its subscales of meaningfulness, compre-hensibility and manageability at T2 as outcome variables. The predictors are therapeutic alliance and the number of consul-tations (T1).ResultsOne hundred patients filled out all three SoC subscales at T1 and T2 and were treated by a psycho-oncologist. Therapeutic bond predicted the change in overall SoC (β = .34, t = 2.26, p = .026) and manageability (β = .47, t =3.02, p = .003). The num-ber of consultations predicted overall SoC (β = .16, t = 2.05, p = .043), meaningfulness (β = .21, t = 2.51, p = .014) and man-ageability (β = .17, t = 2.07, p = .041).ConclusionsOur results suggest that part of successful tension management in PC is a good therapeutic bond and the number of needs-oriented consultations utilised. These predictors affect SoC subdimensions differently.

Group dynamics and therapy outcome of multimodal pain therapies: A prospective observational trial

AbstractBackgroundFor the treatment of chronic pain, interdisciplinary treatment programs are recommended. Despite continuous adaptation and optimization of this cost‐ and time‐intensive and comprehensive form of therapy, it is not successful in some patients. As personality disorders have an important influence on social interaction and behaviour, the aim of our study was to identify the possible impact of patients with personality disorders on group dynamics and to analyse the influence of group dynamics on individual therapy outcomes.MethodsWe conducted a prospective observational study in patients with chronic pain (N = 104) who participated in a 5‐week interdisciplinary treatment program. The main outcome parameters were psychological state and pain intensity before and after the program.ResultsIn contrast to our clinical assumption, we found that neither the type nor the number of patients with personality accentuation or personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome.DiscussionThis trial analysed the connection between group dynamics and therapy outcome of multimodal pain therapies in chronic pain patients considering the factor of personality disorders. Our data demonstrated that neither the type nor the number of patients with personality disorders had a clinically relevant influence on group dynamics and that even a negative group dynamic did not negatively influence the individual therapy outcome. Hence, clinicians should not be afraid to include patients with personality disorders in their treatment programs.Significance StatementThe study emphasizes that clinicians may include patients with personality disorders in multimodal pain treatment programs and groups, provided that the maintenance of a close therapeutic bond with the patient and within the interdisciplinary team is given.

Opinion, Use and Knowledge About Transcranial Magnetic Stimulation in Spain: A National Survey of Mental Health Professionals.

Transcranial magnetic stimulation (TMS) is a non-invasive method of neuromodulation with heterogeneous usage between countries, which may be potentially influenced by healthcare professionals' opinions. This study aimed to assess the knowledge, acceptability, and attitudes of mental health professionals in Spain towards TMS. A cross-sectional multicentric study was conducted using an online survey, with 219 participants including psychiatrists, psychologists, and residents. Nearly 100% of participants correctly answered theoretical aspects related to the rationale and indications of TMS. Although only 55% considered TMS effective, 80% would refer patients if TMS were available at their workplace, and 74% would undergo TMS if experiencing depression. 85% believed neuromodulation training should be increased in residency, and 73% demanded TMS inclusion in public hospitals. Teaching staff and psychologists defined TMS as a last resort (p = 0.03 and 0.045). Both disagreed on its ease of use (p < 0.001) and patient referral (p = 0.01), considering an impact on the therapeutic bond (p = 0.029). Previous TMS training, clinical experience, or availability of TMS at the workplace, were associated with better knowledge, a higher perception of efficacy and utility in treating resistant patients (all p < 0.05). In conclusion, surveyed mental health professionals in Spain demonstrated good knowledge of the technique and positive opinions regarding its utility. Findings emphasized limited clinical experience of the sample, a call for training programs, and the demand for the inclusion of TMS in the portfolio of Spanish public hospitals.

"Finding my voice again" - women's experiences of psychological therapy in perinatal secondary care settings: a qualitative study.

Although women often experience mental health comorbidities in the perinatal period, the evidence-base for psychological therapy across diagnostic boundaries in the perinatal period remains limited. As there is a need to understand experiences of therapy, irrespective of diagnosis, to inform intervention provision, the aims of this study were to explore women's experiences of psychological therapy for perinatal mental health difficulties and to identify the mechanisms that women attributed to the most significant therapeutic change for themselves and/or the mother-infant relationship. Semi-structured interviews were conducted with 16 women who received therapy within specialist perinatal community mental health settings in the Northwest of England, the UK. Interview data were analysed using reflexive thematic analysis. One overarching theme entitled participant life stories were at the heart of therapy was identified alongside three other main themes: 1.) We're in this together - therapeutic bond and establishing a coherent sense of self, 2.) Surfing the urge to 'fix' feelings - Sitting with emotions improved regulation and 3.) Seeing myself in a new light - Shifting self-blame to self-compassion enhanced self-efficacy. Theme 1 consisted of three subthemes. Participants described the quality of the therapeutic relationship as the fundamental foundation to (re)connecting with their needs, values and boundaries, which improved their sense of agency, self-esteem, therapeutic engagement and self-understanding. Shifting emotional avoidance to emotional engagement improved their self-regulation. Considering alternative factors that could have contributed to their experiences helped them to defuse self-blame and enhance self-compassion. Finally, changes in their mental health led to positive relational changes in their relationship with their infant and improved communication with partners. Sensitivity, engagement and responsivity experienced in the therapist-woman relationship was reported to be mirrored in the mother-infant relationship. Developing a coherent sense of self and self-regulation skills both appeared to heighten women's self-compassion and empathy for their infants, which also seemed to improve their ability to tolerate uncertainty and mixed emotions within themselves and their infants. The mechanisms of change in the perinatal period are important to consider at a stakeholder, therapist and service management level to parsimoniously and best meet the needs of women and the mother-infant relationship.

“Ekbom syndrome: delirium engraved on the skin”

IntroductionEkbom syndrome also known as Morgellons syndrome or delirium of parasitosis is a psychiatric condition where the patient has the absolute conviction of being infested in spite of medical evidence. Patients may even mutilate themselves or apply toxic substances in order to get rid of these hypothetical organisms. Sometimes they bring samples of these hypothetical parasites to the office to prove their existence, which is known as the “matchbox sign”, a pathognomonic finding.ObjectivesThe aim of this clinical case is to make visible the impact that this psychiatric condition can have on the patient’s quality of lifeMethodsWe present the case of a 40-year-old woman from Peru who was admitted to the otorhinolaryngology unit for injuries compatible with necrosis of the right pinna. When the patient was examined, scars were found on the lower limbs and back. The patient justifies the scratching lesions with the presence of pathogenic organisms, with no trace of them by the physician.ResultsThe patient was evaluated by psychiatry service during her admission in otorhinolaryngology, being diagnosed with Ekbom’s delirium and starting treatment with 3 mL of Aripiprazole. Subsequently she was referred to the mental health unit where she left the follow-up until today.Conclusions Different effective treatments have been described, among them pimozide, atypical antipsychotics and some SSRIs. However, the complexity of treatment arises when dealing with the irreducible idea that the patient has of being infested, refusing in most cases to receive psychiatric treatment. This can degenerate into major organic and psychological problems that turn the patient’s life into a real hell, which often end up losing much of their daily functionality. The fact of empathizing with the patient and trying to elaborate a plan adjusted to the reality and needs of the moment, can help us to establish a good therapeutic bond that facilitates an early start of treatment and greater therapeutic adherence, enabling a significant improvement in their quality of life.Disclosure of InterestNone Declared

Therapeutic Alliance and Group Cohesion Across Telehealth Delivery of Mentalizing-focused Parenting Groups

ABSTRACT This study assessed changes in therapeutic alliance and group cohesion among parents/primary caregivers enrolled in Connecting and Reflecting Experience (CARE), a short-term, group-based, mentalizing-focused parenting program designed to support a diverse community facing socioeconomic and health disparities. Caregivers (N = 44) experiencing parenting stress or parent-child relational challenges were recruited from their children’s outpatient psychiatry clinic to participate in one of nine 12-session telehealth CARE groups. Caregivers completed the Working Alliance Inventory-Short Revised and the Therapeutic Factors Inventory Cohesiveness subscale after CARE Sessions 1 and 12. Ratings of group cohesion and therapeutic bond with facilitators increased significantly across treatment. Findings indicate that caregivers from underserved families with high levels of parenting stress experienced an increase in group cohesion and therapeutic alliance throughout a telehealth adaptation of CARE.

The relationship between expressive suppression, therapeutic bond, and treatment outcomes of a positive affect intervention for adults with anxiety and/or depression

ABSTRACT Expressive suppression (ES; reducing emotional expression) is linked with reduced social connectedness in individuals with anxiety or depression. One implication is that people who use ES may have difficulty establishing a bond with their therapist which may impede clinical improvement. We examined this hypothesis in 33 adults with clinically elevated anxiety or depression receiving treatment focused on enhancing positive thoughts, emotions, and behaviors. At baseline, participants rated ES for positive and negative emotions during a standardized conversation task designed to generate connectedness. They also rated measures of early (session 3) perceived therapeutic bond and treatment outcomes (i.e. positive affect and social connectedness). ES of positive (r = -.39, p = .018), but not negative (r = .06, p = .747), emotions was negatively associated with therapeutic bond. Therapeutic bond mediated the relationship between greater ES of positive emotions during affiliation and lower post-treatment positive affect, 95% bias-corrected bootstrap confidence interval [−0.021, −0.000], adjusted for pre-treatment positive affect, as well as lower post-treatment social connectedness [−0.397, −0.015]; however, the indirect effect was not significant when accounting for pre-treatment social connectedness (p > .05). ES of positive emotions may be an important factor in the development of therapeutic bond and therefore treatment outcomes for individuals with anxiety or depression.

The role of the therapeutic bond when working with clients in suicidal crisis.

The desire to die by suicide has been linked with interpersonal difficulties and impeded clinical outcomes. Despite the emphasis on the therapeutic relationship in clinical guidelines for working with suicidal clients, little is known about how suicidal clients' interpersonal difficulties manifest in clinical contexts. Additionally, there is limited understanding of the therapeutic relationship in single-session suicidal crisis contexts. Our aim was to examine the trajectory of the therapeutic bond in mediating clients' suicidal desire and outcome in single-session suicidal crisis intervention. Single-session online text-based crisis intervention sessions (N = 354; Mage = 29.43, SD = 9.15; 64.5% women) were coded for suicidal desire, therapeutic bond (each quarter), and outcome. We examined the proposed sequential mediating model (suicidal desire to early bond to bond change to outcome) using structural equation modeling. The proposed sequential mediation model fits the data well, χ2(11) = 22.030, p = .0241, root-mean-square error of approximation = .053, 90% CI [.019, .085], comparative fit index = .983, Tucker-Lewis index = .977, and was a better fit than several alternative models. Further, the indirect effect from suicidal desire to outcome through early bond and bond change was significant (b = -0.474, 99% CI [-0.782, -0.203]). Our findings indicate that therapeutic bonds were beneficial for clients with elevated suicidal desire-and-elevated suicidal desire was negatively associated with therapeutic bonds. These findings highlight the importance of training clinicians to navigate the unique challenges of developing therapeutic bonds with acutely suicidal clients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Measuring the therapeutic bond in genetic counseling: Testing measurement error in the bond subscale of the Working Alliance Inventory.

The therapeutic relationship is a key component of successful genetic counseling. In psychotherapy, a strong therapeutic relationship can improve patient health outcomes and a poor relationship can worsen psychological functioning. Investigation of the therapeutic relationship in genetic counseling has shown evidence for a similar pattern. Reliable measurement of the therapeutic relationship is necessary for consistency across studies in the genetic counseling context. One measure that has been adapted for use in genetic counseling is the Working Alliance Inventory (WAI). However, there have been no studies of the factor structure or item-level method bias analyses for the genetic counseling-adapted version of the WAI. The goal of this study was to test the factor structure of the WAI observer version (WAI-O) bond subscale and assess method bias in a genetic counseling context. We hypothesized that differences in factor structures would exist for items that were positively (n = 9) versus negatively (n = 3) worded (reverse coded). Secondary data analysis was performed on two data sets that utilized the WAI-O in genetic counseling contexts. Data set 1 used simulated genetic counseling sessions that were judged by analog clients recruited through crowdsourcing platforms (N = 861). Data set 2 was conducted with genetic counseling clients, and sessions were evaluated by a research team (N = 120). Principal axis factor analysis with oblique oblimin rotation supported a two-factor solution for the WAI-O bond subscale across data sets. Items factored based on wording, with the positively worded items loading together and the negatively worded items loading on the second factor. Confirmatory factor analyses supported the removal of all negatively worded items from the instrument across data sets. Results suggest that the negatively worded items on the WAI-O may be capturing a construct inconsistent with the positively worded items and support rewording and/or excluding them from use for a more reliable measure of the therapeutic bond.

Terapia ocupacional em Unidade de Terapia Intensiva (UTI): relato de experiência sobre o trabalho com cuidadores/familiares em um hospital público

Abstract There is little Latin American literature regarding the practices of occupational therapists in the context of intensive care units. Although it is clear which interventions are mostly carried out, the details of these are not evident, especially the description of the work carried out with caregivers/family members. For this reason, the objective of the article is to describe this process based on one hand, on a committed and therapeutic bond to understand each subject/family in its uniqueness and on the other, on education from the recognition of the diversity of people's knowledge. Therefore, this article reports an experience of what happens in a public hospital in Chile, where there has been work in the discipline for approximately 10 years, considering the particular actions that are carried out jointly with caregivers/family members, highlighting the following two strategies 1) Committed and therapeutic accompaniment initiated from the initial semi-structured interview as the first meeting between the occupational therapist and caregivers/family members, and 2) Education as a strategy and space for generating support and explicit mutual knowledge at three specific moments in the process. It is concluded that caregivers/family members are fundamental figures during care in an intensive care unit and it is necessary to reflect on the singularities that exist during the course of the intervention, recognizing their knowledge and stories.

Anatomy of a Woebot® (WB001): agent guided CBT for women with postpartum depression

ABSTRACT Introduction Postpartum depression (PPD) is common, persistent, and stigmatized. There are insufficient trained professionals to deliver appropriate screening, diagnosis, and treatment. Areas covered WB001 is a Software as a Medical Device (SaMD) based Agent-Guided Cognitive-Behavioral Therapy (AGCBT) program for the treatment of PPD, for which Breakthrough Device Designation was recently granted by the US Food and Drug Administration. WB001 combines therapeutic alliance, human-centered design, machine learning techniques, and established principles from CBT and interpersonal therapy (IPT). We introduce AGCBT as a new model of service delivery, whilst describing Woebot, the agent technology that enables guidance through the replication of some elements of human relationships. The profile describes the device’s design principles, enabling technology, risk handling, and efficacy data in PPD. Expert opinion WB001 is a dynamic and personalized tool with which patients may establish a therapeutic bond. Woebot is designed to augment (rather than replace) human healthcare providers, unlocking the therapeutic potency associated with guidance, whilst retaining the scalability and agency that characterizes self-help approaches. WB001 has the potential to improve both the quality and the scalability of care through providing support to patients on waiting lists, in between clinical encounters, and enabling automation of measurement-based-care.

Recovery-oriented psychotherapy: Practical recommendations for psychologists in organized care settings.

The concept of recovery has become an increasingly common framework for organizing mental health care, thus many psychologists find themselves working in settings that espouse a recovery orientation to service delivery. However, the concepts of recovery and recovery-oriented services are complex and have many definitions and psychologists struggle to know whether or not the psychotherapy they provide is aligned with recovery-oriented care. This article provides practical recommendations on how to integrate recovery into the common processes of psychotherapy that cut across all theoretical orientations or particular treatment approaches. Specifically, this article details the process of building a therapeutic bond, conceptualizing a client's problems and goals, implementing a treatment plan, and discharge planning, all from a recovery-oriented perspective. A case demonstration and analysis is presented to illustrate the recovery-oriented psychotherapy process described in this article. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Molecule from Madness: An Exploration into Patients’ Illnesses through West Texas Polio

Neurology holds a unique perspective that embodies the art of capturing a patient’s story. Despite medical advancements, many neurological conditions leave patients permanently impaired. This sudden loss of independence can be demoralizing and, in most cases, directly changes a person’s identity. It is therefore a necessary part of a neurologist’s trade to know their patient’s history—their story. Their tales reveal intimate details of their personality changes, memory loss, sensory deprivation, and movement disorders. A true neurologist is a person that remains vulnerable through their willingness to take a history—the story of their patient—and remain curious, vulnerable, and compassionate through their journey to heal and comfort the patient. To understand the patient’s illness experience in neurology, the underlying themes of patient recovery (compassion, determination, and patience) are explored with regard to the neurological patient’s experience. These themes are then expanded to include the neurology patient’s mental perceptions of themselves, and their illness’ influences over their identity, recovery, and daily life. In addition to the patient’s experience, the neurologist’s awareness and emotional response to the patient’s illness experience can provide an opportunity to develop a strong therapeutic bond with their patient and improve patient outcomes. Given that their neurological impairment causes a loss of independence and control over their identity and self-worth, neurologists can incorporate the patient’s experience into their management and treatment, to better address their emotional and spiritual needs as they come to terms with their identity.

Something Lost and Something Gained: Navigating the Bedside Teaching Role as a Hospice and Palliative Medicine Educator.

Hospice and palliative medicine (HPM) educators must often give up the satisfaction of working one-on-one with patients, to allow learners the opportunity to practice key communication skills and form their own therapeutic bonds with patients. Though the loss of that primary relationship with patients may feel challenging, educators may find new opportunity for professional impact and satisfaction by investing in their relationship with learners. This case discussion explores the challenges of bedside teaching in HPM, including the educator's looser connection with patients, need to withhold their own communication skills, and decision of when to interject into a trainee-patient conversation. We then propose strategies to help educators find renewed professional fulfillment in the teacher-learner relationship. By partnering intentionally with learners before, during, and after shared visits, inviting informal reflection between encounters, and preserving independent clinical time, we believe educators may cultivate a more sustainable and meaningful clinical teaching practice.

A six-month telerehabilitation programme delivered via readily accessible technology is acceptable to people following stroke: a qualitative study

ObjectiveTo explore the experiences of participants during a six-month, post-stroke telerehabilitation programme. DesignA qualitative descriptive study to investigate participant experiences of ACTIV (Augmented Community Telerehabilitation Intervention), a six-month tailored exercise programme delivered by physiotherapists primarily using readily accessible telecommunication technology. Semi-structured, in-depth interviews were used to collect data, which were analysed using thematic analysis. SettingInterviews conducted in participants’ homes or a community facility. ParticipantsParticipants were eligible if they had a stroke in the previous 18 months and had participated in ACTIV. ResultsTwenty-one participants were interviewed. Four key themes were constructed from the data: 1. ‘ACTIV was not what I call physio’ (it differed from participants’ expectations of physiotherapy, but they reported many positive aspects to the programme). 2. ‘There’s somebody there’ (ongoing support from the physiotherapists helped participants find strategies to continue improving). 3. ‘Making progress’ (in the face of barriers, small improvements were valued). 4. ‘What I really want’ (participant goals were frequently more general than therapy goals and involved progress towards getting back to ‘normal’). ConclusionsAlthough ACTIV was not what participants expected from physiotherapy, the majority found contact from a physiotherapist reduced the feeling of being left to struggle alone. Most participants found a programme with minimal face-to-face contact augmented by phone calls and encouraging text messages to be helpful and acceptable. Trial registrationAustralia New Zealand Clinical Trials Registration Number: ACTRN12612000464864 Contribution of the paper•The use of readily accessible technology to augment rehabilitation after stroke was acceptable to people who received a six-month programme.•People found text contact maintained a therapeutic bond with their physiotherapist.•Remote contact decreased the perception of being left to manage alone after discharge from physiotherapy.

“In my own comfort zone”: Clients' experiences of relational aspects of online therapy for alcohol problems

AbstractBackgroundTherapists and counsellors increasingly use online video applications to offer treatment in place of face‐to‐face delivery. In the alcohol treatment sector, this offers a range of potential benefits for treatment providers. However, the impact of working remotely via video on the therapeutic relationship remains unclear and under‐researched.AimsThis study aimed to explore how alcohol treatment clients make sense of the relational aspects of therapy delivered remotely, and to examine how the use of remote therapy might disrupt existing ideas around the therapeutic relationship.MethodologyThis study utilised a qualitative design using thematic analysis, with 15 participant interviews with adult service users from a single treatment provider. All participants had previously undertaken at least four 1‐h online therapy sessions.FindingsThe themes that were identified highlighted the significance of the participants' own homes as the site of therapy, with emphasis on the comfort of the home, and the presence of family members and pets. Participants stressed the importance of viewing the face of the therapist, the establishment of a therapeutic bond and specific therapist qualities. Participants also reflected on issues around denial and avoidance associated with self‐image and identity.DiscussionThere are nuanced and potentially unforeseen consequences of undertaking therapy for alcohol problems via video, relating to the significance of the therapy environment and relationship between client and therapist. This may include issues of shame, denial and avoidance, which are of particular significance for clients experiencing difficulties associated with alcohol.

“You have to believe the patient”: What do people with fibromyalgia find helpful (and hindering) when accessing health care?

ABSTRACT Background Fibromyalgia (FM) is a complex, still poorly understood, and difficult-to-treat chronic pain condition for which many people struggle to find adequate care. Aims This study investigated the research question, “What do people accessing health care services for fibromyalgia perceive as helpful, hindering, and absent but desired?” with the aim of identifying clear, implementable changes for clinical practice. Materials and methods This study used the enhanced critical incident technique (ECIT), a qualitative research method that focuses on helping, hindering, and desired factors, to explore the health care experiences of 14 individuals (12 women and 2 men) diagnosed with FM. Results Using qualitative data analysis, results identified three categories of health care experiences: (1) systemic navigation, including financial and economic security; accessibility, flexibility, and continuity of care; and diversity of treatment options; (2) clinician–patient alliance, including invalidation and prejudice; therapeutic bond; and clinician–patient alignment on treatment plan; and (3) patient self-management strategies, including information-seeking and education, self-advocacy, social supports, symptom management strategies, and other coping strategies. Participants tended to conceptualize their health care concerns as a multilayered systemic problem. Conclusions Participants described a medical system they perceived as poorly equipped to support their needs and tended to invalidate their health concerns. Helping experiences tended to be the result of unique efforts on the part of individual clinicians. Findings emphasize the importance of recognizing the complexities and psychological impact of pain, trusting clinician–patient relationships, multidisciplinary/interdisciplinary care within a biopsychosocial framework, and improved education and awareness around psychosocial aspects of FM and effective management of chronic pain.

Relational Work Through Technology: Understanding the Impact of Telemental Health on the Therapeutic Alliance

ABSTRACT The rapid shift to telemental health (TMH) during the COVID-19 pandemic left mental health providers scrambling to adapt, raising concerns about the effect on the quality of the therapeutic alliance. This article explores the impact of TMH on the therapeutic alliance and how relational psychotherapists can support their patients and engage best practices in a way that helps all participants feel connected to the work. It defines the therapeutic alliance, explores the concepts of tasks, goals, and therapeutic bonds, and highlights the importance of developing a positive bond in the context of relational therapy. The paper also describes common challenges encountered while providing psychotherapy virtually, provides guidance on what contributes to a more positive attitude toward TMH interventions, offers a list of recommendations for improving the therapeutic alliance in TMH, and makes recommendations for future study.

O vínculo terapêutico na clínica fonoaudiológica: uma reflexão necessária

ABSTRACT Purpose To understand the meanings that the therapeutic bond assumes for clinical speech therapists. Methods The research was approved by the Ethics Committee, being of a transversal character, with a quantitative-qualitative approach in the Content Analysis. The research with the participation of 96 clinical speech therapists, registered in the Speech Therapy Council of the 3rd region (CRFa 3), which covers the States of Paraná and Santa Catarina. Results Of the 96 speech therapists included, a significant part of the participants defined the therapeutic bond as a relationship/interaction. Regarding the role of the bond for the speech therapy clinical work, most professionals declared theirs as a fundamental basis and another part of the bond is necessary for the evolution/development of the patient. Conclusion It is possible to understand that, according to the therapeutic patients, it is essential to sustain, maintain the clinical work for users, impacting the resignification of the complaint and the minimization of the users' suffering.

The therapeutic link in the speech therapy clinic: a necessary reflection.

To understand the meanings that the therapeutic bond assumes for clinical speech therapists. The research was approved by the Ethics Committee, being of a transversal character, with a quantitative-qualitative approach in the Content Analysis. The research with the participation of 96 clinical speech therapists, registered in the Speech Therapy Council of the 3rd region (CRFa 3), which covers the States of Paraná and Santa Catarina. Of the 96 speech therapists included, a significant part of the participants defined the therapeutic bond as a relationship/interaction. Regarding the role of the bond for the speech therapy clinical work, most professionals declared theirs as a fundamental basis and another part of the bond is necessary for the evolution/development of the patient. It is possible to understand that, according to the therapeutic patients, it is essential to sustain, maintain the clinical work for users, impacting the resignification of the complaint and the minimization of the users' suffering.