Therapeutic Bond Research Articles

Physiological synchrony and therapeutic alliance in an imagery-based treatment.

Client-therapist synchrony in various channels (e.g., self-reported affect or physical movement) has been shown as a key process in the construction and development of therapeutic alliance. However, psychophysiological synchrony between clients and therapists has been understudied, with the few extant studies typically relying on single-session data, and no studies examining it within the context of emotion-focused techniques. The main aim of the current paper is to examine the role of client-therapist physiological synchrony during segments of one emotion-focused technique-namely, imagery (IM) work-in predicting therapeutic alliance, and to compare it to the role of synchrony during segments of more traditional cognitive-behavioral (CB) techniques. We conducted an open-trial study in which 31 clients with test anxiety received a 6-session protocol-based treatment. Both clients' and therapists' electrodermal activity (EDA) were continuously assessed during sessions. The physiological measures for 5 sessions each (N = 128) were used to compute client-therapist synchrony in IM and CB segments. Therapeutic alliance was assessed using the Session Alliance Inventory. Client-therapist dyads' synchrony during IM and CB segments was, on average, greater than chance. Synchrony varied mostly at the session (vs. the dyad) level. Multilevel analyses revealed that the synchrony within IM segments (but not within CB segments) was significantly associated with the therapeutic bond aspect (but not the task/goal aspects) of alliance. Physiological synchrony during emotion-focused IM is tied to the bond component of the therapeutic alliance at the session level. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Social Work With Unaccompanied Asylum-Seeking Young People: Reframing Social Care Professionals As ‘Co-Navigators’

AbstractThis article explores the relationships between unaccompanied asylum-seeking young people and the social care professionals who work with them. Based on the interviews with both young people and professionals, analysed using a thematic narrative approach, the findings seek to reframe practitioners in this field as ‘co-navigators’. Such co-navigators assist asylum-seeking young people to plot a course through complex and uncertain social terrain, including the shifting and inhospitable terrain of immigration regimes. Viewing practice in this way brings into focus the interplay of agency and control in these relationships. In contrast to some previous conceptualisations, the agency of the young people here is expressed through relationships with professionals as many of the young people relied on social care to help them manifest their goals and aspirations; both through pragmatic assistance in navigating the complexity of institutional bureaucracy and through developing emotional, therapeutic bonds. Understanding social care professionals as ‘co-navigators’ allows us to understand the emotional value of practical forms of assistance as well as explore how agency might operate as such relationships evolve.

Reflections on “Stealth Therapy” in Therapeutic Residential Care

ABSTRACT The therapist’s office can often be an intimidating space for children and adolescents, especially those in residential care who have experienced multiple traumas. This environment can block the therapeutic process and hinder a therapeutic alliance from forming between the clinician and the youth. Although unconventional, integrating the method of stealth therapy into the therapeutic work with children and adolescents has shown impressive results in building a stronger therapeutic bond and putting them at ease when discussing difficult topics. Stealth therapy involves the therapist meeting the youth where they are most comfortable and giving the youth space and time to adjust to the therapist’s presence. Allowing the youth to have some control over the situation gives them a sense of safety and security that they may not have ever experienced. Once the youth feel safe with the therapist, they are more likely to open up and discuss traumatic events. Therapists in Therapeutic Residential Care (TRC) traditionally felt guilty if they didn’t offer weekly formal psychotherapy to the youth with complex trauma that populate contemporary TRC. But the outpatient model of traditional psychotherapy meets the needs of a small portion of the youth in TRC. This paper describes an alternative model emphasizing creativity and flexibility in the therapeutic engagement of youth with complex trauma to more adequately meet their needs.

Toward a Synergistic Version of Solution-Focused Brief Therapy: Enhanced Efficacy through the Body and Emotion

A number of prominent solution-focused brief therapists have expressed the view that, to its detriment, this school of therapy tends to downplay emotion. Accordingly, we contend that, given that emotion is a primal binding force, the bonding component of the crucially important therapeutic alliance risks being compromised in the current practice of this approach. We further argue that the prioritization of the depiction of actions that accompany the emotion expressed by the client over the actual participation in this emotion by the therapist tends to superficialize therapeutic communication. This is especially likely to happen when the therapist lapses into a formulaic, action-soliciting interrogatory mode in response to the emotion expressed by the client. In addition, we claim that the incorporation of emotion- and body-based approaches into the solution-focused canon could remedy the affective lacuna referred to above. We note, however, that such a modification would most likely face stiff resistance from some of the gatekeepers of solution-faced therapy, in particular those who subscribe to the “surface-only” descriptive approach advocated by the philosopher Ludwig Wittgenstein. And yet, the effectiveness of depth-oriented therapies, such as sensorimotor psychotherapy and somatic experiencing, is supported by neurophysiological considerations. Finally, we suggest that these therapies, and even creativogenic elements of psychoanalysis, can actually synergize solution-focused brief therapy through the generation of affect-laden images, sensations and thoughts that lend themselves to the realization of outcomes desired by the client, which is the raison d’etre of solution-focused brief therapy. This paper pleads for the incorporation of the above-noted depth approaches into solution-focused brief therapy with a view to augmenting its effectiveness through a stronger therapeutic bond owing to an increased emotional engagement on the part of the therapist.

An exploration of the role of adverse childhood experiences (ACEs) on youth engagement in residential treatment

Literature suggests that child maltreatment may have a negative impact on a youth's ability to engage in treatment, particularly because it might hinder their ability to form a therapeutic bond with the clinician. Despite the prevalence of this viewpoint, there have been few empirical studies that substantiate this negative relationship. This study uses a sample of youth in residential treatment to assess the relationship between child maltreatment, as assessed by the Adverse Childhood Experiences (ACE) Questionnaire, and engagement in treatment, including readiness to change, bond with staff and collaboration on goals and tasks. Results from a sample of 130 youth in residential treatment indicate that instead of a negative relationship between maltreatment and engagement, including its components, a positive relationship exists. Youth with higher levels of maltreatment as measured by ACEs displayed higher levels of engagement in treatment and its components. The findings suggest that more research needs to be done to better understand how maltreatment impacts engagement in treatment and its components.

Congruence of therapeutic bond perceptions and its relation to treatment outcome: Within- and between-dyad effects.

The present study investigates the association between congruence of patients' and therapists' perceptions of the therapeutic bond and symptom improvement. Bond congruence-outcome associations were examined on the within- and between-dyad level for 580 patients (mainly depression and anxiety) receiving cognitive-behavioral therapy. Symptom change was assessed on a session-to-session level as well as from pre- to posttreatment. For the between-dyad analyses, the truth and bias model was applied. For the within-dyad analyses, polynomial regression and response surface analysis were conducted. On the between-dyad level, higher temporal congruence between patients' and therapists' bond ratings (i.e., their correlation) was associated with better treatment outcomes. Additionally, the average discrepancy between therapists' and patients' bond ratings showed a significant quadratic association with treatment outcome. A tendency for therapists to moderately rate the bond lower than their patients' showed lowest posttreatment symptom scores. On the within-dyad level, we found that when patients' and therapists' ratings were in "agreement," higher bond scores were associated with fewer next-session symptoms. For "disagreement," the results showed that if therapists rated the bond as weak, whereas their patients rated it as strong, higher subsequent symptom distress was observed than if patients rated the bond as weak and their therapists rated it as strong. The present study highlights the importance of therapists being vigilant to session-to-session changes in the therapeutic bond to adjust their interventions accordingly. (PsycINFO Database Record

음악치료사의 주관적 안녕감이 치료적 유대감 형성에 미치는 영향 : 인지적 정서조절전략의 매개효과

음악치료사의 주관적 안녕감이 치료적 유대감 형성에 미치는 영향 : 인지적 정서조절전략의 매개효과

Pourquoi une consultation spécifique pour auteurs d’infractions à caractère sexuel : regard sur six années à l’Unité de Psychiatrie et Psychologie légales de Ville-Evrard

This research deals with a retrospective look on the 241 inpatients who crossed the threshold of this Specialized Consultation between January 1, 2010, and September 30, 2016. This research aims to highlight socio-demographic and psychopathological features, if any, and to form opinions and hypotheses concerning the treatment of inpatients under mandatory judicial cares. MethodsTo conduct this research we grounded our hypothesis in a systematic review of files, the gathering of the data contained in those files, and analysis of psychological assessments, and court decisions when available. The data was collected and then compared with the national statistics on crimes in 2015 (ONDRP) and the National Judicial Record. This review concludes with a literature review using databases such as Medline, PubMed, CAIRN, Science Direct searching for the term “Court Ordered Cares”, “Sex Offenders treatment program”, “Criminological Dangerosity Risk”. ObjectivesThis paper aims to determine if there are peculiarities between our active list compared against the national records. What are the main Court Ordered Cares, their length, and what sort of treatment could be initiated within the short term? ResultsThis Specialized Consultation were created 6 years ago in response to an increase in the mandatory supervision involving the psychological treatments of sex offenders. The Paris suburbs (banlieue) were unequally represented at that time and one of the authors of this research decided to start a new consultation designated for this specific population of « patients ». This paper sought to determine if there were some differences between our sample and the national data, from either a psychopathological point of view, or in the categories of crimes. One of our findings was that the length of the mandatory cares mirrored the severity of the judicial sanctions. The mean length of a court ordered care following a sentence, for an offense (exhibitionism, minor sex offenses) was comprised between eighteen months and three years for 76 % of individuals, whereas in cases of serious crimes (rapes e.g.), the length was comprised between three and six years in 71 % of the cases. It could reach a length of six to ten years or more in 15 % of the cases. It might be interesting to consider mandatory cares less than twelve months would not allow for the development of therapeutic bond and thus may prove less effective. Despite a judge's beliefs and hopes, a court ordered care rarely leads to long-term therapy as the probationer tends to regard them as an extension of judicial sanction.

Dissociation and Counterdissociation: Nuanced and Binary Perceptions of Good and Evil

Dissociated experiences are often communicated to analysts. Clinicians may absorb patients' dissociation, thereby creating “counterdissociated” states. Counterdissociation contributes to binary thinking in the analyst similar to black- and-white thinking commonly seen in patients' dissociated states. This can have both positive and negative effects: Counterdissociation may help therapists identify with patients' experience, thereby cementing the therapeutic bond. If analysts remain counterdissociated, however, patients may remain dissociated. As analysts identify their counterdissociation, they may gain insight into patients' needs for dissociation. As they overcome counterdissociation, patients may concurrently overcome dissociation. This allows both to have a more nuanced view of inner experience. With two extended case studies of sexually abused men, this article tracks how an analyst deals with counterdissociation created through intimate contact with dissociated positive and negative introjects of victimizers, thus forming identifications or overidentifications with the patients' abused parts.

When Suicide Is at Stake: Some Thoughts on the Therapeutic Space between Therapists and Adolescents

ABSTRACTLooking at adolescence as a period of turmoil as well as abrupt physical and mental changes, it is not surprising that in western countries suicide is the primary cause of death in adolescents and young adults ages 15–24. Most therapists treating adolescents encounter patients who frequently engage in suicidal behavior. This significantly challenges the therapeutic bond and influences the therapeutic space in a unique way. In this article, we address the challenges specific to the therapeutic alliance in treating adolescents presenting suicidal behaviors. While literature on the nature of the therapeutic bond with adult suicide attempters is available, literature on the distinguishing characteristics of the therapeutic bond with adolescent attempters is lacking. Two vignettes are presented to illustrate this distinctive alliance.

Therapeutic Climate Within a Treatment Program for Categorical Deniers.

The purpose of this study was to examine whether the therapeutic climate within a sex offender "deniers" program, where denial was not challenged, would be equivalent to the therapeutic climate within a conventional program where sex offenders were admitting responsibility. Using a sample of 77 sex offenders, therapeutic alliance and group climate were measured early and late in treatment. As expected, therapeutic alliance was more difficult to attain with deniers early in treatment, particularly therapeutic bond; however, by the end of the treatment, there were no significant differences in therapeutic alliance. There did not appear to be significant differences in group climate early or late in treatment except for the deniers reporting significantly lower levels of open expression of anger and disagreement within the group and, in contrast to the admitters, making significant improvements in group climate over time. Implications for the treatment of categorical deniers and further research suggestions are discussed.

English

In order to investigate clients’ role in the mutuality of therapeutic encounter, this pilot study examined data from 49 participants who had undergone at least three sessions of therapy. The participants completed the Working Alliance Inventory and the Kentucky Inventory of Mindfulness Skills. As hypothesised, higher levels of mindfulness were associated with enhanced working alliance. All three dimensions of the working alliance (quality of therapeutic bond, agreement on tasks, and agreement on goals) were found to be associated with mindfulness. These results suggest that it would be worthwhile to develop future longitudinal research on the relationship between client variables and the development of therapeutic encounter. Key words: Mindfulness, person-centred therapy, therapeutic alliance, mutuality.

A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test

Disparities in the care and outcomes of US racial/ethnic minorities are well documented. Research suggests that provider bias plays a role in these disparities. The implicit association test enables measurement of implicit bias via tests of automatic associations between concepts. Hundreds of studies have examined implicit bias in various settings, but relatively few have been conducted in healthcare. The aim of this systematic review is to synthesize the current knowledge on the role of implicit bias in healthcare disparities. A comprehensive literature search of several databases between May 2015 and September 2016 identified 37 qualifying studies. Of these, 31 found evidence of pro-White or light-skin/anti-Black, Hispanic, American Indian or dark-skin bias among a variety of HCPs across multiple levels of training and disciplines. Fourteen studies examined the association between implicit bias and healthcare outcomes using clinical vignettes or simulated patients. Eight found no statistically significant association between implicit bias and patient care while six studies found that higher implicit bias was associated with disparities in treatment recommendations, expectations of therapeutic bonds, pain management, and empathy. All seven studies that examined the impact of implicit provider bias on real-world patient-provider interaction found that providers with stronger implicit bias demonstrated poorer patient-provider communication. Two studies examined the effect of implicit bias on real-world clinical outcomes. One found an association and the other did not. Two studies tested interventions aimed at reducing bias, but only one found a post-intervention reduction in implicit bias. This review reveals a need for more research exploring implicit bias in real-world patient care, potential modifiers and confounders of the effect of implicit bias on care, and strategies aimed at reducing implicit bias and improving patient-provider communication. Future studies have the opportunity to build on this current body of research, and in doing so will enable us to achieve equity in healthcare and outcomes.

Adolescents’ dramatic engagement predicts their in-session productive behaviors: A psychodrama change process study

This psychodrama change process pilot study examined the association between client in-session dramatic engagement, client in-session behaviors, and the client-therapist therapeutic bond. Sixteen Israeli adolescents at-risk (aged 13–16) received psychodrama group therapy in schools. The findings suggest that over the course of therapy, both in-session client dramatic engagement and general client involvement increased significantly. Client dramatic engagement significantly correlated with therapist-reported bonding with the client, but not with client-reported bonding with the therapist. Greater client dramatic engagement increased the likelihood for client in-session productive behaviors (cognitive-behavioral exploration, emotional exploration, insight, and therapeutic change) and decreased the likelihood for client resistance in sessions. The results highlight the possible relationships between change process variables that are understudied in the psychodrama and drama therapy literature. After reviewing the key factors that may increase resistance in adolescents, as well as therapist bonding and engagement strategies, the study limitations and future directions are discussed.

Dual diagnosis and treatment: The experience of a multiprofessional team in mental health

IntroductionThe work was developed with the people hospitalized in the period of 1 year in a psychiatric clinic in Rio de Janeiro city, Brazil. 175 patients who presented dual diagnosis were evaluated.ObjectivesThe research aims to know the distribution of the most frequent psychiatric diagnosis associated with the disorders for the use of psychoactive substances. The work also has as objective to assess the treatment of patients carrying these disorders so that there is a better efficiency of the individual treatment plan.MethodsThe work consisted of the evaluation of all patients who were admitted to the clinic in the period of 1 year, using the ICD-10 for the diagnosis of dual pathologies. All the patients were assessed by the multiprofessional team, composed by general practicioner, psychiatrist, psychologist, pharmaceutic, therapist in chemical dependence, family therapist and physiotherapist. The patients were treated with the use of psychopharms, cognitive behavioral psychotherapy, 12-step program, art therapy and moderate physical activity. Family members of all patients were also interviewed.ResultsIn the evaluation conducted by the team, it was found the following distribution of the most frequent diagnosis associated to disorder for the use of psychoactive substances: depression (26.3%), personality disorder (22.9%), bipolar disorder (22.3%), non-schizophrenic psychosis (12.6%), schizophrenia (9.1%), and other diagnosis (6.8%).ConclusionsThe formulation of the dual diagnosis provided a better approach of the patients on the part of the team, promoting the strengthening of the therapeutic bond and causing positive impact on the evolution of these disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Client-therapist agreement in the termination process and its association with therapeutic relationship.

There is no consensus among different therapeutic approaches on the process of termination when therapy does not have a prefixed duration. Moreover, both clinicians and researchers are still exploring decision making in the termination of treatment. The present study assessed former client's perspective of therapy termination in a nonprobabilistic sample from Buenos Aires, Argentina. Seventy-three semistructured interviews, lasting ∼60 min each, were conducted with participants that had finished a therapeutic treatment or dropped out. They were asked about several aspects of therapy, including their experience of termination, specifically who decided to terminate, if there was agreement on termination or not, and their thoughts on the termination process. All interviews were transcribed and analyzed using an adaptation of Consensual Qualitative Research (CQR). Quantitative analyses were also conducted to examine associations between variables. Two main factors emerged from the analysis: client/therapist initiative on termination; and level of agreement between client and therapist regarding termination. Whereas nearly all (95%) of therapist-initiated termination cases agreed on termination, client-initiated termination cases could be sorted in agreed (49%) and disagreed (51%) terminations. Both therapist-initiated terminations and agreed upon terminations presented more categories of positive termination motives, better therapeutic bond, and higher overall satisfaction with treatment. Implications for research and clinical practice are discussed. (PsycINFO Database Record

The Mental Representation of the Emotional Universe and that Related to Bonding among University Students of Health Sciences

Abstract Stress and the emotional responses of anxiety, fear and anger, the prevelance of a psychiatric and or psychological symptomatology and a huge emotional exhaustion affect the relationship between the health professional and the patient as regards bonding. This symptomatology may even appear in university students of Health Sciences. Concious of the need to train the management of emotions and bonding in university students, we organised a theoretical-practical workshop in the Department of Occupational Therapy, Speech Therapy and Nursing at the University of Castilla-La Mancha. A total of 77 students participated, all of whom responded to a series of questions. The qualitative analsis of these questions reflects that the most difficult emotions to train are admiration and security. The emotions that most habitually appear are happiness and sadness, while those of anger, fear, disgust and curiosity appear to a lesser extent. With regard to the results of the variables related to bonding, it was shown that the students know which elements make the therapeutic bond easier or more difficult. Finally, the majority of the experiences that the students recounted were related to the spheres of health, education and their relationships with partners.

The therapeutic bond is so powerful.

I was working on a medical ward for older people in my first year of training when a patient, whom I will call Joyce, was admitted following a fall.

Recommendations from parents of obese children in treatment to the health-care team: qualitative study

The family plays an essential role in the adherence and effectiveness in the treatment of childhood obesity. Caregivers’ experience is fundamental for proper guidance. To describe the recommendations for the health-care team made by parents of children that are being treated for obesity. Cross-sectional and descriptive study with a qualitative approach and purposeful sampling. In the first semester of 2015, interviews were conducted with nine parents of children from 4 to 10 years old that were being treated for obesity ad who had at least three medical appointments in the previous year. The data analysis was based on the Grounded Theory Approach through open coding. The study was ethically approved and informed parental consent was obtained. The results were grouped in the following main categories: a) Health-care team-caregiver relationship, b) Health-care team-child relationship, c) Encouraging family participation, d) Encouraging therapeutic adherence in the child and e) Frequency of medical appointments. From the perspective of this group of parents of obese children, the health-care team should establish a close therapeutic bond with the children and their parents during the treatment process, in addition to encouraging family participation. The importance of developing therapeutic interventions that consider the perspective of the patient’s system is emphasized.

Motivation and Treatment Credibility Predicts Dropout, Treatment Adherence, and Clinical Outcomes in an Internet-Based Cognitive Behavioral Relaxation Program: A Randomized Controlled Trial.

BackgroundIn previous research, variables such as age, education, treatment credibility, and therapeutic alliance have shown to affect patients’ treatment adherence and outcome in Internet-based psychotherapy. A more detailed understanding of how such variables are associated with different measures of adherence and clinical outcomes may help in designing more effective online therapy.ObjectiveThe aims of this study were to investigate demographical, psychological, and treatment-specific variables that could predict dropout, treatment adherence, and treatment outcomes in a study of online relaxation for mild to moderate stress symptoms.MethodsParticipant dropout and attrition as well as data from self-report instruments completed before, during, and after the online relaxation program were analyzed. Multiple linear and logistical regression analyses were conducted to predict early dropout, overall attrition, online treatment progress, number of registered relaxation exercises, posttreatment symptom levels, and reliable improvement.ResultsDropout was significantly predicted by treatment credibility, whereas overall attrition was associated with reporting a focus on immediate consequences and experiencing a low level of intrinsic motivation for the treatment. Treatment progress was predicted by education level and treatment credibility, whereas number of registered relaxation exercises was associated with experiencing intrinsic motivation for the treatment. Posttreatment stress symptoms were positively predicted by feeling external pressure to participate in the treatment and negatively predicted by treatment credibility. Reporting reliable symptom improvement after treatment was predicted by treatment credibility and therapeutic bond.ConclusionsThis study confirmed that treatment credibility and a good working alliance are factors associated with successful Internet-based psychotherapy. Further, the study showed that measuring adherence in different ways provides somewhat different results, which underscore the importance of carefully defining treatment adherence in psychotherapy research. Lastly, the results suggest that finding the treatment interesting and engaging may help patients carry through with the intervention and complete prescribed assignments, a result that may help guide the design of future interventions.Trial RegistrationClinicaltrials.gov NCT02535598; http://clinicaltrials.gov/ct2/show/NCT02535598 (Archived by WebCite at http://www.webcitation.org/6fl38ms7y).