Therapeutic Collaboration Research Articles

Psychoeducation as burnout prevention for Hungarian teachers

The aim of this study is to examine the role of psychoeducation in preventing burnout among Hungarian teachers. Psychoeducation is a structured method of delivering professional information, combining elements of education, cognitive-behavioral therapy, and grouptherapy, with the goal of developing coping strategies to maintain health and ensure therapeutic collaboration. As part of the research, a 30-hour training program was developed and implemented with two groups, consisting of kindergarten and special education teachers (N=35). The core components of the training included self-awareness exercises, autogenic training techniques, and conflict management strategies. Changes in participants' burnout levels, psychological immune systems, coping methods, and perceived social support were assessed using pre- and post-training questionnaires (Maslach Burnout Inventory Educator Survey (MBI-ES), Oláh’s Psychological Immune System Survey, Coping Methods Questionnaire, MOS SSS-H Social Support Questionnaire, and Mental Health Test). A significant reduction in burnout was observed. The findings support previous research indicating that psychoeducation can effectively reduce stress and burnout, though its effectiveness may depend on various factors, such as the length and intensity of the program, as well as participants' motivation and commitment. Future research should involve larger sample sizes and longitudinal designs to assess the long-term benefits of psychoeducational interventions more accurately for teacher burnout.

Nurturing the leading edge through life and dementia

ABSTRACT This is a case report that explores the intact selfobject tie and how it supports and promotes the leading edge of self-development in Intersubjective Self Psychology. This discussion is divided into three sections: the first four years of therapy, the middle years, and the final two plus years of a thirteen-year treatment. In the initial years of the treatment, the sustained intact selfobject tie unfolds in the therapeutic relationship, allowing for the expression of the leading edge strivings of both participants, which dominates the intersubjective field. This segment of the treatment has multiple focal points: how to promote and sustain the intact selfobject tie, the leading edge and curative agent of an ISP-informed treatment and how and why transference-based interpretations of the selfobject relationship actively contribute to a successful treatment by broadening and deepening the therapeutic collaboration. The “we” of the relationship is examined, including how an active discussion of the “we” strengthened the bond between them and how this shorthand, which felt generative to the patient and therapist, resulted in the solidification of the leading edge. The middle years of the treatment documents some examples of how the leading edge is manifested in the patient developing a sense of agency and a growing sense of self. In the last year and a half of the therapy, the depth of the leading edge is explored as both the patient and analyst encounter an unexpected turn in the patient’s physical health. This complicated the nature of how the leading edge was expressed. Over a long history of exploring and knowing each other, the “we” between them made possible an extraordinary leading edge experience for both.

Understanding psychoanalytic work online and back to the couch in the wake of the COVID-19 pandemic: an investigation among Italian psychoanalysts.

Worldwide, psychotherapists' clinical experience went through rapid developments with transition to teletherapy during the COVID-19 pandemic. Literature on the use of remote psychoanalysis was not conclusive, leaving the issue of the consequences of the necessary setting alternation open. This study aimed to investigate the psychoanalysts' experiences of shifting to remote work and then returning to in-person setting, considering the effect of the patients' attachment styles and personality configurations. Seventy-one analysts of the Italian Psychoanalytic Society were asked to fill out an online survey about patients who found the transition easier and patients who found it more difficult. General questions on therapeutic work, ISTS (Interpretive and Supportive Technique Scale) for interpretive and supportive aspects of technique, WAI-S-TR (Working Alliance Inventory-Short Revised-Therapist) for therapeutic alliance, RQ (Relationship Questionnaire) for attachment style, and PMAI (Prototype Matching of Anaclitic-Introjective Personality Configuration) for personality configurations were administered. All of the analysts chose to continue the treatment using audio-visual tools. Patients with difficult transitions had a significantly higher frequency of insecure attachment and a higher score on RQ Dismissing scale than patients with easy transitions. No significant differences were found between the two groups in personality configurations, psychotherapeutic alliance, and psychotherapeutic technique. Moreover, a higher level of therapeutic alliance was positively correlated to RQ Secure scale and was negatively correlated to RQ Dismissing scale. Patients with easy transition both to remote work and back to in-person setting had higher scores of therapeutic alliances than those with difficult transition both to remote work and back to in-person setting. Online psychoanalytic therapy was widely used during the COVID-19 pandemic. Patients with insecure attachment styles had greater difficulties in adapting to setting alternations, thus confirming that insecure attachment is a vulnerability factor not only for psychopathological problems but also for a well-functioning therapeutic collaboration. Patient's personality configuration did not influence their adaptation to the setting alternation. The supportive and interpretive styles did not undergo significant changes in the transition from in-person setting to remote setting and vice versa, thus suggesting a continuity in the analysts' "internal setting."

L’ouverture des services en psychiatrie : effets et paradoxes

AimsVia a brief history of Open-Door Policy (ODP) in psychiatry, we discuss its implications and consequences in daily practice (in ethical, clinical, and psychopathological terms). We think that open-door policy in psychiatry is a tool of care in its own right. MethodWe conducted a literature review to analyze ODP in psychiatry in Europe and also made use of clinical experience in a psychiatric hospital in Marseille, France. ResultsODP in this hospital is not a daily decision; we would otherwise have good reasons to close our doors every day. This is a collective position and we bear the risks of the collective, free coming and going of caregivers and patients. It requires us to get out of the zero-risk policy mindset, which we consider an impossible and paralyzing ideal. DiscussionSeveral studies comparing open- and closed-door policy in psychiatry suggest that open-door services have less recourse to coercive measures. The ODP produces concrete effects for patients and caregivers, beyond the freedom of movement or its restriction. ConclusionODP allows for new clinical and transferential modalities due not only to the openness but also the renewal of patients’ fundamental rights to freedom. ODP maintains a better long-term therapeutic collaboration between patients and caregivers.

African Traditional Healthcare Practices vs Conventional Medicine: Future Directions for Healthcare in Africa

Despite resonating deeply with ATM, the BPSSM struggles for broad acceptance and recognition by CM in Africa. The continued existence of multi-health seeking behaviour in Africa calls for purposive therapeutic collaboration between ATM and CM.

Is the quality of therapeutic collaboration associated with the assimilation of problematic experiences progress? A comparison of two cases

ABSTRACT Objective: How are collaborative interactions associated with clients’ progress in therapy? This study addressed this question, by assessing the quality of therapeutic collaboration and comparing it passage by passage with the clients’ assimilation of problematic experiences in two cases of major depression treated with Cognitive Behavioral Therapy, one recovered and one improved-but-not-recovered. Method: We used the Therapeutic Collaboration Coding System to code collaborative work and the Assimilation of Problematic Experiences Scale (APES) to rate clients’ progress. In both cases, for the distribution of specific collaborative therapeutic exchanges, we tested for the difference of empirical means between lower and higher APES levels. Results: Both cases progress in APES, but in contrast with Annie (Improved-but-not-recovered), Kate (Recovered) achieved higher levels of change in last sessions. In addition, we found significant differences in the types of collaborative therapeutic exchanges associated with lower and higher APES levels. Conclusion: Ambivalent therapeutic exchanges distinguished the recovered case from the not recovered case highlighting a source of difficulties in facilitating therapeutic change in CBT. In addition, observations in these cases supported the theoretical suggestion that supporting interventions would be better accepted at lower APES levels, whereas challenging interventions would be better accepted at higher APES levels.

Therapist’s interventions immediately after exceeding the client’s therapeutic zone of proximal development: A comparative case study

Objective When therapists’ proposals are too demanding exceeding clients’ readiness to move into change, clients may resist advancing. We aimed to understand how a therapist behaved immediately after the client resisted advancing into change within Cognitive–Behavioral Therapy. Methods We analyzed a recovered and an unrecovered case, both with Major Depression, and followed by the same therapist. Through the Therapeutic Collaboration Coding System, we analyzed 407 exchanges of interest. Results In both cases, clients resisted more in advancing at intermediate sessions, mainly by the therapist’s challenges to raise insight and debate cognitive beliefs in the recovered case, and to seek experiential meanings in the unrecovered case. Immediately after clients resisted advancing, the therapist tended to insist on challenging them in the same direction. In the recovered case, the therapist did so continually throughout the therapy, sometimes balancing between insisting or stepping back. In the unrecovered case, the therapist insisted on challenging, but mostly at the final session. Occasionally, the therapist insisted on challenging, and clients resisted over consecutive exchanges. Conclusion: Our results reinforce that to enact progress and change clients need to be pushed into change, however it requires therapists’ skillful assessment of clients’ tolerance to move in time.

Therapeutic collaboration in a comfort zone: a non-improved borderline patient psychotherapy case study (Colaboración terapéutica en una zona de confort: estudio de un caso de psicoterapia de un paciente borderline que no experimentó mejoría)

ABSTRACT The quality of dyad interaction seems crucial to the client’s decision to drop out of psychotherapy. To characterize the client’s lack of change and the patterns of therapeutic collaboration in a dropout of psychodynamic therapy for Borderline Personality Disorder (BPD), we used the Therapeutic Collaboration Coding System (TCCS) to assess collaborative work and the Assimilation of Problematic Experiences Scale (APES) to rate client change. The software GridWare was used to characterize patterns of therapeutic collaboration and the R software to describe the client’s change. The dyad worked in a comfort zone for the client, with the therapist supporting the client’s problematic perspective and the client responding with Safety. The APES results showed that the client did not change, remaining in control through avoidance of thinking and discussing his problematic experience. Our results challenge the potential impact of therapists’ interventions on BPD clients’ comfort zones, suggesting that too much focus on their Therapeutic Zone of Proximal Development’s actual level might not be productive.

Using ROM in family therapy.

Routine outcome monitoring (ROM) is in this article defined as a tool for feedback-informed therapy where clients' therapy relevant information is applied in real-time therapy. Because family therapy represents a comprehensive clinical setting, ROM is experienced as particularly useful. In a vignette from family therapy practice, the use of ROM is demonstrated on individual, couple, and family levels with reference to integrative systemic therapy. ROM information is shown to play a central role in the different phases of treatment. It is demonstrated how ROM facilitates patient-centered assessment that strengthens the therapeutic collaboration such as the working alliance, identifying treatment targets, and possible constraints. In particular, ROM revealing alliance rupture followed by alliance repair is emphasized as a crucial therapeutic event in this treatment.

Facilitating the client change: A perspective from the therapeutic zone of proximal development

<p id=C6>Therapeutic zone of proximal development (TZPD) is an extension of Vygotskys concept of the zone of proximal development in the field of psychotherapy. Based on the assimilation model, TZPD represents the space between the actual development level and the potential development level of clients within a developmental sequence. As a new concept to understand the change process of psychotherapy, it can enhance the understanding of setbacks in psychotherapy, provide an easy-to-operate theoretical framework for promoting the change of the client, and provide precise guidance for the therapist to choose supportive or challenging intervention strategies. In terms of research, TZPD theory is based on an unconventional methodology of Theory-Building Qualitative Research. TZPD theory is built upon accumulating observations in qualitative case studies in which TZPD helped the therapist understand and interpret the psychotherapy process. Under this methodology, researchers mainly use a therapeutic collaboration coding system (TCCS) as a research tool to analyze different case studies, understand the causes and characteristics of different counseling cases, and compare the effects of good and bad results based on TZPD, to describe the characteristics of the psychotherapy process. This kind of practice will provide a richer perspective for future research on the theoretical construction of psychological counseling and therapy and the understanding of psychological treatment mechanisms. In clinical practice, as the working area of psychotherapy, TZPD provides a new perspective for understanding the setback phenomenon in the psychotherapy process. Early researchers regarded setbacks as a hindrance in the psychotherapy process, but the TZPD suggests that setbacks may be therapists exploration of the clients TZPD boundaries and preparation for subsequent progress. The key point of therapists work is not to avoid setbacks, but to discover and differentiate the phenomenon of setbacks under the enlightenment of TZPD theory, and choose the appropriate intervention technique at the appropriate stage. The future of TZPD hinges on further exploration of the clinical wisdom of experienced therapists. Its also worthy of carrying out theoretical exploration from different approaches and perspectives, which might ultimately explain setbacks in the process of assimilation and lead to a better understanding of the dynamics of the psychotherapy process.

Therapeutic Collaboration in Career Construction Counseling: Case Studies of an Integrative Model.

The mapping of therapeutic collaboration throughout counseling deepens our understanding of how the helping relationship fosters client change. To better understand the process of career construction counseling (CCC), we analyzed the therapeutic collaboration on six successful face-to-face cases. The participants were six Portuguese adults, five women and one man, real clients of a career counseling service, and four psychologists, three female and one male trained in the career intervention model. The participants completed demographic questions and measures of career certainty, vocational identity, career indecision, and psychological functioning. The Therapeutic Collaboration Coding System was used to track collaboration throughout all interactive episodes. The clinical significance of the intervention was calculated by analyzing pre-post-test statistical differences for each case, with the Reliable Change Index and Z score. The findings evidenced a pattern of therapeutic collaboration evolution for good outcome cases. Based on this pattern, we propose a model of process-outcome evolution for the three phases of CCC.

Alliance rupture and repair processes in psychoanalytic psychotherapy: multimodal in-session shifts from momentary failure to repair

ABSTRACT This exploratory single session-study presents a multimodal, mixed-method description of a session of psychoanalytic psychotherapy and illustrates an in-session “failure”, defined in terms of rupture in the therapeutic alliance and the process of its repair. It aims to enhance our understanding of the mechanisms implicated in therapeutic change. The research materialcomprises session’s video-recording, transcript, and measurements of participants’physiological arousal, as reflected in their heart rate in the session. The analysis consisted of an iterative, multi-layered process that combines observations from verbal and nonverbal modalities of interaction for the identification of significant in-session moments. We applied quantitative descriptive analysis on participants’ physiological arousal and synchronization, qualitative analysis of the clinical dialogue, and coded the in-session fluctuations in the therapeutic alliance,using the Rupture Resolution Rating System. The detailed analysis of specific interactive events in the session illustrates the shift from a “failure” in therapeutic collaboration to gradual repair; this shift entailed increased relatedness and physiological synchronization, and on a semantic level, co-created, reflective meanings in the here-and-now of the therapeutic interaction. The findings highlight ruptures as important in-session events and suggest that the therapist’s empathic oscillation between interpretative and metacommunication strategies can be mutative during moments of relational rupture. Practical Implications Negotiation and resolution of in-session therapeutic ruptures may provide opportunities for therapeutic growth in terms of increased relatedness and reflectiveness. The therapist’s flexible shifts between using interpretative interventions and immediate collaborative explorations in the here-and-now, in the form of metacommunication, seem to facilitate the repair of alliance rupture. Multimodal methodologies and multi-layered analyses, integrating verbal and nonverbal, physiological data in the study of therapeutic interaction can shed light on significant in-session events and mechanisms of the change process.

The Clinical, Biological, Psychological and Psychiatric Impact of the Diagnosis of Breast Cancer in Women.

Objective. Psychosocial factors are correlated with the risk of breast cancer, by the lack of externalization of feelings and aggressive tendencies, or with a negative prognosis, by the presence of a high level of stress and reduced coping abilities. Impairment of psychological status should be assessed early to identify quantifiable psychooncological changes, such as depression, anxiety, and self-esteem. These indicators, measured in this study, may become psychometric markers for predicting the existence of the neoplastic process, prior to histopathological evaluations. Methods. 58 patients diagnosed with breast cancer and in different stages of evolution and 61 breast lumps patients were evaluated for depression, anxiety and self-esteem. Results. The correlation of depression and anxiety levels according to the evolutionary stage of the disease was as follows: in stage I cases of severe depression with significant anxiety predominate, in stage II mild depression predominates with insignificant anxiety, in stage III depression predominates moderate with significant anxiety, while in stage IV moderate depression with significant anxiety predominates. Conclusions. The presence of significant anxiety in the uncertainty phase and the anxious-depressive clinical picture can be an alarm signal for the initiation of specific psychotherapeutic strategies, to increase the adaptive potential and resilience to the disease to ensure a therapeutic collaboration of the patient by increasing adherence and compliance. the proposed therapeutic plan. Relatively sudden anxiety in a young woman, risk factors for breast cancer, and deficient cognitive impairment require intensified clinical and paraclinical investigations to confirm early oncological diagnosis.

Rolul implicării parentale în procesul de intervenție logopedică

This research aims to extend and adapt the therapy techniques, specific to the speak and language disorders domain, for their use in the child’s family environment. The main subjects of the research are the parents of the children diagnosed with speaking problems. By encouraging the parent’s active participation within the logopedic therapy, it is intended to teach them, so that they could continue the therapy in the child’s every day life. Moreover, the therapeutic collaboration between the speech therapist, the child and the parents allow to valorise the observations made by the parents related to the child environment and every day life, completing the information obtained by the therapist during the complex evaluation of the child. Using this exhaustive information, the therapist is able to propose an intervention program that is personalised to the child’s needs. Furthermore, in the context of the recent changing of the work paradigm, when the therapy sessions are conducted in the format of teletherapy, the collaboration and the support offered by the therapist to the parents is essential for the success of the intervention program.

Inpatient Milieu Therapy: Considerations for Adolescent and Transitional Age Youth

Background and Goals: The role of milieu therapy on inpatient treatment has become more prominent due to the changing landscape of hospital care, with shorter length of stay, higher patient acuity, and rapid turnover. The modern inpatient unit promotes less individual psychotherapy with the psychiatrist or therapist, and more milieu and group based treatment that emphasizes acute stabilization. Methods: The authors share some of the core domains that provide the basic framework for milieu treatment within an acute care setting when working with adolescents and transitional age youth (TAY), with the aim to share clinical considerations for milieu therapy and offer practical ideas for implementation in clinical practice. Discussion: The therapeutic milieu and collaboration of an interdisciplinary team has a significant impact on hospital treatment. Considerations for milieu therapy implementation in an inpatient unit include developmentally informed concepts related to milieu treatment of adolescents and TAY patients in a hospital setting.

Using a visually adapted repertory grid technique (VARGT) with people who stalk

PurposeThis paper aims to provide instructions on how to implement an adapted version of the standard repertory grid technique (VARGT). The purpose of which is to provide practitioners with a tool, which enables active engagement by participants in research and clinical practice. This tool has been used effectively with people convicted of stalking offences.Design/methodology/approachRepertory grids, developed from Kelly’s Personal Construct Theory (1955), had never been used with those who stalk, either clinically or in a research context. Visual and kinaesthetic adaptations were made to standard RGT procedures (Grice, 2002; Tan and Hunter, 2002), for use in a mixed methods research study (Wheatley, 2019, p. 77) due to expected challenges in engaging with this group. This manuscript presents theoretical underpinnings and step-by-step instructions for practical application.FindingsThe VARGT is easy to administer and produces rich data, in both qualitative and quantitative formats. This adapted approach encourages active participation and an interpreted therapeutic collaboration (Wheatley et al., 2020).Practical implicationsThis novel technique has engaged men convicted of stalking offences collaboratively in research activities and showed potential for its use as a clinical tool. This instructional technical paper allows the technique to be replicated.Originality/valueThis novel technique has engaged men convicted of stalking offences collaboratively in research activities and showed potential for its use as a clinical tool. This instructional technical paper allows the technique to be replicated.

Management of bladder retention in an elderly person

A nurse clinician in urodynamics - advanced practice shares her experience in implementing self-bladder education sessions for bladder retention. The objective is to promote autonomy in the elderly person with bladder retention while developing collaborative work with the referring health care team to promote the transfer of knowledge. This requires a stance of listening and positive reinforcement in order to achieve a therapeutic collaboration with the patient and/or his or her entourage.

Alliance Ruptures in the Psychotherapy of Adolescents with Borderline Personality Pathology: Risk or Benefit?

Alliance Ruptures in the Psychotherapy of Adolescents with Borderline Personality Pathology: Risk or Benefit? Adolescents with subthreshold or full-blown borderline personality disorders (borderline personality pathology (BPP)) are characterized by a pronounced instability in their self-image and their interpersonal relationships. The building of a stable therapeutic relationship is considerably challenged in patients with BPP. The concept of alliance ruptures and resolutions assumes that the resolution of ongoing relationship difficulties contributes to therapeutic change. Resolutions are strategies of the therapist to address ruptures, to explore their meaning with the patient and to enhance the therapeutic collaboration between the patient and the therapist. This article illustrates the use and benefits of alliance ruptures and resolutions among adolescents with BPP treated with the manualized treatment concept Adolescent Identity Treatment (AIT). Ten patients were treated with AIT. Three out of ten patients dropped out of treatment prematurely. A total of 187 therapy sessions were analyzed using the Rupture and Resolution Rating System (3RS; Eubanks, Lubitz, Muran, Safran, 2018). Alliance ruptures and resolutions are illustrated in session transcripts of a qualitative case vignette. Quantitative analyses show that alliance ruptures occur frequently over the complete treatment course in good outcome patients. However, frequent alliance ruptures at the beginning of treatment represent a risk for premature treatment termination. The concept of alliance ruptures and resolutions may help to improve the ongoing therapeutic alliance in the treatment of adolescents with BPP.

Lived Experience of Treatment for Avoidant Personality Disorder: Searching for Courage to Be

Objective: To inquire into the subjective experience of treatment by persons diagnosed with avoidant personality disorder.Methods: Persons with avoidant personality disorder (n = 15) were interviewed twice, using semi-structured in-depth interviews, and the responses subject to interpretative-phenomenological analysis. Persons with first-hand experience of avoidant personality disorder were included in the research process.Results: The super ordinate theme emerging from the interviews, “searching for courage to be” encompassed three main themes: “seeking trust, strength, and freedom,” “being managed,” and “discovering the possibility for change and development.” The main theme, “being managed,” included the subthemes: “getting a diagnosis,” “receiving medication,” and “attending therapy.”Conclusion: Although this may not be specific to avoidant personality disorder, the findings highlight the importance of being met inter-subjectively as a person with intentionality and agency, even when one does not feel like one. The importance of establishing an emotional bond and emergent trust for open therapeutic collaboration, learning, and becoming able to build courage to begin to approach that which one fears is emphasized.

Therapist’s actions after therapeutic collaboration breaks: a single case study

Aim: This study analyzes how a therapist contributed to therapeutic collaboration reestablishment by describing his actions after therapeutic collaboration breaks in a recovered completer clinical case. Method: Data was collected from a narrative therapy case with the diagnosis of depression spanning 19 sessions. We identified sequences in which therapeutic collaboration breaks were re-established (or not) through the Therapeutic Collaboration Coding System. We analyzed the therapist’s actions after the therapeutic collaboration breaks through Conversation Analysis. Results: Typically, the therapist maintained the action that preceded the therapeutic collaboration break. When he did so by proposing a new meaning to the client’s experience or by highlighting the client’s agency, the therapeutic collaboration was usually re-established; however, when he did so by guiding or making exploratory questions to deepen the client’s experience, the therapeutic collaboration was usually not re-established. When the therapist retreated from his previous action, the therapeutic collaboration tended to be re-established, mainly when he reflected the client’s previous turn. Conclusion: This study suggests that more important than maintaining or retreating from the previous action is how the therapist does so. The therapist’s actions of acknowledging the client’s experience and agency contributed to therapeutic collaboration reestablishment.