Therapist Attitudes Research Articles

Service learning experiences of doctor of physical therapy students with a severe mental illness population.

INTRODUCTION:Physical therapists provide important services to improve physical health for the general population; however, physical therapy interventions are less utilized with underserved populations such as those with severe mental illness (SMI). The quality of services for these populations is impacted in part by negative provider attitudes and lack of preparation to work with the SMI population. This study examined the impact of structured educational field experience on the physical therapist's attitudes and knowledge about working with the SMI population. This will inform future educational practices to best prepare students to provide quality of healthcare to the population.MATERIALS AND METHODS:Seven graduates of a doctor of physical therapy (DPT) program from a Mid-Atlantic University in the United States who participated in an SMI service-learning (SL) experience completed a semi-structured qualitative interview in 2016. Questions about how the experience impacted their current work were asked. Interviews were digitally recorded, transcribed, and examined using interpretive phenomenological analysis. Coding and investigator triangulation were conducted. All interviews reached thematic saturation.RESULTS:The graduated DPT students reported attitudinal changes toward people with SMI through qualitative interviews. They reported an improvement in their skills, greater competence to work with the SMI population, and an increased focus in the use of person-centered services.CONCLUSIONS:The results of this study suggest that DPT students gain an understanding of both the SMI population and themselves during SL. Using SL as part of the DPT educational curriculum can offer students and the opportunity to build confidence in working with the SMI population. SL can also improve their skills and attitudes toward the population, key areas that are identified as barriers to receiving quality physical healthcare among the SMI population.

Pivotal response treatment: A study into the relationship between therapist characteristics and fidelity of implementation.

In this study, we investigated the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether child age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 level III certified pivotal response treatment therapists who recorded three 10-min pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. Results indicated that therapists’ attitude toward evidence-based practices, specifically openness to innovation, and therapists’ experience with pivotal response treatment significantly predicted fidelity of pivotal response treatment implementation. Cross-validation methods largely confirmed these findings. Therapist personality, therapist–child relationship, and child characteristics were not significantly related to pivotal response treatment fidelity. Implications for clinical practice and directions for future research are discussed.Lay abstractPivotal response treatment is a naturalistic behavioral intervention that teaches pivotal skills to children with autism spectrum disorder to produce widespread gains in other skills. Although most children with autism spectrum disorder benefit from pivotal response treatment, intervention outcomes vary considerably among children. Fidelity of intervention implementation (i.e. the extent to which an intervention is implemented as intended) may affect intervention outcomes. In this study, we studied the relationship between fidelity of pivotal response treatment implementation and therapist characteristics, such as therapist personality, therapist–child relationship, therapist attitude toward evidence-based practices, and therapist experience. We also explored whether a child’s age and autism symptom severity were related to pivotal response treatment fidelity. Participants were 41 pivotal response treatment therapists who videotaped three pivotal response treatment sessions and completed four questionnaires to measure therapist characteristics. This study found that therapists’ openness to innovation and their experience with pivotal response treatment predicted fidelity of implementation. Therapist personality, therapist–child relationship, and child characteristics were not related to pivotal response treatment fidelity. The results of this study emphasize that it is important (1) to target therapists’ attitudes toward innovation prior to or during training in pivotal response treatment and (2) to provide therapists with ongoing supervision and feedback after training to increase fidelity of implementation and thus to improve intervention outcomes for children with autism spectrum disorder.

"Outpatient physical therapist attitudes toward and behaviors in cardiovascular disease screening: a national survey," Severin et al. Phys Ther. 2019;99:833-848.

"Outpatient physical therapist attitudes toward and behaviors in cardiovascular disease screening: a national survey," Severin et al. Phys Ther. 2019;99:833-848.

A Comparison of Attitudes and Practice between Pediatric Nurses and Respiratory Therapists in Addressing Tobacco Smoke Exposure during an Inpatient Pediatric Hospital Stay

Background Second and third hand smoke exposure is a major issue in pediatrics. Growing evidence supports smoking cessation interventions in pediatric hospitals. Little is known about the role of inpatient pediatric nurses (RN’s) and respiratory therapists (RT’s) in smoking cessation interventions for parents and caregivers of hospitalized children. Purpose We seek to improve our understanding of nurse and respiratory therapists attitudes and activities around smoking cessation during a child’s hospitalization. Aim 1: Identify and compare current …

Targeted interventions to prevent transitioning from acute to chronic low back pain in high-risk patients: development and delivery of a pragmatic training course of psychologically informed physical therapy for the TARGET trial

BackgroundLow back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically informed physical therapy (PIPT) is a secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduce that risk. Training models that are feasible to implement with acceptable training quality are needed to improve scalability for widespread implementation of PIPT. This manuscript describes the PIPT training program that was developed for training physical therapists providing PIPT in the TARGET trial.MethodsThe PIPT training program was developed, tested, and modified using an iterative process. Content development consisted of stakeholder engagement, beta testing, modification of training, and confirmation of final course objectives. Methods of delivery consisted of a website that included brief online educational modules followed by a live 8-h workshop that included video-based mock case scenarios and case-based role playing. Attitudes, beliefs, and confidence in implementing PIPT principles were assessed before and immediately after training to measure training quality and impact.ResultsEarly stakeholder engagement and beta testing indicated the need for increased emphasis on experiential learning opportunities and patient-centered communication training. Booster training varied extensively across TARGET sites with involvement of ‘clinician champions’ providing brief follow-up sessions identified as best practice. Favorable post-training changes in physical therapist attitudes and beliefs toward biopsychosocial treatment orientation and increased confidence in implementing PIPT principles were observed.ConclusionsPIPT training for provider participation in the TARGET trial was feasible to deliver. Course content was acceptable to physical therapists and resulted in improved beliefs and confidence in applying PIPT skills during clinical practice. Ongoing consultation and site-based continuing education were methods by which specific TARGET sites maintained or augmented PIPT skill training; however, implementing ongoing training was challenging in general. Due to the pragmatic nature of the TARGET trial, it was not possible to directly measure the effect of PIPT training on treatment fidelity, which was a limitation of our approach.Trial registrationClinicalTrials.gov, NCT02647658. Registered on 6 January 2016.

Outpatient Physical Therapist Attitudes Toward and Behaviors in Cardiovascular Disease Screening: A National Survey.

BackgroundScreening the cardiovascular system is an important and necessary component of the physical therapist examination to ensure patient safety, appropriate referral, and timely medical management of cardiovascular disease (CVD) and risk factors. The most basic screening includes a measurement of resting blood pressure (BP) and heart rate (HR). Previous work demonstrated that rates of BP and HR screening and perceptions toward screening by physical therapists are inadequate.ObjectiveThe purpose was to assess the current attitudes and behaviors of physical therapists in the United States regarding the screening of patients for CVD or risk factors in outpatient orthopedic practice.DesignThis was a cross-sectional, online survey study.MethodsData were collected from an anonymous adaptive online survey delivered via an email list.ResultsA total of 1812 surveys were included in this analysis. A majority of respondents (n = 931; 51.38%) reported that at least half of their current caseload included patients either with diagnosed CVD or at moderate or greater risk of a future occurrence. A total of 14.8% of respondents measured BP and HR on the initial examination for each new patient. The most commonly self-reported barriers to screening were lack of time (37.44%) and lack of perceived importance (35.62%). The most commonly self-reported facilitators of routine screening were perceived importance (79.48%) and clinic policy (38.43%). Clinicians who managed caseloads with the highest CVD risk were the most likely to screen.LimitationsAlthough the sampling population included was large and representative of the profession, only members of the American Physical Therapy Association Orthopaedic Section were included in this survey.ConclusionsDespite the high prevalence of patients either diagnosed with or at risk for CVD, few physical therapists consistently included BP and HR on the initial examination. The results of this survey suggest that efforts to improve understanding of the importance of screening and modifications of clinic policy could be effective strategies for improving rates of HR and BP screening.

Attitudes Toward and Familiarity With Virtual Reality Therapy Among Practicing Cognitive Behavior Therapists: A Cross-Sectional Survey Study in the Era of Consumer VR Platforms.

Virtual reality exposure therapy (VRET) is an efficacious treatment for fear and anxiety and has the potential to solve both logistic issues for therapists and be used for scalable self-help interventions. However, VRET has yet to see large-scale implementation in clinical settings or as a consumer product, and past research suggests that while therapists may acknowledge the many advantages of VRET, they view the technology as technically inaccessible and expensive. We reasoned that after the 2016 release of several consumer virtual reality (VR) platforms and associated public acquaintance with VR, therapists’ concerns about VRET may have evolved. The present study surveyed attitudes toward and familiarity with VR and VRET among practicing cognitive behavior therapists (n = 185) attending a conference. Results showed that therapists had an overall positive attitude toward VRET (pros rated higher than cons) and viewed VR as applicable to conditions other than anxiety. Unlike in earlier research, high financial costs and technical difficulties were no longer top-rated negative aspects. Average negative attitude was a larger negative predictor of self-rated likelihood of future use than positive attitude was a positive predictor and partially mediated the positive association between VRET knowledge and likelihood of future use, suggesting that promotional efforts should focus on addressing concerns. We conclude that therapist’s attitudes toward VRET appear to have evolved in recent years, and no longer appear to constitute a major barrier to implementing the next generation of VR technology in regular clinical practice.

Examination of changes in psychodynamic art psychotherapy process of patients with borderline personality disorder

Objective: The aim of this study was to examine of changes in the individual psychodynamic art therapy process of patients with borderline personality disorder. Method: The study was designed in the longitudinal survey model. In this study, the changes in psychodynamic psychotherapy process of 11 patients with BPD were examined. Pa-tients who participated in psychotherapy for at least 4 years were included in the study. The psychotherapy process based on object relations model which is conducted with individual art psychotherapy approach was used by a psychotherapist experienced in psychodynamic art psychotherapy. The frequency of psychotherapy interviews with patients changed between 1 and 3 times a week, and a psychiatrist periodically examined the patient. Supervision was provided during the psychotherapy process. In the psychotherapy process, the behaviors of the patients, the issues they raised, the feelings they experienced and shared during the session, and the attitude of the psychother-apist were recorded through the Psychotherapy Process Observation List. SPSS 22.0 package program is used for data analysis. Results: In this study, it was observed that patients continued their psychotherapy for 6-8 years, and it is seen that there is a change in the aggressive and maladaptive behaviors of the patients, the emotions, the sub-jects, the patients and the therapist's attitudes during the psychotherapy process. At the beginning of psychother-apy, aggressive, self-mutilative and disrupting behaviors were observed. Despite the decrease in aggression and fighting behavior in the third year, there was an increase in behaviors that disrupt the therapy limits and forced the therapy. The therapist was also worried about desperation and losing control. On the other hand, it is observed statistically that the patients continue to have psychotherapy and the symptoms have decreased significantly in the end of the period. Discussion: The most important result emphasized by this study is that the psychotherapy of BPs is not silent and calm, intense emotional fluctuations can center the therapist and the patient, and that both the patient and the therapist's behavior change together in the long term psychotherapy process and it is important to focus on the therapy relationship in terms of both sides.

The role of physical therapists' knowledge, attitudes, and practices in health promotion in Arsi zone, Southeast Ethiopia

BACKGROUND: Physical activity is a first-line therapy and protects against many chronic health conditions. Primary health-care practitioners are ideally positioned to promote physical activity. Physical therapy interventions should be aimed at promotion and maintenance of health, quality of life, and fitness. There is, however, a shortage of such research evidence in Ethiopia. OBJECTIVE: We aimed to estimate the level of knowledge, attitude, and practice (KAP) of physical therapists toward health promotion in Arsi zone of Oromia, Southeast Ethiopia. MATERIALS AND METHODS: This community-based, cross-sectional study was conducted in April 2018 among 45 physical therapists. Data were collected using pretested, structured, and self-administered questionnaires. Participants were selected by quota sampling technique. The questionnaire was drafted specifically to test the KAP. The data were double entered and analyzed by SPSS program version 20.0. Descriptive statistics were used. The KAP were estimated using proportion. RESULTS: In the present study, the response rate was 90.0%. Ages of the respondents ranged between 24 and 87 years. Nearly 57.8% of the participants got initial physical therapy knowledge from either of their parents, 53.3% of the respondents heard about health promotion from families and friends, and 57.8% of them received health promotion at their workplace. The overall percentage of all the respondents' KAP in health promotion was 60.1%. CONCLUSIONS: The respondents' have good KAP toward health promotion. However, there is still room for improvement. In addition, there is a lack of proper guidelines in determining the impact of physical therapy.

STRATEGI PENGEMBANGAN ESPACE SPA BALI DALAM MENGHADAPI PERSAINGAN GLOBAL

This research aim to find out the development strategies of Espace Spa Bali in facing global competition, to find out the the guests characteristic and to find out of the guest push and pull motivation in visiting Espace Spa Bali. Random sampling was used with total sample of 45 guests (15% of 300 visiting guests in a month). The data were taken from interview and questionnaire. The SWOT analysis technique was used to analyze the data obtained through the interview, and the descriptive frequency technique was used to analyze the guests characteristics and motivation questionnare data. The result of research showing that Espace Spa Bali is on quadran I (aggressive) with x axis (2.50) and y axix (2.45). the developed strategies are strengthening the brand, quality, marketing and price, also increasing the cooperation with stakeholders. The guest mostly female coming from Australia, France and Japan with the education background from senior high school, diploma, bachelor degrees, ages range from 26 till 56 years old, married status and single are balanced. Guests mostly has job as a staff or office employees and first time visiting Bali. The push motivation factor are indicate that the reason guests visiting Espace Spa Bali for rejuvenation, social an joy, luxury life style, health and beauty, relaxation, escape from routin job. The pull motivation factor are indicate that the guests choose Espace Spa Bali because of proffesionalism and attitude of therapist, good amenities, clean and tidy facility, the room decoration adjust for comfortable treatment Keywords: Global Competition, Development Strategies, Characterics, Push Motivation, Pull Motivation

Evidence-based practice: What therapists say about it?

The significance of evidence based practice (EBP) can not be overstated. However, literature on the perception of occupational therapists and physical therapists toward EBP, is scarce. The purpose of this survey study was to examine occupational and physical therapists's attitudes toward evidence based practice. A total of 47 among 261 practicing occupational and physical therapists in a health care system in the Midwest responded to the questionnaire previously developed by Rubin and Parrish, 2011. Follow up reminders were implemented to achieve a higher response rate. The results of the study showed that therapists maintained an overall positive attitude toward EBP, reported familiarity with the EBP process and an overall positive attitude toward EBP. In addition, therapists reported intend to engage in the EBP process but their current engagement was a little less than “some of the time.” However, therapists reported slightly lean unfeasible to engage in the EBP process. Barriers to engaging in EBP included time, access, and the constraints of the responders’ practice setting. Overall, the findings of this study showed that therapists hold positive perception on evidence based practice and such findings are consistent with previous research. The current study suggests practicing occupational therapists and physical therapists in general have positive perception on evidence based practice, particularly in the area of familiarity with EBP, the intend to and current engagement of EBP. Therapists, however, identified many factors that contribute to their negative perception on feasibility of the EBP in their day-to-day practice. Administrative support, decreased productivity pressure, adequate education and training are essential in ensuring and promoting EBP, a key ingredient in help achieve triple aims of health care services.

Coaching in early physical therapy intervention: the COPCA program as an example of translation of theory into practice

Background: Coaching is en vogue in pediatric physiotherapy, but often applied rather unspecific and undefined.Methods: This paper aims to describe coaching in early physiotherapy intervention, taking the specific coaching approach of the family-centered program “COPing with and CAring for infants with special needs” (COPCA) as a case in point.Results: The theoretical underpinnings of coaching in COPCA, including a meta-model, family-centered practice, the Neuronal Group Selection Theory and the goal-oriented coaching approach, are discussed. Next, the translation of theory into practical ingredients for coaching of families of a child with special needs is presented. The latter includes the appreciation of family autonomy and attitudes, and the creativity to ask specific questions to support the families in making their own decisions to promote their child’s development during daily care-giving routines.Conclusion: It is concluded that the approach of coaching is demanding for both families and pediatric physiotherapists. It requires an active role of the family members in the intervention process and for therapists that they incorporate the attitude of a coach that largely differs from the attitude of the traditional therapist. For families and pediatric physiotherapists appreciating these changes in attitude, COPCA’s coaching offers a promising form of early intervention.Implications for rehabilitationWe recommend the implementation of the promising approach of goal-oriented and solution-focused coaching in pediatric rehabilitation and/or early intervention.We recommend applying coaching methods that are based on explicit theoretical background and clinical knowledge.We recommend formal training in coaching before professionals apply coaching in pediatric rehabilitation and/or early intervention.

Mixed-method analysis of program leader perspectives on the sustainment of multiple child evidence-based practices in a system-driven implementation

BackgroundUnderstanding program leader perspectives on the sustainment of evidence-based practice (EBP) in community mental health settings is essential to improving implementation. To date, however, much of the literature has focused on direct service provider perspectives on EBP implementation. The aim of this mixed-method study was to identify factors associated with the sustainment of multiple EBPs within a system-driven implementation effort in children’s mental health services.MethodsData were gathered from 186 leaders at 59 agencies within the Los Angeles County Department of Mental Health who were contracted to deliver one of six EBPs within the Prevention and Early Intervention initiative.ResultsMulti-level analyses of quantitative survey data (N = 186) revealed a greater probability of leader-reported EBP sustainment in large agencies and when leaders held more positive perceptions toward the EBP. Themes from semi-structured qualitative interviews conducted with a subset of survey participants (n = 47) expanded quantitative findings by providing detail on facilitating conditions in larger agencies and aspects of EBP fit that were perceived to lead to greater sustainment, including perceived fit with client needs, implementation requirements, aspects of the organizational workforce, availability of trainings, and overall therapist attitudes about EBPs.ConclusionsFindings inform EBP implementation efforts regarding decisions around organizational-level supports and promotion of EBP fit.

Cultural processes in psychotherapy for perinatal loss: Breaking the cultural taboo against perinatal grief.

This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents' ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent's loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent's response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent's experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent's feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed. (PsycINFO Database Record

Therapists’ attitudes to offering eCBT in an inner-city IAPT service: a survey study

AbstractDespite an emerging evidence base for the efficacy of supported computerized cognitive behavioural therapy (eCBT), uptake in services has been slow. Therapists’ beliefs about eCBT may constitute a barrier to offering eCBT to clients, but little research has investigated this topic. The aim of this study was to investigate therapist attitudes towards eCBT in one inner-city Improving Access to Psychological Therapies (IAPT) service using a survey design. Data were analysed using descriptive statistics. Thirty-three therapists took part in the study. Although 97% of participants reported that they knew ‘what eCBT involves’, and 62% reported that they were ‘confident to offer eCBT to clients’, only 10% endorsed that ‘there is a strong evidence-base to support the use of eCBT’. Two-thirds of the sample believed that eCBT ‘could be effective for mild and moderate mental health difficulties’, but most participants believed that eCBT would perform ‘worse’ or ‘much worse’ than face-to-face interventions for a range of disorders. Barriers to offering eCBT related predominantly to assumptions about client expectations of therapy, and perceived lack of a therapeutic relationship. Participants identified the provision of training on eCBT for those recommending treatment options to clients as a potential solution. Results from this study highlight therapists’ attitudes to eCBT that might contribute to low uptake rates of eCBT. Particularly, misperceptions about the evidence base for eCBT may be prevalent. Appropriate training and ongoing supervision for therapists are considered as interventions that may increase acceptance of eCBT as a valid treatment option.

Spirituality in Psychotherapy

While scientific interest in the relationship between psychotherapeutic praxis and spirituality is growing, there is still little knowledge on this topic, especially in an East Central European context. To explore how psychotherapists understand spiritual issues and experiences they encounter in their work and to learn what happens to these issues in the course of psychotherapy, this study analyses semi-structured interviews with 30 Hungarian psychotherapists. Applying a grounded theory analytical strategy, three main topics were identified: the therapist's attitude towards spirituality leaves a discernible trace in the psychoterapeutic treatment; the therapist influences the way spiritual issues are treated; and the therapist may have a shared spiritual experience with the client. We present individual variations of these experiences as they appear in the code tree. Results are interpreted with reference to a systemic view of the psychotherapeutic process, the intersubjective space of patient and therapist, and the notion of the therapists’ mentalizational capacity.

Directiveness in psychotherapy: A phenomenological-narrative study of therapist attitudes.

This study of directiveness draws on the literature on patient-therapist matching, neutrality, and resistance. Our aim was to investigate how psychotherapists conceptualize directiveness as an attitude, with a focus on pantheoretical aspects of directiveness. Our data are narratives from 18 interviews with psychotherapists of different theoretical orientations (cognitive-behavioural, family-systems, humanistic-experiential, and psychodynamic), and from focus-group discussions with six other psychotherapists. The analysis yielded four general themes: expression of directiveness (behaviour, agency, structure), its presence (depending on phase of and goals for therapy), its positive and negative outcomes (for patients and therapists, respectively), and therapist awareness (initial and shifting, depending on theoretical orientation). Directiveness may be construed as an attitude. It supposedly increases via certain responses, but only a few of these are considered positive by therapists at large. Directiveness may be more present in early and late phases of therapy, and more warranted with patients that function poorly. There are both positive and negative outcomes of directiveness, but therapists are more prone to disclose the former. Therapist directiveness supposedly increases via advice, questions, clarifications, steering to topics, goal setting, self-disclosure, and session management. Directiveness is seen as more present in early and late phases of therapy. Directing is more warranted with patients who function poorly. Possible positive outcomes of directiveness are clarity, feeling of security, and saving time; negative outcomes are decrease of agency, increase of resistance, and less patient self-attribution of improvement. It is unlikely that therapists disclose adverse directive behaviours. Those who do, attribute them to psychotherapy structure if their attitudes are negative, and to personal choice if they are positive. This may hamper therapists managing their own level of directiveness.

(363) Changes in physical therapist attitudes, beliefs, and confidence about low back pain management following participation in a Psychologically Informed Physical Therapy (PIPT) training course

(363) Changes in physical therapist attitudes, beliefs, and confidence about low back pain management following participation in a Psychologically Informed Physical Therapy (PIPT) training course

How Intervention and Implementation Characteristics Relate to Community Therapists' Attitudes Toward Evidence-Based Practices: A Mixed Methods Study.

Therapists' perceptions toward evidence-based practices (EBPs) are important in implementation efforts, however little is known about characteristics of EBPs associated with more positive attitudes. This mixed-methods study examined how intervention and implementation characteristics of six EBPs related to therapist attitudes. Quantitative analysis of 793 cross-sectional surveys revealed that therapists endorsed more positive attitudes toward EBPs with (1) prescribed session content and order and (2) required consultation. Associations between these intervention and implementation characteristics and attitudes were not moderated by therapist experience or emotional exhaustion. Qualitative analyses complemented quantitative findings, indicating that "structure" was appealing for interventions and that therapists felt supported by consultation.

À la recherche d’un dosage minimal d’antipsychotiques : construire une décision partagée avec les personnes souffrant de psychose

Resume L’observance du traitement antipsychotique est souvent faible. Ainsi, deux tiers des participants arretent le traitement dans les protocoles d’evaluation clinique en raison de problemes de tolerance ou d’efficacite. Dans les annees 1980, des etudes ont montre l’interet et les limites des methodes alternatives au traitement antipsychotique de maintien comme le traitement intermittent ou le traitement prophylactique avec des doses minimales. Neanmoins, ces alternatives ont ete largement delaissees en raison de leur efficacite relative, ce qui tend a limiter les choix therapeutiques au maintien d’un traitement antipsychotique aux doses utilisees en phase aigue. Cette attitude peut interferer avec la relation therapeutique et nuire a l’appropriation du traitement par les patients. Le but de cet article est de discuter la recherche d’un dosage minimal comme methode psychiatrique et psychotherapeutique pour ameliorer l’ insight , l’observance du traitement et l’alliance therapeutique, ainsi que de favoriser le retablissement, la gestion autonome de la sante et la reduction des effets secondaires tout en evitant les consequences negatives du risque de rechute. La recherche d’un dosage antipsychotique minimal reste controversee, mais repose sur des bases scientifiques telles que les notions de saillance aberrante ou de taux d’occupation des recepteurs dopaminergiques D2 et beneficie d’un regain d’interet, en particulier pour les premiers episodes psychotiques.