Therapist Experience Research Articles

Therapists' experience of the lifeline in narrative exposure therapy.

This study aimed to explore the therapist experience of delivering the lifeline component of narrative exposure therapy (NET), an intervention for individuals with posttraumatic stress disorder resulting from exposure to multiple traumatic events. The lifeline in NET involves constructing a chronological representation of the client's life using physical symbols to depict traumatic events as well as positive experiences. A semistructured interview was conducted with 16 therapists experienced in delivering the lifeline component of NET to adult clients. The data from these interviews were analyzed using thematic analysis. Five overarching domains were identified, each encapsulating three themes. The first domain pertains to the overlapping purposes of the lifeline, united by the vital function of developing the therapeutic relationship. The second domain describes the value and potential therapeutic mechanisms of the lifeline's "whole life" perspective. The third domain speaks to the intensely emotional nature of the lifeline process and some of the challenges this presents. The fourth domain relates to the physicality of the lifeline and the value this adds beyond a purely verbal method. The final domain encompasses several challenges described by therapists as well as potential areas for further development. This study provides a rich account of the novel lifeline component in NET. The findings provide direction for refinement of clinical practice and avenues for future research.

Does practice really make perfect? A longitudinal analysis of the relationship between therapist experience and therapy outcome: A replication of Goldberg, Rousmaniere, et al. (2016).

Experience is often regarded as a prerequisite of high performance. In the field of psychotherapy, research has yielded inconsistent results regarding the association between experience and therapy outcome. However, this research was mostly conducted cross-sectionally. A longitudinal study from the U.S. recently indicated that psychotherapists' experience was not associated with therapy outcomes. The present study aimed at replicating Goldberg, Rousmaniere, et al. (2016) study in the German healthcare system. Using routine evaluation data of a large German university psychotherapy outpatient clinic, the effect of N = 241 therapists' experience on the outcomes of their patients (N = 3,432) was assessed longitudinally using linear and logistic multilevel modeling. Experience was operationalized using the number of days since the first patient of a therapist as well as using the number of patients treated beforehand. Outcome criteria were defined as change in general psychopathology as well as response, remission, and early termination. Several covariates (number of sessions per case, licensure, and main diagnosis) were also examined. Across all operationalizations of experience (time since first patient and number of cases treated) and therapy outcome (change in psychopathology, response, remission, and early termination), results largely suggest no association between therapists' experience and therapy outcome. Preliminary evidence suggests that therapists need fewer sessions to achieve the same outcomes when they gain more experience. Therapeutic experience seems to be unrelated to patients' change in psychopathology. This lack of findings is of importance for improving postgraduate training and the quality of psychotherapy in general. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Drama Therapy Family Mask Protocol in a forensic setting: Participant and therapist experience

In this clinical commentary, steps of a Drama Therapy Family Mask Protocol, implemented in a carceral setting, are discussed, using a case example. Steps include: mask making, ‘intermingling’, reparative family drama and participant reflection. Masks as a projective technique may provide a greater sense of safety in a forensic setting to support the participant’s experience while exploring their family drama. An autoethnographic response to the implementation of this protocol is processed through art and written response.

A Physical Therapist's Experience as a Point-of-Contact Care Provider in a Wilderness Environment: A Case Series Report

Background Wilderness physical therapists (WPTs) are on-scene primary providers who combine physical therapy, emergency first aid, and wilderness survival skills to manage people with a wide array of injuries and illnesses in remote environments. Case Presentation Patient 1, a 51-year-old female, was unable to bear weight after sustaining a right knee injury from falling into a river while hiking. The WPT immobilized a suspected knee fracture using a SAM® Splint, moved the patient and her group to safer location, and constructed a shelter. Shortly after, patient 2, a 14-year-old male, fell and sustained a forehead laceration. Hemostasis was obtained and the patient was monitored for neurologic abnormalities. Safety was complicated by rainfall, darkness, and the absence of cell service to notify emergency medical services. Outcome and Follow-Up Emergency medical services arrived 4 hours after the initial injury and evacuated both individuals. Plain film radiographs of patient 1's knee were interpreted as normal; however, subsequent magnetic resonance imaging revealed a posterior tibial plateau fracture with ligamentous injury. Following a 20-hour observation period, patient 2 was returned to continue the hike with his group. Discussion This case illustrates the emergency medical, leadership, and situational awareness skills required of a WPT. This case also illustrates the in-field application of the Ottawa knee rules and the importance of careful neurologic assessment in individuals with head trauma. JOSPT Cases 2022;2(3):175–182. Epub: 21 June 2022. doi:10.2519/josptcases.2022.10944

Supplemental Material for Does Practice Really Make Perfect? A Longitudinal Analysis of the Relationship Between Therapist Experience and Therapy Outcome: A Replication of Goldberg, Rousmaniere, et al. (2016)

Supplemental Material for Does Practice Really Make Perfect? A Longitudinal Analysis of the Relationship Between Therapist Experience and Therapy Outcome: A Replication of Goldberg, Rousmaniere, et al. (2016)

The years of physical therapist experience influence the prescription time for orthosis in patients with post stroke: A retrospective observational study in a rehabilitation setting

The years of physical therapist experience influence the prescription time for orthosis in patients with post stroke: A retrospective observational study in a rehabilitation setting

Reward During Arm Training Improves Impairment and Activity After Stroke: A Randomized Controlled Trial

Background Learning and learning-related neuroplasticity in motor cortex are potential mechanisms mediating recovery of movement abilities after stroke. These mechanisms depend on dopaminergic projections from midbrain that may encode reward information. Likewise, therapist experience confirms the role of feedback/reward for training efficacy after stroke. Objective To test the hypothesis that rehabilitative training can be enhanced by adding performance feedback and monetary rewards. Methods This multicentric, assessor-blinded, randomized controlled trial used the ArmeoSenso virtual reality rehabilitation system to train 37 first-ever subacute stroke patients in arm-reaching to moving targets. The rewarded group (n = 19) trained with performance feedback (gameplay) and contingent monetary reward. The control group (n = 18) used the same system without monetary reward and with graphically minimized performance feedback. Primary outcome was the change in the two-dimensional reaching space until the end of the intervention period. Secondary clinical assessments were performed at baseline, after 3 weeks of training (15 1-hour sessions), and at 3 month follow-up. Duration and intensity of the interventions as well as concomitant therapy were comparable between groups. Results The two-dimensional reaching space showed an overall improvement but no difference between groups. The rewarded group, however, showed significantly greater improvements from baseline in secondary outcomes assessing arm activity (Box and Block Test at post-training: 6.03±2.95, P = .046 and 3 months: 9.66±3.11, P = .003; Wolf Motor Function Test [Score] at 3 months: .63±.22, P = .007) and arm impairment (Fugl-Meyer Upper Extremity at 3 months: 8.22±3.11, P = .011). Conclusions Although neutral in its primary outcome, the trial signals a potential facilitating effect of reward on training-mediated improvement of arm paresis. Trial registration ClinicalTrials.gov (ID: NCT02257125).

Assimilating problematic life script themes in clinical supervision: The case of Sarah

AbstractObjectivesLife script is a transactional analysis concept describing a pattern of human experience, interaction and meaning making developed in childhood that can be activated in adulthood, sometimes creating problems. Problematic life script themes can impact a therapist's experience and interaction during clinical work and interfere with therapeutic effectiveness. This study used the comparative script system theory to assess how one therapist's problematic life script themes were manifested in supervision, how they were addressed, and whether addressing them advanced assimilation of the problematic material.MethodSeven consecutive monthly supervision sessions with a 50‐year‐old, highly experienced female therapist in private practice (pseudonym ‘Sarah’) were analysed by a team of five investigators using a qualitative theory‐building approach. The assimilation of problematic experiences sequence (APES) was used to track changes in Sarah's life script themes.ResultsProblematic life script themes were evident in each supervision session. Progress though the APES varied across themes and six different clients discussed during the sessions.ConclusionsThe supervisee's life script themes emerged prominently in supervision session content, and most were successfully navigated. The observations supported the theoretical suggestion that assimilation of supervisee unprocessed life script material may be a prominent component of routine professional supervision.

Externalisation in family‐based treatment of anorexia nervosa: The therapist's experience

AbstractFamily‐based treatment (FBT) is an evidence‐based treatment for adolescent eating disorders that incorporates many principles from family therapy. It uses the externalisation of anorexic thoughts and behaviours to separate the person from the anorexia nervosa (AN) through language and metaphor. Little is known about how clinicians understand, conceptualise and support families to externalise. Semi‐structured interviews conducted with FBT‐trained clinicians working in child and adolescent mental health services were analysed using thematic analysis. Three themes emerged: the clinician’s use of externalisation, the impact on family functioning and the barriers to externalisation. Externalisation can support a young person’s recovery from AN when used in conjunction with other therapeutic skills. Clinicians should be aware of potential barriers to the implementation of externalisation, such as problem awareness, age and duration of illness. Practitioner points Clinicians value externalisation as an important therapeutic technique within the FBT model, while acknowledging that the ‘ED as illness’ metaphor can challenge their own beliefs. Externalisation can improve family functioning, family communication and reducing conflict within relationships in families with AN. Lack of insight into the AN can present as a barrier to externalisation for a young person.

A Pilot Study of a Sensor Enhanced Activity Management System for Promoting Home Rehabilitation Exercise Performed during the COVID-19 Pandemic: Therapist Experience, Reimbursement, and Recommendations for Implementation.

Adherence to home exercise programs (HEPs) during physical rehabilitation is usually unmonitored and is thought to be low from self-reports. This article describes exploratory implementation of a Sensor Enhanced Activity Management (SEAM) system that combines HEP management software with a movement sensor for monitoring and motivating HEP adherence. The article also presents results from attempting to gain reimbursement for home use of the system with therapist oversight using Remote Physiologic Monitoring (RPM) codes. Four therapists used the system in their regular practice during the first six months of the COVID-19 pandemic. Therapists filled out surveys, kept notes, and participated in interviews. Billing and reimbursement data were obtained from the treatment facility. Exercise data from the SEAM system were used to understand HEP adherence. Patients were active for a mean of 40% (26% SD) of prescribed days and completed a mean of 25% (25% SD) of prescribed exercises. The therapists billed 23 RPM codes (USD 2353), and payers reimbursed eight of those instances (USD 649.21). The therapists reported that remote monitoring and the use of a physical movement sensor was motivating to their patients and increased adherence. Sustained technical support for therapists will likely improve implementation of new remote monitoring and treatment systems. RPM codes may enable reimbursement for review and program management activities, but, despite COVID-19 CMS waivers, organizations may have more success if these services are billed under supervision of a physician.

Parent Experience and Cost Savings Associated With a Novel Tele-physiatry Program for Children Living in Rural and Underserved Communities

ObjectiveThe aim of this study was to investigate parent and therapist experience and cost savings from the payer perspective associated with a novel tele-physiatry program for children living in rural and underserved communities. DesignWe designed a noninferiority, cluster-randomized crossover study at 4 school-based clinics to evaluate parent experience and perceived quality of care between a telemedicine-based approach in which the physiatrist conducts the visit remotely with an in-person therapist and a traditional in-person physiatrist clinic. SettingFour school-based clinics in Northern California. ParticipantsA total of 268 encounters (124 telemedicine and 144 in-person) were completed by 200 unique patients (N=200). InterventionsNot applicable. Main Outcome MeasuresParent and therapist experience scores. ResultsFor parents and therapists, experience and perceived quality of care were high with no significant differences between telemedicine and in-person encounters. For parents whose children received a telemedicine encounter, 40 (54.8%) reported no preference for their child's subsequent encounter, 21 (28.8%) preferred a physiatrist telemedicine visit, and 12 (16.4%) preferred a physiatrist in-person visit. From the payer perspective, costs were $100 higher for in-person clinics owing to physician mileage reimbursement. ConclusionsWe found that school-based tele-physiatry for children with special health care needs is not inferior to in-person encounters with regard to parent and provider experience and perceived quality of care. Tele-physiatry was also associated with an average cost savings of $100 per clinic to the payer.

Taking the therapeutic community outside in the COVID-19 pandemic

PurposeThe COVID-19 pandemic has affected psychotherapy practice. A common change is a move to online sessions over video calls. In their therapeutic community (TC) for those with personality disorders, the authors have used video calls but not all clients could work in this way. The authors decided to meet patients outside and walked with them while adhering to government guidelines. This study aims to present the authors’ experience with one client who was interviewed afterwards about the experience.Design/methodology/approachA total of 10 walking therapy sessions of 60-min duration were conducted with the patient. After the sessions, both the patient and therapist were interviewed about their experience. The resulting interviews with both patient and therapist were thematically analysed independently by both authors.FindingsThere were common themes to both the client and therapist’s account following thematic analysis. These were: modelling and normalising in the real world, replacing what COVID-19 had taken away from the TC experience, changes at home, therapist disclosure, outcomes and good endings and being outside of the clinical environment.Research limitations/implicationsThe authors have presented a single case of the patient and therapist experience of outdoor therapy sessions in a TC context response to the COVID-19 pandemic. The findings are not generalisable and can only provide a suggestion at the positive potential for working in this way. The authors hope that the positive effects of outdoor therapy noted here may inspire other clinicians to consider similar novel approaches in their work.Originality/valueThis study describes a novel way that a TC has adapted to the COVID-19 pandemic.

Therapeutic relationship and professional burnout in psychotherapists: A structural equation model approach.

Previous studies on the therapists' burnout have focused on individual and environmental risk factors. This study aimed to analyse whether variables reflecting therapeutic relationship-the therapist experience of relational depth and quality of the therapeutic relationship-can be related to psychotherapist burnout. Four alternative path models were examined. A total of 101 humanistic-experiential psychotherapists, aged between 29 and 86 years, participated in the research. The Relational Depth Frequency Scale, the Scale to Assess the Therapeutic Relationship, the Psychological Well-Being Scale and the Link Burnout Questionnaire were applied to the research. The results showed that relational depth and therapeutic quality correlated negatively with psychotherapist burnout. Relational depth is the main predictor of psychological well-being and psychotherapist burnout through its effect on therapeutic quality. The experiences of relational depth, primarily of person-centred therapists, have positive psychological potential in predicting lower professional burnout.

Moderate reliability of the lateral step down test amongst experienced and novice physical therapists

ABSTRACT Background/Introduction: The lateral step-down test is used to appraise movement quality in patients with patellofemoral pain (PFP), however, it is unclear if reliability of the test is affected by physical therapist experience. Objective: Determine if there is a difference in reliability between ‘experienced’ and ‘novice’ physical therapists appraising movement quality of patients with PFP during the lateral step-down test. Methods: Three ‘experienced’ and 3 ‘novice’ physical therapists analyzed movement quality of 22 participants [mean age (SD) 28.25 (6.5) years] with PFP. Physical therapists viewed two-dimensional videos of participants performing the lateral step-down test and appraised the quality with a score (0–1 = ‘good’; 2–3 = ‘fair’, and 4–5 = ‘poor’) at baseline and 1 week. Inter- and intra-rater reliability were calculated with kappa and percent agreement. Differences between the groups were assessed with the chi-square test with an a priori alpha level of < 0.05. Results: Inter- and intra-rater reliability ranged from fair to moderate (ĸ = 0.40–0.65). There was no difference in reliability between ‘experienced’ and ‘novice’ physical therapists at baseline (p = .13) or 1 week post testing (p = .94). Conclusions: There was no difference in reliability between ‘experienced’ and ‘novice’ physical therapists using categories to appraise movement quality during the lateral step-down test for patients with chronic PFP.

Psychotherapists\u2019 emotional reactions to patients\u2019 personality trait in personality disorder treatment settings: an exploratory study

BackgroundTherapist’s emotional reactions toward patients in clinical facilities are a key concept in the treatment of personality disorders. Considering only clinical settings specialized in treatment of personality pathology the present paper aimed at: (1) assessing any direct relationship between patient symptom severity and therapist emotional response; (2) exploring patients’ functioning configurations that can be associated with specific therapist reactions (3) investigating whether these relationships remains significant when accounting for other setting variables related to patients or therapist.MethodsThe present study included 43 outpatients with personality disorders who underwent a psychotherapy treatment in two Italian facilities dedicated to outpatients with personality disorders and their 19 psychotherapists. The Symptom Checklist-90-Revised (SCL-90R) was used to explore clinical severity condition. Psychotherapists completed the Therapist Response Questionnaire (TRQ) to identify pattern of therapists’ response and the Shedler-Westen Assessment Procedure-200 (SWAP-200) in order to assess personality traits of the patients.ResultsNo significant relationship between the clinical severity of the symptoms and the therapist’ responses was found. Even when controlled for clinical severity condition, duration of the treatment, age and educational level of the patient or years of therapist experience, most of SWAP-200 traits appeared to be significant predictors of therapist’ emotional responses.ConclusionsThe present study confirms the value of therapists’ emotional response as a useful tool in understanding psychological processes related to clinical practice highlighting its context-dependent dimension.

Treatment provision for adults with ADHD during the COVID-19 pandemic: an exploratory study on patient and therapist experience with on-site sessions using face masks vs. telepsychiatric sessions

BackgroundMaintaining the therapeutic care of psychiatric patients during the first wave of the COVID-19 pandemic in Switzerland required changes to the way in which sessions were conducted, such as telepsychiatric interventions or using face masks during on-site sessions. While little is known about how face masks affect the therapeutic experience of patients and therapists, the effectiveness of telepsychiatry is well documented for several psychiatric disorders. However, research on the benefits of telepsychiatry in adult patients with attention-deficit/hyperactivity disorder (ADHD) remains scarce. This seems problematic since the symptoms typically associated with ADHD, such as attention problems and distractibility, may lessen the utility of telepsychiatry for this particular group. The present study’s aim was to explore how adult patients with ADHD and their therapists experienced therapy sessions during the COVID-19 pandemic in three different settings: face-to-face with the therapist wearing a face mask, via telephone, or via videoconferencing.MethodsIn this exploratory, quantitatively driven mixed-method study (quantitative questionnaire data and qualitative data from open-ended responses), we assessed patients’ evaluation of the session, their treatment satisfaction, and patients’ and therapists’ ratings of therapeutic alliance. We also collected qualitative comments on both sides’ experience of the session. Overall, 97 therapist and 66 patient questionnaires were completed. Results are reported for the N = 60 cases for which data from both parties were available. Sequential multiple regressions adjusted for therapist and number of sessions were used for the main quantitative analyses.ResultsNo statistically significant differences regarding session flow, post-session positivity, satisfaction and therapeutic alliance were observed. The only exception was that telepsychiatric sessions were rated as significantly less deep than face-to-face sessions, an effect that may decline over time, especially in the videoconferencing group. Patients and therapists identified similar facilitating and complicating aspects, but differed in their emphasis of specific elements.ConclusionsBoth settings, on-site with the therapist wearing a face mask and telepsychiatric, seem to be valid options to continue treatment of adults with ADHD during a situation such as the COVID-19 pandemic. Aspects such as patient preference, session content, and therapeutic methods may be useful to identify the most suitable modality.

Intensive short-term dynamic psychotherapy provided by novice psychotherapists: effects on symptomatology and psychological structure in patients with anxiety disorders.

This study examines the effectiveness of psychotherapy provided by novice therapists, in an attempt to clarify the controversial relationship between treatment effectiveness and therapist experience. To achieve this, we examined the short- and long-term effectiveness of intensive short-term dynamic psychotherapy (ISTDP) in the treatment of patients with the Diagnostic and Statistical Manual of Mental Disorder, IV edition - Text Revision anxiety disorders, as provided by novice psychology trainees. Twenty-two patients with anxiety disorders were provided ISTDP. Patients improved significantly on all outcome indices, including the global assessment of functioning, the symptom checklist and the inventory of interpersonal problems, at the end of the treatment and at 6 and 12 month follow-up. In addition to these results, there was marked structural personality change as evidenced by ratings on the Shedler Westen assessment procedure (SWAP-200), at the same assessment moments; the SWAP-200 psychological health index score showed a meaningful increase in adaptive psychological resources and capacities, while the mean number of personality diagnoses decreased from the beginning to the end of therapy, and all patients maintaining their gains in 6-12 month follow-up. We conclude that ISTDP provided by novice psychotherapists is efficacious in bringing broad and in-depth change to pathology that can perpetuate anxiety disorders and other psychiatric conditions.

Therapeutic distance in client-therapist narratives: client attachment, therapist attachment, and dyadic effects

Based on the attachment framework, therapeutic distance conceptualization focuses on closeness–distance dynamics in the therapeutic relationship. We aimed to evaluate the psychometric properties of the Therapeutic-Distance-Scale, Observer-version (TDS-O) and apply a dyadic approach to examine associations between attachment characteristics and therapeutic distance experiences of clients, therapists, and mutual effects. Sixty-six clients and their 29 therapists completed the ECR and relational narratives collected in RAP interviews at early, mid, and late psychodynamic-therapy were rated on TDS-O scales: too close, too distant, autonomy, and engagement. The TDS-O showed good IRR, internal reliability and content validity. Client anxiety was not associated with therapeutic distance but associated with autonomy. Client avoidance associated with clients’ experiencing therapist as too close, and lower engagement only at early therapy, but was not associated with therapists’ experience. Therapist anxiety was not related to closeness–distance at early therapy but related to gaps between client and therapist experiences at mid and late therapy. Therapist avoidance related to clients experiencing therapists as too close and granting less autonomy at early and mid-therapy, and to therapist experience of distance at late therapy. The findings underscore the importance of therapists’ regulating therapeutic distance through attunement to client’s interpersonal needs and therapy phase.

Infant mental health home visiting: intervention dosage and therapist experience interact to support improvements in maternal reflective functioning

ABSTRACT This study examined changes in parental reflective functioning (PRF) among mothers enrolled in Infant Mental Health-Home Visiting (IMH-HV) and explored whether parental risk, treatment dosage or therapist experience predicted change in PRF. Participants included 75 mothers and their children who were enrolled in IMH-HV delivered by Community Mental Health therapists. Results indicated significant improvements in PRF from baseline to 12-months. Maternal demographic and psychosocial risk, therapist experience and treatment dosage were not directly associated with changes in PRF. However, Mothers who received more treatment sessions from therapists with six or more years of experience demonstrated the greatest improvements in PRF, while mothers who received more treatment sessions from therapists who had been practicing IMH for less than 15 months showed a decline in PRF. Therapists working with very high-risk families may need specific training and ongoing reflective supervision over a period of years to promote improvement in PRF.

Exploring the development and maintenance of therapeutic relationships through e-Health support: A narrative analysis of therapist experiences.

Objective:Amid COVID-19 disruptions, e-therapy has become even more essential and has rapidly expanded across statutory, private and third sectors to meet growing demands for digital mental health support. A challenge in digital therapeutic care is how to develop and maintain a supportive, collaborative therapeutic relationship, built upon mutual trust and respect; intrinsic values of relationships that are often implied through complex non-verbal cues. Online practitioners are eager to learn how to adapt to online delivery, although platform-specific training is limited. The aim of the current study was to focus upon the therapist experience of online therapeutic relationships with young people, exploring a range of factors through their perspectives, including the impact of anonymity.Methods:Eight e-therapy practitioners were recruited from Kooth, an online mental health service. Narrative interviews undertaken via Skype facilitated reflective conversational one-to-one discussions, based upon the practitioners’ individual experiences, led by the interviewee. Following transcription and anonymisation, a narrative analysis was undertaken to explore participants’ experiences, perspectives and reflections.Results:Four analytic layers arose from the narratives, which explored the challenging learning experience of translating existing therapeutic skills to online working, rapidly building therapeutic relationships, managing risk in the online therapeutic relationship, and techniques for maintaining a digital therapeutic relationship.Conclusion:The study provides novel insights into the flexibility and adjustments therapists can make to improve online interventions and delivery through the development and maintenance of positive therapeutic relationships. Recommendations are also made in relation to platform-specific training, communicative adaptations, risk management and practitioner support.