Therapist Interaction Research Articles

Internet-delivered emotion regulation therapy for adolescents engaging in non-suicidal self-injury and their parents: A qualitative, online focus group study.

We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI). A qualitative study nested within a controlled feasibility trial. Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis. Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents. Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.

Transgender, Gender-Diverse, and Nonbinary Experiences in Physical Therapy: A Descriptive Qualitative Study.

The objective was to explore experiences with and identify barriers and facilitators of utilizing physical therapy for people who identify as transgender, gender diverse, and nonbinary (TGNB). A qualitative descriptive design was employed using semistructured interviews conducted in New Zealand. Eligible participants were individuals who were 12years old or older, who self-identified as TGNB, and who had accessed physical therapy at a community-based clinic that also provides a gender-affirming service. Participants were recruited via email invitation to the clinic database. Interview data were analyzed using reflexive thematic analysis. Demographics are reported descriptively. Seventeen individuals (15-64years old and identifying as 11 different genders) participated. All participants reported physical therapist experiences relating to 1 or more of the following 4 themes: challenging cisnormativity at policy, environmental, clinic, and therapist levels; safety and trust throughout the clinical experience, including clinic credibility for being a safe provider, clinic displays of TGNB inclusivity, implementation of safe clinic processes, and respectful therapist interactions; inclusive experiences in a clinic that provided affordable care and took active steps to understand and affirm TGNB identities and with physical therapists who had a high level of knowledge of TGNB-specific health issues and took a biopsychosocial approach to care; and sensitivity to body discomfort or dysphoria triggers. Barriers to and facilitators of care were identified at policy, environmental, clinic, and therapist levels. People who identify as TGNB face challenges to accessing safe and culturally sensitive physical therapy. However, there are achievable areas for improvement at policy, environmental, clinic, and physical therapist levels to gain trust and engagement in care for the TGNB community. This study provides a detailed exploration of TGNB physical therapist experiences and identifies specific areas of improvement for TGNB physical therapy care to provide clinicians and physical therapy clinics insights into the provision of safe and culturally sensitive physical therapy.

Introducing Mechanically Assisted Cough for Patients With Progressive Neurological Disease: Patient-Physical Therapist Interaction and Physical Therapist Perspective.

The goal of this study was to explore the patient-physical therapist interaction and the physical therapist's experience of the introductory session for mechanical insufflation-exsufflation (MI-E) device treatment for patients with progressive neurological disease. Qualitative content analysis of participant's observation of interaction between patients and physical therapists during 9 MI-E introduction sessions in different clinical care settings and 10 follow-up interviews with 6 physical therapists. The introduction of MI-E emerged as a process of instilling a sense of security in the patient. The process can be described in 4 steps: (1) gain understanding by being responsive to the person's whole life situation; (2) share knowledge and expectations in a respectful and permissive way; (3) introduce the device in a gentle and reciprocal interactivity; and (4) adapt to home use in an inclusive dialog with the patient and their significant others. Physical therapists described a need for assurance to instill a sense of security in the patient, implying a need for confidence, competent peers, guiding yet flexible routines, and emotional support. Physical therapists have a need to foster assurance in employing a person-centered approach to make a patient feel secure in the process of introducing MI-E treatment. Multiple modes of professional knowledge were used together with action-based and relational-based ethics to facilitate a person-centered care approach. This seems to be a promising approach for providing good care when introducing MI-E to patients. Further research is needed to explore this from the patient's perspective. This study added to the body of knowledge regarding MI-E treatment in relation to patients. This has direct implication, particularly for inexperienced physical therapists, for informed care for the patient during introduction. Our study also supports that person-centered care should be implemented at all levels of health care to make it possible for physical therapists to practice person-centered care.

The Future of Psychotherapy Research and Neuroscience: Introducing the 4E/MoBI Approach to the Study of Patient–Therapist Interaction

The integration of neuroscience and psychotherapy research has long been a topic of interest in the field of mental health. A significant challenge in psychotherapy research is understanding the dyadic interaction between patient and therapist. This interaction is complex, emerging from a myriad of multi-level factors such as gestures, verbal communication, mentalization, and environmental influences. This article aims to present a roadmap for the future integration of neuroscience and psychotherapy research, addressing the complexities of human interaction. We introduce the 4E/MoBI approach, a framework that combines theoretical and methodological tools to study the dynamics of the brain, body, and environment in real-world settings. This approach emphasizes the use of physiological systems (e.g., heart and brain), behavioral interactions (e.g., conversations and eye-tracking), and environmental video recordings. Additionally, the scalable experimental design (SED) heuristic is discussed as a method to blend controlled experiments with real-world scenarios, allowing for the parametric testing of neurobehavioral markers. As a practical demonstration of the SED heuristic within the 4E/MoBI framework, a concrete experimental example using the N170 event-related potential (ERP) component is presented. While the N170 ERP component is not posited as the foundational marker in the field, it serves to illustrate the application of hypothesis-driven designs and analyses. The 4E/MoBI approach offers a promising avenue for the integration of neuroscience and psychotherapy research. By addressing existing gaps, such as the physiology and phenomenology of expertise in psychotherapy, this framework can foster a virtuous relationship between the two disciplines, paving the way for more comprehensive and nuanced understandings of therapeutic interactions.

Interaction of pediatrician, oncologist and therapist in the complex therapy of children’s patients

The interaction of pediatricians with pediatric oncologists is important for the optimization and treatment of children suffering from oncological diseases. Modern practice strives for a combined approach that includes the interaction of specialists from different fields of medicine in order to improve the quality of medical services provided. The purpose of the article is to provide pediatricians with updated information about the state of pediatric cancer care. In this paper, the following aspects are highlighted, which are aimed at optimizing and applying innovations in the treatment of oncological diseases in children, in particular: reducing the toxicity of drugs in treatment, studying cancer biology, considering new treatment methods, monitoring the disease, since these areas are key topics of general pediatric medicine. The review of immunotherapy and combined approaches in the treatment of oncological diseases of children was carried out. Attention is paid to precision oncology aimed at identifying drugs that will work with specific mutations in the field of tumor destruction. Issues related to the interaction of a pediatrician, oncologist and ENT in combination therapy are also considered.

Comparing clinical decision-making of AI technology to a multi-professional care team in an electronic cognitive behavioural therapy program for depression: protocol.

Depression is a leading cause of disability worldwide, affecting up to 300 million people globally. Despite its high prevalence and debilitating effects, only one-third of patients newly diagnosed with depression initiate treatment. Electronic cognitive behavioural therapy (e-CBT) is an effective treatment for depression and is a feasible solution to make mental health care more accessible. Due to its online format, e-CBT can be combined with variable therapist engagement to address different care needs. Typically, a multi-professional care team determines which combination therapy most benefits the patient. However, this process can add to the costs of these programs. Artificial intelligence (AI) has been proposed to offset these costs. This study is a double-blinded randomized controlled trial recruiting individuals experiencing depression. The degree of care intensity a participant will receive will be randomly decided by either: (1) a machine learning algorithm, or (2) an assessment made by a group of healthcare professionals. Subsequently, participants will receive depression-specific e-CBT treatment through the secure online platform. There will be three available intensities of therapist interaction: (1) e-CBT; (2) e-CBT with a 15-20-min phone/video call; and (3) e-CBT with pharmacotherapy. This approach aims to accurately allocate care tailored to each patient's needs, allowing for more efficient use of resources. Artificial intelligence and providing patients with varying intensities of care can increase the efficiency of mental health care services. This study aims to determine a cost-effective method to decrease depressive symptoms and increase treatment adherence to online psychotherapy by allocating the correct intensity of therapist care for individuals diagnosed with depression. This will be done by comparing a decision-making machine learning algorithm to a multi-professional care team. This approach aims to accurately allocate care tailored to each patient's needs, allowing for more efficient use of resources with the convergence of technologies and healthcare. The study received ethics approval and began participant recruitment in December 2022. Participant recruitment has been conducted through targeted advertisements and physician referrals. Complete data collection and analysis are expected to conclude by August 2024. ClinicalTrials.Gov, identifier NCT04747873.

Youth-Therapist and Parent-Therapist Match and Mismatch on Internalizing and Externalizing Treatment Goals as Predictors of Treatment Engagement.

Therapist-client cognitive match upon key constructs such as treatment goals is purported to be an important component of culturally competent care. For adolescent clients, treatment may involve both youths and their parents, suggesting the need to consider both youth-therapist and parent-therapist perspectives. This longitudinal study examined broadband youth-therapist and parent-therapist treatment goal matching and mismatching in relationship to treatment engagement in a culturally diverse sample of 245 outpatient mental health service-using youth. Although goal matching/mismatching did not uniformly predict treatment engagement as measured by a total score, youth-therapist internalizing goal matching predicted better youth engagement, and parent-therapist externalizing goal mismatch marginally predicted worse parent engagement. When selected post hoc analyses examined relationships to four individual engagement dimensions, youth-therapist internalizing goal matches positively predicted youth Client-therapist interaction, Communication/Openness, Client's perceived usefulness of therapy, and Collaboration with treatment, while parent-therapist externalizing goal mismatch negatively predicted parent Collaboration with treatment. Findings support the importance of cognitive match on treatment goals as well as the consideration of both parent and youth perspectives, matched and mismatched goals, internalizing and externalizing goals, and examining individual dimensions in addition to total scores of engagement.

Lung cancer survivors’ views on telerehabilitation following curative intent therapy: a formative qualitative study

ObjectivesTo inform personalised home-based rehabilitation interventions, we sought to gain in-depth understanding of lung cancer survivors’ (1) attitudes and perceived self-efficacy towards telemedicine; (2) knowledge of the benefits of rehabilitation...

Evaluation of counselling materials for hybrid cardiac rehabilitation in a low-resource setting: Perceptions of patients and providers

ObjectiveThis study evaluated the usefulness of a booklet as support material for counseling focused on self-efficacy and therapist interaction in the course of counseling in a hybrid CR program (i.e., supervised and unsupervised sessions) developed for low-resource settings. MethodsCounseling material was developed by a multidisciplinary team, with patient input. Using multi-methods, first input from patients from six centers in Chile was sought through a telephone survey (cross-sectional). Second, input from physiotherapists delivering the intervention at all centres was solicited qualitatively through a focus group on Zoom. Content analysis was performed using a deductive-thematic approach. ResultsSeventy-one patients were included. All (100 %) participants responded that the materials were easy to understand, contained suggestions applicable to daily life, captured their attention and was useful for future questions. The booklet overall was rated 6.7 ± 0.6/7 %, and 98.2 % were satisfied with the counselling. Overall themes from the six deliverers related to the CR intervention (e.g., well manualized protocols for counselling), the deliverer (e.g., expertise to deliver) and patients (e.g., found information useful). ConclusionThe usefulness of the counseling together with the supporting booklet was established by patients and delivering professionals. Practice implicationsThus, with some final refinement, this resource can be disseminated for use by other Spanish CR programs.

Homework assignment and compliance review from a behavioural perspective: the verbal sequences between therapist and client

Therapeutic (homework) tasks are a characteristic strategy in behavioral psychology to achieve clinical change. The aim of the present study is to determine how behavioural therapists assign therapeutic tasks and review their compliance. Observational methodology was used to analyse the verbal interaction of therapists and clients in 211 recorded sessions (19 complete successful cases) using a validated coding system (SIST-INTER-INSTR). The values for inter- and intra-judge reliability were from good to excellent. The study shows that behavioural psychologists offer motivating verbalisations when assigning therapeutic tasks. During the review of task compliance, therapists frequently provide positive reinforcement when clients report complete compliance with the assigned task but stop the review of tasks when clients report non-compliance or only partial compliance with the task. These sequences provide information about how behavioural therapists provide instructions for therapeutic tasks and review their compliance. This is a first step to study how these verbal sequences favour the establishment of TC and the effectiveness of treatment.

Patient-Therapist Cooperative Hand Telerehabilitation through a Novel Framework Involving the Virtual Glove System.

Telerehabilitation is important for post-stroke or post-surgery rehabilitation because the tasks it uses are reproducible. When combined with assistive technologies, such as robots, virtual reality, tracking systems, or a combination of them, it can also allow the recording of a patient's progression and rehabilitation monitoring, along with an objective evaluation. In this paper, we present the structure, from actors and functionalities to software and hardware views, of a novel framework that allows cooperation between patients and therapists. The system uses a computer-vision-based system named virtual glove for real-time hand tracking (40 fps), which is translated into a light and precise system. The novelty of this work lies in the fact that it gives the therapist quantitative, not only qualitative, information about the hand's mobility, for every hand joint separately, while at the same time providing control of the result of the rehabilitation by also quantitatively monitoring the progress of the hand mobility. Finally, it also offers a strategy for patient-therapist interaction and therapist-therapist data sharing.

Integrative interaction of a speech therapist and a psychologist in the comprehensive support of children with speech development disorders

Integrative interaction of a speech therapist and a psychologist in the comprehensive support of children with speech development disorders

Novel Technology Deployed for Remote Ventilator Management by Respiratory Therapists During the COVID-19 Pandemic: Lessons Learned.

A novel remote ventilator management (control) technology (Omnitool) was implemented for use with ICU patients during the COVID-19 pandemic to mitigate in-person respiratory therapist interactions and preserve personal protective equipment. In the latter half of 2020, eight mechanical ventilators were purchased and enabled for Omnitool deployment through the application of a vendor software option. Subsequently, these ventilators were outfitted with commercially available informatics hardware that permitted remote communication and management via the existing hospital network. In total, 17 patients with COVID-19 respiratory failure were placed on Omnitool enabled ventilators between January 1, 2021-April 30, 2021. The median Omnitool use days was 10. Deployment of a novel remote ventilator management technology is feasible; however, further study is needed to simplify the set up and utilization of the system. Future demands for remote ventilator management are predictable, whether in rural areas, military scenarios without adequate RT staffing, or in circumstances with new and easily transmissible toxic infections, and will continue to encourage the development of relatively easy to apply informatics-based solutions. Herein we share five lessons learned from our Omnitool deployment.

Mathematical Model of Interaction of Therapist and Patients with Bipolar Disorder: A Systematic Literature Review.

Mood swings in patients with bipolar disorder (BD) are difficult to control and can lead to self-harm and suicide. The interaction between the therapist and BD will determine the success of therapy. The interaction model between the therapist and BD begins by reviewing the models that were previously developed using the Systematic Literature Review and Bibliometric methods. The limit of articles used was sourced from the Science Direct, Google Scholar, and Dimensions databases from 2009 to 2022. The results obtained were 67 articles out of a total of 382 articles, which were then re-selected. The results of the selection of the last articles reviewed were 52 articles. Using VOSviewer version 1.6.16, a visualization of the relationship between the quotes “model”, “therapy”, “emotions”, and “bipolar disorder” can be seen. This study also discusses the types of therapy that can be used by BD, as well as treatment innovations and the mathematical model of the therapy itself. The results of this study are expected to help further researchers to develop an interaction model between therapists and BD to improve the quality of life of BD.

Occupational and Physical Therapists' Use of Intrapersonal and Interpersonal Emotion Regulation Strategies During Patient Interactions: A Qualitative Study.

Occupational and physical therapists' use of intrapersonal and interpersonal emotion regulation strategies may play an important role in building therapeutic relationships, but little is known about how they use these strategies during patient interactions. To understand how therapists use intrapersonal and interpersonal emotion regulation strategies during their patient interactions. This qualitative study consisted of two stages of data collection. In Stage 1, therapists were interviewed regarding how they use emotion regulation strategies in their therapeutic relationships. In Stage 2, patient-therapist dyads were observed during treatment sessions and then interviewed at the end of the therapeutic relationship. Inpatient and outpatient rehabilitation hospitals and clinics in the United Kingdom. In Stage 1, 13 occupational therapists and 9 physical therapists participated; in Stage 2, 14 patient-therapist dyads participated. A semistructured interview guide was used to ask therapists how they use emotion regulation strategies during patient interactions. Therapists used a wide range of interpersonal and intrapersonal emotion regulation strategies that can be categorized in prominent emotion regulation strategy taxonomies. They used these strategies both proactively, in anticipation of emotional events, and reactively, in response to emotional events. Their use helped them to build and maintain the therapeutic relationship and to protect themselves, feel better, and get their jobs done. The ability to regulate one's own and others' emotions is an essential part of therapists' work. In this study, therapists used a wide range of emotion regulation strategies to benefit themselves and their patients. What This Article Adds: This is the first study to identify the specific intrapersonal and interpersonal emotion regulation strategies used by occupational and physical therapists during patient-therapist interactions. This study makes an important contribution to understanding therapists' use of proactive and reactive emotion regulation strategies to build and maintain therapeutic relationships.

Parent Perspectives on Constraint-Induced Movement Therapy for Children With Cerebral Palsy

Abstract Date Presented 03/31/2022 This research explores caregiver perspectives on constraint-induced movement therapy, used with children with cerebral palsy. The focus is on the lived experiences of the caregivers, specifically ftheir perspectives of the treatment and therapist interactions throughout treatment. This research advances practice by further defining caregiver needs and experiences and focusing on ways therapists can develop strong therapist-caregiver relationships throughout an intensive form of therapy. Primary Author and Speaker: Erica Wentzel Additional Authors and Speakers: Janelle Barna

1059 PHYSICAL ACTIVITY AMONG OLDER PEOPLE ADMITTED TO A UNIVERSITY HOSPITAL IN MALAYSIA

Abstract Introduction Physical inactivity is prevalent among hospitalised older people and is associated with poor outcomes. This study aims to determine activity levels in a Malaysian university hospital. Method Direct observation of patients admitted to the geriatric medicine ward over 2 weeks between the hours of 8 am-8 pm was performed. Data was collated onto an observation diary which was piloted, and changes made iteratively. A taxonomy of inpatient activity and healthcare staff interaction was created. Observer training was done to ensure familiarity and consistency in the recording. Data was presented descriptively and comparison made between weekday/weekend. Minutes of activity time per-hour (mins/hr) was use to report findings. Results Ninety-one patients were observed over 1918.8 hours (weekday, 1579.67 hours; weekends, 363.87 hours). The observed median (Q1,Q3) was 15.1 (9.4, 30.1) hours per-patient. 32.6 minutes per day on average was spent upright, with the rest spent either sitting or lying down. 78.9% of patients’ time was spent doing nothing. Patients’ position was different between weekdays vs weekends, lying, 35.7 vs 40.8 mins/hr; sitting, 23.3 vs 18.2 mins/hr; and standing, 1.1 vs 1.0 mins/hr. Patients spent significantly less proportion of time active at the weekends (weekdays, 28.3% vs weekends, 19.9%). When individual activities were analysed, patients were doing less walking (weekend, 0.4 vs weekday, 0.01 mins/hr, p = 0.01) therapy-supervised exercise (1.1 vs 0.02 mins/hr, p < 0.01), and nursing care (0.6 vs 0.1 mins/hr, p < 0.01) over the weekend. There was also less doctor interaction (weekday, 1.1 vs 0.5 mins/hr, p = 0.04) and no therapist interaction at the weekend. Nursing input was unchanged. Conclusion Older people admitted to a university hospital in Malaysia were very inactive. There was further reduction in activity levels and healthcare interaction at the weekend. Maintaining physical activity during hospitalisation is required to ensure best possible recovery from their acute illness.

The alliance construct in psychotherapies: from evolution to revolution in theory and research

The alliance construct in psychotherapies: from evolution to revolution in theory and research

Musical interaction in music therapy for depression treatment

Music therapy is efficacious for the treatment of depression. Compared to other psychotherapeutic forms, it allows for the emergence of various modes of mutual interaction, thus enabling multiple channels for emotional expression and fostering therapeutic alliance. Although musical interaction patterns between client and therapist have been regarded as predictors of therapeutic outcome in depression, this has not yet been systematically investigated. We aim to address this gap by analyzing the possible linkage between musical interaction features and changes in depression score. In a clinical trial, digital piano improvisations from 58 Finnish clients and their therapists were recorded over 12 sessions of music therapy lasting 6 weeks. Subsequently, a variety of symbolic features describing pitch, rhythm, duration, and velocity were extracted from the improvisations. We observed a number of relationships between client–therapist interaction and clinical improvement. Clients with largest improvements displayed higher overall interaction, particularly more musical interaction in the middle of the therapy process than in the beginning and end. In contrast, clients with lower depression change score exhibited overall lower interaction and yielded other temporal profiles of interaction. The association between clinical improvement and an inverted U-shaped curve of musical interaction is discussed in the light of process-outcome literature.

Couples’ Experience of Enactment-Based Couple-Centered Intervention vs. Therapist-Centered Intervention—An Exploratory Qualitative Examination

Enactments represent a clinical process and structure common to marital therapy, consisting of episodes of direct couple engagement carefully promoted, monitored, and coached by the therapist. Couple-enactment-centered therapy is supported by a relational systems theory rationale for interaction-focused intervention. We specifically explored couples’ experience of relationship enactments and their potential to promote positive relationship interaction and outcomes. In an experimental design, participant couples received three couple-enactment-centered sessions (intervention through couple interaction) followed by three therapist-centered sessions (intervention through therapist interaction), with sequencing randomly alternated (CECx3–TCx3 or TCx3–CECx3). In this study, through qualitative interviews we sought the voices, perceptions, and experiences of couples regarding these modalities and their potentially unique utility. Qualitative data from 12 participants was analyzed using a group hermeneutic approach. Findings included that (a) therapeutic alliance, achieved in a more salient way through TC, was important to positive clinical and couple outcomes, (b) the sequencing of approaches was significant, and (c) modality (CEC or TC) influenced participant experience of relational change. Our discussion hypothesizes a general profile of participants’ experiences of these two approaches in therapy, contributing to an emerging framework potentially informing best couple therapy practice utilizing both TC and CEC modalities in sequence.