Therapist Perspectives Research Articles

Learning from therapists about the challenges and opportunities of training in cognitive behavioral therapy for psychosis: qualitative findings from a US-based service evaluation

ABSTRACT Background CBT for psychosis (CBTp) is a care standard for people with psychosis in the United States (US). However, CBTp access is poor. The context differs from the UK, where CBTp was primarily developed. This US-based service evaluation addresses a knowledge gap and forms a pilot study: a broad goal was to learn about CBTp training’s impact on therapists. Specific aims were to: 1) describe the challenges and opportunities of CBTp training by interviewing therapists competent in formulation-driven CBTp; 2) make recommendations for practice and research. Methods Therapists’ experiences of a 3-day CBTp workshop and 12-month consultation period in a US outpatient service were evaluated via focus groups. Participants were eight of ten therapists achieving CBTp competency. Results Thematic analysis of focus group content yielded four themes: 1) Before CBTp: Support and medication; 2) Hope and possibility; 3) A reality check; 4) The future: Ongoing development or “flavor of the week”. Discussion Therapist perspectives help elucidate barriers and facilitators for US CBTp implementation, from the challenge for therapist-case managers of accommodating CBTp, to the potential of shared therapeutic models for team cohesion. Recommendations include clarifying how best to use CBTp within large caseloads, and mixed method longitudinal studies of training.

Breaking the ‘culture of silence’: exploring therapist perspectives of culturally sensitive systemic psychotherapy in contested sociopolitical contexts – a Northern Ireland case study

Breaking the ‘culture of silence’: exploring therapist perspectives of culturally sensitive systemic psychotherapy in contested sociopolitical contexts – a Northern Ireland case study

The Role of Occupational Therapy in Supporting Youth with Asthma: Therapist Perspectives

Occupational therapists address physical environments, which can improve outcomes for youth with asthma, a prevalent chronic childhood illness. This study examines pediatric occupational therapists’ perceptions of their role supporting youth with asthma, perceived usability of an occupational therapy asthma home assessment, and the impact of asthma on participation. A cross-sectional exploratory survey of 171 participants found that despite lack of tools for asthma trigger reduction assessment and intervention, therapists believe it is within their scope of practice and that they would benefit from an occupational therapy-based asthma tool. Occupational therapists should be members of multidisciplinary asthma teams, and assess and address environmental triggers.

‘This space inside’: An art-based autoethnographic exploration of the hysterectomy experience

This article presents an art-based autoethnographic account of the hysterectomy experience, from the perspective of a perinatal therapist based in a large maternity hospital. The key questions explored include the ways in which a sense of bodily and psychic integrity can be reclaimed post-operatively, alongside the integration of losses associated with a hysterectomy. The article is structured as an autoethnographic exploration, derived from a visual diary incorporating image-making, hand-stitching and writing. Four key themes are discussed with reference to specific images: ‘Navigating disruption’, ‘Adjusting to a changed body’, ‘Accommodating losses: Emerging into Otherhood’ and ‘Renewal: Recovering an inner space’. This personal account is considered against wider cultural and sociopolitical discourses which inform our constructions of femininity. The article offers a counterpoint to medical narratives which may assume recovery from a hysterectomy to be synonymous only with physical recuperation.

Representation of Therapy and Therapists in Indian Movies and TV Series: An Examination of Accuracy, Influence, and Perception

Film and psychology share a longstanding relationship with evolving depictions of therapy and therapists. While extensive research explores Hollywood's portrayal of mental health, a gap exists in understanding therapists in Indian media. This study addresses this void, examining how Indian movies and TV series portray therapists and their impact on audiences. Utilizing qualitative methodology, expert interviews provide insights into therapist perspectives. Bollywood often simplifies mental health, while regional cinema offers more authentic representations. Critiques target films like 'Dear Zindagi,' 'Atrangi Re,' and Tamil movies 'Beast' and 'Anniyan,' as well as the series 'The Family Man' for unrealistic therapy scenes. Positive examples include Tamil and Malayalam films like 'Kumbalangi Nights' and 'Irugapatru,' and the series 'Made in Heaven' for ethical therapist portrayals. Indian media tends to trivialize therapy, perpetuating misconceptions, and stigma. Experts stress the importance of responsible depictions, even in extreme treatments like Electroconvulsive Therapy (ECT). Therapists face challenges addressing misconceptions fuelled by media portrayals during sessions, underscoring the need for accurate and empathetic representations in Indian media.

The therapist role in parent-led cognitive behavioral therapy for children after trauma: treating trauma from a distance

ABSTRACT This article examines the therapist experience of their role in providing Stepped Care Cognitive-Behavioral-Therapy for Children after Trauma (SC-CBT-CT), a semi-homebased, parent-led trauma-treatment for children (7–12). Previous research has documented that parent-led, therapist-assisted psychological interventions are an acceptable and effective type of service delivery. Yet, the therapist perspective on their role when providing parent-led treatments has received limited research attention. Attention is therefore directed to the therapist experience of engaging parents, establishing relationships, and working with children’s trauma narratives from a distance—through the engagement of parents. The data material consists of semi-structured interviews with SC-CBT-CT therapists. To identify patterns of experience, thought, and viewpoints in the overall data, a stepwise thematic analysis approach was applied. Two core themes emerged: 1) Perceptions of therapeutic control and therapeutic presence when engaging parents to lead their own children through an exposure-based program; 2) Establishment and maintenance of therapeutic alliances with and between parents and children. Although parents are inherently well-positioned to engage with their own children about trauma, the article highlights that treatment adherence, progression, and perseverance is contingent upon systematic therapist guidance, monitoring, and availability for support and problem-solving.

Making Mistakes Together: Therapy Participant, Parent, and Therapist Perspectives on Music Therapy in Two Different Settings

Abstract The impact of setting and therapist perspective are explored through the shared experiences of Morgan (a therapy participant), Cheryl (a parent), and Kerry (a music therapist). Undertaken through a series of conversations, the authors identify three themes that reflect differences in the school setting and music therapy clinic where Morgan, a teenager with Down syndrome, participated in music therapy: (1) The structure and expectations of the setting, (2) the values of the setting, and (3) The perspectives of the people working in the setting. Each theme is explored in relation to these two settings, revealing important differences in the experiences and perceptions of each author. Further reflections provide opportunities for readers to consider their own perspectives with regard to music therapy service delivery, particularly in terms of how one aligns with, or is differentiated from, the setting in which they work. Plain language abstract (written by Morgan) This project is about music therapy at school and at the clinic. Readers will learn how music therapy helps Morgan. People, like teachers, should read the project to know Morgan. Music therapists should read the project to be happy and proud. Please go to Appendix A for a plain language summary of the whole article.

Ethical Considerations in Co-Authoring Research with Music Therapy Stakeholders

Abstract While stakeholders provide invaluable perspectives about music therapy, particularly through the lens of their expertise as participants in music therapy encounters, their perspectives are rarely amplified in the context of full participation in research teams. In support of stakeholder participation in music therapy research, this article introduces and explores ethical considerations related to co-authorship. These ethical considerations are approached in three ways: (1) describing how co-authorship has been undertaken with music therapy stakeholders, specifically disabled children and adults, in a range of contexts, (2) Identifying ethical considerations related to our team’s own research project (Devlin, K., Johnston, M., & Johnston, C. [2024]. Making mistakes together: therapy participant, parent, and therapist perspectives on music therapy in two different settings. Music Therapy Perspectives) with two coauthors who are also stakeholders, and (3) providing guidelines for music therapists interested in coauthoring research with stakeholders. In doing so, the importance of co-authorship as an accessible, equitable research practice is emphasized. Plain language abstract This article is about planning, doing, and writing research with people who are usually studied in music therapy research. We call this co-research. We talk about: How to keep people safe How to make decisions together How to work and write as a team If we should use our real names

Evidence-Based Strategies for Injury Prevention and Exercise Prescription in Elderly Communities: The Physical Therapist's Perspective

Injury prevention and exercise prescription are critical components of healthcare for older adults. Physical therapists play a critical role in fall risk screening, assessment, and prevention in elderly communities. By incorporating STEADI (Stopping Elderly Accidents, Deaths, and Injuries) and other evidence-based tools and resources, physical therapists can help identify and address fall risk factors, link older adults with community-based programs and resources, and reduce the incidence of falls and related injuries in this population. Evidence-based interventions for fall prevention include exercise interventions that are tailored and include a combination of exercise types, considering individual abilities and preferences. Exercise programs can reduce falls in older people living in residential aged care facilities, but exercise has little or no lasting effect on falls after the end of a program. Physical therapists should consider the patient's fall risk, functional limitations, and comorbidities when prescribing exercises for balance and falls prevention. Physical therapists can help elderly communities implement evidence-based strategies for injury prevention and exercise prescription by adopting a person-centered approach, challenging ageist stereotypes, using sound outcome measures, prioritizing physical activity, and collaborating with other healthcare professionals. By doing so, physical therapists can promote the health, independence, and well-being of older adults, and help them lead active, fulfilling lives. A combination of strength, balance, and functional training exercises, as well as other evidence-based strategies, can significantly reduce the risk of falls in elderly communities. Physical therapists and healthcare providers should consider these interventions when developing fall prevention programs for older adults. Exercise interventions for preventing falls in elderly communities should be implemented regularly, with a frequency of at least three sessions per week, and for a duration of up to 12 months. Keywords: Elderly communities, injury prevention, exercise prescription in elderly, falls prevention, aging

Digital Interventions for Combating Internet Addiction in Young Children: Qualitative Study of Parent and Therapist Perspectives.

Internet addiction is an emerging mental health issue in this digital age. Nowadays, children start using the internet in early childhood, thus making them vulnerable to addictive use. Previous studies have reported that the risk of internet addiction tends to be higher in lower-income regions with lower quality of life, such as Indonesia. Indonesia has high risks and prevalence of internet addiction, including in children. Digital interventions have been developed as an option to combat internet addiction in children. However, little is known about what parents and therapists in Indonesia perceive about these types of interventions. This study aims to investigate the experiences, perceptions, and considerations of parents and therapists regarding digital interventions for combating internet addiction in young Indonesian children. This study used a qualitative exploratory approach through semistructured interviews. We involved 22 parents of children aged 7 to 11 years and 6 experienced internet addiction therapists for children. The interview data were transcribed and analyzed using thematic analysis. Participants in this study recognized 3 existing digital interventions to combat internet addiction: Google Family Link, YouTube Kids, and Apple parental control. They perceived that digital interventions could be beneficial in continuously promoting healthy digital behavior in children and supporting parents in supervision. However, the existing interventions were not highly used due to limitations such as the apps' functionality and usability, parental capability, parent-child relationships, cultural incompatibility, and data privacy. The findings suggest that digital interventions should focus not only on restricting and monitoring screen time but also on suggesting substitutive activities for children, developing children's competencies to combat addictive behavior, improving digital literacy in children and parents, and supporting parental decision-making to promote healthy digital behavior in their children. Suggestions for future digital interventions are provided, such as making the existing features more usable and relatable, investigating gamification features to enhance parental motivation and capability in managing their children's internet use, providing tailored or personalized content to suit users' characteristics, and considering the provision of training and information about the use of interventions and privacy agreements.

Therapists and patients perceptions of a mixed reality system designed to improve trunk control and upper extremity function

A prototype system aimed at improving arm function and trunk control after stroke has been developed that combines mixed-reality (MR) feedback with a mobile seat system (Holoreach). The purpose of this study was to assess the usability of Holoreach in a rehabilitation setting from both the patient and therapist perspective. Ten therapists (eight physiotherapists and two occupational therapists) used the device in their regular therapy programs for fifteen stroke patients with trunk control issues. Each patient received four individual therapy sessions with the device performed under the supervision of the therapist. Therapists and patients kept therapy diaries and used customized questionnaires. At the end of the study two focus groups were conducted to further assess usability. Generally, the prototype system is suitable for training trunk and arm control. The therapists expressed overall positive views on the impact of Holoreach. They characterized it as new, motivating, fresh, joyful, interesting, and exciting. All therapists and 80% of the patients agreed with the statement that training with Holoreach is beneficial for rehabilitation. Nonetheless, improvements are required in the hardware and software, and design. The prototype system contributes at various levels to the rapidly evolving advances in neurorehabilitation, particularly regarding the practical aspect of exercise delivery.

Piloting a language translation device for Mandarin-speaking patients presenting for radiotherapy treatment—assessing patient and radiation therapist perspectives

PurposeCulturally and linguistically diverse (CALD) cancer patients report unmet informational and emotional needs when receiving radiotherapy (RT). This feasibility study aimed to evaluate the clinical use of an instant translation device (ITD) to facilitate communication between Mandarin-speaking patients and radiation therapists (RTTs) within the Australian public RT setting. The primary aim was to assess the ability to convey information relating to daily patient care and build rapport using the device.MethodsA single-arm prospective interventional trial was employed with patient and RTT participants. Eligible patient participants were aged 18 years or older, diagnosed with cancer, referred for RT with self-reported Mandarin as the primary language spoken at home. Patients who had previously received RT were excluded. Consenting patient participants completed a baseline assessment of health literacy (REALM-SF) and English proficiency (LexTALE). Surveys were administered to patients and consenting RTTs at the cessation of treatment, forming two distinct participant groups. Descriptive statistics were used to compare participant groups.ResultsEleven patients and 36 RTTs were recruited to the study. Descriptive statistics demonstrated participant group agreement in conveying treatment instructions, though differing experiences were reported against general conversation. Although the reporting of technical difficulties was inconsistent, both groups recommended the application of the ITD within the RT domain.ConclusionThis feasibility study demonstrated encouraging accounts of patients and RTTs with regard to ITD use in the context of RT treatment. Expanded, multi-institutional recruitment is required to yield statistical significance, inform the impact of the device, and determine requisite training requirements.Trial registrationHREC reference number: LNR/18/PMCC/115 (18/100L). HREC approval date: 10 July 2018.

Therapist perspectives on telehealth-based virtual reality exposure therapy

Virtual reality (VR) can enhance mental health care. In particular, the effectiveness of VR-based exposure therapy (VRET) has been well-demonstrated for treatment of anxiety disorders. However, most applications of VRET remain localized to clinic spaces. We aimed to explore mental health therapists’ perceptions of telehealth-based VRET (tele-VRET) by conducting semi-structured, qualitative interviews with 18 telemental health therapists between October and December 2022. Interview topics included telehealth experiences, exposure therapy over telehealth, previous experiences with VR, and perspectives on tele-VRET. Therapists described how telehealth reduced barriers (88.9%, 16/18), enhanced therapy (61.1%, 11/18), and improved access to clients (38.9%, 7/18), but entailed problems with technology (61.1%, 11/18), uncontrolled settings (55.6%, 10/18), and communication difficulties (50%, 9/18). Therapists adapted exposure therapy to telehealth by using online resources (66.7%, 12/18), preparing client expectations (55.6%, 10/18), and adjusting workflows (27.8%, 5/18). Most therapists had used VR before (72.2%, 13/18) and had positive impressions of VR (55.6%, 10/18), but none had used VR clinically. In response to tele-VRET, therapists requested interactive session activities (77.8%, 14/18) and customizable interventions components (55.6%, 10/18). Concerns about tele-VRET included risks with certain clients (77.8%, 14/18), costs (50%, 9/18), side effects and privacy (22.2%, 4/18), and inappropriateness for specific forms of exposure therapy (16.7%, 3/18). These results reveal how combining telehealth and VRET may expand therapeutic options for mental healthcare providers and can help inform collaborative development of immersive health technologies.

LGBTQIA+ Cultural Competence in Physical Therapy: An Exploratory Qualitative Study From the Clinician's Perspective.

The purpose of this study was to understand the lesbian, gay, bisexual, transgender, queer, intersex, agender, and other gender and sexually diverse identities (LGBTQIA+) health care experience and associated cultural competence from the physical therapist perspective (physical therapist and physical therapist assistant). An exploratory qualitative approach implementing semi-structured focus groups and private interviews was utilized. To further anonymity, researchers allowed subjects to keep their camera off on Zoom. An interview protocol included questions guided by Campinha-Bacote domains of cultural competence (cultural awareness, skill, knowledge, encounter, and desire) to collect individual experiences, stories, discussions, thoughts, and opinions. Physical therapist clinicians were recruited from the clinical education affiliation lists of Regis University and Thomas Jefferson University. Seventy-one practicing physical therapists from the USA agreed to be part of the study. Themes were organized using the Social Ecological Model Framework. Themes are in parentheses following each level of the Social Ecological Model and include intrapersonal level (psychological stress and implicit and explicit biases), interpersonal (acceptance and competency), organizational (experience), community (advocacy), and society and policy (explicit biases and policy). Cultural competence in physical therapy is influenced by intrapersonal, interpersonal, organizational, community, and social and policy factors. Themes of psychological stress, limited awareness, decreased acceptance, and competency as well as limited exposure and experience, and a lack of advocacy and broader societal and policy issues prevent adequate LGBTQIA+ cultural competency of physical therapist providers. Further research in the physical therapist profession is needed to elaborate on the student, educator, and patient perspectives and how this information informs the LGBTQIA+ cultural competence of clinicians. This project may have a significant impact on suggestions for the delivery of content for health profession education to best impact health equity goals and save lives. Implementation of this content may have a direct impact on health disparities in LGBTQIA+ populations by reducing stigma and discrimination from health care providers, thus improving quality of health care and decreasing rates of patient mortality for LGBTQIA+ individuals.

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.

Points of departure: A qualitative study exploring relational facilitators and barriers in the first treatment session

Objective To explore how patients and therapists in an outpatient specialized substance use disorder treatment setting experienced the first treatment session, and to identify relational facilitators and barriers seen from both patient and therapist perspectives. Method: The study is based on a qualitative approach and semi-structured interviews of patients (n = 12) and therapists (n = 12). Interviews were conducted soon after the first treatment session and analyzed in accordance with reflexive thematic analysis. Results: We identified subthemes for patients and therapists, respectively. In addition, we found that patients and therapists described certain comparable experiences and actions which we integrated as core themes: (a) feeling uncertain about what to expect; (b) forming first impressions; (c) balancing multiple concurrent concerns; (d) seeking feedback from the other; and (e) sensing a way forward. The subthemes specify patients’ and therapists’ unique meanings and approaches to each core theme. Finally, we summarized unique and shared relational facilitators and barriers. Conclusion: Patients and therapists use the first session to form an impression of the other, but they are also concerned with the impression they themselves give. They, therefore, monitor the other's in-session reactions and responses which constitute facilitators or barriers for their own further relational actions.

Patient and therapist perspectives on motor imagery training in Parkinson’s Disease: a qualitative descriptive study

Patient and therapist perspectives on motor imagery training in Parkinson’s Disease: a qualitative descriptive study

Words are delicious

Words are delicious

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.

‘Attachment is such a core issue’: Therapist perspectives on attachment injuries in marriages in India

AbstractBackgroundMarital distress is a risk factor for a panoply of mental and physical health disorders. One of the causes of marital distress that is increasingly gaining relevance is attachment injuries in the marital relationship. Emerging from the confluence of adult attachment theory and emotionally focussed couples therapy, attachment injuries refer to tears in the relationship bond caused by abandonment or betrayal in the marriage, especially at times of critical need when attachment needs are salient.ObjectiveThe objective of this study was to investigate how therapists in India conceptualise and assess attachment injuries in marital relationships.MethodA qualitative design was used, whereby in‐depth interviews were conducted with 13 therapists and the transcripts were analysed using thematic analysis.ResultsThe analysis resulted in two overarching themes. The first was ‘Attachment Injuries are a Common Phenomenon in Couples undergoing Marital Distress’, which included themes related to markers of attachment injuries, injurious events, the gendered nature of attachment injury experiences and the impact of attachment injuries. The second overarching theme was ‘Therapists Utilize Diverse Methods for the Crucial Process of Identification of Attachment Injuries’, which included themes related to the methods used for assessment, the significance of attachment lens, the role of early experiences and the utility of identifying attachment injuries.ConclusionThe results highlighted how attachment injuries, originating from various injurious events, are often a component of marital distress in couples accessing therapy. The findings also pointed towards the need for therapists to develop competency in assessing and addressing attachment injuries, irrespective of their primary therapy orientation.