Therapist Relationship Research Articles

Client-centred practice: Perspectives of persons with a traumatic brain injury

Background: Client-centred practice is well established as a core foundation of occupational therapy; however, there is little research evidence concerning the client experience. Objectives: To understand client-centred practice from the perspective of adults with a traumatic brain injury (TBI) participating in community-based occupational therapy. Methods: Six adults with a moderate–severe TBI participated in two semi-structured, qualitative interviews each. In total 12 interview transcripts and additional data were coded using constructivist grounded theory methods. Results: Data analysis produced three main themes and sub-themes: (i) Experiencing the client–therapist relationship: Seeing me as the person I was; Getting to know me in the now; Making a positive connection; (ii) Actively participating in therapy: Valuing the therapist; Being partners in therapy; and (iii) Finding my place in life: Adjusting to who I am now and Sharing my journey. Conclusion: The results present a framework for understanding client-centred practice as a person-centred process of engagement between the client and the therapist, as informed from the client perspective. Significance: Occupational therapists are encouraged to value and invest in the development of relationships with clients whilst the importance of seeking and integrating the client perspective into practice and research is affirmed for the profession.

‘Accepting what is’: an approach for managing the long-term sexual side effects of selective serotonin reuptake inhibitors (SSRIs) in women

Sexual difficulties may not be a pressing issue for women on antidepressants during the early phase of selective serotonin reuptake inhibitor (SSRI) treatment; however, this can emerge as a substantial problem once women are stabilised on medication. Little is known about how women cope with the adverse sexual effects of SSRIs. This qualitative study used Interpretative Phenomenological Analysis to explore the experiences of Australian women currently coping with the sexual side effects of this antidepressant. Interviews were conducted with 10 heterosexual women, aged 45 years and younger. Four major coping strategies were identified “searching”, “suffering in silence”, “trying to resolve” and “accepting what is”. This paper explores one particular response “accepting what is”, which includes a number of strategies commonly employed by women on long-term medication. Findings from the study have particular relevance for sex and relationship therapists and may assist women in managing sexual side effects that are perceived to be beyond their control. This paper adds to the current literature by increasing understanding of how “accepting what is” can be a step forward, particularly for women who have chosen to remain on long-term medication. In theoretical terms, a deeper understanding of how women cope could inform debate about the appropriate management of long-term sexual side effects in the absence of effective pharmacological interventions.

Parent Perceptions of School-based Occupational Therapy Services

This study aims to explore the perceptions of parents of children receiving occupational therapy in educational settings, understand the importance of the parent/occupational therapist relationship and its impact on the outcomes of therapy. In addition, this study aims to reveal best practices when providing services within the school system in the United States.

The Parolee–Parole Officer Relationship as a Mediator of Criminal Justice Outcomes

Although psychotherapy literature identifies the client–therapist relationship as a key factor contributing to client outcomes, few studies have examined whether relationship quality among corrections populations and supervising officers influences outcomes. This is surprising given that many criminal justice intervention models include quality of the client–practitioner relationship. Parolees enrolled in a six-site randomized clinical trial, where they were assigned to a parole officer–therapist–client collaborative intervention designed to improve relationship quality ( n = 253) or supervision as usual ( n = 227), were asked to rate relationship quality with their supervising officer. Results showed parolees assigned to the intervention endorsed significantly higher relationship ratings and demonstrated a lower violation rate than those assigned to the control group. Ratings of the parolee–parole officer relationship mediated the relationship between study condition and outcomes; better perceived relationship quality was associated with fewer drug use days and violations during the follow-up period, regardless of the study condition. Findings are discussed as they pertain to supervision relationships.

An exploration of sports rehabilitators' and athletic rehabilitation therapists' views on fear of reinjury after anterior cruciate ligament reconstruction.

Research involving long-term follow-up of patients after successful anterior cruciate ligament reconstruction (ACLR) has shown that return-to-sport rates are not as good as would be expected despite many patients' having normal knee-function scores. The psychological component, specifically fear of reinjury, plays a critical role in determining patients' return to play and is frequently underestimated. Little is known about the recognition and intervention from the therapist's perspective. To gain a greater understanding of the views of sports rehabilitators and athletic rehabilitation therapists on recognition of fear of reinjury in clients after ACLR. A qualitative approach, consisting of semistructured interviews with a purposive sample of 8 participants, sports rehabilitators, or athletic rehabilitation therapists. This population has been largely unexamined in this context in previous research. Thematic analysis yielded 2 main themes: communication and education. Participants discussed the importance of communication in the client-therapist relationship and how it is used in addressing misinformation and fear of reinjury. All participants used education in outlining the rehabilitation pathway and dealing with those providing social support around the client. Issues emerged relating to therapists' recognition of observable signs of fear of reinjury in the clinical setting. Overall, participants thought that fear of reinjury was not a barrier to return to play after ACLR. There is a need for more education of therapists on recognizing fear of reinjury and the appropriate use of psychological intervention skills as a method for dealing with this throughout the rehabilitation process.

The Love-hate Relationship of Physical Therapists with Electronic Patient Records

Abstract Physical therapists use computers for administration for two decades now. The use of computers for clinical documentation is growing. The question arises how physical therapists think about Electronic Patient Records. 27 students of the bachelor of physical therapy interviewed 44 physical therapists in private practices according to the USE IT-adoption model in order to measure the adoption of Electronic Patient Records. All physical therapists use computers in practice, because they are required to register quality and performance indicators for financial reasons. Physical therapists demonstrate a positive attitude towards Electronic Patient Records, because of the potential to share patient data. However, they consider reporting in the EPR time consuming, and often irrelevant for providing good care. In order to achieve adoption of Electronic Patient Records by physical therapists, a rethinking of the rules for reimbursement of physical therapy, including a relieve of the administrative burden, should precede the necessary redesign of EPR's for physical therapists.

Параллельный процесс в супервизии: история понятия и объяснительные модели

The article is dedicated to the parallel process — phenomenon of structure and dy- namics reduplication of the therapist and client relationships in the relationships between supervisor and therapist. The concept of parallel process is commonly used by the psychotherapeutic community but at the same time it is not clear enough and therefore sometimes evokes skepticism. It is shown that parallel process is a descriptive but not explanatory concept. The psychodynamics as a condition for the observed paralleling can be various and requires in each case a specific analysis. The history of the concept of parallel process is related to psychoanalysis. Identification, transference/countertransference and projective identification are the main concepts on which the explanatory models of parallel process are based. The authors show that a parallel process is a result of the defensive behavior patterns typical for all participants of communication: client, therapist and supervisor. Asymmetric distribution of the power/subordination positions which is indicative for the situations of psychotherapy and supervision is a provoking condition for the expansion of parallel process chains. Article demonstrates an example of the parallel process analysis in a case study of supervision session for students practicing the Co-experiencing psychotherapy. The authors conclude that «hermeneutics of suspicion» and the model of «defended subject» specific for the psychoanalysis can be used for the studies of the communication process in psychotherapy and supervision oriented not only to psychoanalysis but to the other modalities as well.

A quest for truth or solidarity? A third way ahead for psychoanalysis

Today, there are two ways of conceiving psychoanalysis, a classical one focused on the search for truth within the internal world of the patient, and a contemporary one perceiving the patient–therapist relationship as the axis of exploration. Rorty's criterion, which divides disciplines into either truth-based or solidarity-based, may be applied to this dichotomy. These conflicting positions come from two different historical periods: the Enlightenment and the contemporary world. They inhabit a sterile environment without theoretical discussion or comparison. The Renaissance relocated man at the centre of creation and urged him to seek encounters with others as well as with the truth concealed in nature. Possibly, these elements of truth and solidarity, initially designed as complementary, integrative, and nonconflicting, can be found in the work of some psychoanalysts, specifically in Otto Kernberg's proposals. Kernberg makes a creative integration of object relations theory, especially in its Kleinian approach, and ego psychology. In addition, Kernberg's consideration of affects as key elements of the human's internal world reflects a third psychoanalytical “way,” exposing the centrality of relational experiences from the earliest stages of life, alongside constitutional drive forces that link us to our biological make-up and determine much of our inner world and behaviour.

Exploring client adherence factors related to clinical outcomes

With the increase in chronic disease and the ageing of the population, understanding requisite self-management adherence of people who are frail is important, especially given its association with service outcomes. This study sought to investigate five key client adherence factors reported in the literature, and frailty reduction in a clinical trial intervention group. The intervention participants in the Frailty Trial were stratified into three groups on the basis of their frailty score; improved, unchanged or deteriorated, and a sample meeting the inclusion criteria was randomly selected from each group. The intervention therapists were asked to complete a survey for each of the clients seeking their views on client motivation, client participation, client–therapist relationship, client trust and the value of the service to the client. A strong relationship was demonstrated between each of the five adherence variables and the outcome of the service, with motivation and participation having the greatest impact.

Regulation Theory and Affect Regulation Psychotherapy: A Clinical Primer

This article offers an essay on the influence of advances in developmental neuroscience and neuropsychoanalysis for our understanding of the interpersonal neurobiological change mechanisms embedded in the mother–infant and client–therapist relationship. Regulation theory and affect regulation therapy are reviewed, along with attachment, affect regulation, and the development of the right brain. Right-brain communications within the therapeutic alliance are described, leading to the conclusion that the right brain is dominant in psychotherapy. Changes in not only the client’s but also the clinician’s brain over long-term clinical experiences are discussed.

“Does sex therapy work? How can we know?” Measuring outcomes in sex therapy

We are still left with the issue of characterising what counts as successful outcome in sex therapy. The aim of this paper is to report the progress of the outcome measurement project initiated by the College of Sexual and Relationship Therapists. In this report, I have reviewed the existing literature to answer the following question: “Does there currently exist a validated evaluation tool (or a package of tools) by which the effectiveness and success of sex therapy in dealing with sexual problems can be measured and demonstrated?”. I start with discussing some of the key dilemmas in relation to measuring outcomes in sex therapy and arrive at a conceptual framework to address this. I finish with suggesting a few measurement tools that can be utilised in this regard.

Long-term effects of analysis of the patient–therapist relationship in the context of patients’ personality pathology and therapists’ parental feelings.

Analysis of the patient-therapist relationship (relationship work) is considered a core active ingredient in dynamic psychotherapy. However, there are contradictory findings as for whom and under what circumstances these interventions are beneficial. This study investigates long-term effects of relationship work in the context of patients' level of personality pathology and therapists' self-reported parental feelings. One hundred outpatients seeking psychotherapy for depression, anxiety, and personality disorders were randomly assigned to weekly dynamic psychotherapy, either with or without relationship work, for 1 year. Personality pathology was evaluated before treatment as the sum of fulfilled personality disorder criteria items on the Structured Clinical Interview for DSM-III-R Personality Disorders. Therapist feelings were assessed using the Feeling Word Checklist-58. The outcome variables were the Psychodynamic Functioning Scales and Inventory of Interpersonal Problems, measured at pretreatment, midtreatment, posttreatment, 1 year, and 3 years after treatment termination. A significant interaction of treatment group (relationship work vs. no relationship work) by personality pathology by parental therapist feelings was present, indicating that parental feelings were differentially associated with long-term effects of relationship work, depending on the level of personality pathology. In the context of low parental feelings, relationship work was positive for all patients. However, when parental feelings were stronger, the specific effects of such interventions were even more positive for patients with high levels of personality pathology, but negative for patients with low levels of personality pathology. The interaction of parental therapist feelings and patients' personality pathology was strongly associated with the long-term specific effects of analysis of the patient-therapist relationship.

Interviewing Maurizio Andolfi Downunder

In this interview Aldo Gurgone interviews Maurizio Andolfi, Professor of Psychology at La Sapienza, University of Rome, Director of the Academia di Psicoterapia Familiare in Rome and Editor-in Chief of Terapia Familiare. Andolfi is currently living in Perth and conducting training workshops in family therapy throughout Australia. Aldo Gurgone is a clinical psychologist, well-known relationship therapist and Director of the William Street Family Therapy Centre in Perth. In the interview Maurizio describes his early training and work with key figures in U.S. family therapy like Whitaker and Minuchin and discusses his unique multigenerational experiential approach to family therapy, which uses the problem child as a consultant, the family as a resource and highlights using the self of the therapist. In a postscript there is a dialogue between Andolfi and the editor of ANZJFT about the development of family therapy in Italy and Australia.

Recognizing Guilt and Shame: Therapeutic Ruptures with Parents of Children in Psychotherapy

The parent–therapist relationship is one of the most important facets of child psychotherapy. Guilt and shame are common sources of rupture between parents and child therapists. Overlooking such ruptures with parents can interfere with or even halt psychotherapy with children. A review of empirical and theoretical literature on ruptures in the therapeutic relationship is followed by discussion of how clinicians might identify guilt- and shame-based ruptures in the parent–therapist relationship. The process of repairing parent-therapist ruptures is emphasized as one process that can assist parental growth and development, which in turn can create space for children to grow and develop in tandem with their parent(s). A case study illustrates how guilt and shame manifest in the form of a race-based rupture in the parent–therapist relationship. A discussion of guilt, shame, and oppression concludes this article.

Individual Music-Centered Assessment Profile for Neurodevelopmental Disorders (IMCAP-ND): New Developments in Music-Centered Evaluation

In Nordoff-Robbins Music Therapy (NRMT) the client's musical responses, pertaining to his/her process of playing and relating, are the primary source of data (Bruscia, 1987). To that end, Nordoff and Robbins developed a series of assess- ment tools and methods focused on evaluating the quality of the client's musical processes within the context of musi- cal engagement and relationship (Bruscia, 1987; Nordoff & Robbins, 2007). In more recent times, however, there have been additional assessment tools created by Nordoff-Robbins Music Therapists including the Music Therapy Communication and Social Interaction Scale (MTCSI) (Hummel-Rossi, Turry, et. al., 2008; Guerrero & Turry, 2012), and the most recently published, Individual Music-Centered Assessment Profile for Neurodevelopmental Disorders (IMCAP-ND): A Clinical Manual (Carpente, 2013). Both, the MTCSI and IMCAP-ND are concerned with assessing the client's ability to relate and communicate in active music making.BackgroundDating back to the early 1960s, based on their clinical work, Paul Nordoff and Clive Robbins developed several assess- ment tools dealing with evaluating clinical-musical processes as well as the quality of the client and therapist relationship. These assessment tools included indexing, Tempo-Dynamic Schema, Thirteen Categories of Response, and three assess- ment scales (Bruscia, 1987).Indexing is a form of microanalysis in which the therapist carefully reviews and records all client responses and thera- pist's interventions in each session, as well as transcribing clini- cally pertinent music. Descriptions of musical and non-musical responses are correlated to the time in which they occurred (Bruscia, 1987). The Tempo-Dynamics Schema was designed to correlate or associate pathology to musical expression specific to the client's ability to engage in musical-play with regard to tempo and dynamic range (Bruscia, 1987; Nordoff & Robbins, 2007). In addition, Thirteen Categories of Response deal with understanding how clients relate musically and interpersonally (e.g., facial expressions, gestures, etc.) to the therapist's improvi- sations while playing drum, piano, and/or voice.Finally, Nordoff and Robbins developed three evaluation scales. Scale I: Client-Therapist Relationship in Musical Activity was designed to describe the quality of the client-therapist relation- ship during musical activity; Scale II: Musical Communicativeness was developed to assess the client's ability to musically communi- cate via instrument, vocal, and movement; and Scale III: Musical Response was created to provide classifications for how and what the client plays (instrumentally) and vocalizes with regard to the quality of engagement specific to rhythmic and melodic forms (Nordoff & Robbins, 2007; Brusica, 1987).In 2008, the Music Therapy Communication and Social Interaction scale (MTCSI) was created by an interdisciplinary team consisting of Nordoff-Robbins music therapists and psy- chologists. The MTCSI was developed to assess communica- tion and social interactive behaviors of children during music therapy (Guerrero & Turry, 2012; Hummel-Rossi et. al., 2008). Attaining high inter-rater reliability as well as strong support for its content validity, (2012) the MTCI assessment process involves coding video recorded sessions in one-minute inter- vals while observing the child's ability to engage in instrument play, vocalization, movement, as well as display social-emo- tional behaviors e.g., gestures, eye contact, joint attention, etc. (Guerrero & Turry, 2012). The tool is intended for use in a wide range of disciplines that include creative arts therapists, psy- chologists, educators, and speech, occupational, and physical therapists (Hummel-Rossi et. al., 2008).IMCAP-NDIn 2013, The Individual Music-Centered Assessment Profile for Neurodevelopmental Disorders (IMCAP-ND) was designed to assess musical-play interactions with individu- als with neurodevelopmental disorders (Carpente, 2013). …

Becoming Real Together: The Parallel Discovery of Authenticity in a Traumatized Child and First-Time Therapist

This case study describes the parallel process of a patient and first-time therapist in finding their authentic selves. The treatment of a child suffering from relational trauma and early abuse is presented. The evolving relationship between patient and therapist is highlighted with an emphasis on the ways in which this relationship changed the definitions of self for both patient and therapist. The role of transference projections and the role of the “other” in the patient therapist relationship are also addressed. Finally, the training therapist's process of meaning making in supervision is explored in parallel with the development of the treatment.

Obituary

Daniel (Dan) Stern was an American psychoanalytically trained child psychiatrist whose careful research of infant—parent interaction led to groundbreaking new ways of thinking about the infant, infants’ capacities and development, mothers and the infant–mother and patient–therapist relationship. He was a pioneer in the field of studying videotaped interactions between mothers and babies. Early in his career, Stern made observations of infants and mothers using video, later analysing these records as part of his research project. He brought to light the intimate interactions of infants and their mothers, the findings of which subsequently led to his theory of development of the self occurring within a social context.

Ethics in an Age of Information Seekers: A Survey of Licensed Healthcare Providers about Online Social Networking

The present study explores how licensed health care providers use social media. The researchers utilized a survey to explore 88 licensed psychologists, physicians, and social workers average numbers of Facebook© friends, social groups, and photo albums as well as attitudes toward possible regulation of online social networking by professional organizations. Statistically significant differences were found among groups regarding the degree to which they wanted guidance on ethically managing this new technology, with psychologists and social workers desiring more guidance than physicians. Overall, this study shows that the majority of the psychologists, physicians, and social workers who participated in this study now frequently use Facebook, often providing information on profiles that may include that which is not generally disclosed in a client–therapist relationship.

College of Sexual and Relationship Therapists Conference, London, UK, November 2012

While the College of Sexual and Relationship Therapists (COSRT) holds two fascinating conferences each year, the one held in London in November 2012 was particularly pertinent to Journal readers. For...

College of Sexual and Relationship Therapists (COSRT)

The College of Sexual and Relationship Therapists (COSRT) is the UK's leading membership organisation for therapists specialising in sexual and relationship issues. Founded more than 30 years ago (and originally...