Therapists In Private Practice Research Articles

Changes in therapists’ client dropout rates over time: Findings from a practice‐research group

AbstractResearch has failed to consistently show that therapists facilitate better client outcomes as they gain more experience. The present study was designed to examine changes in early client retention over the course of extended periods of time among 2591 therapists in private practice. Naturalistic data collected between 2018 and 2022 was extracted from a technology‐enabled practice‐research group (PRG). Therapists displayed an increase in client dropout rates as they gained more experience on the PRG. Additionally, larger caseloads on the PRG were associated with lower increases in client dropout over time. Finally, therapists working with clients paying higher out‐of‐pocket fees (e.g., co‐pays) had higher increases in client dropout over time. These findings provide additional evidence supporting the distinction between clinical experience and expertise.

Nourish: A Framework for Nourishing Eating-Disordered Clients Using a Structural and Relational Methodology

This article introduces an integrative framework for working with clinical disorders and maladaptive behaviors. This framework is based on the author’s experience working with eating and weight issues. The term “eating disorders” is used to refer to both undereating and overeating or obesity. Existing psychotherapy approaches to eating disorders and weight-related issues are explored, and the transactional analysis literature on eating disorders is evaluated. The author presents a framework she has found useful, which she calls Nourish. She has developed this model following heuristic research with 19 long-term clients with eating disorders and weight issues, especially anorexia nervosa, bulimia, binge eating, and obesity. This integrative, holistic framework combines classical TA theory and a relational approach to working clinically with eating and weight and focuses on supporting therapists in private practice as well as in clinical teams.

The Size and Structure of the Swiss Occupational Therapy Workforce. A Survey Study / Anzahl und Struktur der Ergotherapie-Arbeitsplätze in der Schweiz: eine Online-Befragung

Abstract Background As in other health professions, there is a shortage of skilled labour in the field of occupational therapy in Switzerland. To plan and implement effective measures to counter this shortage, empirical data on the size and structure of the Swiss occupational therapy workforce are needed. Method We conducted an online survey aimed at employers of occupational therapists, team leaders and self-employed occupational therapists in Switzerland. We collected data on the size and structure of the workforce in terms of sociodemographic characteristics, regional distribution, areas of work, and related topics. To analyse quantitative data, we used descriptive statistics and regression analysis. Qualitative data were narratively described. Results We collected data from 968 respondents pertaining to 3,022 Swiss occupational therapists, with a response rate of 73.6% for medical institutions and 58.2% for occupational therapists in private practice. Women make up 90.1% of the Swiss occupational therapy workforce. Swiss occupational therapists most often work with clients who have difficulties in connection with injuries or illnesses of the upper limbs, neurological illnesses or injuries, or challenges with mental health. The ratio of occupational therapists per 10,000 inhabitants in Switzerland is at least 3.2. Swiss occupational therapy provision is least dense in Central Switzerland. The average reported turnover rate among occupational therapy teams was calculated to be 20% (SD=27.9). Conclusion The results illustrate the persistent lack of gender diversity in the profession. They also show some disparities in geographical distribution and area of practice, which will be analysed in more detail in subsequent publications.

The long-term outcome of accelerated experiential dynamic psychotherapy: 6- and 12-month follow-up results.

Accelerated experiential dynamic psychotherapy (AEDP; Fosha, 2000, 2021b) is an integrative, healing-oriented, mind-body, affect-focused therapy. A posttreatment outcome study demonstrated AEDP's effectiveness (Iwakabe et al., 2020) on a variety of measures of psychological functioning. This study sought to address AEDP's long-term effectiveness. As previously reported, 63 adult patients completed a 16-session AEDP treatment with qualified therapists in private practice in the United States, Canada, Israel, Japan, and Sweden. Forty patients responded to 6-month follow-up and 52 responded to 12-month follow-up. Results indicate that patients maintained their posttreatment therapeutic gains, both 6 and 12 months later. Large effect sizes (d = 0.74 to d = 1.60) both for reductions on measures of psychopathology (e.g., depression, negative automatic thoughts, experiential avoidance) and improvements on measures of positive mental health (e.g., well-being, self-compassion) were obtained. Patients with more pervasive and severe problems tended to have larger effect sizes (all ds > 1.0) and a larger proportion of them achieved clinically significant change over 6 and 12 months than patients with subclinical symptomatology. Piecewise growth modeling was used to confirm these results, with attrition over the follow-up period taken into account. Consistent with the above findings, piecewise growth modeling similarly showed that patients significantly improved from pre- to posttreatment and maintained gains from posttreatment through the 6- and 12-month follow-up. These results provide empirical support for the long-term effectiveness of AEDP for alleviating a variety of psychological problems and enhancing positive functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Leisure education and recreation participation: a niche for recreational therapy in South Africa

ABSTRACT The practice of Recreational Therapy/Therapeutic recreation (RT/TR) in South Africa (SA) is currently unrecognized, and whether some of the existing health professions in SA are providing services like those of RT/TR, as practised in the United States of America, is unclear. Biokinetics, physiotherapy and occupational therapy are the three professions currently registered with the Health Professions Council of South Africa with similarities in their definitions of scopes of practice to the definition of RT/TR. A qualitative interpretive descriptive study-design was followed, consisting of thematic analysis of 30 semi-structured telephonic interviews, which were conducted with biokineticists, physiotherapists and occupational therapists in private practice. Data analysis resulted in the identification of three themes. Although functional intervention programmes are presented by biokineticists, physiotherapists and occupational therapists, their programmes could not be classified as RT/TR orientated. There is a gap that could be filled by RT/TR in SA, in terms of the provision of leisure education and recreation participation programmes. This study provides information about the services available and identifies the gaps in the services of the three healthcare professions. The study concludes with a proposed continuum that indicates which services are currently provided and where RT/TR can fit into the current healthcare sector.

Rewind technique for trauma in ambulance staff

Journal of Paramedic PracticeVol. 14, No. 4 CommentRewind technique for trauma in ambulance staffLyanne PudneyLyanne PudneyEmail:E-mail Address: [email protected]Therapist in Private Practice; Frontline 19 Volunteer with a Research Interest in PTSD in Emergency Services Staff; Colchester, UKSearch for more papers by this authorLyanne PudneyPublished Online:7 Apr 2022https://doi.org/10.12968/jpar.2022.14.4.170AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Adams S, Allan S. Muss' Rewind treatment for trauma: description and multi-site pilot study. Journal of Mental Health. 2018;27(5):468–474. https://doi.org/10.1080/09638237.2018.1487539 Crossref, Google ScholarAdams S, Allan S, Andrews W et al. Four practice-based preliminary studies on Human Givens Rewind treatment for posttraumatic stress in Great Britain [version 2; peer review: 1 approved]. F1000Research 2022, 9:1252. https://doi.org/10.12688/f1000research.25779.2 Crossref, Google ScholarGray RM, Liotta RF. PTSD: Extinction, reconsolidation, and the visual-kinesthetic dissociation protocol. Traumatol. 2012;18(2):3–16. https://doi.org/10.1177/1534765611431835 Crossref, Google ScholarGray R, Budden-Potts D, Bourke F. Reconsolidation of Traumatic Memories for PTSD: A randomized controlled trial of 74 male veterans. Psychotherapy Res. 2017;1–19. Google ScholarMIND. Mental Health in the Emergency Services. Our 2019 Survey Results – Ambulance Service. 2019. https://www.mind.org.uk/media-a/4847/2019-survey-ambulance-service-summary.pdf (accessed 25 March 2022) Google ScholarMuss DC. A new technique for treating post-traumatic stress disorder. Br J Clin Psychol. 1991;30(1):91–92. https://doi.org/10.1111/j.2044-8260.1991.tb00924.x Crossref, Google ScholarNational Institute for Health and Care Excellence. Post-traumatic Stress Disorder Guideline [NG116]. 2018. https://www.nice.org.uk/guidance/ng116/chapter/Recommendations#management-of-ptsd-in-children-young-people-and-adults (accessed 25 March 2022) Google ScholarPudney L. Could the Rewind Technique be offered to Emergency Service Workers with Post-traumatic Stress Disorder (PTSD)? 2018. https://doi.org/10.13140/RG.2.2.35734.42567 Google ScholarStevelink S, Pernet D, Dregan A et al. The mental health of emergency services personnel in the UK Biobank: a comparison with the working population. Eur J Psychotraumatol. 2020;11(1):1799477. https://doi.org/10.1080/20008198.2020.1799477 Crossref, Google ScholarTylee D, Gray R, Glatt SJ, Bourke F. Evaluation of the reconsolidation of traumatic memories protocol for the treatment of PTSD:’ a randomized, wait-list-controlled trial. J Military Veteran Family Health. 2017;3(1):21–33 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 April 2022Volume 14Issue 4ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 7 April 2022 Published in print 2 April 2022 Information© MA Healthcare LimitedPDF download

S2K guideline on the diagnosis and treatment of interstitial cystitis (IC/BPS) : Discussion of the current guideline using a case study

IC/BPS is achronic progressive disorder that is often difficult and unsatisfactory for the person affected and the treating therapist. Treatment should therefore be comprehensive, interdisciplinary, multimodal and take into account the biopsychosocial model. The guideline forms athread through the diverse diagnostic and therapeutic options and provides extensive background information on the definition, epidemiology and aetiopathogenesis of this rare disease. However, practice and theory/guideline are different. Adaptation to the individual case is therefore necessary and explicitly desired. The guideline should therefore serve as asource of ideas for colleagues to compile their own standards suitable for their practice. On the one hand, therapy approaches that have been tried and tested in everyday clinical practice are passed on. On the other hand, the frequent lack of evidence should also be viewed critically. Further studies, if possible multi-centre, specifically designed for different aspects of IC/BPS would be desirable. Close networking between therapists in private practice and special centres is essential for the best possible treatment of people with IC/BPS. The guideline is intended to show the limits of what can be done in practices and outpatient clinics and to provide guidance on when patients should be referred to a"Centre for Interstitial Cystitis and Pelvic Pain". Overall, the guideline has improved the presence of this rare disease among colleagues. Acomprehensive supplement, update and further substantiation with the state of current research is thus desirable.

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.

Contemplating Raising Fees: An Exercise in Therapist Disquiet

This paper discusses the experience of psychodynamically oriented therapists in private practice as they contemplate raising their fees. Raising fees stirs up competing self-interest, transference-countertransference reverberations, financial fantasies and realities, ethical concerns, and uncomfortable as well as satisfied self-reflection. These dynamics are discussed under the following categories: exercise of power; incurring guilt; inappropriate entitlement; fear of loss; modeling of self-care; rapaciousness; unconscious factors; and self-esteem. A cautionary case example is provided. Six suggestions are offered to make therapists' contemplation of raising fees less stressful. The author hopes that this article will foster more open discussions among therapists about the tensions involved in raising fees and, in the process, lead to an enhanced understanding, acceptance, and detoxification of the feelings involved.

A Preliminary Overview of Music Therapy Reimbursement Practice in the United States

Abstract Music therapy services are currently being reimbursed through state and private insurance funding streams, yet to date, there is no known systematic exploration on music therapy reimbursement practices. Such information would be helpful to include when communicating with third-party payers and can assist in tracking reimbursement trends. Thus, we sought to provide baseline information on how music therapy services are currently being reimbursed in the United States, with a focus on approved treatment parameters, referral sources, Current Procedural Terminology (CPT) codes used, and types of music interventions and music therapy experiences implemented. Board-certified music therapists in private practice who had successfully obtained reimbursement for music therapy services between 2012 and 2018 completed a 28-item online survey. In total, 7 respondents provided information on 55 unique reimbursement cases from 5 different states, most of which were based on Medicaid waiver programs. We conducted descriptive analyses to summarize music therapy reimbursement practices. Most of the clients were referred by doctors or physician’s assistants. The most common CPT code utilized was 97530 (Therapeutic Activities, one-on-one, each 15 minutes), and most of the International Classification of Diseases, 10th Revision (ICD-10) diagnostic codes were based on specific diagnoses rather than general clinical needs. In most of the cases, reimbursement of music therapy was ongoing, and services incorporated a variety of music therapy methods, with few specific music interventions identified. Most notably, reimbursement practice varied by state; thus, we recommend the creation and dissemination of state-specific surveys.

Music Therapy Private Practice in the United States: Updated Financial and Marketing Recommendations.

More and more music therapists in the United States are entering into private practice. For a private practice to survive, a therapist must make sound financial and marketing decisions that can have wide-ranging implications on the success of the business. Clear and current recommendations from music therapists in private practice can help those wanting to go into private practice as well as those already in private practice. The purpose of this study was to identify a current descriptive profile of music therapists in private practice in the United States as well as marketing and financial recommendations. In addition, comparing this survey with previous surveys can reveal possible trends in the field. Music therapists (N = 745) who self-identified as being self-employed or in private practice were sent a survey designed by the researchers. A total of 193 respondents returned the survey revealing that current therapists in private practice are better educated and value the internet and social media for marketing and session implementation more than respondents of previous surveys. Respondents recommend that music therapists in private practice continually learn by taking business classes and consulting with business experts; diversify funding sources, service options, and populations served; and connect with music therapists and nonmusic therapists in the community.

Lessons Learned: Forty Years of Clinical Work With Suicide Loss Survivors.

The author has been a grief therapist in private practice for almost 40 years. The largest percentage of his clients have been suicide loss survivors, and in this article, the author reflects on the “lessons learned” about how grief therapy with survivors is both the same as, and very different from, work with clients bereaved after other types of losses. After briefly reviewing some of the empirical literature about differences between suicide bereavement and grief after other modes of death, the author argues that perhaps the most distinguishing and difficult aspect of a suicide loss is the “perceived intentionality” of the death, and the related “perceived responsibility” for the death. The author goes on to identify a number of tasks of psychological reintegration after a suicide loss that can serve as a template for treatment goals for clinicians and clients alike. These include the cultivation of a very specific type of secure and nurturing therapeutic alliance; extensive psychoeducation about suicide, trauma, and grief; the need to help the client repair the psychological continuing bond with the deceased; and providing gentle support for the survivor in rebuilding an assumptive world that has been shattered by the suicide of a loved one. Finally, the article concludes with a discussion of the clinical implications of these differences for work with suicide loss survivors.

"How do Pilates Trained Physiotherapists utilize and value Pilates Exercise for MSK conditions? A Qualitative Study".

Pilates is a popular exercise therapy approach offering numerous benefits, including muscular strength, flexibility, control, and core stability. Pilates has been widely utilized in the prevention and rehabilitation of a variety of musculoskeletal disorders. The aim of this study was to explore the experiences and opinions of Pilates trained NHS and private practice physiotherapists in the UK, regarding the perceived benefits, risks, delivery and rationale for this exercise method. This qualitative study used a self-designed electronic survey to retrieve the views of 30 physiotherapists, who had undertaken formal Pilates Instruction training, recruited by a purposive and snowball sampling method. Questions were either multiple choice or open-ended, examined via thematic analysis. Physiotherapists identified the most important benefits of Pilates as reduction in fear-avoidance, improving bodily awareness and increasing muscular strength. Exercises that promote general movement were highlighted as being particularly useful, with a majority recommending daily practice for optimum benefit. Participants recognized lack of core strength as a key indicator, whereas others criticized excessive focus on this principle. Physiotherapists identified a range of inter-linked benefits and recognized that Pilates is hugely modifiable. Individualizing exercises can further encourage participation and negate the restriction of some health conditions. NHS and Private Practice Therapists utilize Pilates in a similar way, although rationales for its use may differ, as the justification for Pilates exercise may be evolving. Pilates appears a valuable methodology in the NHS, which can help patients engage with activity.

Ethical Considerations in Music Therapy Private Practice: A Review of the Literature

Abstract For music therapists in private practice, ethical choices are embedded within every professional action and interaction. While many of these ethical choices are common to all clinicians, some are specific to private practice. Literature from music therapy and other healthcare professions, as well as business literature, were reviewed to identify ethical dilemmas commonly found in private practice, discuss potential reasons for unethical behavior, and explore how music therapists in private practice can work through ethical dilemmas.

“Sincerely Held Principles” or Prejudice? The Tennessee Counseling Discrimination Law

In 2016, Tennessee became the first state to allow counselors and therapists in private practice to deny services to any client based on the therapist’s sincerely held principles. The law’s proponents framed mental health care ethics as infringing on counselors’ religious liberties; its critics denounced the bill because it apparently targeted LGBT+ individuals. This exploratory study is the first statewide assessment of LGBT+ Tennesseans’ ( N = 346) perceptions of the law and how it may affect their help-seeking attitudes and behaviors. Evidence suggests widespread awareness of the law among our respondents and deep skepticism toward mental health care. Further, most respondents view the law as cover for discrimination. We stress the need for broader research on conscience clauses and call for advocacy against these laws, which have the potential to engender widespread harm to multiple minority groups.

Unsafe Chewing: Choking and Other Risks

Unsafe Chewing: Choking and Other Risks

Predictors to Private Practice Occupational Therapy Fieldwork Opportunities in Canada: New Evidence suggests New Solutions

The study examined predictors to increasing and enhancing fieldwork education opportunities provided by occupational therapists working in private practice. A cross-sectional design that used a self-administered questionnaire was provided to Canadian occupational therapists in private practice. Participants receiving funding from the workers’ compensation sector, those with between 11 and 20 years of work experience, and therapists working full-time hours were more likely to accept a student in fieldwork placement. Respondents who indicated that physical space and resources were not barriers to taking students on placement were more likely to accept students. Therapists more comfortable with the criteria and methods for appropriate and effective student teaching and supervision were also more likely to accept a student for fieldwork placement. The study findings can inform academic programs on how best to support preceptorship and guide university fieldwork coordinators’ strategies for outreach and education for private practitioners.

Does a Web-Based Exercise Programming System Improve Home Exercise Adherence for People With Musculoskeletal Conditions?

The aim of the study was to evaluate whether a web-based exercise programming system improves adherence to a home exercise program for people with musculoskeletal conditions. Eligible patients with a musculoskeletal condition presenting to a physical therapist in private practice were randomized to the following: (a) control (home exercise prescribed by therapist's usual methods) or (b) intervention (home exercise prescribed using a web-based exercise programming system). The primary outcome was self-rated exercise adherence measured at week 3 via 11-point Numeric Rating Scales. Secondary outcomes were satisfaction with exercise delivery and confidence in ability to undertake prescribed exercise. Process measures were also included. We enrolled 305 participants, with loss to follow-up of 14.5% (22/152) and 13.7% (21/153) in intervention and control groups, respectively. Compared with controls, the intervention group reported higher exercise adherence (mean difference Numeric Rating Scale units (95% confidence intervals): adherence overall -1.0 [-1.6 to -0.3] and regarding number of exercises in session -0.7 [-1.3 to -0.1], number of repetitions -0.8 [-1.4 to -0.2], and number of sessions -1.0 [-1.6 to -0.3]). The intervention group showed greater confidence to exercise than control, with no difference in satisfaction. A web-based exercise programming system improved home exercise adherence and confidence in ability to undertake exercise, although the clinical relevance of the results needs to be established.

Exposure therapy for youth with anxiety: Utilization rates and predictors of implementation in a sample of practicing clinicians from across the United States

Exposure therapy is a highly effective, evidence-based treatment technique for children and adolescents with anxiety disorders. Regardless, therapists in the community are reported to use exposure relatively rarely compared with other approaches. The goal of the present study was to identify how practicing clinicians treat youth with anxiety disorders across the United States and what factors contribute to their use of exposure therapy. Recruited from public directories, 257 private practice therapists who treat anxious youth were surveyed. Non-exposure cognitive-behavioral techniques like cognitive restructuring and relaxation techniques were used significantly more frequently than exposure. Providers with more training in exposure therapy and fewer negative beliefs about this approach reported using exposure significantly more in the treatment of youth with social anxiety, obsessive-compulsive, and panic disorders. Self-identification as an anxiety disorder specialist significantly predicted exposure use for youth with posttraumatic stress disorder. Most therapists in private practice have minimal training in exposure therapy, perceive a lack of training options, and believe there would be a benefit to acquiring more training. The implications of these findings are discussed, including how to optimally design training opportunities in exposure therapy.

Building and Handling Therapeutic Closeness in the Therapist-Client Relationship in Behavioral and Cognitive Psychotherapy

The present study unpacks an important dimension of clinical practice from the therapists’ vantage point. We interviewed 26 therapists in private practice about how the personal relationship with the client works from their perspective and conducted a grounded theory analysis. Three categories emerged. One refers to scope, aims and corollaries of the connection with the client; a second to preventing harm and managing drawbacks; and a third to taking therapeutic advantage of challenges related to closeness. Together, these categories form a model that describes how the close connection modifies therapeutic effects and generates challenges the therapist needs to deal with. The closer the dyad, the easier therapists will affect and be affected by the client. Therapists try to direct closeness to where it can nourish client process without harming the relationship, the client or themselves, and when closeness backfires, they may still try to harness uninvited effects for the benefit of therapy. This model concerning therapists’ lived experience is offered to inform research on the therapist-client relationship and as a contribution to clinical competency models.