Therapist Perspectives Research Articles

Patient, Rheumatologist and Therapist Perspectives on the Implementation of an Allied Health Rheumatology Triage (AHRT) Initiative in Ontario Rheumatology Clinics.

PurposeThe objective of this qualitative study was to explore patient, rheumatologist, and extended role practitioner (ERP) perspectives on the integration of an allied health rheumatology triage (AHRT) intervention in Ontario rheumatology clinics. Triage is the process of identifying the urgency of a patient’s condition to ensure they receive specialist care within an appropriate length of time. This research explores the clinical/logistical impact of triage by occupational and physical therapists with advanced arthritis training (ERPs), including facilitators and barriers of success, and recommendations for future application.Participants and MethodsSemi-structured telephone interviews were held with participating rheumatologists, ERPs, and a sample of patients from each clinical site (4 community, 3 hospital) in five Ontario cities. Interviews were audio-recorded and transcribed verbatim. Transcripts were analyzed using basic qualitative description. Two independent researchers compared coding and achieved consensus.ResultsPatients (n=10), rheumatologists (n=6), and ERPs (n=5) participated in the study and reported reduced wait-times to rheumatology care, diagnosis, and treatment for those with inflammatory arthritis (IA). Rheumatologists and ERPs perceived that the intervention improved clinical efficiency and quality of care. Patients reported high satisfaction with ERP assessments, valuing early joint examination/laboratory tests, urgent referral if needed, and the provision of information, support, and management strategies. Facilitators of success included: supportive clinical staff, regular communication and collaboration between rheumatologist and ERP, and sufficient clinical space. Recommendations included extending ERP roles to include stable patient follow-up, and ERP care between scheduled rheumatology appointments.ConclusionFindings support the integration of ERPs in a triage role in the community and hospital-based rheumatology models of care. Future research is needed to explore the impact of utilizing ERPs for stable patient follow-up in rheumatology settings.

Therapist Reported Reasons for Client Termination: A Content Analysis of Termination Reports

Client termination is prevalent yet not fully understood. Research has provided some reasons, but more information is needed to fully grasp the subject. The authors of this study sought to enhance understanding regarding why clients terminate therapy by exploring therapist perspectives through reports of client termination. Data were collected from 201 therapist termination reports. A qualitative content analysis was conducted. Findings were categorized and aggregated under thematic descriptions. Results revealed themes for why clients terminated therapy. Some of the findings included: progress towards or goals met, no show/no response, school break, and time/scheduling issue. Results are discussed and implications are provided.

Gardening as a Meaningful Occupation in Initial Stroke Rehabilitation: An Occupational Therapist Perspective

Background: Initial rehabilitation after stroke is demanding for patients whose primary aim is to regain their functions. The literature indicates that gardening may provide medical rehabilitation opportunities and health resources. This study explored occupational therapists’ own observations and descriptions on how participation in a gardening group may support inpatients’ initial rehabilitation following acute stroke.

Common Factors of Psychotherapy in Inpatients With Major Depressive Disorder: A Pilot Study.

Background: Psychotherapeutic interventions share common factors, which might contribute to treatment success independent of the type of psychotherapy. Previous research on common factors of psychotherapy was mostly conducted in outpatients and covered the development of common factors throughout a therapy over months or years. However, the role of common factors for the psychotherapeutic treatment success in inpatients during their hospital stay has not been addressed so far. The present research therefore aimed to explore changes of the common factors within a short-term stay at the psychiatric hospital for inpatients with major depressive disorder (MDD) and their relation to treatment outcome. Method: We developed a standardized manualized individual cognitive–behavioral psychotherapy (SMiCBT) for depression. The SMiCBT treatment lasted 4 weeks with eight therapy sessions. Following each treatment session, patients and therapists separately completed the questionnaire of “Stundenbogen für die Allgemeine und Differentielle Einzel-Psychotherapie” (STEP) to assess common factors from the perspective of the patient and the therapist. Severity of depression was also measured by the German version of the “Beck Depression Inventory” (BDI-II) before and after the treatment (SMiCBT). We conducted multilevel analysis for the longitudinal data for each scale of the STEP. Results: We found an improvement in the severity of depressive symptoms across the treatment period according to BDI-II scores. Regarding the STEP scales, motivational clarification and problem-solving scores increased over the treatment period for both patient and therapist perspectives. This was not the case for the scale therapeutic relationship. Furthermore, baseline levels of motivational clarification and problem solving were related to the treatment response. Limitations: The results have to be interpreted with care because of the small sample with MDD and the lack of a control group for comparison of treatment outcome. Conclusion: Our data demonstrate that common factors improve within a short-term psychotherapy in inpatients with MDD. Most importantly, our research highlights the distinguished role of motivational clarification and problem solving for the improvement of depressive symptoms during short-term psychotherapy in inpatient settings.

How to improve compression garment wear after burns: Patient and therapist perspectives

BackgroundCompression garments are a widely used intervention for the management of hypertrophic scar and recent research demonstrates the varied experiences of patients wearing compression garments. However, the patient and therapist perspective on how to improve the experience of wearing compression garments remains unexplored. ObjectiveTo gain an understanding of the patient and therapist perspective of potential improvements to the provision of compression garments after burns. MethodA qualitative research design with an interpretive description approach was utilised in this study. Data was collected from patients through semi-structured interviews and a focus group and therapists by a focus group. Thematic analysis was completed to reveal the key themes across the data. ResultsTwo main themes were identified: “what patients want” and “access to professional development”. The first theme “what patients want” described three suggested improvements including education, peer support, and increased participation in garment prescription. ConclusionsThe reported patient and therapist perspectives highlight the need for further research into service improvement to enhance the patient experience of wearing compression garments after burns.

Preparing Children with Autism for Transition to Mainstream School and Perspectives on Supporting Positive School Experiences.

School readiness is important to a positive start and success in school but children with Autism Spectrum Disorder (ASD) are at risk of not being school-ready. This study aimed to explore parent and therapist perspectives on school readiness skills of children with ASD and factors impacting on a positive mainstream school experience. A mixed methods design was used. Key findings were that school readiness depends on child and school factors, with social skills the most important child factor. The child's experience was largely reliant on teacher and education assistant attitudes and highlighted a need for further training and support. This study identified areas of focus for early intervention as well as school-aged intervention and the need for collaborative practice.

Cognitive heuristics in borderline personality disorder across treatment: A longitudinal non-parametric analysis.

The development of a constructive therapeutic alliance may represent an important feature of interpersonal adaptation in clients with Borderline Personality Disorder (BPD). The present study explores cognitive heuristics as dynamic features of change in relationship with the therapeutic alliance in the treatment of BPD. In total, N = 60 clients with BPD, are included in the present study. In the context of brief therapy, the therapeutic alliance (WAI) is assessed from the client and the therapist perspectives after each therapy session; cognitive heuristics are assessed three times (CERS). The data analyses are on the basis of non-parametric clusters (kml3d) linked with the therapeutic alliance. The results showed that clusters of cognitive heuristics trajectories are linked with the client's therapeutic alliance (t(55) = 2.30, p = .03), but they remained unrelated with the evolution of the therapist's alliance. These results are discussed with regard to the interpersonal adaptiveness of cognitive heuristics in the context of BPD undergoing treatment.

Informal Leadership in the Clinical Setting: Occupational Therapist Perspectives

Abstract Date Presented 4/20/2018 This novel qualitative research considered participation in the role of informal leader for 10 occupational therapists in Ontario, Canada. A qualitative analysis supports understanding the role and its unique clinical contribution. Recommendations for curriculum and professional support are provided. Primary Author and Speaker: Clark Patrick Heard Contributing Authors: Jared Scott, Emily Van Der Kamp, Tanisha McGinn, Amjad Yahia

Occupational Therapist Perspectives on the Potential of Performance Profiling in Practice

Abstract Date Presented 4/20/2018 Performance profiling is a natural application of Kelly’s (1955) personal construct theory. Nine expert occupational therapists from three counties participated in the research. There was agreement that performance profiling could support occupational therapy practice by enhancing communication. Primary Author and Speaker: Michelle Perryman Contributing Authors: Karen Morris

Therapeutic change in young people—A qualitative investigation of client and therapist perspectives

AbstractBackgroundYoung people's vulnerability to developing mental illness makes it important to understand therapeutic change, integrating the views of both young people and their therapists, to improve treatment effectiveness. To date, qualitative research aiming to triangulate experiences of therapeutic change in young people has not clearly differentiated the unique perspectives of clients and therapists. Instead both groups’ perspectives have been analysed together, which may be phenomenologically problematic considering clients are the site of change, while therapists observe it.AimsThis study explored experiences of therapeutic change from the perspectives of young people and their therapists. Three clients aged 17–19 years, and their two therapists, participated in semi‐structured interviews post‐therapy.MethodsSix themes were identified for clients: facing problems alone; how the therapeutic space was used; change characteristics; partial changes; the role of context in change; and growing into the new self. Four themes were identified for therapists: problematic experiences; change processes; therapist‐related change process; and change qualities.ResultsSix themes were identified for clients: facing problems alone; how the therapeutic space was used; change characteristics; partial changes; the role of context in change; and growing into the new self. Four themes were identified for therapists: problematic experiences; change processes; therapist‐related change process; and change qualities.ConclusionsCongruent with adult research, common and specific factors was important to change. Contextual and relational factors were particularly important for young people, who described that isolation caused by their problems caused distress beyond the impact of symptoms. Therapeutic change was facilitated through responsive therapy practices that led to developmentally normal levels of activity and changes in selfhood. Participants accepted a good‐enough level of recovery which was anticipated to continue post‐therapy.

Humor Associated With Positive Outcomes in Individual Psychotherapy.

Considerable anecdotal evidence points to the usefulness of humor in the therapeutic process, but empirical evidence is lacking. The purpose of this study, conducted in Belgium, was to search for an association between humor and therapy outcomes in a population of 110 adult psychotherapy clients who attended at least 10 therapy sessions. Clients and their therapist evaluated the frequency and intensity of humorous events, as well as therapy effectiveness, therapeutic alliance, perceived hope, and pleasure in participating in therapy sessions. A strong positive correlation was observed between humor and therapy effectiveness, from both client (rs=0.40; p<0.001) and therapist perspectives (rs=0.37; p<0.001). The link between humor and therapy effectiveness remained significant in subgroups of clients with more severe illness, although these clients reported less humor in their therapy sessions. Further research is needed to determine whether humor enhances outcomes or whether positive outcomes trigger occurrence of humor.

The impact of technology on therapeutic alliance and engagement in psychotherapy: The therapist's perspective

ObjectiveIn this article, we investigate therapist views on their experiences using a technological adjunct (goACT) to traditional, face‐to‐face psychotherapy. goACT is a web‐based mobile interactive software application that facilitates an interactive platform, allowing therapists to connect with their clients between face‐to‐face psychotherapy sessions.MethodParticipants were six provisional psychologists and seven patients. Data were collected at two post‐therapy focus groups in order to qualitatively understand therapist experience of goACT as a therapy adjunct. Data were analysed utilising thematic analysis.ResultsFour main themes emerged: (1) “discretional use of goACT” linked to therapist preferences and client suitability; (2) “therapist concerns” linked to boundaries, workload, technological glitches, and therapeutic risks; (3) “goACT expands the parameters of therapy” through increased opportunities to provide care and connection with patients and increased access to the process of therapy; and (4) “goACT enhances therapy” through reciprocal responsibility and guided empowerment. Therapists in this study were more open to the use of technology in therapy than has been reported in previous research and did not find that it affected their workload.ConclusionTherapists indicated that when aligned to the specific needs of individual patients, an advanced mobile and web‐based interactive software application (goACT) has the potential to enhance engagement, rapport, and patient empowerment in face‐to‐face psychotherapy.

'Power in Mobility': parent and therapist perspectives of the experiences of children learning to use powered mobility.

The aim of this study was to gain insights, from the perspectives of both parents and pediatric therapists, into the experiences of children learning to use a power mobility device. The purposive sample included 33 participants: 14 parents of children who were learning, or had learned, to use a power mobility device and 19 pediatric occupational therapists or physical therapists. Data were gathered face-to-face via seven focus groups consisting of either parents or therapists, and eight one-on-one interviews. Data were analyzed using the constant comparative method. Three main themes were identified: (1) 'Power in mobility' described how learning to use powered mobility changed more than just a child's locomotor abilities; (2) 'There is no recipe' revealed how learning to use powered mobility occurred along an individualized continuum of skills that often unfolded over time in a cyclical process; (3) 'Emotional journey' explored how learning to use powered mobility was an emotionally charged undertaking for all those involved. Learning to use a power mobility device is a complex process that often requires perseverance and determination on the part of the child, family, and therapist. Powered mobility use impacts more than just a child's locomotor abilities. Learning to use a power mobility device is a highly individualized process. Learning to use powered mobility may be an emotionally charged process.

When therapist estimations of the process of treatment can predict patients rating on outcome: The case of the working alliance.

It has been demonstrated that patient perspective on alliance can predict subsequent treatment outcome as reported by the therapist but not the other way around. This study aimed to investigate the circumstances in which therapists can provide estimations of alliance capable of predicting patient perceptions of subsequent session outcome. The study focused on 2 potential indicators: time in treatment and treatment efficacy. Data of 107 treatment completers assigned to either cognitive-behavioral therapy or alliance focused therapy were analyzed. Data included session-to-session assessments of alliance and the session outcome measure across the 30 weeks of treatment as well as pretreatment to posttreatment assessments of treatment efficacy using the Symptom Checklist-90-Revised. An actor-partner interdependence model of longitudinal hierarchically nested data, disentangled for within- and between-patients effects, was used. The interactive effects of time and treatment efficacy and their combined effect were examined. At the sample level, as expected, the therapist perspective of alliance did not significantly predict patient perception of subsequent session outcome, but significant interaction effects were detected. Therapists' perspective on the alliance was a stronger predictor of patients' perception of subsequent session outcome when therapy was more rather than less effective. This effect was evident mainly early in treatment, during which greater variability across dyads was found. Findings suggest that although therapists' ratings of the alliance are not consistently predictive of patients' rating of subsequent session outcome, they are better predictors in more than in less effective treatments. (PsycINFO Database Record

Informal Leadership in the Clinical Setting: Occupational Therapist Perspectives

Informal Leadership in the Clinical Setting: Occupational Therapist Perspectives

The Fairy Tale Model: Secure Facility Therapist Perceptions

The current exploratory qualitative study sought to investigate novice therapist experience of implementing a phased trauma recovery approach, the Fairy Tale Model (FTM), in secure accommodation in Scotland. Participants were ten therapists trained and supervised in FTM over a 6 month period. Therapists delivered FTM to 37 youth. Individual interviews with therapists were based on the objectives of FTM, and explored the benefits, challenges and facilitating factors for both youth and therapists. Perceived benefits for therapists included increases in trauma-informed knowledge, skills, and confidence. Youth were perceived by therapists, to be less emotionally dysregulated and more motivated, hopeful, and communicative. Challenges for therapists involved the complexity of youth difficulties, competing work demands, difficulties unlearning established approaches, and short duration placements. Prioritizing therapy, intensive sessions, and frequent communication with care staff were seen as facilitating factors. Recommendations are made for FTM delivery and more robust mixed methods evaluative research including therapist, youth and other stakeholder perspectives.

Ideas of the change process: family and therapist perspectives on systemic psychotherapy for children with conduct disorder

AbstractThis report is based on a small‐scale qualitative study exploring therapist and client perspectives on the therapeutic change process in home‐based family therapy for children with conduct disorder. The study consisted of focus group discussions with therapists, interviews with client families and audiotaped therapy sessions. The findings suggested that home‐based therapy (home visits) was effective in improving hard‐to‐reach clients’ access to help, resources, and opportunities, as well as the therapists’ access to invaluable information about their clients. Home‐based therapy also helped the therapists to develop professionally, making it possible for them and their clients to engage in different power relationships, which were seen by both parties as one of the principal motivating forces and important aspects of the change process. In addition, exploring clients’ perspectives appeared to be useful.Practitioner points The process of engaging with hard‐to‐reach families starts in the context of specific therapist‐client power relationships with the therapist encouraging the family to take charge Home‐based therapy is useful for children with conduct disorder Home‐based therapy provides children, family and therapists with information, resources, opportunities and good access, which are not always available in customary clinical settings

Art therapy for patients diagnosed with personality disorders cluster B/C: A thematic analysis of emotion regulation from patient and art therapist perspectives

ABSTRACTThis study examined the explanation for the found causal relationship between art therapy and positive therapeutic effects, in a previously conducted randomised controlled trial (RCT) with personality disorders cluster B/C. In-depth interviews were used to collect the data, in order to examine the experience without preconceived notions or expectations. Thematic analysis was used to analyse the data to generate and interpret themes. Eight patients who participated in the RCT intervention were asked to evaluate their experiences with art media highlighting emotion regulation and Expressive Therapies Continuum (ETC) levels. Also three art therapists were asked to evaluate the artwork made by these participants. Thematic analysis resulted in five themes. These results suggested that through the targeted use of art assignments, material handling, and preferred approaches to art process and ETC levels, patients experienced, shaped and shared emotions not previously wilfully encountered. The therapeutic effects were explained by combined specific art therapy factors linked to the art media. These factors were reported by participants as evoking and helping them understand and regulate internal images and emotions. Results suggested that art therapy encourages a present-focused awareness and stimulates emotional processes evoked by material interaction.

Observer, youth, and therapist perspectives on the alliance in cognitive behavioral treatment for youth anxiety.

This study examined the score reliability and validity of observer- (Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale [TPOCS-A]; Vanderbilt Therapeutic Alliance Scale Revised, Short Form [VTAS-R-SF]), therapist- (Therapeutic Alliance Scale for Children Therapist Version [TASC-T]), and youth-rated (Therapeutic Alliance Scale for Children Child Version [TASC-C]) alliance instruments. Youths (N = 50) aged 7-15 (Mage = 10.28 years, SD = 1.84; 88.0% Caucasian; 60.0% male) diagnosed with a principal anxiety disorder received manual-based cognitive-behavioral treatment. Four independent coders, 2 using the TPOCS-A and 2 using the VTAS-R-SF, rated 2 sessions per case from early (Session 3) and late (Sessions 12) treatment. Youth and therapists completed the TASC-C and TASC-T at the end Session 3 and 12. Internal consistency of the alliance instruments was α > .80 and interrater reliability of the observer-rated instruments was ICC(2,2) > .75. The TPOCS-A, VTAS-R-SF, and TASC-T scores showed evidence of convergent validity. Conversely, the TASC-C scores failed to converge with the other instruments in a sample of children (age <11), but did converge in a sample of adolescents (age ≥11). Findings supported the predictive validity of the TASC-T and TASC-C scores. However, whereas the direction of the alliance-outcome association for both observer-rated instruments was in the expected direction for children (negative), the correlations were in the opposite direction for adolescents (positive). Overall, findings support the score reliability of observer- and therapist-report alliance instruments, but questions are raised about the score validity for the observer- and youth-report alliance instruments. (PsycINFO Database Record

Therapeutic alliance in psychological therapy for people with schizophrenia and related psychoses: A systematic review.

Therapeutic alliance is a key predictor of therapy outcomes. Alliance may be particularly pertinent for people with schizophrenia as this group often have a history of interpersonal trauma and relationship difficulties including difficult relationships with mental health staff. This review aimed to determine (a) the quality of therapeutic alliance between people with schizophrenia and their therapists; (b) whether alliance predicts therapeutic outcomes; and (c) variables associated with alliance. Databases were searched from inception up to April 2015. The search yielded 4,586 articles, resulting in 26 eligible studies, involving 18 independent samples. Weighted average client and therapist Working Alliance Inventory-Short Form total scores were 64.51 and 61.26, respectively. There was evidence that alliance predicts overall psychotic symptomatic outcomes and preliminary evidence for alliance predicting rehospitalization, medication use, and self-esteem outcomes. There was evidence for specific client-related factors being linked to different perspectives of alliance. For example, poorer insight and previous sexual abuse were associated with worse client-rated alliance, whereas baseline negative symptoms were associated with worse therapist-rated alliance. Therapist and therapy-related factors, including therapists' genuineness, trustworthiness, and empathy were associated with better client-rated alliance, whereas suitability for therapy, homework compliance, and attendance were associated with better therapist-rated alliance. Key clinical implications include the need to consider alliance from both client and therapist perspectives during therapy and training and supervision to enhance therapist qualities that foster good alliance. Future research requires longitudinal studies with larger samples that include pan-theoretical, well-validated alliance measures to determine causal predictor variables.