Therapy Clients Research Articles

Research on the Cognitive Orientation to daily Occupational Performance Approach: A Bibliometric Review.

The Cognitive Orientation to daily Occupational Performance (CO-OP) is an evidence-based intervention approach that has significantly increased in popularity over the past two decades. However, how the research literature on this topic is patterned is still unknown, so it is difficult to identify potential areas for research and clinical interest. To analyze the literature published on the CO-OP approach to provide a detailed and structured analysis of the publication patterns. All literature related to CO-OP included in the Web of Science database through June 15, 2024. All published studies related to CO-OP were included in the bibliometric analysis, which was conducted on the raw data retrieved from the Web of Science database using the Bibliometrix R package. The annual growth rate in CO-OP research has been 0.8%, significantly increasing from 2015 onward. Most of the research has been published in occupational therapy and rehabilitation journals by English-speaking research teams, and its scope has expanded from developmental coordination disorder to a wide range of health conditions. In addition, two main lines of research have emerged: one focusing on understanding the underlying cognitive processes involved in CO-OP and the other focusing on its clinical effectiveness. Research on CO-OP has significantly increased over the past decade, and it currently encompasses a wide range of areas. This analysis may facilitate the advancement of research on and the clinical practical application of CO-OP. Plain-Language Summary: The Cognitive Orientation to daily Occupational Performance (CO-OP) is an evidence-based intervention approach that has significantly increased in popularity over the past two decades. Occupational therapists use it to improve the occupational performance of both children and adults with movement difficulties. However, it is unknown how the research literature on this topic is patterned, so it is difficult to identify potential areas for research and clinical interest. This study found that scientific literature on CO-OP has significantly increased in the past decade and that its scope has expanded from developmental coordination disorder to a wider range of health conditions, such as cerebral palsy. Moreover, research is now focused on two main questions: What are the underlying cognitive processes involved during intervention, and how effective is the CO-OP approach? These findings can be used to further improve occupational performance and participation among occupational therapy clients who struggle with motor performance and planning.

Abortion Law Changes and Occupational Therapy Practice in the United States.

The U.S. Supreme Court overturned Roe v. Wade in 2022, changing access to abortion in many states. The impact of these changes on occupational therapy practice has not yet been explored through empirical research. To explore the perspectives of occupational therapy practitioners on how restrictions to abortion in the United States may have influenced their clients' needs and thus their practice. This was a qualitative research study. We used an interpretivist epistemological approach and an inductive, thematic content analysis. Participants were recruited through state occupational therapy associations and social media. Two independent researchers coded data and had an initial agreement percentage of 88%. Data trustworthiness was enhanced through documentation of decisions, reflexive thinking about our positionality and the data, and team-based discussions. Occupational therapy practitioners (N = 15) working in states with new abortion law changes at the time of interviews. The four key themes of this study were as follows: (1) abortion restriction laws are affecting some occupational therapy clients' mental health, (2) clients are discussing reproductive health with occupational therapy practitioners across a variety of settings, (3) occupational therapy practitioners are using clinical judgment and their personal beliefs to support clients affected by abortion restrictions, and (4) occupational therapy practitioners are seeking guidance and evidence-based resources to best support clients in the wake of abortion-related legislation changes. Our findings underscore the relevance of reproductive health to occupational therapy practice and highlight the importance of preparing occupational therapy practitioners to respond to client needs related to abortion care. Plain-Language Summary: We sought to determine whether occupational therapy practitioners perceive that the 2022 abortion-related restrictions are affecting occupational therapy practice; specifically, we wanted to know whether and how practice is being affected and what resources occupational therapy practitioners might need to address clients' needs. Fifteen occupational therapy practitioners were interviewed and revealed that many of their clients were experiencing stress and anxiety (i.e., mental health challenges) specifically related to abortion access. We also found that occupational therapy practitioners who routinely discuss reproductive health with clients were commonly hearing from clients about abortion-related needs. Overall, this research uncovers a need for resources and guidance from state or national occupational therapy organizations so that occupational therapy practitioners can better support their clients given these new changes in abortion access. Positionality Statement: We are a team of three researchers who identify as cisgender women, and we reside in an urban area in the northeastern United States. Two of us identify as White, and one identifies as a person of color. We have all participated in reproductive health access advocacy and critically examined our own lenses as we engaged in this analysis.

Morality and emotion in therapy clients’ accounts for suicidality

ABSTRACT Suicide is a substantial public health problem, yet little is understood about the ways in which clinicians and clients discuss suicide attempts. This study investigates commonalities in psychology clients’ accounts of suicide attempts that were survived, or aborted after being enacted or planned and prepared. We used conversation analysis to investigate conversations within psychosocial (risk-assessment) sequences during four initial psychology consultations (interviews) recorded in an Australian voluntary outpatient multidisciplinary healthcare clinic. Analysis showed that clients’ suicidality accounts routinely included reports of morally problematic treatment by others, with clients typically seeking clinician responses to these elements of their accounts. Clinicians were not, however, observed to engage the moral dimensions of clients’ accounts and instead routinely oriented to the impact of these behaviours on clients. We conclude by discussing the implications and consequences of these differing orientations for psychologists, clients, and future suicide-risk research.

Development and validation of the Gender Identity and Expression Microaggressions in Therapy Scale (GIEMTS).

Developing affirming interventions for transgender and nonbinary (TNB) therapy clients requires understanding their experiences with microaggressions in psychotherapy, yet no self-report measure of anti-TNB microaggressions in this context exists. Moreover, few studies have tested the associations between anti-TNB microaggressions and therapy processes. To better address the burden of unmet mental health care needs among TNB people, this three-study investigation designed and tested the psychometric properties of the Gender Identity and Expression Microaggressions in Therapy Scale (GIEMTS), a measure of TNB individuals' encounters with microaggressions in psychotherapy. Study 1 (N = 225) identified a four-factor model, comprising the themes of Educational Burdening, Lack of Affirmation, Inflation, and Invalidation. These subscales exhibited strong internal consistency reliabilities and demonstrated convergent and discriminant validity. The results of Study 2 (N = 435) replicated the four-factor structure through confirmatory factor analysis. However, bifactor analysis revealed that the Educational Burdening, Inflation, and Invalidation subscale scores were mostly accounted by a General Anti-TNB Microaggressions scale score-though Lack of Affirmation showed evidence of its independence. Also in Study 2, both scales were uniquely negatively associated with the working alliance. Study 3 (N = 151) found evidence for the test-retest reliability of GIEMTS scores over a 2-3-week period. Overall, the GIEMTS emerged as a robust and psychometrically sound instrument that captures the experiences of TNB individuals in therapy settings. The study concludes with valuable recommendations for training and clinical practice to bolster TNB mental health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Model of Core Emotional Needs and Toxic Experiences: Their Links with Schema Domains, Well-Being, and Ill-Being.

This study examined the second-order schema domains of Early Maladaptive and Adaptive Schemas based on recent trends and compared them with the five theoretical second-order schema domains commonly used in schema therapy. Using six international Eastern and Western community samples-Singapore (n = 628), Malaysia (n = 229), USA (n = 396), South Africa (n = 390), Nigeria (n = 364), India (n = 306)-confirmatory factor analysis showed that the four second-order domains of EMSs and EASs, which ran almost parallel with each other, were the most robust models calling into question the validity of the five domain model. Given the hypothesized links between schemas and needs, these four categories of EMSs and EASs represent four categories of toxic experiences and core emotional needs, respectively. These categories were supported empirically and are useful to parents as well as to clinicians as they approach child rearing and the treatment of clients in schema therapy from the vantage point of needs. These four categories of psychological core emotional needs, as well as toxic experiences, were found, as expected, to be linked with various measures of well-being and ill-being.

Community rehabilitation by the trained village health volunteers on activities of daily living and quality of life in stroke survivors

Background: The number of people with disabilities resulting from strokes is increasing in Thailand. The major sequela of the disease was weakness in one side of the body that causes difficulty in activities of daily living (ADL) and poor quality of life (QOL) for stroke survivors. Community-based rehabilitation could be one of the strategies that enhances functional performance and improves QOL in these individuals. There were many disabled people in Mae Ka subdistrict, San Pa Tong District, Chiang Mai Province, where health care providers and local people were enthusiastic to take care of each other’s health in the community. Objective: The present study aimed to investigate rehabilitation outcomes in ADL and QOL of stroke participants who received rehabilitation services from trained village health volunteers (VHVs). Materials and methods: This study was a quasi-experimental research design. Subjects were recruited using purposive sampling, including 10 stroke survivors. Instruments used were 1) ADL Assessment for Occupational Therapy Clients; and 2) World Health Organization Quality of Life Assessment, Short Form-Thai version. The statistics used were descriptive, as well as the Wilcoxon Signed Ranks Test. Results: Results demonstrated that scores of basic activities of daily living (BADL) in the participants increased significantly (p<0.05) except for sexual expression. The score in the instrumental activities of daily living (IADL) was also significantly higher at post-rehabilitation than pre-intervention (p<0.05), as was the total ADL score. Stroke patients had significantly higher QOL scores after intervention than the pretest (p<0.05). Conclusion: These indicated that the community rehabilitation center at Mae Ka Subdistrict Administrative Organization, San Pa Tong District, Chiang Mai Province, run by the trained VHVs could promote ability in daily activities and improve QOL in stroke participants who come for their services.

Effects of Safe and Sound Protocol on self-reported autonomic reactivity, anxiety, and depression in speech therapy clients with voice, throat, and breathing complaints

Medically unexplained oto-rhino-laryngeal symptoms (MUORLS) may have a pathophysiology related to brain-body state regulation. We use predictions from the Polyvagal Theory to investigate whether clients with voice problems have increased autonomic reactivity, anxiety, and depression. Study 1 included 54 clients with MUORLS, and a comparison group of 26 individuals without MUORLS. Outcome measures were anxiety and depression (Hospital Anxiety and Depression Scale, HADS), autonomic reactivity (Body Perception Questionnaire Short Form, BPQ-SF), and extent of voice handicap (The Voice Handicap Index, VHI) for the clients. The client group scored higher than the control group in supra-diaphragmatic reactivity, but there were no group differences in other measures. To extend the findings of Study 1, a feasibility study (Study 2) evaluated the effects of the Safe and Sound Protocol (SSP), a Polyvagal-informed protocol, on the same outcome measures. Study 2 included 33 clients with self-reported voice and throat complaints. Outcome measures assessed pre- and post-SSP were anxiety and depression (HADS) and autonomic reactivity (BPQ-SF). Results demonstrated a significant decrease in anxiety, depression, and autonomic reactivity post-SSP. In conclusion, a better understanding of the mechanisms that underlie MUORLS may provide guidance for using neurophysiologically based interventions, such as SSP, that target autonomic state regulation.

A randomized wait-list controlled trial of Men in Mind: Enhancing mental health practitioners' self-rated clinical competencies to work with men.

Improved engagement of men in psychotherapy is an essential element in improving male health outcomes. This trial examined whether the Men in Mind intervention improved practitioners' self-rated clinical competencies to engage and respond to male clients in therapy. A parallel, single-blind, wait-list randomized controlled trial was conducted with Australian-based mental health practitioners, currently administering psychotherapy to males, fluent in English, and not currently completing their undergraduate degree. Participants were randomly assigned 1:1, through variable-sized blocks stratified by gender, to either the intervention (Men in Mind) or wait-list control. Men in Mind was offered as a self-led 6-week, five-module online program to upskill practitioners to engage and respond to male clients. The primary outcome was self-reported competency in engaging men in psychotherapy, measured by the Engaging Men in Therapy Scale (EMITS) at 6 weeks. All analyses were by intention-to-treat. Between January 16 and March 17, 2022, 587 participants were randomly assigned to the intervention (n = 300) or wait-list control (n = 287). In total, 492 (84%) participants completed the primary endpoint assessment at 6 weeks. Men in Mind demonstrated a large effect of improved EMITS scores compared to the control group (d = 2.63, 95% CI [2.39, 2.87], p < .001). Men in Mind was effective at increasing mental health practitioners' self-reported efficacy to work with men, which is potentially a key change mechanism in their ability to improve health outcomes for male clients. A limitation of the trial was the use of a bespoke, self-reported primary outcome, while a strength was the gender-responsive intervention design. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Modifying Conventional Psychiatric Practice to Serve Indigenous People

IntroductionPsychiatry has historically underserved Indigenous people. Earlier, cross-cultural psychiatry assumed that psychiatric disorders were universal and varied little across cultures. We must acknowledge their different views of mind and mental health.ObjectivesIn our auto-ethnographic approach, we introduce or re-introduce participants to cultural beliefs, values, and methods for treating addictions, including narrative methods (storytelling), which receive greater acceptance by indigenous and marginalized peoples. Indigenous philosophy states that we see the world using the stories we have absorbed or constructed to explain our perceptions. Using substances is a story that is connected to poverty and adverse childhood events.MethodsWe create new stories to develop a sense of agency, that one’s actions can make a difference in one’s life. We present our experiences and findings from providing psychiatric and addiction services in rural and remote Indigenous settings in Canada (Saskatchewan and Northern Ontario) and in Maine (USA). We present data on a modified approach to psychiatric evaluations and services that emphasizes Indigenous values and begins with a life story interview that determines positive aspects of the client’s history and problem areas and engages the client in therapy from the beginning of the evaluation.ResultsWe will demonstrate how this process changes the process of the psychiatric interview, engages Indigenous clients, and results in better outcomes. We discuss how psychotherapy must change to engage Indigenous clients and to be effective with addictions. She will present data on this area. We present the lessons learned and the results of using this approach with a tribal population in Maine. Some key concepts include (1) reframing the person’s self-story about being addicted within a threat-power-meaning network, (2) working with stories about the spirit of the addiction and the consequences of ingesting spirit-laden substances without knowing their songs and protocols, (3) constructing future-self-narratives that explore right relationships and meaningful conduct, (4) constructing stories about the intergenerational transmission of addictions and exploring the question of “whom will be the recipient of your addiction?” We understood that the client sets their goals and defines what recovery means for them, which is the heart of a harm reduction approach.ConclusionsIndigenous cultures across the world are different but share some similarities including a highly relational approach to defining the self, a collectivist mindset in which the needs of the group can supersede the needs of the individual, a reliance upon stories for transmission of knowledge and culture, and a commitment to a biopsychosocial and spiritual approach, which is often symbolized by the metaphor of the Four Cardinal Directions.Disclosure of InterestNone Declared

Investigation of the effectiveness of articulation therapy through tele-practice on children with cleft palate in Khuzestan Province during COVID-19 pandemic

IntroductionA cleft palate is a common type of facial malformation. Compensatory articulation errors are one of the important causes of unclear speech in children with cleft palate. Tele-practice (TP) helps to connect therapists and clients for assessment and therapy. Our goal is to investigate the effectiveness of articulation therapy through tele-practice on cleft palate children in Khuzestan Province during the COVID-19 pandemic. Materials & methodsBefore starting the treatment, a 20-min speech sample was recorded individually from all the children. Speech intelligibility and the percentage of correct consonants were assessed for each speech sample. The control group received treatment sessions in person at the cleft palate center, and the other group received treatment via tele-practice using the ZOOM platform. Treatment sessions were provided in the form of 45–60-min group sessions, twice a week, for 5 weeks (10 sessions in total). After 10 treatment sessions, the speech sample was recorded again. The level of parental satisfaction was measured using a Likert 5-level survey. ResultsThe mean score of intelligibility of the two groups decreased (−1.4400 and 0.7200). The two groups' mean percentage of correct consonants increased. (26.09 and 17.90). In both groups, the mean score of parents’ satisfaction with the treatment was high (3.44 and 3.84). The mean of difference before and after the speech intelligibility and the percentage of correct consonants variables in both groups was statistically significant (P = 0.001 and P = 0.002, respectively). In both groups, the satisfaction variable was not associated with a statistically significant difference (P = 0.067). ConclusionThe effectiveness of in-person therapy over a certain period of time is higher than tele-practice. Nevertheless, the results demonstrated an increase in the intelligibility of speech and the percentage of correct consonants in both groups, thus proving the effectiveness of articulation therapy in correcting compensatory articulation errors in children with cleft palate through in-person and tele-practice.

Satisfaction with service delivery among HIV treatment clients enrolled in differentiated and conventional models of care in South Africa: a baseline survey.

Differentiated service delivery (DSD) models aim to increase the responsiveness of HIV treatment programmes to the individual needs of antiretroviral therapy (ART) clients to improve treatment outcomes and quality of life. Little is known about how DSD client experiences differ from conventional care. From May to November 2021, we interviewed adult (≥18) ART clients at 21 primary clinics in four districts of South Africa. Participants were enrolled consecutively at routine visits and stratified into four groups: conventional care-not eligible for DSD (conventional-not-eligible); conventional care eligible for but not enrolled in DSD (conventional-not-enrolled); facility pickup point DSD model; and external pickup point DSD model. Satisfaction was assessed using questions with 5-point Likert-scale responses. Mean scores were categorized as not satisfied (score ≤3) or satisfied (>3). We used logistic regression to assess differences and report crude and adjusted odds ratios (aORs). Qualitative themes were identified through content analysis. Eight hundred and sixty-seven participants (70% female, median age 39) were surveyed: 24% facility pick-up points; 27% external pick-up points; 25% conventional-not-eligible; and 24% conventional-not-enrolled. Seventy-four percent of all study participants expressed satisfaction with their HIV care. Those enrolled in DSD models were more likely to be satisfied, with an aOR of 6.24 (95% CI [3.18-12.24]) for external pick-up point versus conventional-not-eligible and an aOR of 3.30 (1.95-5.58) for facility pick-up point versus conventional-not-eligible. Conventional-not-enrolled clients were slightly but not significantly more satisfied than conventional-not-eligible clients (1.29, 0.85-1.96). Those seeking outside healthcare (crude OR 0.57, 0.41-0.81) or reporting more annual clinic visits (0.52, 0.29-0.93) were less likely to be satisfied. Conventional care participants reporting satisfaction with their current model of care perceived providers as helpful, respectful, and friendly and were satisfied with care despite long queues. DSD model participants emphasized ease and convenience, particularly not having to queue. Most adult ART clients in South Africa were satisfied with their care, but those enrolled in DSD models expressed slightly greater satisfaction than those remaining in conventional care. Efforts should focus on enrolling more eligible patients into DSD models, expanding eligibility criteria to cover a wider client base, and further improving the models' desirable characteristics.

Beyond multicultural competency: a scoping review of multicultural orientation in psychotherapy and clinical supervision

Purpose Psychotherapy and clinical supervision outcomes are influenced by client and supervisee factors, one of which is cultural identity. Those with diverse racial and ethnic minoritised identities often experience disparities in therapy outcomes. Therapists and supervisors need to be responsive to the identity of those they support. The multicultural orientation (MCO) framework is an emerging concept in psychotherapy and clinical supervision that may offer these practitioners a framework to be responsive. Design/methodology/approach A preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews was conducted. Six databases, PubMed, Scopus, Embase, Academic Search Complete, Web of Science and PsychInfo, were searched for peer-reviewed literature published in English between the years 2000 and 2023. Findings A total of 1,553 sources were identified, of which (n = 42) are included in this review. Findings suggest that MCO is still in its infancy as applied to therapy and clinical supervision. Most of the research has been conducted in America, using quantitative methodologies with white western populations. Cultural humility is the most studied MCO pillar, and variables such as reductions in psychological stress, the working alliance and microaggressions are reported on as outcomes. MCO applied to the group therapy process is an emerging finding of interest. However, more research is needed, especially experiential designs across different and diverse populations and contexts. Originality/value MCO is an emerging therapy and clinical supervision process that has the potential to improve the outcomes for therapy clients and supervisees. Further research is needed to replicate current studies, and further research with diverse populations, countries and contexts should be undertaken as a priority.

Satisfaction of antiretroviral therapy services and its associated factors among adult clients attending antiretroviral therapy in Woliso town, Ethiopia

BackgroundAntiretroviral therapy client satisfaction is a significant tool that enables to strengthen the quality of life of the clients. The study aimed to assess the satisfaction of clients with antiretroviral therapy services and its associated factors among adult clients attending antiretroviral therapy.MethodsA cross-sectional study was undertaken from 28 August to 27 October 2022. Data were analyzed by using Logistic regression.ResultClients who did not attend formal education and attended health education information were significantly associated with satisfaction on antiretroviral therapy services.ConclusionHIV care services should introduce systematic health education programs to improve satisfaction with antiretroviral therapy services.

Expanding a health technology solution to address therapist challenges in implementing homework with adult therapy clients: A mixed methods study (Preprint)

Expanding a health technology solution to address therapist challenges in implementing homework with adult therapy clients: A mixed methods study (Preprint)

Practice and Recommendations for Universal Design for Learning in Occupational Therapy Client Education

Practice and Recommendations for Universal Design for Learning in Occupational Therapy Client Education

Uptake and associated factors of six multi-month scripting/appointment spacing differentiated service delivery model of care among stable clients on antiretroviral therapy in Southern Ethiopia.

Differentiated service delivery models have been developed to accommodate the rising number of stable antiretroviral therapy clients and to maintain improvements in health outcomes and care retention. Ethiopia adopted the appointment spacing model and has had notable successes in implementing it. However, with the implementation of the six multi-month scripting/appointment spacing model in Ethiopia, little is known about the uptake and its associated factors. Therefore, this study aimed to assess the uptake and associated factors of the six multi-month scripting/appointment spacing differentiated service delivery model of care among stable clients on antiretroviral therapy in Southern Ethiopia. A hospital-based cross-sectional study was conducted among 419 stable clients on antiretroviral therapy in southern Ethiopia from June 22 to September 29, 2023. A systematic sampling technique was used to select the study participants. Using a structured questionnaire, socio-demographic, health service delivery, behavioral, and clinical-related data were collected. The collected data were entered into Epi Data version 3.1 and analyzed using Stata version 14. Variables with a P-value <0.05 in the multivariable logistic analysis were considered statistically significant. Multicollinearity and model fitness were checked using the variance inflation factor and the Hosmer and Lemeshow goodness of fit tests, respectively. The uptake of the six multi-month scripting/appointment spacing differentiated service delivery model of care was 63.25% (95% confidence interval (CI): 58.61%, 67.88%). Missed appointment (Adjusted Odds Ratio (AOR): 1.91 (95% CI: 1.13, 3.25)), distance to antiretroviral therapy facility (AOR: 2.90 (95% CI: 1.67, 5.04)), duration on antiretroviral therapy (AOR: 2.21 (95% CI: 1.34, 3.64)), and intermediate social support (AOR: 2.02 (95% CI: 1.29, 3.17)) and strong social support (AOR: 2.71 (95% CI: 1.23, 5.97)) were factors significantly associated with the uptake. The uptake of six multi-month scripting/appointment spacing differentiated service delivery models of care was six out of ten clients on antiretroviral therapy. To further improve the uptake, a precise intervention on the identified associated factor is required.

Psychotherapist perceptions of engagement-building behaviours with youth clients across developmental levels.

Building a positive therapeutic relationship is a challenging, yet critical, first step in conducting youth psychotherapy. A number of studies in the youth treatment literature have indicated that a positive therapeutic alliance is related to increased treatment attendance, participation, and outcome. Some research has examined therapist behaviours for engaging therapy clients; however, developmental differences in alliance formation have had limited exploration. The current study surveyed clinicians about their use of specific engagement strategies and the developmental stage of their youth clients. It was hypothesised that participants would differentially rate the importance of different aspects of therapeutic engagement based upon a youth client's developmental stage and that these would correspond with differences in specific engagement strategies. A total of 64 clinicians with experience treating youth completed the study. The participants completed a questionnaire administered online that asked them to rate the importance of developmental differences to forming a therapeutic relationship and provide example client behaviours from their clinical experience for each developmental stage. Results showed clinicians felt the relative importance of collaboration, advocacy, and trustworthiness increased with age. These differences were also evidenced in the specific strategies clinicians endorsed in relation to each engagement factor across developmental stages. This program of research will eventually aid in the development of new guidelines for engaging clients in youth psychotherapy. In addition, the results may be used to enhance psychotherapy training for those working with children and adolescents.

Stigma toward people living with Human Immunodeficiency Virus: Insights from Anti-Retroviral Therapy clients in north-eastern Ghana

Stigma toward People Living with Human Immunodeficiency Virus (PLHIV) remains a public health concern in Ghana and beyond. Whereas several studies have associated Anti-Retroviral Therapy (ART) services with stigma, the specific forms, and key drivers of stigma towards ART clients in poverty-stricken settings have not been exhaustively explored. Based on a case study of ART clients in the Upper East Region, this study explores the specific forms and the main drivers of stigma towards ART clients. We employed a qualitative research approach in the collection and analysis of the data. Purposive sampling was used to select the ART facilities and staff, and a convenient sampling procedure was employed to select the ART clients to participate in semi-structured key informant interviews. Barriers such as lack of knowledge, cultural norms, and a weak enabling environment were found to drive ‘public stigma’ and ‘self-stigma’ towards ART clients in the region. The former manifests in gossip, finger-pointing, insults, mockery, avoidance, and refusal of employment; while self-stigma was shown in a ‘feeling of guilt’, ‘self-isolation’, ‘excessive thinking’, ‘fear of insults’, and ‘fear of death’. These may lead to adverse health outcomes and loss of livelihoods. Therefore, we advocate the immediate and strict implementation of existing policies and legislation that aim to eliminate HIV-induced stigma in communities. Within this implementation framework, the Ghana Health Service, the Ghana AIDS Commission, the Christian Health Association of Ghana, and Non-Governmental Organizations (NGOs) in health are entreated to employ culturally appropriate education to increase awareness of the effectiveness of ART and promote the adoption of accepting attitudes towards ART clients in communities. We also recommend the conduct of a large-scale mixed methods research to identify specific forms of stigma encountered by ART clients in the country to inform the (re)design and implementation of ART anti-stigma policies and programmes.

Depressed adults’ experiences of listening to their own clinical improvisations at home: A process evaluation of the music therapy homework

ABSTRACT Introduction Depression has a negative impact on millions of people worldwide, necessitating research into appropriate therapeutic methods. The aim of this qualitative study is to investigate how music therapy clients experience listening to their own clinical improvisations at home, as a part of treatment for depression. Method Adults with major depressive disorder were offered 12 individual sessions of bi-weekly integrative improvisational music therapy, as part of a randomised controlled trial. Participants were asked to complete an online diary after listening to their clinical improvisations. Reflexive thematic analysis was performed on diary entries, and content analysis was applied to music therapists’ reports. Results Fourteen of 32 participants submitted a total of 58 diary entries. Participants' experiences were represented by five themes: music (playing, listening, music perception, music parameters), therapy (therapeutic processing, illness, music therapy trial), emotions (positive emotions, negative emotions, other emotions), embodiment (body parts, sensations, actions) and narrative (chronology, symbolic references). Music therapists’ reports indicated that low compliance and negative experiences during the task could be affected by severity of depression, and ease of use of the technological interface. Discussion Participants’ experiences varied from extremely negative to positive in every theme, finding music they produced beautiful or hideous, feeling proud or ashamed of making it, being energised, or exhausted by it, feeling supported or pressured by the music therapist, and recalling happy or terrifying memories. The findings suggest that a homework task can affect the therapeutic process in both positive and negative ways and should be further researched before implementation.

THERAPEUTIC MODELS AND FEATURES OF THE PSYCHOTHERAPEUTIC DISCOURSE OF KEN KESEY’S NOVEL “ONE FLEW OVER THE CUCKOO’S NEST”

The article describes two models of psychotherapy and the language of the psychotherapeutic discourse in Ken Kesey’s novel “One Flew Over the Cuckoo's Nest” (translated from English by D. Shepelev). First raised by M. Foucault, the theme of psychotherapy in hospitals of mental disorders as a practice of power was described in medical, pedagogical, autobiographical literature. The paper compares two models of the psychotherapeutic approach to human socialisation, conditionally associated with the manipulative method of the senior nurse of the psychiatric clinic and the humanistic method of McMurphy, the patient. The two types of the psychotherapeutic discourse, techniques of psychotherapy, features of the language of agents and clients of therapy – all these things make it possible to conclude that the qualities of the psychotherapist himself, but not abstract clichés, are of decisive importance in psychotherapy, and literature, thanks to numerous expressive means, helps to attract a wide audience to the topic of human mental health.