Training Of Therapists Research Articles

The assessment of therapist responsiveness in psychotherapy research: a systematic review.

Therapist responsiveness is an emerging construct in psychotherapy research that still lacks a clear definition and, consequently, a unique operationalization. Indeed, there is a great overlap between therapist responsiveness and other variables, such as attunement, flexibility, and empathy. This overlap inevitably hinders the assessment of the therapist's responsiveness, although it is crucial for the effectiveness of the treatments. Therefore, the current systematic review aims at exploring the different methodologies of measurement and analysis of therapist responsiveness, including both direct and indirect instruments. The results confirmed difficulties and divergences in the operationalization of the construct, as shown by the great heterogeneity found in the choice and use of the tools. Furthermore, this review provides guidance for future research, clinical practice, and training of therapists.

The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: A systematic review.

Involving parents of children with cerebral palsy (C-CP) in home exercise programmes (HEP) is globally practiced strategy closely linked to improved physical performance and functional outcomes for the child. Nevertheless, non-adherence to HEP is increasing at an alarming rate, and little is known about the factors influencing adherence to HEP (AHEP) especially in parents of C-CP. This systematic review aimed to identify the factors enhancing AHEP among parents of C-CP to reinforce the efficacy of rehabilitation practices proposed by health professionals, researchers, and educators. We conducted searches in PubMed, Scopus, CINHAL, PsycINFO, and Embase for articles published up to March 2023, that investigated the factors influencing AHEP among parents of C-CP. A narrative synthesis was conducted using the search results and pertinent material from other sources. Overall, non-adherence rates to HEP were moderate to high, ranging from 34% to 79.2%. Strong evidence suggests that factors enhancing AHEP fall into three categories: child-related (such as younger age and better gross motor function [GMF]), the caregiver-related (including high self-efficacy and knowledge, strong social support, low levels of depression, anxiety and stress symptoms, and a low perception of barriers), and the physiotherapist-related. For the latter category, the parent's perception of a supportive and collaborative relationship with the therapist is one of the conditions most favourably influences AHEP. Our findings highlight that factors influencing AHEP are multifactorial. Some, such as GMF or the economic and social conditions of the family, are challenging to change. However, the relationship between therapist and parent is an aspect that can be strengthened. These results underscore the importance of substantial training and psychosocial support for therapists to enhance their awareness and competence in building supportive relationship with parents.

The Role of Cognitive Reappraisal Strategies in Modulating Traumatic Memories

Cognitive reappraisal is a cognitive-behavioral technique that plays a crucial role in modulating emotional responses to traumatic memories, especially in clinical settings treating disorders such as post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD). This paper provides an in-depth exploration of the integration of cognitive reappraisal into therapeutic modalities, including Cognitive-Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). It examines the empirical evidence supporting the efficacy of cognitive reappraisal, discusses the challenges and considerations in its clinical application, and highlights the necessity for tailored approaches to enhance therapeutic outcomes. The systematic review of literature reveals that cognitive reappraisal significantly reduces emotional distress and improves psychological functioning, with neurobiological evidence showing changes in brain activity related to emotion processing. Despite its benefits, the effective implementation of cognitive reappraisal faces challenges such as therapist training, patient resistance, cultural considerations, and the need for integration with other therapeutic techniques. Addressing these challenges is essential for maximizing the effectiveness of cognitive reappraisal in therapy. This paper underscores the potential of cognitive reappraisal to transform therapeutic practices and enhance mental health care for individuals experiencing trauma-related disorders.

Effectiveness of a modified behavioural activation treatment training program for primary medical staff to manage depressive symptoms among rural elderly in Hunan Province, China: study protocol for a cluster randomised controlled trial

IntroductionDepression is a major global health problem, with high prevalence rates of depressive symptoms observed among the elderly population in China, particularly exacerbating in rural areas. Due to a lack...

Examining the association between balance self-efficacy and virtual balance performance in individuals with stroke: a cross-sectional study

ABSTRACT Background Balance self-efficacy is a strong predictor of fall risk after stroke and is related to performance on balance and walking tests. The use of telerehabilitation for delivering stroke rehabilitation has increased in recent years and there is a need to adapt common clinical assessments to be administered in virtual formats, but the association between balance self-efficacy and virtually administered clinical tests of balance performance has yet to be established. This study examined the association between the Activities-specific Balance Confidence (ABC) Scale and virtually administered Timed Up and Go (TUG), Tandem Stand, and Functional Reach tests (FRT) in individuals with stroke. Methods This was a secondary analysis of baseline data from two telerehabilitation trials with individuals with stroke. All assessments were administered by trained physical therapists through videoconferencing software. Multivariate regression analyses were used to examine the associations between the ABC scale and TUG test, Tandem Stand test, and FRT, adjusted for age and number of comorbidities. Results Data from 51 participants (n = 11 female, median age = 64 [IQR: 18] years, 9.3 ± 4.6 months poststroke) were analyzed. The ABC scores were associated with TUG (R2 = 0.56, F(3,47) = 20.26, p < 0.01), but not Tandem Stand (R2 = 0.18, F(5,45) = 1.93, p = 0.11) or FRT (R2 = 0.14, F(3,47) = 2.55, p = 0.07) tests. Conclusion We observed associations between the ABC scores and virtual TUG, but not with Tandem Stand or FRT, which may be attributed to the context-specificity of balance self-efficacy. As virtual administration of outcomes assessments becomes part of common practice in stroke rehabilitation, our study supports the use of virtually administered TUG in stroke.

Does Person-of-the-Therapist Training (POTT) Promote Self-Caring Attitude for Trainees in a Chinese Society? A Directed Content Analysis at a University in Taiwan

ABSTRACT Literature has demonstrated the importance of self-care for marriage and family therapists (MFTs) and trainees. However, little research elaborated on how we can promote self-care in therapist training and education, especially in Chinese societies. This study focused on the self-caring attitude graduate students reported after enrolling in a Person-of-the-Therapist Training (POTT) class taught at a university in Taiwan. In this class, students were required to write a final paper to reflect on the personal and professional changes they had experienced during this class and to provide feedback about the class. These de-identified final papers from research participating students were the source of the qualitative data. Using directed content analysis, the author found that the students’ self-caring attitude improved after the course. Cultural and contextual factors that might have influenced participants’ self-caring attitude during this process are discussed. Clinical and training recommendations for educators are included as well.

Report of a small feasibility study involving group analysts and groupwork practitioners in facilitating self-practice/self-reflection groups in the training of cognitive behaviour therapists

This article provides a narrative account of a small research study run with a grant from the Institute of Group Analysis (IGA) Legacy Fund. It discusses the challenges and opportunities of engaging in research involving interdisciplinary collaboration between trainee cognitive behaviour therapists working in the NHS and group analysts/groupwork practitioners. It makes the case for building on the results of this study by developing a protocol for a pre-post pilot study using a mixed methods approach to explore whether IGA-led groupwork in CBT training has any effect on patient outcomes and service key performance indicators.

Rehabilitative Health Care Professionals' Perceptions of Appearance-Based Professionalism.

Professionalism has been discussed and defined in a variety of ways, including attire and other forms of self-expression. To determine athletic trainer (AT), physical therapist (PT), and athletic training or PT students' perceptions of appearance-based professionalism in the workplace and, secondly, to ascertain how perceptions differed across professions. Cross-sectional study. Web-based survey. Athletic trainers, PTs, and athletic training and PT students who were predominantly White, non-Hispanic, female, aged 30 ± 9 years, and recruited via listservs and social media. The independent variables were participant demographics. The dependent variables were self-reported perceptions of professionalism for each photo. The survey consisted of 3 sections: demographics, 8 photos of ATs or PTs with depictions of patient-provider interactions, and open-ended responses. For each photo, participants selected yes, no, or unsure regarding the photo. An open-ended response was prompted with a no or unsure selection. The participant further described the reason for that choice. Most participants determined the health care provider depicted in 7 photos appeared professional. Only 1 photo was deemed unprofessional by the professional majority. Significant differences existed between students and professionals for 5 photos. The proportion of participants who reported the photos were unprofessional differed among professions for 2 photos. From our qualitative analysis, we found 6 domains: (1) unprofessional attire and hair, (2) situation-dependent attire, (3) role confusion and health care employer or employee identification, (4) nonappearance related, (5) tattoo-related bias, and (6) rethinking after question is displayed. What is considered appropriate and professional is not concrete. Differing concepts of professionalism generated biased judgments and criticisms. Our findings should lead providers to reexamine the definition of professionalism. The past should not dictate the future, and today's social mores can help shape the definition as it should be considered in today's settings.

Swedish massage as an adjunct approach to Help suppOrt individuals Pregnant after Experiencing a prior Stillbirth (HOPES): a convergent parallel mixed-methods single-arm feasibility trial protocol

BackgroundWomen experiencing pregnancy after stillbirth experience high levels of anxiety, fear and depression. Standard antenatal care may be emotionally unsuitable for many women at this time, and there is a lack of evidence on what interventions or approaches to care might benefit these women. Therapeutic massage may assist women after stillbirth by decreasing anxiety, worry and stress.ObjectiveThis paper outlines the objectives, methodology, outcome and assessment measures for the Helping suppOrt individuals Pregnant after Experiencing a Stillbirth (HOPES) feasibility trial which evaluates massage as an adjunct approach to care for pregnant women who have experienced a prior stillbirth. It also outlines data collection timing and considerations for analysing the data.MethodsHOPES will use a convergent parallel mixed-methods, single-arm repeated measures trial design in trained massage therapists’ private clinics across Australia. HOPES aims to recruit 75 individuals pregnant after a previous stillbirth. The intervention is massage therapy treatments, and participants will receive up to five massages within a 4-month period at intervals of their choosing. Primary quantitative outcomes are the feasibility and acceptability of the massage intervention. Secondary outcomes include determining the optimal timing of massage therapy delivery and the collection of measures for anxiety, worry, stress and self-management. A thematic analysis of women’s experiences undertaking the intervention will also be conducted. A narrative and joint display approach to integrate mixed-methods data is planned.DiscussionThe HOPES study will determine the feasibility and preliminary evidence for massage therapy as an intervention to support women who are pregnant after a stillbirth.Trial registration.ClinicalTrials.gov NCT05636553. Registered on December 3, 2022, and the trial is ongoing.

Telepractice Parent Training of Enhanced Milieu Teaching With Phonological Emphasis (EMT+PE) For Persian-Speaking Toddlers With Nonsyndromic Cleft Palate: Protocol for a Randomized Controlled Trial.

Children born with a cleft palate with or without a cleft lip (CP/L) are at increased risk for delayed language development and speech sound disorders. Enhanced Milieu Teaching with Phonological Emphasis (EMT+PE) is a recommended naturalistic intervention for toddlers with CP/L. The parents' role in providing naturalistic interventions is critical and they need training based on learning principles to implement these interventions. Telepractice is an appropriate method for training parents and children with various speech-related disorders. This study aims to determine and compare the effectiveness of telepractice and the parent-implemented EMT+PE intervention on language and speech measures in toddlers with CP/L with usual interventions and determine the effectiveness maintenance of the intervention. A randomized controlled trial (RCT) will assess the efficacy of telepractice and the parent-implemented EMT+PE intervention in enhancing speech and language measures in toddlers with CP/L. Eligible participants will be randomly assigned to one of 2 groups: the conventional intervention group and the EMT+PE intervention group. Participants' speech and language measures will be evaluated remotely by trained raters before and after the intervention and 2 months after the intervention. Parents of participants in the intervention group will receive 3 months of training in speech and language supportive strategies from trained therapists using telehealth fidelity scales. Parents of participants in the control group will receive the conventional speech and language intervention by cleft team therapists. Study outcomes will include language variables (mean length of utterance) and speech production variables (percent correct consonants). The protocol was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences in February 2022. The selection process of participants, as well as training therapists and raters, commenced in January 2022, the therapy and follow-up period ended in June 2023, and pre- and postintervention assessments have been conducted. Data analysis is ongoing, and we expect to publish our results by the summer of 2024. Funding is yet to be received. The results of this study may help us develop a speech and language intervention with a different delivery model for toddlers with CP/L, and the cleft team care can use these results in service delivery. Consistent with our hypothesis, speech and language measures are expected to improve. DERR1-10.2196/54426.

A pilot study evaluating online training for therapist delivery of interpersonal psychotherapy for eating disorders.

Individuals with eating disorders (EDs) often do not receive evidence-based care, such as interpersonal psychotherapy (IPT), partly due to lack of accessible training in these treatments. The standard method of training (i.e., in-person workshops) is expensive and time consuming, prompting a need for more scalable training tools. The primary aim of this pilot and open trial was to examine the effects of an IPT online training platform on training outcomes (i.e., IPT fidelity, knowledge, and acceptance) and, secondarily, whether online training was different from in-person training (using a comparative sample from a separate study) in terms of training outcomes and patient symptoms. Participants were therapists (N = 60) and student patients (N = 42) at 38 college counseling centers. Therapists completed baseline questionnaires and collected data from a student patient with ED symptoms. Therapists then participated in an IPT online training program and completed post-training assessments. Following online training, acceptance of evidence-based treatments, therapist knowledge of IPT, therapist acceptance of IPT, and treatment fidelity increased; acceptance of online training was high at baseline and remained stable after training. Using the 90% confidence interval on outcome effect sizes, results suggested IPT online training was not different from in-person training on most outcomes. Results are based on 60% of therapists who originally enrolled due to high dropout rate of therapist participants. Findings from this preliminary pilot study support the use of IPT online training, which could increase access to evidence-based ED treatment and improve patient care. Lack of accessible therapist training has contributed to many therapists not delivering, and therefore many patients not receiving, evidence-based treatment. This study evaluated a highly disseminable online training and compared outcomes to traditional in-person training and found that training and patient outcomes were not different. Online training has the potential to enhance access to evidence-base care, which could in turn optimize patient outcomes.

Assessing Therapy and Rehabilitation Comprehension of Chemical Labelling and Forming Chemical Safety Competence Specialists

Introduction. Considering the higher risk of man-made chemical disasters due to military operations, the demand for the training of qualified therapists and rehabilitators is increasing. Future healthcare professionals should be competent in chemical safety and fully possess information on the designation and classification of hazardous substances and the labelling of chemical substances. Therefore, the relevance of their competent risk assessment is growing regarding the use of dangerous chemical substances of an inorganic and organic nature and their anthropogenic influence.&#x0D; Aim and tasks. The paper aims to determine the formation of chemical safety competence among future specialists in therapy and rehabilitation.&#x0D; The results. A questionnaire established that future rehabilitators should acquire chemical safety competence to decipher hazard markings and possess information about the rules for working with chemicals based on a detailed study of the marking and labelling of chemical substances and rules for their use and disposal. Only 47.1% of the respondents (according to their assessment) knew the rules for handling chemicals, and 41.2% deciphered a potential danger to human health (carcinogenic effect). However, 88.2% of the higher education students interviewed wanted to develop chemical safety competence using unique chemical safety cards.&#x0D; Conclusions. The correct interpretation of the marking constituent elements allows for avoiding accidents and injuries while handling chemicals, and in the moment of a threat to human health or damage, allows the application of the given algorithm for providing first aid. Therefore, understanding the main components of chemical safety by future rehabilitators is possible through applying relevant knowledge, skills and abilities in further professional activities. However, future therapists and rehabilitators cannot correctly decipher the designation of the carcinogenic danger and do not have complete information about the rules for working with chemical substances. Therefore, it is necessary to conduct additional activities for future therapists and rehabilitators for their better understanding of the rules for handling chemicals and deciphering the dangers indicated on the labels of chemical products.

Efficacy and Feasibility of Short-Stretch Compression Therapy for Filarial Lymphedema in Sri Lanka.

The WHO-recommended essential package of care (EPC) for filarial limb lymphedema consists of daily limb washing, entry lesion management, limb protection, exercises, and elevation. Decongestive therapy (DT) with compression bandaging by trained lymphedema therapists adds additional benefit but is unavailable for most in low- and middle-income countries (LMICs). To determine whether DT using self-adjustable, short-stretch compression garments (SSCG), prefitted using portable, three-dimensional infrared imaging (3DII), would be effective and feasible in LMIC settings, we conducted a pilot 6-week, interventional, single-group, open-label pilot study in Galle, Sri Lanka. Ten participants with Dreyer stage 3 lymphedema used SSCG for 2 weeks after a 4-week lead-in EPC period. Effect of EPC and compression on quality of life was assessed using the 12-item WHO Disability Assessment Schedule 2.0 (WHODAS 2.0). Median participant age was 73 years (range: 32-85 years). Median percent limb volume reduction due to compression was 11.3% (range: 1.1-27.2%). WHODAS 2.0 scores did not change significantly between enrollment and study end. Garment acceptability was high throughout the study. These results provide proof of concept for 3DII-enabled SSCG in LMICs where trained therapists for filarial lymphedema may not be available.

Changes in BDNF methylation patterns after cognitive remediation therapy in schizophrenia: A randomized and controlled trial

Although cognitive remediation therapy (CRT) produces cognitive benefits in schizophrenia, we do not yet understand whether molecular changes are associated with this cognitive improvement. A gene central to synaptic plasticity, the BDNF, has been proposed as one potential route. This study assesses whether BDNF methylation changes following CRT-produced cognitive improvement are detected. A randomized and controlled trial was performed with two groups (CRT, n = 40; TAU: Treatment as Usual, n = 20) on a sample of participants with schizophrenia. CRT was delivered by trained therapists using a web-based computerized program. Mixed Models, where the interaction of treatment (CRT, TAU) by time (T0: 0 weeks, T1: 16 weeks) was the main effect were used. Then, we tested the association between the treatment and methylation changes in three CpG islands of the BDNF gene. CRT group showed significant improvements in some cognitive domains. Between-groups differential changes in 5 CpG units over time were found, 4 in island 1 (CpG1.2, CpG1.7, CpG1.10, CpG1.17) and 1 in island 3 (CpG3.2). CRT group showed increases in methylation in CpG1.2, CpG1.7 and decreases in pG1.10, CpG1.17, and CpG3.2. Differences in the degree of methylation were associated with changes in Speed of Processing, Working Memory, and Verbal Learning within the CRT group. Those findings provide new data on the relationship between cognitive improvement and changes in peripheral methylation levels of BDNF gene, a key factor involved in neuroplasticity regulation.Trial Registration: NCT04278027.

Assessing the Awareness and Practices of Physical Therapists in Managing Modifiable Risk Factors for Stroke in Saudi Arabia

Aims &amp; Objective: The current research on physical therapists' understanding of managing modifiable risk factors for stroke in Saudi Arabia is limited. This study aims to evaluate physical therapists' knowledge in Saudi Arabia on managing modifiable stroke risk factors and their prioritization of stroke prevention. It also seeks to understand the connection between therapists' awareness, experience, perceptions, and information access with their readiness to apply stroke prevention measures. Methodology: A cross-sectional online questionnaire survey was administered to registered Physical therapists in the Riyadh region between February and July of 2022. An online questionnaire was developed with 18 questions to evaluate the knowledge and perception of the Physical therapist about the risk factors and management of stroke. Socio-demographic information, participant's knowledge and perception of stroke risk factors, and participant's stroke risk factor sources of information. Results: The results of this survey suggest that while most physical therapists in Saudi Arabia have a good understanding of stroke risk factors, there are still some knowledge gaps that need to be addressed. The fact that a significant percentage of respondents were unsure about the relationship between some risk factors and stroke highlights the need for ongoing education and training for physical therapists in this area. Conclusions: The findings underscore the importance of education, training, work experience, and sources of knowledge in shaping physical therapists' beliefs and practice behaviors.

Use of cupping therapy in musculoskeletal disorders: A cross-sectional study on the profile, training, and practice of Brazilian physical therapists

IntroductionCupping therapy is a widely used technique in Brazilian physical therapy for the treatment of musculoskeletal disorders. However, there is limited scientific evidence to support its effectiveness. ObjectiveTo investigate the profile, training, clinical practice, and scientific updates of Brazilian Physical Therapists who use cupping therapy as a therapeutic resource for musculoskeletal disorders. MethodsA cross-sectional study was conducted through an online questionnaire, including 646 Physical Therapists who use cupping therapy in their practice. All data were analysed descriptively. ResultsCupping therapy is a technique that has been widely adopted in clinical practice by Physical Therapists, particularly among young, female professionals who have recently graduated from private universities. The primary reason for interest in this technique among these Physical Therapists is the high demand from patients. Additionally, it is often used in conjunction with other manual therapeutic techniques. They identified easy access, low cost, and ease of use as the key factors that make cupping therapy an attractive option. However, a lack of high-quality scientific evidence, as described in the literature, was identified as a major barrier to its use. ConclusionThe Physical Therapists included in this study use cupping therapy in their clinical practice, relying heavily on their own experience and the preferences of their patients, rather than utilizing the third pillar of evidence-based practice, which is to rely on the best available evidence. This study suggests that these Physical Therapists are currently implementing a technique without current scientific recommendations for its use in the treatment of musculoskeletal disorders.

Attention Autism™ training for occupational therapists: a pilot study

Purpose At present, there is no reference to Attention Autism (AA) as a framework and therapeutic tool with autistic children in occupational therapy (OT) literature. By way of introducing AA as a potential intervention to the OT community, this study aims to investigate the extent to which participation in a two-day AA training could contribute to increasing confidence and inspire changes in practice for Irish occupational therapists (OTs) supporting autistic children. Design/methodology/approach A pilot study design with mixed qualitative and quantitative methods was used to evaluate the impact of a two-day AA training on six OTs. The OTs support autistic children throughout Ireland across public, private and voluntary sectors. They completed brief, non-standardised questionnaires 2 weeks before the training (Time 1) and again 12 weeks post (Time 2) training session. At Time 2, additional exploratory questions were answered by OTs regarding their use of AA in practice. Findings This explorative study’s quantitative findings presented percentage change increases within three areas of confidence for all OTs. These include establishing attention, motivating and developing functional skill goals with autistic children. One of the participants did not score any change in confidence in a fourth area, building rapport, however, the five other participants scored percentage change increases. Qualitative data provided by participants showed that they were implementing AA in practice since attending the training. Five of the participants reported positive experiences of using AA and one participant reported the programme was not suitable for her caseload because of their level of understanding and need. Research limitations/implications This was a small, exploratory, practice-based study. As this is the first study exploring this area of practice for OTs, to the best of the authors’ knowledge, there were no standardised methods of assessment available, therefore a self-designed survey was used by the author which had a limited number of open-ended questions and four Likert scale questions. This study was also limited in that there was one main researcher who also delivered the two-day AA training. The sample data set was small which resulted in the limitation of the choice of methods used to analyse the quantitative data. Percentage changes were used as the only available and reliable method for a small data set. Originality/value Findings of this study, despite their preliminary nature, indicate that AA training may be a useful professional development consideration for OTs who provide a service for autistic children. Further AA research in OT is required including larger and more rigorous studies. An alternative training option of The Curiosity Programme may be considered for OTs supporting children who may not yet be ready to participate in AA.

Reliability and validity of an app-assisted tissue compliance meter in measuring tissue stiffness on a phantom model.

Most methods for soft tissue stiffness assessment require high financial resources, significant technical effort, or extensive therapist training. The PACT Sense device was developed to be used in a wide range of applications and user groups. However, to date, there are no data on its validity and reliability. The aim of this study was to investigate the validity and reliability of the PACT device. A polyurethane phantom tissue model (PTM) mimicking the mechanical properties of the fascia profunda and the erector spinae muscle was used. Stiffness measurements with PACT were conducted by two independent investigators. For construct validity, correlations were calculated between the known stiffness of the PTM and values obtained with PACT. For concurrent validity, we determined the association between the PACT values and additional measurements with the established MyotonPRO device. To estimate interrater and intrarater (two measurements with an interval of 7 days) reliability, we used the intraclass correlation coefficient (ICC). Correlation analysis (PTM/PACT) revealed very high concurrent validity (r = 0.99; p < 0.001), construct validity (PACT/MyotonPRO) was 0.87, p < 0.001. Both, interrater reliability (ICC = 0.85; p = 0.036) and intrarater reliability were good (ICC = 0.89; p < 0.001). The PACT provides valid and reliable stiffness measurements in tissue phantoms. Further studies in humans are needed to confirm its physiometric properties under in vivo conditions.

Solutions Trial: Solution Focused Brief Therapy (SFBT) in 10–17-year-olds presenting at police custody: a randomised controlled trial

BackgroundWithin England, children and young people (CYP) who come into police custody are referred to Liaison and Diversion (L&D) teams. L&D teams have responsibility for liaising with healthcare and other support services while working to divert CYP away from the criminal justice system but have traditionally not provided targeted psychological interventions to CYP. Considering evidence that Solution Focused Brief Therapy (SFBT) leads to a reduction in internalising and externalising behaviour problems in CYP, the aim of this randomised controlled trial (RCT) was to determine whether there is a difference between services as usual (SAU) plus SFBT offered by trained therapists working within a L&D team, and SAU alone, in reducing offending behaviours in 10–17-year-olds presenting at police custody.MethodsDesign: two-arm individually RCT with internal pilot and process evaluation.Participants: N = approximately 448 CYP aged 10–17 years presenting at one of three police custody suites in the area served by Lancashire and South Cumbria NHS Foundation Trust (LSCFT) who are referred to the L&D team. Participants will be recruited and allocated to intervention:control on a 1:1 basis. Interviews will be performed with 30–40 CYP in the intervention arm, 15 CYP in the control arm, up to 20 parents/guardians across both arms, up to 15 practitioners, and up to 10 site staff responsible for screening CYP for the trial.Intervention and control: Those allocated to the intervention will be offered SAU plus SFBT, and control participants will receive SAU only.Primary outcome: CYP frequency of offending behaviours assessed through the Self-Report Delinquency Measure (SRDM) at 12 months post-randomisation.Secondary outcomes: criminal offence data (national police database); emotional and behavioural difficulties (self-report and parent/guardian reported); gang affiliation (self-report).Process evaluation: evaluation of acceptability and experiences of the CYP, parents/guardians, site staff and practitioners; fidelity of SFBT delivery.DiscussionThis two-arm individually RCT will evaluate the effectiveness of SFBT in reducing offending behaviours in CYP presenting at police custody suites within the area served by LSCFT. Our process evaluation will assess the fidelity of delivery of SFBT, the factors affecting implementation, the acceptability of SFBT in CYP aged 10–17 years and recruitment and reach. We will also examine systems and structures for future delivery, therefore assessing overall scalability.Trial registrationClinicalTrials.gov ISRCTN14195235. Registered on June 16, 2023.

State of the Science: LGBTQ-Affirmative Psychotherapy

Sexual and gender minority (SGM) individuals experience significantly higher levels of depression, anxiety, and behavioral comorbidities (i.e., substance use, suicide) compared to heterosexual and cisgender individuals. LGBTQ-affirmative psychotherapy aims to ameliorate the adverse psychosocial processes, ultimately caused by stigma, that underlie this disparity. Over the past two decades, the mental health field has introduced professional guidelines and treatment protocols for LGBTQ-affirmative psychotherapy, and established their efficacy across distinct SGM populations, delivery modalities, and settings. This state of the science review outlines the history, current evidence, and future directions of LGBTQ-affirmative psychotherapy. It provides an historical account of clinically relevant research for SGM populations and outlines the factors that moved the field from pathologizing perspectives to affirmative approaches. It then discusses the current evidence for LGBTQ-affirmative psychotherapy, as well as studies identifying treatment moderators, including race/ethnicity and stigma exposure, as well as potential treatment mechanisms, including hypervigilance, shame, negative self-schemas, unassertiveness, and emotion dysregulation. SGM individuals can only benefit from LGBTQ-affirmative psychotherapy if protocols are widely available and used by therapists. To this end, the article presents current findings on implementation and dissemination, such as therapist training, and different treatment delivery modalities. Finally, the article outlines an agenda for future research to advance the field of LGBTQ-affirmative psychotherapy, including identifying treatment mechanisms, successfully implementing and disseminating treatment protocols, determining which contexts and client characteristics warrant adaptations to current protocols, and understanding how LGBTQ-affirmative psychotherapy can interact with structural and systemic conditions to exert the strongest possible impact on SGM mental health.