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This study aimed to explore the views of family carers of people living with dementia from ethnic minority groups and their therapists on internet-delivered, self-help acceptance and commitment therapy for family carers (iACT4CARERS), enhanced with additional therapist guidance. To achieve this, a qualitative approach with semi-structured interviews was employed with ethnic minority carers who completed Enhanced iACT4CARERS (n=9) and therapists who supported them throughout the programme (n=5). The interviews were audio-recorded, transcribed and analysed using framework analysis. Four over-arching themes were identified: (1) Value of the programme to ethnic minority carers, (2) Barriers for ethnic minority carers, (3) Sense of connectedness through written feedback, and (4) Sense of connectedness through one-to-one sessions. Theme 1 reflected that ethnic minority carers valued ACT techniques, highlighting their usefulness and simplicity, leading to perceived benefits. Theme 2 revealed the irrelevance of examples provided of carer experiences throughout the programme due to differences in family carers’ experiences of providing care within ethnic minority communities. Theme 3 highlighted that carers’ engagement with the programme was facilitated by feelings of validation and encouragement received from their therapist via weekly written feedback. Finally, Theme 4 highlighted that additional one-to-one support sessions allowed both carers and therapists to develop strong therapeutic relationships. This enhanced subsequent text-based online interactions, allowing carers to be more open and engaged. Also, therapists reported that a strong sense of connectedness helped them to tailor their feedback. Enhanced iACT4CARERS that uses carers’ experiences more relevant to ethnic minority communities may be more acceptable.
Key learning aims
(1) To understand the views of family carers of people living with dementia from ethnic minority groups and their therapists on internet-delivered, self-help acceptance and commitment therapy (ACT), which has been found to be feasible and acceptable with White British carers.
(2) To understand whether additional one-to-one support can help develop effective therapeutic relationships and thus improve the experiences of carers in completing the programme.
(3) To learn whether any cultural adaptations are needed to improve the acceptability of internet-delivered self-help ACT among this population.
This qualitative systematic review aimed to synthesise existing qualitative research on HCPs’ perceptions and experiences of obesity and its management in primary care settings.
Background:
Healthcare professionals (HCPs), particularly those in primary care, play a key role in policy implementation around weight management. Overweight and obese individuals are subject to weight stigma which has negative health consequences and reduces the likelihood of healthcare service usage. An understanding of HCPs’ perceptions of obesity and weight management in primary care is necessary for the development and delivery of effective initiatives.
Methods:
A search strategy developed using the SPIDER framework was applied to Medline and CINAHL databases. Inclusion criteria were applied, and quality assessment was undertaken using the CASP framework. Fifteen papers meeting the inclusion criteria were analysed thematically.
Findings:
Four themes were identified: conflicting discourses surrounding obesity, medicalisation of obesity, organisational factors, and lack of patient knowledge and motivation. Conflicting discourses around obesity refers to the differing views of HCPs regarding what it means to have and treat obesity. Medicalisation of obesity considers whether obesity should be treated as a medical condition. Organisational factors were identified as knowledge, resources and time that affected HCPs’ ability to provide care to overweight or obese. Finally, the review discovered that patients required their own knowledge and motivation to lose weight. This review has highlighted the need to provide safe, non-judgemental spaces for HCPs and patients to discuss weight and weight loss. This is essential to the therapeutic relationship and the provision of effective obesity management.
Mental health services have changed beyond recognition in my 38-year career. In this editorial I reflect on those changes and highlight the issues that undermine patient care and damage staff morale. In particular, modern mental health services have undermined the therapeutic relationship, the bedrock underpinning all psychiatric treatment.
The focus of this chapter is the moral aspects of the nurse–patient relationship. Some people might think Carole is treating Christine with disrespect by misleading and then avoiding her. Others might think Carole is just being realistic. After all, the doctor really is busy and will not be free until 11.30 a.m. In order to work out whether or not this is an appropriate way to treat a patient, the nurse will need to have a good understanding of their responsibilities to their patients and the moral basis of those responsibilities.
Rights and obligations are like two sides of the same coin. A legal right comes with a corresponding obligation, or duty. A right is a legal entitlement to do something, and an obligation is the constraint upon individuals’ behaviour that comes with that entitlement. However, the nurse–patient relationship involves more than legalities. As discussed in Chapter 1, interpersonal relationships involve moral values, such as respect, beneficence and compassion.
The term trauma comes from the ancient Greek word “titrosko” than means perforate. Sexual harassment and abuse of a person during childhood is an important risk factor for mental trauma.
Objectives
Present the impact of sexual harassment and abuse in the mental health of adolescents and the imprortance of therapeutic relationship.
Methods
From the literature review the child needs love which is demostrated with tenderness. The adult (perpetrator) with a disorder responds to the child’s tenderness with the language of passion. The immature Ego of the child is not strong enough to deal with the adult behavior and this causes anxiety, helplessness, confusion and guilt about the relationship with the adult. During the psychotherapeutic process, 4 main protagonists emerge : the victim, the perpetrator, an absent mother and an omnipotent savior.
Results
Mental trauma can adversely affect the development of the neurobiological system resulting in difficulty coping with stressful events. Untreated trauma can lead to serious psychopathology such as anxiety disorders , depressive disorder, personality disorders, addictions. The creation of a therapeutic relationship, understanding the adolescent and his family potential, the recognition and treatment of transference-countertransference phenomena and the existence of a clinical setting that acts as a restraint mechanism could contribute to the therapy of mental trauma.
Conclusions
The Therapeutic Department for Adolescents could be an environment to contain, process and transform the painful into pleasant emotions, as well as aiming the authenticity of the person with a history of sexual harassment and abuse.
Michaelson & Rahim describe a very welcome sustainable training framework for teaching clinical communication skills to trainees on MRCPsych courses. This commentary expands on their article, noting how psychiatrists listen and ask questions affects the therapeutic relationship and patients’ willingness or ability to disclose sensitive information, which is particularly important in risk assessment. Extending videorecording role-plays in training to routine (including remote) clinical consultations and involving patients and carers in training will be key to identifying communication that has a positive impact on patient experience and outcomes.
Establishing a treatment relationship with a mental healthcare provider can be difficult for myriad reasons. This chapter discusses the different types of mental healthcare providers, including prescribing clinicians, psychotherapists, and behavior analysts. All bring a unique and useful perspective to treatment. When deciding on the right provider, it is important to consider the symptoms and behaviors to be addressed. Providers can be found through recommendations of primary care physicians, PWS associations, professional organizations, state licensing boards, and recommendations of friends or family members. Finally, while ending a relationship with a provider can be difficult, there are times when it may be necessary in order to provide continuity or improve the quality of care you or your loved one is receiving. A collaborative relationship with your loved one’s treating clinician is based on trust and strengthened overtime. With careful cultivation, your relationship with a provider can prove to be long-lasting support to your loved one with PWS.
Clinical psychological practice is founded upon the therapeutic relationship. A science-informed practice then requires that the elements used to build that relationship have an evidence base. Thus, the chapter reviews the empirical foundations of the therapeutic relationship and what steps can be taken to build a therapeutic alliance that correlates positively with beneficial treatment outcomes. The chapter outlines in practical steps how strong therapeutic relationships can be built by evidence-based practices that strengthen the alliance in an empathic manner. It illustrates key skills of building empathy through encouraging, re-stating, and paraphrasing communications in a manner that conveys to the patient an understanding of the content and the emotion behind what is communicated. The chapter concludes with a discussion of problems that can arise in the therapeutic relationship and practical steps to manage alliance ruptures.
Assessment in the mental health field is a dynamic process of learning, using experience and applying multiple sources of knowledge and evidence. This chapter presents an overview of assessment practices and processes undertaken within formal mental health care and discusses these within the context of consumer–health practitioner partnerships. We start by considering how assessment practices are a prominent feature of understanding a person’s situation and life context, and how these need to be based on the principles of person-centred, trauma-informed care and cultural safety. We discuss the importance of engagement and therapeutic relationships skills in ensuring consumers, carers and family members are meaningfully connected within a process for identifying the mental health problems the person is experiencing. Part of this awareness is reflecting on what it is like for a person to be assessed, and the power dynamics involved in naming experience, symptoms and diagnosis. The chapter then looks at the paradigm of comprehensive assessment, with specific discussions about strengths-based assessment, mental state examination and the roles of different health professionals.
Assessment in the mental health field is a dynamic process of learning, using experience and applying multiple sources of knowledge and evidence. This chapter presents an overview of assessment practices and processes undertaken within formal mental health care and discusses these within the context of consumer–health practitioner partnerships. We start by considering how assessment practices are a prominent feature of understanding a person’s situation and life context, and how these need to be based on the principles of person-centred, trauma-informed care and cultural safety. We discuss the importance of engagement and therapeutic relationships skills in ensuring consumers, carers and family members are meaningfully connected within a process for identifying the mental health problems the person is experiencing. Part of this awareness is reflecting on what it is like for a person to be assessed, and the power dynamics involved in naming experience, symptoms and diagnosis. The chapter then looks at the paradigm of comprehensive assessment, with specific discussions about strengths-based assessment, mental state examination and the roles of different health professionals.
An effective, parsimonious way to treat patients who present with comorbid conditions and other complexities is to use process-based, generic CBT employing case conceptualization. This approach allows therapists to assess and target the patient’s maladaptive processes in functioning that may underlie several areas of diagnostic concern, and whose remediation may produce multiple clinical benefits. The case conceptualization serves as a road map to understand the patient’s subjective phenomenology, thus facilitating well-targeted interventions and abetting the therapeutic relationship. The case of Zina demonstrates how the patient’s avoidance strategies and maladaptive schemas played roles in her mood disorder (with suicidality), anxiety, eating disorder, substance use, and purging – and how all of these interfered with her life goals. The therapist prioritized Zina’s safety and attended closely to the therapeutic relationship. The case conceptualization helped illuminate ways to enhance Zina’s participation in treatment (including pharmacotherapy). Eighty sessions produced positive results.
Engagement is increasingly recognised as important for maximising rehabilitation outcome following stroke. However, engagement can be challenging when neurological impairment impacts a persons’ ability to activate the regulatory processes necessary for engagement and in the context of a changed self. We explored engagement in stroke rehabilitation from the perspective of people with stroke with a primary focus on identifying key processes that appeared important to engagement in stroke rehabilitation.
Design and Methods:
This study drew on Interpretive Description methodology. Maximum variation and theoretical sampling were used to capture diversity in the sample and access a depth and breadth of perspectives. Data collection included semi-structured interviews with people with stroke (n = 19). Data were analysed through a collaborative and iterative process drawing on range of analytical tools including coding, memoing, diagramming and group discussions.
Findings:
Our findings highlight that engagement is a complex, nuanced, responsive, flexible and inherently two-way process. Developing connections appeared central to engagement with connections taking various forms. The most fundamental was the therapeutic connection between the person with stroke and their practitioner as it provided the foundation on which to build other connections. Connection was made possible through five collaborative processes: Knowing, Entrusting, Adapting, Investing and Reciprocating.
Conclusions:
Engagement is a social and relational process enabled through an inherently person-centred approach and active and ongoing reflexivity – highlighting the importance of a humanising approach to care where aspects of self, care and emotion are evident, for both the person with stroke and their practitioner.
This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists’ workload, (3) therapists’ confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists’ burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.
Key learning aims
(1) To understand which factors facilitated therapists’ positive perceptions and acceptability of providing internet-delivered guided self-help ACT (iACT4CARERS).
(2) To understand what challenges acted as barriers to therapists’ positive perceptions and acceptability of providing iACT4CARERS.
(3) To learn what aspects of the training and the intervention can be refined to improve the acceptability to therapists in trials involving internet-delivered guided self-help interventions for family carers.
Therapeutic connections enhance patient experience and outcomes after neurological injury or illness. While we have some understanding of the components necessary to optimise therapeutic connections, these have developed from western-centric ideals. This study sought to explore the perspectives of Māori brain injury survivors, and their whānau (wider family and community), to develop more culturally informed understandings of what matters most for Māori in the development and experience of therapeutic connection.
Design and Methods:
A bicultural approach underpinned by principles of Kaupapa Māori Research was used. Whānau views and experiences were gathered through wānanga (focus groups). These perspectives were analysed drawing on Māori methods of noho puku (self-reflection), whanaungatanga (relational linkage) and kaitiakitanga (guardianship).
Findings:
Three wānanga were held with 16 people – 5 brain injury survivors and 11 whānau members. The phrase ‘therapeutic connection’ did not resonate; instead, people spoke of meaningful connections. For rehabilitation encounters to be meaningful, three layers of connection were acknowledged. The elemental layer features wairua (spirit) and hononga (connection) which both underpinned and surrounded interactions. The relational layer reflects the importance of whānau identity and collectivism, of being valued, known, and interactively spoken with. Finally, the experiential layer consists of relational aspects important within the experience: relationships of reciprocity that are mana-enhancing and grounded in trust. These layers are interwoven, and together serve as a framework for meaningful connections.
Conclusions:
Meaningful connections in neurorehabilitation are underpinned by wairua and hononga; are multi-layered; are enabled through interactions with people, practice, process and place; are inclusive of whānau and resonate with Māori worldviews. The primacy of wairua and whānau within an interconnected view of health, challenges individualistic notions inherent in western health models and deepens existing understandings of meaningful connections in neurorehabilitation which can guide future rehabilitation research, teaching and practice.
A positive therapeutic (or working) alliance has been associated with better outcomes for clients in the psychotherapeutic and traumatic brain injury (TBI) rehabilitation literature. The aim of this pilot study was to gain an understanding of the therapeutic alliance in community rehabilitation from the perspectives of adults with TBI and their close others who have completed a community rehabilitation programme.
Method:
This study used a constructivist, qualitative methodology which applied grounded theory analysis techniques. Using purposeful sampling, three pairs of participants (adults with TBI and close others) who had finished a community rehabilitation programme completed separate in-depth interviews which were transcribed verbatim and progressively analysed using a process of constant comparison.
Results:
A preliminary framework illustrating participants’ experience of a therapeutic alliance was generated, comprising three interconnected themes: being recognised as an individual, working together and feeling personally connected. All participants viewed being able to work together as important in their experience of community rehabilitation and described features that helped and hindered the alliance.
Conclusion:
These pilot study results demonstrate the importance of the therapeutic alliance to the rehabilitation experience of individuals with TBI and those close to them.
As in many areas of life, the covid-19 epidemic has had a great impact on psychological counselor training. Although studies and practices on online counseling are increasing every day in the world, there has not been a psychological counseling method preferred by experts in Turkey, which comes from community culture and, where physical contact is important, until the pandemic.
Objectives
The examination of the opinions of the students studying in the last year of the psychological counseling and guidance undergraduate program during the pandemic regarding online counseling, where they perform their first psychological counseling experience.
Methods
The study was conducted with 10 counseling students, 9 women and 1 Man. The age range of the students is 22-24 and the average age is 20.6. The students’ opinions are taken with open-ended questions such as “Can you share your views on online counseling before online counseling?“ The reflection letter that the students responded to was subjected to content analysis.
Results
The findings of the study show that there are four themes: Emotions before the counseling process, Thoughts before the counseling process, Therapeutic relationship, Online counseling in professional life. For example; in online counseling, negative emotions such as anxiety, excitement, fear, anxiety, stress, anxiety, as well as feeling comfortable and safe are among the positive feelings they experience in their therapeutic relationships.
Conclusions
As a result, although students have a positive view of online counseling, they mainly prefer to do it face-to-face. The findings were discussed taking into account Turkish culture.
In mental health nursing, the therapeutic relationship is central to the care process, since the restoration of the balance of the person in mental suffering relies on significant interpersonal relationships.
Objectives
This scoping review aims to map which personal qualities of the nurse favor the therapeutic relationship in mental health nursing.
Methods
A question was formulated according to the PICo method: What are the nurse’s personal qualities that benefit the therapeutic relationship with the patient in mental health settings? For the selection of studies were used the following databases: Cochrane Database of Systematic Reviews; CINAHL; MEDLINE. A survey was carried out, with the following Boolean conjugation (nurse AND patient) and (personal AND qualities) and (mental AND health) and (therapeutic relation OR relation*). The limit applied to this research was the full text.
Results
A total of 12 studies were analyzed. These are predominantly qualitative with different methodological approaches. The nurse’s personal attributes or qualities imply not making judgments, be patient, be open and genuine. It was also evidenced the importance of the professional and personal dimensions in the therapeutic relationship.
Conclusions
In all studies, it was clear that the therapeutic relationship is influenced by attributes of the professional dimension that are linked, mainly, with the theoretical domain, technical knowledge and by attributes of the personal dimension that are related with the professional’s personal qualities or characteristics. The strategies used for the development of the therapeutic relationship imply the involvement of the person nurse, using this to elements of the personal and social sphere.
Many family-based interventions for child and adolescent mental health problems rely on the engagement of mothers, and fathers have often been overlooked or excluded. However, given the evidence that children receive better outcomes from interventions when fathers participate, the lower participation rate of fathers relative to mothers represents an area for immediate action. This chapter describes the benefits of engaging both parents in assessment and interventions and common barriers to engaging fathers. It also explores a range of process strategies that clinicians can enact to enhance the engagement of fathers in assessment and treatment for child mental health problems. Finally, it describes a range of clinician competencies in relation to the engagement of fathers. The participation of fathers as well as mothers ensures a thorough approach to assessment, diagnosis, case formulation and treatment in family-based interventions, thereby potentially increasing the overall effectiveness of treatment for child mental health problems.
Precision psychiatry is currently described as an approach that would bring significant advance to psychiatric clinical practice. Theaim of this article is to investigate Precision Psychiatry’s promise for the future; should we substantially invest in this new approach? Thearticle is based on a review of the literature and reports a conceptual analysis. A critical examination of Precision Psychiatry’s foundationsshows us that its fundaments are obsolete and flawed: we cannot reduce mental suffering to essences in biology. It is problematic to statethat biological processes hold and capture qualia and meaning, and in themselves and without context would hold and capture somethinglike abnormality. Despite its good efforts, precision psychiatry does not represent a sufficiently promising alternative to the phenotyping thatcomes with the current classification systems.
Patterns of interaction and attitudes in the relationships of 21 young schizophrenic patients, their parents and therapists were explored and compared with each other in this pilot study. The focus was on expressed emotion (EE), which was revealed to have an important impact on the course of the illness. In this study, the EE status of the relatives as well as of the therapists was rated using the five-minute speech sample method. Furthermore, data on the quality of interaction of therapists and parents with the patients were derived from the therapist/relative-patient interaction scale. Results showed that one-third of both the therapists and the parents were rated high on EE. High-EE relatives were rejected and perceived as inscrutable by the patients. The assessment of the therapeutic and familial relationships demonstrated the patients’ need for unequivocal communication. Differences and similarities in the interaction styles, and their implications for research and therapy are discussed.