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Therapeutic Alliance (therapeutic + alliance)

Distribution by Scientific Domains

Psychology	57%
Medical Sciences	26%
Humanities and Social Sciences	16%

Selected Abstracts

IMPACT OF MARITAL AND PSYCHOLOGICAL DISTRESS ON THERAPEUTIC ALLIANCE IN COUPLES UNDERGOING COUPLE THERAPY

JOURNAL OF MARITAL AND FAMILY THERAPY, Issue 2 2005
Salima Mamodhoussen
In this study, we describe the psychometric properties of the Couple Therapy Alliance Scale, revised (CTAS,r) and investigates the impact of marital and psychiatric distress on alliance. Seventy-nine couples in therapy completed a French version of the Dyadic Adjustment Scale and of the Psychiatric Symptoms Index at session one, and a French version of the CTAS,r at session three. Results indicate that the French version of the CTAS,r has adequate psychometric properties, although the subscales of the instrument are highly intercorrelated. Furthermore, marital adjustment predicts alliance scores, whereas psychiatric symptoms do not. Finally, male marital adjustment and female psychiatric symptoms are lower in couples where spouses have divergent perceptions of the alliance. Future research directions are discussed. [source]

THE THERAPEUTIC ALLIANCE IN HOME-BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

JOURNAL OF MARITAL AND FAMILY THERAPY, Issue 1 2002
Lee N. Johnson
This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented. [source]

Early Therapeutic Alliance as a Predictor of Treatment Outcome for Adolescent Cannabis Users in Outpatient Treatment

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 2006
Guy S. Diamond PhD
The association of early alliance to treatment attendance and longitudinal outcomes were examined in 356 adolescents participating in a randomized clinical trial targeting cannabis use. Both patient and therapist views of alliance were examined, and outcomes were evaluated over 12 months after numerous other sources of variance were controlled. Patient-rated alliance predicted a reduction in cannabis use at three and six months and a reduction in substance-related problem behaviors at six months. Therapist-rated alliance did not predict outcomes. Neither patient nor therapist alliance ratings were associated with attendance. The findings support the important and often overlooked role that alliance can play in treating substance abusing, often delinquent, adolescents. [source]

How do adolescents with bulimia nervosa rate the acceptability and therapeutic relationship in family-based treatment?

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 5 2008
Shannon L. Zaitsoff PhD
Abstract Objective: To describe therapeutic alliance and treatment acceptability ratings of adolescents with bulimia nervosa (BN) participating in family-based treatment (FBT-BN) and to explore how participant characteristics relate to these constructs. Method: Adolescents with BN (n = 80) in a randomized controlled trial comparing FBT-BN and individual supportive psychotherapy (SPT), completed the Eating Disorder Examination, Rosenberg Self-esteem Scale, and Beck Depression Inventory prior to treatment. The Helping Relationship Questionnaire, patient expectancy for treatment, treatment suitability, and self-reported estimates of improvement ratings were obtained at multiple points throughout treatment. Results: Therapeutic alliance and treatment acceptability ratings were positive in both treatments and generally did not differ. Within FBT-BN, more severe eating disorder symptomatology pretreatment was related to lower alliance ratings mid-treatment (p < .05). However, reductions in binge and purge behaviors over the course of treatment were not related to alliance or acceptability for participants in FBT-BN (all p's > .10). Conclusion: Contrary to expectations of FBT-BN, adolescents receiving both treatments develop a strong alliance with the therapist. © 2008 by Wiley Periodicals, Inc. Int J Eat Disord 2008 [source]

Annotation: The therapeutic alliance , a significant but neglected variable in child mental health treatment studies

THE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 5 2006
Jonathan Green
Background:, There has been relatively little research into therapeutic alliance in child and adolescent mental health and virtually no incorporation of alliance measures as a variable in treatment trials in Child and Adolescent Mental Health Services (CAMHS). Method:, A selective literature review on studies in therapeutic alliance in adulthood and childhood along with a theoretical formulation of possible mechanisms of alliance. Results:, Therapeutic alliance is reliably measurable both by observation and questionnaire methods at all points in the treatment cycle. In both adult and child studies it shows a consistent, albeit modest, association with treatment outcome. In specific adult studies it has shown a high predictive validity in relation to outcome compared to other variables. In child studies alliance is particularly salient in externalising disorder and predicts outcome of inpatient treatment. Child alliance and parental alliance are independent factors. Theoretical models of alliance outlined in this paper suggest testable hypotheses regarding predictors for positive and negative alliance. Conclusions:, Therapeutic alliance in CAMHS is measurable and worth measuring. It is likely to be an important variable for treatment outcome studies and should be included in future trial designs. [source]

Exploring therapeutic alliance in brief inpatient psychotherapy: a preliminary study

CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 5 2010
Mark A. Blais
Abstract Background: Therapeutic alliance is one of the most widely investigated variables in psychotherapy research but few studies have explored its role in inpatient psychotherapy. Many factors likely contribute to the lack of inpatient alliance research including the short length of hospital stays, complexity of patient psychopathology and the burdensome quality of most alliance scales. This paper reports on the development and initial application of two comparable brief scales designed to capture patient and therapist alliance ratings. Method: Participants were 20 patients receiving supportive,expressive inpatient psychotherapy. The patients were predominantly depressed women. Baseline measures of distress, symptom severity and functioning were obtained at the first and third sessions. Measures of alliance were obtained at the second session. Results: The brief alliance scales demonstrated adequate internal consistency and the individual items had good adjusted item-to-scale correlations. Consistent with the broad alliance literature, we found that patients rated alliance higher than therapists, patient and therapist alliance ratings were not significantly correlated, and level of functioning was significantly associated with both patients and therapists' alliance ratings. The perceived depth of psychotherapy was also significantly associated with alliance. Unexpectedly, alliance ratings were also negatively associated with improvement during hospitalization. Conclusions: Overall, the study demonstrates both the feasibility and potential benefit of conducting inpatient psychotherapy research.,Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: This paper shows that inpatient psychotherapy can be studied and potentially improved through the application of brief targeted instruments. [source]

The relationship of patient defensive functioning and alliance with therapist technique during short-term psychodynamic psychotherapy

CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY (AN INTERNATIONAL JOURNAL OF THEORY & PRACTICE), Issue 1 2006
Caleb J. Siefert
This study investigates the relationship of patient defensive functioning, therapeutic alliance and therapists' use of technical interventions in Short-Term Psychodynamic Psychotherapy (STPP; Book, 1998; Luborsky, 1984; Strupp & Binder, 1984; Wachtel, 1993). Participants in this study were 44 patients admitted for individual psychotherapy at a university based outpatient community clinic. Patient defensive functioning was assessed with the Defensive Functioning Scale (DFS) of the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994). Therapeutic alliance was assessed using patient ratings from the Combined Alliance Short Form (CASF; Hatcher & Barends, 1996). External raters coded videotaped sessions using the Comparative Psychotherapy Process Scale (CPPS; Hilsenroth, Blagys, Ackerman Bonge & Blais, in press) to assess the use of Psychodynamic,Interpersonal (PI) and Cognitive,Behavioral (CB) techniques early (third or fourth session) in psychotherapy. Patient Overall Defensive Functioning (ODF) was found to predict therapists' overall use of PI interventions, as well as specific PI and CB interventions. Additionally, patients who utilized fewer adaptive defenses were found to receive more PI interventions in general. The implications of these findings for treatment planning and intervention are discussed.,Copyright © 2006 John Wiley & Sons, Ltd. [source]

Do early therapeutic alliance, motivation, and stages of change predict therapy change for high-risk, psychopathic violent prisoners?

CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2010
Devon L. L. Polaschek
Background,Examination of the extent of offenders' engagement in change, and in rehabilitation programmes, is important to understanding success or failure following rehabilitation. In treatment programmes, the alliance between therapist and offender, and the therapy process itself appear central to progress offenders make that may reduce their criminal risk. But research with offenders seldom has measured therapeutic alliance and clinical writing suggests that it is difficult to form an alliance with those not ready to change their behaviour; especially with higher risk and psychopathic offenders. Aims and Methods,This study outlines the course of the therapeutic alliance in an 8-month treatment programme for high-risk, PCL-psychopathic violent prisoners. It examines relationships between early-treatment therapeutic alliance, therapists' global ratings of motivation to change, and initial stage of change on dynamic risk factors. In addition, it investigates which factors best predict who will complete treatment and change behaviourally during treatment. Conclusion,In this challenging, high-needs client group, early-programme stage of change, therapists' perceptions of motivation, therapeutic alliance and psychopathy did not predict how much change prisoners made. Regardless of initial levels, prisoners whose alliance increased the most over the course of treatment made the most change. Copyright © 2010 John Wiley & Sons, Ltd. [source]

Understanding anorexia nervosa through analysis of thematic content of letters in an adolescent sample

EUROPEAN EATING DISORDERS REVIEW, Issue 5 2006
Glen Freedman
Abstract Objective Positive and negative themes about their illness have been identified in an adult population with anorexia nervosa. It was our goal to explore the thematic content of the letters written by an adolescent population in order to better our understanding of how this different population relates to the illness. Method Twenty-seven adolescents with anorexia nervosa were asked to write two letters to their eating disorder, one addressing it as a friend and the other, as an enemy. The coding scheme initially developed by Serpell and Treasure, with minor adjustments, was used to code the letters by two trained raters, with high inter-rater reliability. Results Many similarities and a few notable differences between the adolescent population and an adult population were noted. Compared to an adult population, adolescents valued to a greater degree the sense of feeling looked after by the disorder and the increased attention that they felt the disorder provided. In contrast, they did not view loss of periods as a benefit. Regarding perceived costs of anorexia nervosa, adolescents described a greater degree of psychological distress in relation to the disorder, and a greater sense of having been tricked by the disorder. They did not describe as much frustration with preoccupation with thoughts about food or of being controlled by food. All other themes were not considered appreciably different in terms of percentage of statements or of subjects. Discussion An understanding of how adolescents relate to their illness in terms of themes can help to provide the therapist with a sense of where a patient is in terms of motivation and readiness for recovery. This in turn can aid in the determination of an appropriate treatment approach that is most likely to foster an optimal therapeutic alliance and to enhance motivation to recover. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

Treatment non-negotiables: why we need them and how to make them work

EUROPEAN EATING DISORDERS REVIEW, Issue 4 2006
Josie Geller
Abstract In this paper, we define mandatory treatment components as ,treatment non-negotiables' and suggest that the manner in which non-negotiables are set and implemented has a significant impact on therapeutic alliance and outcome in the eating disorders. Common non-negotiable difficulties are reviewed and a philosophy is provided that can be applied to all stages of treatment: non-negotiables need to have a sound rationale, be consistently implemented, not take the client by surprise, and maximize client autonomy. We do not believe that a given non-negotiable is ,right' or ,wrong', but rather that treatment non-negotiables are optimally developed in response to the client population, treatment setting, clinician values and beliefs about change, and client and clinician input and experience. Copyright © 2006 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

Triadic nonverbal communication in mother,infant consultations: Two contrasted cases,

INFANT MENTAL HEALTH JOURNAL, Issue 3 2009
M.J. Hervé
The aim of the present case study was to present and discuss the analysis of triadic nonverbal communication between mother, infant, and therapist in two early consultations as an indicator of the therapeutic alliance. The analysis explored nonverbal triadic interactions (body positions and facial orientations of the mother, infant, and therapist, and expressive behaviors of the infant) and triadic affective sharing (via a microanalytic interview of the therapist). The quality of the therapeutic alliance and clinical outcome for each case are described. The description of the two cases illustrates the importance of the progressive development of nonverbal "engagement" by the three people (triadic alliance) and of moments with triadic emotional sharing. The contribution of the therapist appears to be crucial, in particular via his or her body and affective engagement with the infant. The triadic alliance appears to be both an indicator of the therapeutic alliance and an element that can foster it. [source]

How do adolescents with bulimia nervosa rate the acceptability and therapeutic relationship in family-based treatment?

The quality of treatment of eating disorders: A comparison of the therapists' and the patients' perspective

INTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 4 2008
Simone de la Rie MA
Abstract Objective: The aims of this study were to investigate the quality of treatment of eating disorders (EDs) from the therapists' and patients' perspective and to compare their views. Method: The Questionnaire for Eating Problems and Treatment (QEPT) was administered to 73 therapists working with patients with ED, to 156 current ED and 148 former ED patients. The QEPT addresses the quality of treatment of EDs. ED diagnosis was assessed by the Eating Disorder Examination Questionnaire. Answers were analyzed quantitatively and qualitatively. Results: Both therapists and patients most often mentioned focus of treatment, therapeutic alliance, and communicational skills as important aspects of the quality of treatment. However, they valued similar topics differently. Therapists valued the focus on ED symptoms and behavioral change more highly, whereas patients underscored the importance of the therapeutic relationship and addressing underlying problems. Most therapists work from a cognitive behavioral orientation, but protocol-based treatment was not found important. Conclusion: There is an avid need for dissemination of evidence-based treatment. Therapists' and patients' views supplement current evidence-based knowledge on treatment quality of EDs. Optimal treatment of EDs will be facilitated when these three bodies of knowledge,the available evidence and the therapists' and patients' views,are integrated. © 2007 by Wiley Periodicals, Inc. Int J Eat Disord, 2008 [source]

Factorial validation of a French short-form of the Working Alliance Inventory

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 1 2006
Marc Corbière
Abstract Evaluation of the therapeutic alliance is crucial for understanding the therapeutic process and its results. However, few instruments are available in French. This article aims to validate a French short form of the Working Alliance Inventory (WAI). Unlike other questionnaires, the WAI is the most widely used in psychotherapy research as well as in social psychiatry. Confirmatory factor analyses were carried out on a sample of 150 client-case manager dyads in order to determine the validity of this short-form instrument. The results of these confirmatory factor analyses allowed us to answer different authors' questions (Horvath and Greenberg, 1989; Tracey and Kokotovic, 1989) regarding the factorial structure of the WAI. The results also indicated a unidimensional solution as being the most valid for the two samples. We suggest that, in future studies, only one score be considered for the evaluation of the WAI. We also suggest modifying two statements in the English and French versions in order to render a faithful comparison between the therapist and client versions. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Conceptual analysis of compliance

JOURNAL OF CLINICAL NURSING, Issue 1 2000
Helvi Kyngäs PhD
,,Compliance has been studied from a wide range of scientific perspectives including medicine, nursing, psychology and health economics. ,,There is no agreement regarding a commonly accepted definition. Lack of consistency in the definition and measurement of compliance is a major problem in research which becomes more complicated in an international study. ,,The response to the confusion over the term compliance has been to suggest and use alternative terms such as adherence, co-operation, mutuality and therapeutic alliance. These terms are ill-defined and often are used as synonyms. ,,The purpose of this paper is to analyse definitions of the concept of compliance. Abstracts from MEDLINE have been analysed in order to identify the types of compliance research that have been carried out. [source]

Developing and maintaining the therapeutic alliance with self-injuring patients

JOURNAL OF CLINICAL PSYCHOLOGY, Issue 11 2007
Nira Nafisi
In this article, the authors outline methods of strengthening the therapist,patient bond with individuals who self-injure. Self-injuring patients present with a host of challenges that differ from other patient populations and therefore certain approaches may be more effective than others. Among the strategies described are validation, checking in, working collaboratively toward goals, providing support, and repairing a ruptured alliance. Potential pitfalls (e.g., reinforcing maladaptive behavior, negative judging, and the fundamental attribution error) to which psychotherapists often fall prey are discussed as well. Self-injury is explained as functional rather than manipulative behavior and detailed clinical guidelines and examples are provided to better illustrate approaches that will improve the therapeutic alliance. © 2007 Wiley Periodicals, Inc. J Clin Psychol: In Session 63: 1069,1079, 2007. [source]

Help seeking and satisfaction among Latinas: The roles of setting, ethnic identity, and therapeutic alliance

JOURNAL OF COMMUNITY PSYCHOLOGY, Issue 3 2005
Manuel Paris Jr.
This study explored help seeking among primary Spanish speaking women of Hispanic origin who had behavioral health needs. We evaluated relational and cultural aspects of care and service utilization by using qualitative and quantitative measures of perceived behavioral health needs, therapeutic relationships, ethnic identity and degree of acculturation, and satisfaction with services among 103 women. We explored the nature of the therapeutic relationship and satisfaction with services among Latinas who received behavioral health services at: (1) a community behavioral health center, (2) a community health center, and (3) a faith-based agency. Overall, results demonstrated that participants had strong therapeutic alliances and were satisfied with services at the three different treatment sites. Differences noted, including clinical and research implications, are also described. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 299,312, 2005. [source]

Differentiation, perceived stress and therapeutic alliance as key factors in the early stage of couple therapy

JOURNAL OF FAMILY THERAPY, Issue 2 2010
Michael Knerr
A sample of 168 couples were assessed at intake and over the first six sessions of treatment providing the opportunity to investigate not only the impact of client and common factors on initial levels of satisfaction, but also trajectories of change in satisfaction over time. The study used multi-level modelling to examine changes in relationship satisfaction for both partners, thus enabling the couple to be maintained as the unit of analysis. We first examined changes in satisfaction and, having discovered differences there, we then investigated the impact of client factors of differentiation and stress in explaining these differences in relationship satisfaction. Finally we explored the additional influence of the common factor, therapeutic alliance, while controlling for the client factors, on relationship satisfaction. [source]

An Examination of Mandated Versus Voluntary Referral as a Determinant of Clinical Outcome

JOURNAL OF MARITAL AND FAMILY THERAPY, Issue 3 2009
Christine M. J. Snyder
A literature review was undertaken to examine evidence for the effectiveness of psychotherapy with mandated clients. The primary question addressed was whether or not clients mandated to therapy, whether by court order or by order of their employers, show poorer outcomes than clients who enter therapy voluntarily. To this end, research on client resistance and motivational readiness to change was reviewed. This was followed by an examination of research on the effectiveness of mandated treatment. The question of the potential influence of relationship factors such as the therapeutic alliance was also addressed. The literature review was followed by suggestions for future research on the effectiveness of treatment for clients with mandated or voluntary referral status. [source]

THE THERAPEUTIC ALLIANCE IN HOME-BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

From medicalization to hybridization: a postcolonial discourse for psychiatric nurses

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2001
P. E. Wilkin RMN MA
I begin with an Orwellian dilemma [Orwell G. (1968)The Collected Essays, Journalism and Letters of George Orwell, Vol. 1, p. 239. Harcourt Brace Jovanovich, New York]: do I ,shoot the elephant' (by writing the abstract) to impress the editor? Or, with the courage of my postmodern convictions, do I lay down my rifle and disregard such suppressive editorial instructions? Bang! My words strafe the paper and the elephant is dead. How difficult it is to stay standing against the powerful currents of the dominant tradition. How easy it is to disavow the inequalities and injustices of that tradition when your livelihood (and your ego) depends upon it. So goes the theme of my paper, that, despite the clarion calls of the illustrious minority to reject the patriarchal model of medical psychiatry, psychiatric nurses continue to be propelled by the twin engines of illness and diagnosis. Yet as soon as psychiatry encounters the ,other' it becomes, in Homi K. Bhabha's words, ,hybridized': a pregnant pause created from the seeds of two different cultures. In this sense, every psychiatric moment becomes a golden opportunity for the psychiatric nurse to abdicate her role as medical factotum. Freed from these contractual obligations, she can join the ,other' and share in his experiences, sustaining rather than negating him within a truly therapeutic alliance. In similar fashion, this article has become a mixture of rhetorical fluidity and structured reality: a hybridized compromise which acknowledges the journal's publication boundaries yet still revels, at times, in the freedom of an open and lyrical text. [source]

Mechanisms of anger and treatment outcome in combat veterans with posttraumatic stress disorder

JOURNAL OF TRAUMATIC STRESS, Issue 2 2008
David Forbes
Research has identified anger as prominent in, and an influence on, treatment outcome for military veterans with posttraumatic stress disorder (PTSD). This study examined factors influencing the relationship between anger and outcome to improve treatment effectiveness. Participants comprised 103 veterans attending PTSD treatment. Measures of PTSD and comorbidity were obtained at intake and 9-month follow-up. Measures also included potential mediators of therapeutic alliance, social support, problematic/undermining relationships and fear of emotion. Path analyses supported anger as a predictor of treatment outcome, with only fear of anger and alcohol comorbidity accounting for the variance between anger and outcome. To improve treatment effectiveness, clinicians need to assess veterans' anger, aggression, and alcohol use, as well as their current fear of anger and elucidate the relationship between these factors. [source]

Engagement in occupations among men and women with schizophrenia

OCCUPATIONAL THERAPY INTERNATIONAL, Issue 2 2006
Ulrika Bejerholm
Abstract This study describes engagement in daily occupations of 10 women and 10 men with schizophrenia. A 24-hour diary of time use and interview were used and analysed by content analysis. Three levels of occupational engagement were identified; (1) mainly disengaged throughout the day, (2) disengaged during some part of the day, and (3) largely engaged in occupations during the day. Each level of occupational engagement was related to a daily rhythm and a sense of meaning. The results of the content analysis showed that levels of engagement ranged from performing mostly quiet activities, alone, with little sense of meaning, to engaging in meaningful occupations that involved social interactions. In general female participants preferred activities in their home environment while males preferred activities outside their home environment. Although this study was limited by geographic and cultural boundaries, as well by the sample size, the results showed that being diagnosed as having schizophrenia does not necessarily mean having an impoverished lifestyle. Thus, it is important for occupational therapists to identify these variations in engagement in order to have a realistic point of departure in the evaluation process and in forming a therapeutic alliance with the client. In future research, methods need to be developed that can gather extensive information on how occupational engagement is related to health and well-being in individuals diagnosed with schizophrenia. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Effective Interaction With Patients With Schizophrenia: Qualitative Evaluation of the Interaction Skills Training Programme

PERSPECTIVES IN PSYCHIATRIC CARE, Issue 4 2009
Berno Van Meijel RN
PURPOSE., The purpose of this study was to describe experiences of caregivers with the Interaction Skills Training Programme, and to evaluate the training effects observed by caregivers. DESIGN AND METHODS., A qualitative research design was applied. Semistructured interviews were conducted with 17 caregivers who had followed the training program. FINDINGS., The research findings clearly confirm the value of the program. Positive effects of the training were reported in terms of: (a) awareness and insightfulness; (b) the attitude of caregivers; (c) the quality of the therapeutic alliance; and (d) job perception. PRACTICE IMPLICATIONS., Training interactive skills may contribute to a better quality of care for chronic psychiatric patients. Based on the qualitative study, implementation of the skills training program can be recommended. [source]

The Role of Interpreters in Psychotherapy With Refugees: An Exploratory Study

AMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 1 2005
Kenneth E. Miller PhD
Findings are presented from a narrative study that examined the use of interpreters in psychotherapy with refugees. Fifteen therapists and 15 interpreters were interviewed at 14 refugee mental health treatment centers in the United States. Core findings concerned the impact of interpreters on the therapeutic alliance, the complex emotional reactions that may arise within the therapy triad, the effects of interpreting on interpreters' own well-being, the multiple roles that interpreters play in addition to translating language, and the training and supervision needs of interpreters and of therapists who work with them. Implications of these findings for agencies that use interpreters in their clinical work with refugees are considered, and specific recommendations are made concerning the hiring, training, and support of interpreting staff. [source]

Countertransference to psychiatric patients in a clinical setting: Development of the Feeling Checklist,Japanese version

PSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 6 2006
FUJIKA KATSUKI rn
Abstract, Countertransference is an important dimension of the therapeutic alliance between care providers and patients. The Feeling Checklist (FC) is a self-report questionnaire for the assessment of countertransference by hospital staff toward patients. The FC was translated from English into Japanese and its factor structure, reliability, and validity in the Japanese version (FC-J) were examined. A total of 281 Japanese psychiatric nurses were tested with the FC-J. All nurses were primarily involved in provision of psychiatric care. Principal-component factor analysis with varimax rotation was performed to identify the potential components of the FC-J. In a factor analysis of the FC-J, seven factors were extracted. The five subscales that were determined and labeled included Reject, Distance, Helpfulness, Closeness, and Involvement, which collectively accounted for 56.0% of the variance. Cronbach's ,, a measure of internal consistency, for individual subscales was 0.833 for Reject, 0.763 for Distance, 0.768 for Helpfulness, 0.617 for Closeness, and 0.663 for Involvement. Notably, there was a significant correlation between the FC-J and the Nurse Attitude Scale (P < 0.0001). Moreover, one-way anova was performed with each FC-J subscale to examine differences among psychiatric diagnoses in the study sample. A significant difference was found for Involvement (P < 0.001), with the total score on Involvement being the highest in the personality disorder group. These results are considered to verify the reliability and validity of the FC-J as a scale to measure countertransference among Japanese care providers. The use of this scale allows individual care providers to recognize and be cognizant of their own countertransference objectively and thereby contributes to improve the relationship between patients and care providers. [source]

Inpatient treatment in child and adolescent psychiatry , a prospective study of health gain and costs

THE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 12 2007
Jonathan Green
Background:, Inpatient treatment is a complex intervention for the most serious mental health disorders in child and adolescent psychiatry. This is the first large-scale study into its effectiveness and costs. Previous studies have been criticised for methodological weaknesses. Methods:, A prospective cohort study, including economic evaluation, conducted in 8 UK units (total n = 150) with one year follow-up after discharge. Patients acted as their own controls. Outcome measurement was the clinician-rated Childhood Global Assessment Scale (CGAS); researcher-rated health needs assessment; parent- and teacher-rated symptomatology. Results:, We found a significant (p < .001) and clinically meaningful 12-point improvement in CGAS following mean 16.6 week admission (effect size .92); this improvement was sustained at 1 year follow-up. Comparatively, during the mean 16.4 week pre-admission period there was a 3.7-point improvement (effect size .27). Health needs assessment showed similar gain (p < .001, effect size 1.25), as did teacher- and parent-rated symptoms. Improvement was found across all diagnoses. Longer stays, positive therapeutic alliance and better premorbid family functioning independently predicted better outcome. Mean cost of admission was £24,100; pre-admission and post-discharge support costs were similar. Conclusions:, Inpatient treatment is associated with substantive sustained health gain across a range of diagnoses. Lack of intensive outpatient-treatment alternatives limits any unqualified inference about causal effects, but the rigour of measurement here gives the strongest indication to date of the positive impact of admission for complex mental health problems in young people. [source]

Annotation: The therapeutic alliance , a significant but neglected variable in child mental health treatment studies

The Tree Theme Method as an intervention in psychosocial occupational therapy: Client acceptability and outcomes

AUSTRALIAN OCCUPATIONAL THERAPY JOURNAL, Issue 3 2009
A. Birgitta Gunnarsson
Background/aim:,The Tree Theme Method (TTM) is an intervention in which the client paints trees representing certain periods in his/her life. The intervention comprises five sessions, using trees as a starting point to tell one's life story. This study, which is part of an implementation project, aimed to examine the therapeutic alliance and client satisfaction, in relation to perceptions of everyday occupations and health-related factors, with clients going through a TTM intervention. Methods:,Nine occupational therapists recruited 35 clients, at general outpatient mental health care units, for the TTM intervention. Self-rating instruments, targeting therapeutic alliance (HAq-II), different aspects of daily occupations (Canadian Occupational Performance Measure, Satisfaction with Daily Occupations), health-related factors (Sense of Coherence measure, Mastery Scale, Symptom Checklist-90-R) and client satisfaction (Client Satisfaction Questionnaire), were administrated before and after the intervention. Results:,A good initial therapeutic alliance, experienced by both therapists and clients, was correlated to increased changes regarding occupational performance and self-mastery. According to the therapists' ratings, a good initial therapeutic alliance was correlated to increased sense of coherence and a decreased level of psychiatric symptoms. The results showed positive significant changes in occupational performance and health-related factors. High ratings of the therapeutic alliance by the therapists were also related to high client satisfaction. Conclusions:,The TTM seemed to function well in psychosocial occupational therapy, but there is a need for further implementation studies to deepen our understanding of the treatment process, comprising both technique and formation of the therapeutic alliance. [source]