Clients' experiences of cognitive restructuring techniques: A tape-assisted recall study

Aim: Despite being the treatment of choice for many psychological disorders,there are still gaps in our understanding of the process and experience of CBT. This paper aimed to conduct a meta-synthesis of clients’ perspectives of CBT, in order to investigate these gaps and to contribute to a cumulative knowledge base concerning clients’ experiences of therapeutic processes in CBT. Method: Nine qualitative studies that examined clients’ experiences of individual CBT met the inclusion criteria for the review. Methodological appraisal of the studies was conducted and the findings were synthesised using thematic analysis. Results: The meta-synthesis generated ten themes which were clustered into three domains: “Technical aspects of CBT”, “The therapeutic relationship” and “The therapeutic journey: from doubt to belief”. Conclusion: The meta-synthesis showed that clients value both the technical and relational aspects of therapy, suggesting that both are important ingredients of change. A possible direction for future research is to specify the interrelationships between these factors to provide a more fine-grained understanding of the ingredients of effective therapeutic interactions

Psychometric evaluation of therapist competency rating scales

Literature Review A systematic review of the psychometric properties and quality of scales measuring therapist competency in delivering psychotherapy to adults was conducted. Thirteen studies met the a priori criteria and were included in the final analysis. The results showed seven therapist competency rating scales had good reliability and validity. All studies tested the interrater reliability of scales, but limited evidence was provided for validity. The psychometric methodology between studies was inconsistent. Most scales were applicable to high-intensity CBT practice, or for specific treatment with drug-dependent patients. Further research is needed to develop psychometrically valid and reliable therapist competency rating scales for a range of theoretical therapeutic approaches and mental health conditions. Research Report The research report provided a psychometric evaluation of the Psychological Wellbeing Practitioner Competency rating Scale for Assessment (PWPCS-A) and Treatment (PWPCS-T). The scales measure practitioner competency in delivering low-intensity CBT treatments for patients with mild to moderate anxiety or depression. Data was utilised from PWPCS-A and PWPCS-T ratings from 176 expert, qualified, and novice psychological wellbeing practitioners (PWPs). Further analysis of reliability, and validity was determined from data collected from 114 PWP trainees’ Observed Structured Clinical Examinations. The PWPCS-A showed excellent reliability and validity, and the PWPCS-T demonstrated acceptable results. The research provides support for the use of the PWP competency scales for PWP training. Limitations, clinical implications, and future research are discussed

The Ethical Imagination: A Hermeneutical Study

This research examines and describes the ways psychotherapists address ethical dilemmas through a hermeneutic analysis of how they responded to a portrayal of a therapy session represented in a television series. Interview transcripts were analyzed and assessed for both how therapists navigate difficult ethical terrain, and upon what, thematically, they tend to direct their thought and concern. Moreover, particular consideration is given to the role of imagination in the development of ethical meaning, intention, and understanding in the clinical context, which intersects with a critique of the American Psychological Association\u27s ethics code and its underlying philosophical assumptions. Such theoretical underpinnings suggest a view of therapists as rational agents capable of applying ethical rules and codes to resolve dilemmas in a logical, formulaic manner, a view which is questioned for its failure to account for the empathetic, vitalizing, and hermeneutic value of imaginative thought, rehearsal, and reflection in practice. Finally, implications for therapy, pedagogy, and interpersonal understanding are explored

Exploring the therapeutic process in therapies with young people using the Adolescent Psychotherapy Q-set

Background: The Adolescent Psychotherapy Q-set (APQ) is a pan-theoretical empirically validated process measure with potential for statistical analysis describing the unique characteristics of therapy sessions conducted with adolescents. Aims: This literature review aims to examine the development of the APQ and its applications in research and practice to guide future applications. Methods: A literature search on the PsycInfo and UCL Explore search engines and subsequent scanning of search results yielded nine published studies using the APQ. One unpublished study was made available to the author by the measure developer. Process: Studies were critically reviewed one by one paying attention to their research methodology, innovative use of the APQ, and their contributions to the field of adolescent psychotherapy process research. The APQ’s applications in this small body of literature was then evaluated. A review of relevant applications of the APQ’s child and adult equivalents highlighted directions for the APQ’s future potential. Results: Following its empirical validation, the APQ has been applied theoretically, in research of clinical practice, and in supervision. The APQ’s application to create therapy prototypes of therapy modalities has shown its good discriminatory quality and suitability to study treatment adherence. Using the APQ across therapies has shown it can detect important trends in therapy processes across large data sets. The APQ’s applications in single-case studies has shown the measures’ suitability to this research methodology, having already produced important insights in adolescent therapy process research. The review found the APQ to be sensitive to subtle differences in therapeutic techniques and interactions whilst possibly missing non-verbal factors and within-session variability. The APQ’s use of direct observation in real-life clinical settings, suitability for various statistical analyses and triangulation as well as its potential to find process-outcome links in adolescent therapy are clear advantages. Conclusions: Although empirical research conducted with the APQ is in its infancy, its applications so far have shown the versatility of this measure and its potential to add knowledge to the field of adolescent psychotherapy process research. The review highlights important methodological directions for future research, including a move beyond research based on modality prototypes. Part 2: Empirical Research Project What therapy processes precede dissatisfied dropout in STPP for adolescent depression: a single-case qualitative exploration guided by the Adolescent Psychotherapy Q-set Abstract Background: A significant percentage of young people in treatment for depression drop out of psychotherapy, some due to dissatisfaction with the therapy offered. The therapeutic processes preceding dissatisfied dropouts in the adolescent population are insufficiently understood. Aims: The current single-case study aimed to explore the therapeutic process of a 12-session, prematurely-ended therapy with a young person dissatisfied with short-term psychoanalytic psychotherapy (STPP) received for depression. Methods: The Adolescent Psychotherapy Q-set (APQ), an empirically validated process measure, was used in tandem with clinical case analysis to explore the therapy process over time. Results: The analysis of twelve APQ ratings found a productive patient-therapy couple working collaboratively to understand the young person’s experiences and emotions. Following an initial phase of the young person presenting as emotional and vulnerable, she became increasingly ambivalent about partaking in psychotherapy. A lively and argumentative period exploring the young person’s ambivalence and increased sense of well-being culminated in eventual dropout. Conclusion: Even in a strong, collaborative working relationship with an engaged young person, ambivalence around dependency and vulnerability can threaten treatment completion. The APQ is a suitable measure to explore general treatment processes preceding dropout, but its usefulness could be enhanced through systematic methodological pluralism

Exploring the Therapeutic Alliance in Cognitive-Behavior Therapy with Children with Autism Spectrum Disorder: An Interpretative Phenomenological Approach

Abstract The therapeutic alliance (TA) is the most studied process of adult psychotherapeutic change (Zack et al., 2007) and has been found to have a moderate but robust relationship with therapeutic outcome regardless of treatment modality (Horvath, 2001). The TA is loosely described as the extent to which the therapist and the participant connect emotionally and work together towards goals. Conceptualizations of the TA with children have relied on adult models, even though it is widely acknowledged that the pediatric population will rarely willingly commit to therapy, nor readily admit to any challenges that they may be experiencing (Keeley, Geffken, McNamara & Storch, 2011). For children with Autism Spectrum Disorder (ASD) the therapeutic alliance may require an even greater retheorizing considering the communicative and social difficulties of this particular population. Despite this need, research on children with ASD and the therapeutic TA is almost non-existent. In this qualitative study, transcripts from semi-structured interviews with mothers of children with ASD were analyzed using Interpretative Phenomenological Analysis (IPA). IPA closely examines how individual people make sense of their life experiences using a theme-by-theme approach. The three interviewees were mothers whose children were participants in a nine-week Cognitive Behaviour Therapy (CBT) group for obsessive-compulsive behaviours (OCB). A total of four superordinate themes were identified: (i) Centralization and disremembering the TA, (ii) Qualities of the therapist, (iii) TA and the importance of time, and (iv) Signs of a healthy TA. The mothers’ perspectives on the TA suggest that, for them and their children, a strong TA was a required component of the therapy. Implications for clinicians and researchers are discussed

The Lived Experience of Facilitating the Violet Oaklander Model of Psychotherapy for Children and Adolescents

The purpose of this phenomenological study was to describe the experience of facilitating the Oaklander Model of Gestalt Play Therapy when treating children or adolescents in psychotherapy. Interviews were conducted with clinicians who have received training and use the Oaklander method in their practice of psychotherapy. Transcriptions of the interviews were coded and analyzed, revealing a consistent experience along various themes. Participants reported that this Gestalt method allows a non-linear method of helping clients to unfold according to the needs and challenges of each session. Participants also reported that the end goal of the Oaklander Gestalt model helped young clients express themselves through the use of customized strategies that included consideration of the experiences and physical capabilities of children. The model’s focus on the strength of the clinician-client, clinician-parent, and parent-client relationship facilitated self-awareness and sense of self through effective mind-body interventions. Further exploration by broadening the range, size, and type of sample studied is recommended. The electronic version of this dissertation is available free at Ohiolink ETD Center, www.ohiolink.edu/et

Exploring the perception of cognitive behaviour group therapy for older adults with depression and / or anxiety

Available from British Library Document Supply Centre-DSC:DXN049056 / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

A qualitative investigation of the therapeutic relationship in the facilitation of empowerment in psychological therapy for adults with learning disabilities

A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the award of Professional Doctorate in Counselling Psychology.Background Many authors in the field of adult learning disabilities have described the challenges experienced by clinicians in obtaining evidence regarding the effectiveness of psychological therapies for this particular client group (e.g. it can be a costly, lengthy, time-consuming process) (Taylor, Lindsay, Hastings & Hatton, 2013). Gaps also exist in the area of social justice and empowerment in relation to this population, which has historically experienced significant inequalities. This research intended to contribute to the current information available for researchers and psychological practitioners and to focus upon particular practical issues highlighted as important to the service-users, therapists and support workers within a single UK NHS service. The aims of this research project were: 1. To investigate what factors clients with learning disabilities find most helpful and empowering in the psychological therapy received from psychological therapists. 2. To ascertain how the therapeutic relationship affects psychological well-being within a learning disabled population, as facilitated by their therapists and support workers. 3. To explore the importance of support workers’ involvement in providing support with psychotherapeutic work for PWLD. 4. To consider how empowerment is experienced and conceptualised by the main stakeholders in the therapeutic encounter, between PWLD, their therapist and their support worker. Method Five triads were interviewed, each consisting of a person with learning disabilities, a psychological therapist and a support worker. Qualitative methodology was used to analyse the data obtained, via Interpretative Phenomenological Analysis (IPA). Findings The resulting research findings highlighted the importance of four super-ordinate themes: i) Values, Stigma & Social Equity; ii) Building Relationships, Collaboration & Trust; iii) Coping & Adaptations and iv) Positive Outcomes. Implications for various key groups including counselling psychologists, were considered and findings were contextualised with prior research findings. Conclusions The researcher’s original contribution to knowledge relates to the inclusion and exploration of the experiences and perspectives of three related stakeholder groups, including previously under-represented participants with learning disabilities, in order to voice what was important to them in terms of the therapeutic relationship and the facilitation of empowerment through psychological therapy