SUPPORTING THE THERAPIST IN ONLINE THERAPY

In the last decade, eSupport (Internet-reliant therapy) has gained substantial attention, both in research and practice. Several studies in psychology show that structured eSupport (e.g. Computerized Cognitive Behavioural Therapy), is promising both with regard to therapeutic efficacy and cost-effectiveness. However, the transition from face-to-face therapy to eSupport creates new challenges for therapists, such as lack of (traditional) structure and access to secondary information (e.g. body language) about their patients. In this paper, a design science research approach has been employed in the context of eSupport. Drawing on the knowledge base of face-to-face conversations, face-to-face therapy, and pragmatic IS theory, a framework for patient indicators has been designed. The design has been justified through both (i) descriptive evaluations based on the selected knowledge base, and (ii) experiences collected in a stakeholder-centric design process, including experimental evaluation of an eSupport platform that implement the indicator framework. The framework was designed to allow new indicators to be ?plugged in? dynamically and inserted into tailorable lists. New indicators can be created either through specialization of an indicator base class, or by configuring metadata for generic indicators that tap into an action log. Indicator values are cached, both to boost performance and to support trend analysis of patient indicators. We conclude that the indicator framework serves to improve support for therapists: It offers structure and access to both primary and secondary information in new ways. In doing so, it meets some of the key challenges that therapists encounter in the transition to eSupport

Therapist-Supported Online Remote Behavioural Intervention for Tics (ORBIT) in Children and Adolescents: A Single-Blind Randomised Controlled Trial

Background: Behaviour therapy is an effective treatment in children and adolescents with tic disorders but is rarely available. Online delivery could widen access to therapy. We evaluated the efficacy of internet-delivered, therapist-supported and parent-assisted Exposure and Response Prevention (ERP) for tics. / Methods: Multi-centre, parallel group, single-blind, randomised controlled trial. Eligible participants were aged 9-17 years with Tourette syndrome/chronic tic disorder, who had not received behaviour therapy for tics within 12 months, and had a Yale Global Tic Severity Scale (YGTSS) Total Tic Severity Score (TTSS) of >15, or >10 if motor or vocal tics only. Participants were recruited via 16 patient identification centres, two study sites, or online self-referral, and were randomised (1:1) by blinded outcome-assessors to receive either 10 weeks of ERP or psychoeducation (active control). The primary outcome was YGTSS-TTSS at 3 months’ post-randomisation, analysis was by intention-to-treat. The mean cost per patient for the intervention and health care costs were calculated. Registrations are ISRCTN (ISRCTN70758207) and ClinicalTrials.gov (NCT03483493). / Findings: Between 8 th May 2018 and 30 th September 2019, 224 participants were enrolled; 112 to ERP and 112 to psychoeducation. The ERP intervention reduced YGTSS-TTSS by 2 . 29 points (95% CI: ‑3 . 86 to -0 . 71) compared to the psychoeducation group at 3 months, an effect that increased by 6 months post-randomisation (-2 . 64, 95% CI: -4 . 56 to -0 . 73). The average therapist time spent supporting the intervention was 2 . 5 hours. The additional cost per participant of the ERP intervention compared to psychoeducation was £159 (95% CI -£53 to £370). There were two unrelated serious adverse events, both in the psychoeducation group. / Interpretation: Online-delivered, therapist-supported ERP therapy is clinically effective at reducing tics, with minimal therapist contact time. Online delivery could improve access to evidence-based treatment for tics in children and adolescents

The use of email as a component of adult stammering therapy : a preliminary report

In West Glasgow email has evolved from a rapid means of arranging therapy appointments with adults who stammer into a medium for exchange of therapeutic messages with some clients. Since 2004, sixteen clients have used email to communicate as part of their therapy programme. The benefits include improving access to services, supporting speech change, facilitating lasting personal growth, improving clinical decision-making, equalizing the therapist-client relationship and enhancing caseload management. Although this experience suggests that email is appropriate for stammering therapy, the effectiveness and ethics of, and the rationale for, clinical practice that includes email need careful consideration. Further research is required to formally evaluate the client experience

A Review into eHealth Services and Therapies: Potential for Virtual Therapeutic Communities - Supporting People with Severe Personality Disorder

eHealth has expanded hugely over the last fifteen years and continues to evolve, providing greater benefits for patients, health care professionals and providers alike. The technologies that support these systems have become increasingly more sophisticated and have progressed significantly from standard databases, used for patient records, to highly advanced Virtual Reality (VR) systems for the treatment of complex mental health illnesses. The scope of this paper is to initially explore e-Health, particularly in relation to technologies supporting the treatment and management of wellbeing in mental health. It then provides a case study of how technology in e-Health can lend itself to an application that could support and maintain the wellbeing of people with a severe mental illness. The case study uses Borderline Personality Disorder as an example, but could be applicable in many other areas, including depression, anxiety, addiction and PTSD. This type of application demonstrates how e-Health can empower the individuals using it but also potentially reducing the impact upon health care providers and services.Comment: Book chapte

Multiple Media Interfaces for Music Therapy

This article describes interfaces (and the supporting technological infrastructure) to create audiovisual instruments for use in music therapy. In considering how the multidimensional nature of sound requires multidimensional input control, we propose a model to help designers manage the complex mapping between input devices and multiple media software. We also itemize a research agenda

Carers\u27 preferences for the delivery of therapy services for people with disability in rural Australia: Evidence from a discrete choice experiment

Background: The implementation of the Australian National Disability Insurance Scheme (NDIS) is expected to generate a responsive, person-centred system that will empower people with disability to choose the services and support they receive. However little attention has been paid to examine how users of the NDIS will choose and spend their individual budgets. This study aimed to determine quantitatively the relative importance that carers of people with a disability living in rural Australia place on different therapy service delivery characteristics. Methods: A stated preference discrete choice experiment (DCE) was incorporated into a survey of carers of people with disability living in rural Australia. Carers chose between therapy delivery services differing in attributes such as travel time to receive therapy, sector providing the service (i.e. Government, not-for-profit, private), out-of-pocket costs, person who delivers the therapy (therapist or other staff) and waiting time. Results: A total of 133 carers completed the DCE. The majority of respondents cared for a child with a disability (84%), the average age of the person they cared for was 17 years (SD 14.25). Participants expressed strong preferences for a short waiting time (0-3 months) to receive therapy services; services delivered by a therapist, no out of pocket cost and travelling up to 4 hours to receive a therapy session (p Conclusion: Carers of people with a disability in rural Australia exhibited strongest preferences for short waiting times (0-3 months). Therapy services that are delivered by therapy assistants or support workers will require careful introduction to achieve uptake and acceptability

How do school counselling and therapy services undertake participation activities in a way that meets the ethical requirements of therapeutic practice?

This study explores how organisations providing counselling and therapy services within schools undertake participation activities, and the ways in which ethical considerations might have affected the choice of methods. It primarily focuses on the participation of children and young people in improving the quality of services. The research aimed to gather potential models of involving children and young people in the development of services. Two semi-structured interviews and one focus group took place, gathering data from five services providing therapeutic services in schools in London or the South East. The research found that while participative practice is inherent in the day-to-day delivery of therapy and counselling, it is still in development at an organisational level. The need for standardisation of approach at an organisational level clashed with the therapist and counsellors’ need to consider an ethical approach and the individual needs of clients. Specific challenges related to collecting the views of young children were noted in the interviews.The study concludes that devising a prescriptive approach that is delivered identically in every case is not appropriate. Every method used must be differentiated for different ages and developmental stages, and a level of flexibility in its implementation must be allowed. This flexibility will allow the therapist or counsellor to adapt the approach in situations where its delivery may conflict with ethical principles

Telehealth for expanding the reach of early autism training to parents.

Although there is consensus that parents should be involved in interventions designed for young children with autism spectrum disorder (ASD), parent participation alone does not ensure consistent, generalized gains in children's development. Barriers such as costly intervention, time-intensive sessions, and family life may prevent parents from using the intervention at home. Telehealth integrates communication technologies to provide health-related services at a distance. A 12 one-hour per week parent intervention program was tested using telehealth delivery with nine families with ASD. The goal was to examine its feasibility and acceptance for promoting child learning throughout families' daily play and caretaking interactions at home. Parents became skilled at using teachable moments to promote children's spontaneous language and imitation skills and were pleased with the support and ease of telehealth learning. Preliminary results suggest the potential of technology for helping parents understand and use early intervention practices more often in their daily interactions with children

e-Mental health for mood and anxiety disorders in general practice

Familiarises general practitioners (GPs) with the range of online programs in Australia that have demonstrated efficacy and are currently available for use by patients with mental health problems. Background Australia is a world leader in the development of internetdelivered programs for the prevention and management of mood and anxiety disorders. Despite a strong evidence base of time- and cost-effectiveness, as well as clinical efficacy, the uptake of these programs in general practice remains low. Objective To familiarise general practitioners (GPs) with the range of online programs in Australia that have demonstrated efficacy and are currently available for use by patients with mental health problems. Discussion E-mental health programs provide an efficacious and accessible form of mental healthcare and have the potential to fill the gap for those for whom such care is inaccessible, unaffordable or unacceptable. Clinicians can also use it in a stepped-care manner to augment existing healthcare services. There are a number of online resources currently available to Australians who have mood or anxiety disorders. These resources have strong evidence to support their effectiveness. Online portals facilitate access to these programs. Recently the Australian Federal Government has funded an education program (eMHPrac) for GPs and mental health professionals, to outline what is available, indicate situations where recommending such resources is appropriate, and suggest ways in which they can be incorporated into general practice

Interactional positioning and narrative self-construction in the first session of psychodynamic-interpersonal psychotherapy

The purpose of this study is to identify possible session one indicators of end of treatment psychotherapy outcome using the framework of three types of interactional positioning; client’s self-positioning, client’s positioning between narrated self and different partners, and the positioning between client and therapist. Three successful cases of 8-session psychodynamic-interpersonal (PI) therapy were selected on the basis of client Beck Depression Inventory scores. One unsuccessful case was also selected against which identified patterns could be tested. The successful clients were more descriptive about their problems and demonstrated active rapport-building, while the therapist used positionings expressed by the client in order to explore the positionings developed between them during therapy. The unsuccessful case was characterized by lack of positive self-comment, minimization of agentic self-capacity, and empathy-disrupting narrative confusions. We conclude that the theory of interactional positioning has been useful in identifying patterns worth exploring as early indicators of success in PI therapy