Negotiating System Requirements to Secure Client Engagement – Therapist Strategies in Adolescent Psychotherapy Initiated by Others

Background: Many adolescent clients come to treatment reluctantly, at the initiative of others. Adolescents also quit therapy prematurely more often than adult clients do. This points to the value of finding good ways to engage adolescent clients in treatment and understanding more of what therapists do to achieve this task. Methods: We used focus group methodology to explore therapist strategies and behaviors to engage adolescent clients who come to therapy at the initiative of others. Ten focus group interviews with a total of 51 therapists were conducted with existing treatment teams from seven different clinics in community mental health care for children and youth. Reflexive thematic analysis was used as a framework to guide the analytical process. Findings: Navigating a position allowing the therapist and adolescent to meet and work toward a shared understanding of the situation and what could help was considered the main gateway to client engagement. To do this, therapists had to manage the pull between system requirements and their obligation to the individual adolescent client, represented by the theme Managing system requirements. The process of working with the adolescent to ensure engagement is represented by the four themes: Counteracting initial obstacles for client engagement – “You are not trapped here”; Sharing definitional power – “What does it look like to you?”; Practicing transparency – “I want you to know what I see”; and Tailoring as ideal – “I will design this therapy for you.” Implication and conclusion: Therapists want to understand their adolescent clients’ position better, and subsequently adjust the treatment goals and techniques to establish sufficient common ground to allow both the therapist and adolescent to find the therapeutic project worthwhile. However, system requirements and service organization were found to obstruct and influence these processes in several ways, pointing to the significance of exploring the interplay between system organization and therapeutic practice more thoroughly. There was also a variation between therapist behaviors described by different therapists within the same treatment teams, as well as systematic differences between treatment teams, pointing to the importance of future research differentiating wanted from unwanted variation in treatment.publishedVersio

Patient Perspectives on Working with Preferences in Psychotherapy: A Consensual Qualitative Research Study

Objective:Assessing and accommodating patient preferences is integral to evidence-based practice. This qualitative study sought to explore patient perspectives and experiences of working with preferences in psychotherapy. Methods: Participants were 13 UK-based patients who had 24 or fewer sessions of a collaborative–integrative psychotherapy. Ten participants identified as female and three as male. Interviews were conducted at endpoint and analyzed using a team-based, consensual qualitative research approach.Results: Three superordinate domains were developed: Preferences Themselves, Process of Working with Preferences in Psychotherapy, and Effect of Preference Work (or its Absence). Patients typically wanted leadership, challenge, and input from their psychotherapist, and an affirming style. Patients attributed the origin of their preferences to Preferences originated from patients’ personal history, characteristics, or circumstances; the present psychotherapy; or past episodes of psychotherapy. Some preferences changed over time. Preference work had positive effects on the therapeutic relationship and patients’ intrapersonal worlds; however, not accommodating patient preferences could also be beneficial. Conclusion:Our findings provide in-depth answers to a range of novel questions on preference work—the mechanisms by which preference work yields positive outcomes, factors that facilitate preference work, and origins of patients’ preferences—as well as helping to nuance previously established quantitative findings. Implications of these results for clinical training and practice are discussed

A pluralistic perspective on research in psychotherapy:harnessing passion, difference and dialogue to promote justice and relevance

The adoption of a pluralistic perspective on research design, processes of data collection and analysis and dissemination of findings, has the potential to enable psychotherapy research to make a more effective contribution to building a just society. A review of the key features of the concept of pluralism is followed by a historical analysis of the ways in which research in counselling, psychotherapy and related disciplines has moved in the direction of a pluralistic position around knowledge creation. Core principles of a pluralistic approach to research are identified and explored in the context of a critical case study of contemporary research into psychotherapy for depression, examples of pluralistically oriented research practices, and analysis of a pluralistic conceptualisation of the nature of evidence. Implications of a pluralistic perspective for research training and practice are discussed. Pluralistic inquiry that emphasises dialogue, collaboration, epistemic justice and the co-existence of multiple truths, creates opportunities for individuals, families and communities from a wide range of backgrounds to co-produce knowledge in ways that support their capacities for active citizenship and involvement in open democratic decision-making. To fulfil these possibilities, it is necessary for psychotherapy research to be oriented towards social goals that are sufficiently relevant to both researchers and co-participants to harness their passion and work together for a common good

The effect of endurance training on body composition and blood lipids in older adults : a randomized controlled trial

Background: Ageing is associated with changes in body composition and blood lipids. Reduced muscle mass and increased body fat are inevitable consequence of the ageing process. In addition, total cholesterol is known to increase with age, and increased body fat has shown associations with abnormal lipid values. Limited information is available regarding the effects of endurance training on blood lipids in elderly, and the effect of endurance training on body composition. The present study examines the effects of three years of endurance training on body composition and blood lipids in older adults. Possible gender differences will also be investigated. Materials and methods: This was a population-based randomized controlled trial. Body composition and blood lipids were determined in 400 healthy community-dwelling men and women (204 women and 194 men with a mean age of 71.9 ± 1.36). Body composition was measured using bioelectrical impedance analysis and blood lipids were measured by taking a blood sample from an arm vein in a fasted state.Results: Three years of endurance training resulted in modest reduction in body weight, with larger reduction in the high-intensity training group compared with the moderate-intensity training group (p0.05). Gender differences were prominent in body composition and blood lipid measures at baseline and in interaction with group and time (p<0.05). There were gender differences in response to endurance training in terms of waist, BMI, visceral fat and LDL-cholesterol (p<0.05). Women showed a larger reduction in waist and BMI in the high-intensity training group than men (p<0.015), and men showed a larger reduction in LDL-cholesterol and visceral fat the control and moderate-intensity training groups than women (p<0.05). Men and women also changed differently in muscle mass and triglycerides over time (p<0.05), with men decreasing more than women. Conclusion: These results demonstrate that three years of endurance training has modest effect on body composition and no effect on blood lipids. Gender differences in body composition and blood lipids were prominent at baseline. In addition, few gender differences were seen in response to training. Women reduced waist and BMI more than men in the high-intensity training group, whereas men reduced LDL-cholesterol and visceral fat more than women in the control and moderate-intensity training groups. Men and women also changed differently in muscle mass and triglycerides over time, with men decreasing more than women

Alliance formation in high-conflict custody mediation: a serial case analysis

Through an in‐depth qualitative analysis of five cases of mandatory high‐conflict custody mediation, we analysed interpersonal processes associated with the early formation of a working alliance in a three‐way interaction. The analysis showed that the mediator efficiently managed the focus of the conversation and validated the parents’ perspectives, but was reticent in addressing interactional issues. Our findings suggest that mediators in high‐conflict custody mediation cases can facilitate the formation of an alliance between the parents, as well as between the mediator and the parents, by taking into account three main aspects of the interaction: (1) the management of the focus of the conversation; (2) validation of the parties’ perspectives; and (3) adapting interventions and tasks to the cohesion of the parent dyad

När döden knackar på : Uttryck för försoning i det lidande som amyotrofisk lateralskleros innebär

Bakgrund: Att drabbas av ALS är traumatiskt för den drabbade människan och leder vanligtvis till en drastisk förkortning av livet. Att inte försonas med sitt öde kan innebära att den sista tiden i den döende människans liv innefattar förtvivlan och dödsångest. Därför är det viktigt med kunskap om försoning hos vårdpersonal. Syfte: Studien syftar till att undersöka om och i så fall hur människor med diagnosen ALS ger uttryck för försoning med sin dödliga och snabbt progressiva sjukdom. Metod: Analysen utfördes inspirerat av Lundmans och Hällgren Graneheims (2008) metod för kvalitativ innehållsanalys för att undersöka de latenta uttrycken för begreppet försoning. Analysen utfördes på fyra självbiografier. Resultat: Stunder av försoning kan uttryckas som uthärdligt lidande, stunder med upplevelser av tillfredsställelse samt skapande av upplevelser av trygghet genom existentiella funderingar. Faktorer som kan möjliggöra stunder av försoning kan vara utvecklande av nya perspektiv, tröst som resulterar i frånvaro av rädsla och genom meningsskapande av livssituationen. Slutsats: Upplevelser av försoning kan komma till uttryck på många olika sätt utifrån individuella faktorer, som social kontext och värderingar. Upplevelser av försoning kan inträffa under korta och pendlade perioder och är inget konstant tillstånd.Background: To suffer from amyotrophic lateral sclerosis is traumatic for the affected individual and usually leads to a drastic shortening of life. The absence of reconciliation towards the dying person´s destiny may lead to that the remaining part of life comprises despair and agony. Therefore, it is important for care givers to have knowledge about meaning of reconciliation.  Aim: The study aims to examine whether, and if so, persons diagnosed with amyotrophic lateral sclerosis express reconciliation with their deadly and rapidly progressive disease. Methods: The analysis performed was inspired by Lundman´s and Hällgren Graneheim´s (2008) method of qualitative content analysis to examine the latent expressions of the concept of reconciliation. The analysis is based on four autobiographies. Results: Moments of reconciliation can be expressed as bearable suffering, experiences of satisfaction and experiences of safety through existential thoughts. Factors that could enable moments of reconciliation may be the development of new perspectives, comfort which results in the absence of fear and through creation of a meaning of life situation. Conclusion: Experiences of reconciliation can be expressed in many different ways based on individual factors such as social context and values. Moments of reconciliation can occur over short periods and are not a constant condition

När döden knackar på : Uttryck för försoning i det lidande som amyotrofisk lateralskleros innebär

Bakgrund: Att drabbas av ALS är traumatiskt för den drabbade människan och leder vanligtvis till en drastisk förkortning av livet. Att inte försonas med sitt öde kan innebära att den sista tiden i den döende människans liv innefattar förtvivlan och dödsångest. Därför är det viktigt med kunskap om försoning hos vårdpersonal. Syfte: Studien syftar till att undersöka om och i så fall hur människor med diagnosen ALS ger uttryck för försoning med sin dödliga och snabbt progressiva sjukdom. Metod: Analysen utfördes inspirerat av Lundmans och Hällgren Graneheims (2008) metod för kvalitativ innehållsanalys för att undersöka de latenta uttrycken för begreppet försoning. Analysen utfördes på fyra självbiografier. Resultat: Stunder av försoning kan uttryckas som uthärdligt lidande, stunder med upplevelser av tillfredsställelse samt skapande av upplevelser av trygghet genom existentiella funderingar. Faktorer som kan möjliggöra stunder av försoning kan vara utvecklande av nya perspektiv, tröst som resulterar i frånvaro av rädsla och genom meningsskapande av livssituationen. Slutsats: Upplevelser av försoning kan komma till uttryck på många olika sätt utifrån individuella faktorer, som social kontext och värderingar. Upplevelser av försoning kan inträffa under korta och pendlade perioder och är inget konstant tillstånd.Background: To suffer from amyotrophic lateral sclerosis is traumatic for the affected individual and usually leads to a drastic shortening of life. The absence of reconciliation towards the dying person´s destiny may lead to that the remaining part of life comprises despair and agony. Therefore, it is important for care givers to have knowledge about meaning of reconciliation.  Aim: The study aims to examine whether, and if so, persons diagnosed with amyotrophic lateral sclerosis express reconciliation with their deadly and rapidly progressive disease. Methods: The analysis performed was inspired by Lundman´s and Hällgren Graneheim´s (2008) method of qualitative content analysis to examine the latent expressions of the concept of reconciliation. The analysis is based on four autobiographies. Results: Moments of reconciliation can be expressed as bearable suffering, experiences of satisfaction and experiences of safety through existential thoughts. Factors that could enable moments of reconciliation may be the development of new perspectives, comfort which results in the absence of fear and through creation of a meaning of life situation. Conclusion: Experiences of reconciliation can be expressed in many different ways based on individual factors such as social context and values. Moments of reconciliation can occur over short periods and are not a constant condition

Clinicians’ retrospective perceptions of failure to detect sexual abuse in a young man with autism and mild intellectual disability

Background: Individuals with intellectual disability (ID) and autism spectrum disorder (ASD) are at increased risk of sexual abuse. However, little is known about facilitating detection and disclosure. One year after discharge from a specialised psychiatric ward, a young man with mild ID and ASD disclosed previously unknown sexual abuse. The aim of the present study was to explore clinicians’ perceptions of their failure to detect abuse. Method: Interpretative phenomenological analysis was used to explore five staff members’ perceptions, with data being collected through an individual, semi-structured interview. Results: Staff reported behaviours that, in retrospect, they understood as possible indicators of abuse and/or attempts by the patient to disclose. Factors contributing to non-detection included insufficient trauma sensitivity, lack of exploration, and diagnostic overshadowing. Conclusions: Symptoms of trauma should be routinely explored in individuals with ASD and ID referred for psychiatric assessment – even in the absence of known trauma or abuse

Identification of Implementation Strategies Used for the Circle of Security-Virginia Family Model Intervention: Concept Mapping Study

Background: A reoccurring finding from health and clinical services is the failure to implement theory and research into practice and policy in appropriate and efficient ways, which is why it is essential to develop and identify implementation strategies, as they constitute the how-to component of translating and changing health practices. Objective: The aim of this study was to provide a systematic and comprehensive review of the implementation strategies that have been applied for the Circle of Security-Virginia Family (COS-VF) model by developing an implementation protocol. Methods: First, informal interviews and documents were analyzed using concept mapping to identify implementation strategies. All documentation from the Network for Infant Mental Health’s work with COS-VF was made available and included for analysis, and the participants were interviewed to validate the findings and add information not present in the archives. To avoid lack of clarity, an existing taxonomy of implementation strategies, the Expert Recommendations for Implementing Change, was used to conceptualize (ie, name and define) strategies. Second, the identified strategies were specified according to Proctor and colleagues’ recommendations for reporting in terms of seven dimensions: actor, the action, action targets, temporality, dose, implementation outcomes, and theoretical justification. This ensures a full description of the implementation strategies and how these should be used in practice. Results: Ten implementation strategies were identified: (1) develop educational materials, (2) conduct ongoing training, (3) audit and feedback, (4) make training dynamic, (5) distribute educational materials, (6) mandate change, (7) obtain formal commitments, (8) centralize technical assistance, (9) create or change credentialing and licensure standards, and (10) organize clinician implementation team meetings. Conclusions: This protocol provides a systematic and comprehensive overview of the implementation of the COS-VF in health services. It constitutes a blueprint for the implementation of COS-VF that supports the interpretation of subsequent evaluation studies, facilitates knowledge transfer and reproducibility of research results in practice, and eases the replication and comparison of implementation strategies in COS-VF and other interventions