Background:
Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients ...with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion.
Aim:
To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care.
Design:
A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients’ responses to the EQ-5D quality of life instrument.
Setting/participants:
Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital.
Results:
EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs.
Conclusion:
The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.
The effects of non-directive supportive therapy (NDST) for adult depression have been examined in a considerable number of studies, but no meta-analysis of these studies has been conducted. We ...selected 31 studies on NDST from a comprehensive database of trials, examining psychotherapies for adult depression, and conducted meta-analyses in which NDST was compared with control groups, other psychotherapies and pharmacotherapy. We found that NDST is effective in the treatment of depression in adults (g=0.58; 95% CI: 0.45–0.72). NDST was less effective than other psychological treatments (differential effect size g=−0.20; 95% CI: −0.32 to −0.08, p<0.01), but these differences were no longer present after controlling for researcher allegiance. We estimated that extra-therapeutic factors (those processes operating in waiting-list and care-as-usual controls) were responsible for 33.3% of the overall improvement, non-specific factors (the effects of NDST compared with control groups) for 49.6%, and specific factors (the effects of NDST compared with other therapies) for 17.1%. NDST has a considerable effect on symptoms of depression. Most of the effect of therapy for adult depression is realized by non-specific factors, and our results suggest that the contribution of specific effects is limited at best.
► Non-directive supportive therapy is effective in depressed patients. ► Other psychotherapies are somewhat more effective. ► After adjustment for researcher allegiance there is no difference. ► The effects of non-directive supportive therapy are moderate (effect size g=0.58).
The purpose of this article is to present a case history of an individual client deeply affected by the 2016 election of Donald Trump: an unexpected key to her self‐empowerment. Raised in poverty and ...with a history of being sexually abused, the client's anger and frustration at Hillary Clinton's loss in the election led to an examination in therapy of the role of gender in her life and enabled her to strengthen her sense of agency in her world.
Introduction
Sexual well-being (SWB) of the older population can be significantly influenced by age (1) and sexual difficulties (2).
Objectives
Through qualitative research, this study focused on ...sexual themes that affect the SWB addressed by the older people in person-centered therapy.
Methods
Twenty-five older adults, aged between 65 and 82 years and residents on the community participated in this study.
Results
The results revealed eight main themes for these participants: Absence of a partner, family interference, dissatisfaction with the body, cleanliness and body care, problems in sexual function, physical violence, problems in sexual communication and fear of contracting sexually transmitted diseases. The most discussed themes were the absence of a partner, problems with sexual function and dissatisfaction with the body.
Conclusions
This study highlights the importance of exploring the sexual difficulties that the older population feels in relation to their SWB. 1.von Humboldt S et al. Sexual expression in old age: How older adults from different cultures express sexually? Sex Res Social Policy. 2020;1-15. 2.von Humboldt S et al. Are older adults satisfied with their sexuality? Outcomes from a cross-cultural study. Educ Gerontol. 2020;46:284-293.
Disclosure
No significant relationships.
To date, transgender and gender-diverse voice clients' perceptions and individual goals have been missing in discussions and research on gender-affirming voice therapy. Little is, therefore, known ...about the client's expectations of therapy outcomes and how these are met by treatments developed from views of vocal gender as perceived by cisgender persons. This study aimed to explore clients' individual motives and perceived barriers to undertaking gender-affirming voice therapy.
Individual, semistructured interviews with 15 transgender and gender-diverse voice clients considering voice therapy were conducted and explored using qualitative content analysis.
Three themes were identified during the analysis of the participants' narratives. In the first theme, "the incongruent voice setting the rules," the contribution of the voice on the experienced gender dysphoria is put in focus. The second theme, "to reach a voice of my own choice," centers around anticipated personal gains using a modified voice. The third theme, "a voice out of reach," relates to worries and restricting factors for not being able to reach one's set goals for voice modification.
The interviews clearly indicate a need for a person-centered voice therapy that starts from the individuals' expressed motives for modifying the voice yet also are affirmative of anticipated difficulties related to voice modification. We recommend that these themes should form the basis of the pretherapy joint discussion between the voice client and the speech-language pathologist to ensure therapy goals that are realistic and relevant to the client.
Background: Client-centred goal setting is central to the process of enabling occupation. Yet, there are multiple barriers to incorporating client-centred goal setting in practice. We sought to ...determine what might facilitate or impede the formation of client-centred goals in a context highly supportive of client-centred goal setting
Methods: We used conversational analysis to examine goal-setting conversations that took place during a pilot trial of Occupational Performance Coaching for stroke survivors. Twelve goal-setting sessions were purposively selected, transcribed, and analyzed according to conventions for conversation analysis.
Results: Two main types of interactions were observed: introductory actions and goal selection actions. Introductory actions set the context for goal setting and involved sharing information and seeking clarification related to goal requirements and clients' occupational performance competencies. Goal selection actions were a series of interactions whereby the goals were explored, endorsed or dropped.
Conclusion: Client-centred occupational performance goals may be facilitated through placing goal-setting in the context of life changes and lifelong development of goals, and through listening to clients' stories. Therapists may improve consistency in adoption of client-suggested goals through clarifying meaning attached to goals and being attuned to power dynamics and underlying values and beliefs around risk and goal attainability.
Therapists' perspectives on positive regard Ort, Daisy; Moore, Caitlin; Farber, Barry A.
Person-centered & experiential psychotherapies,
04/2023, Letnik:
22, Številka:
2
Journal Article
Recenzirano
This study investigated multiple aspects of therapists' provision of positive regard (PR), including their assessment of the importance of PR in their practice, their sense of which specific aspects ...of PR are most affirming, and their perception of which aspects they provide most frequently to their clients. A total of 269 psychotherapists, primarily female, White, residing in the United States, and representing a range of theoretical orientations, completed a web-based survey with three Likert-type measures that reflected an understanding of PR as a wider-ranging concept than unconditional positive regard (UPR). Results suggest that therapists acknowledge PR as central to treatment process and outcome, that there is significant thematic breadth to the ways they choose to convey PR, and that the behaviors and statements they perceive as most affirming are also those that they are most likely to express in therapy. These findings, in conjunction with the significant convergence between therapists' and clients' perceptions of the nature and importance of PR, suggest that PR is a far more widely adopted attitude across multiple theoretical orientations than has generally been assumed.
Abstract Personalized medicine is aimed at identifying which characteristics of an individual predict the outcome of a specific treatment, in order to get a better match between the individual and ...the treatment received. We conducted a systematic review and meta-analysis of randomized trials comparing two psychotherapies directly in a group of depressed patients with a specific characteristic. We focused on the six most examined types of psychotherapy for adult depression. Our searches resulted in 41 studies with 2,741 patients who met inclusion criteria. These 41 studies examined 27 specific characteristics of patients. Power calculations indicated that we would need 4 studies for each characteristic to find a clinically relevant effect size set at g = 0.50 and 16 studies for an effect size of 0.24. Only 3 patient characteristics were found to have sufficient power and to significantly moderate treatment outcomes. Cognitive-behavioral therapy was found to be more effective than other therapies in older adults ( g = 0.29), in patients with comorbid addictive disorders ( g = 0.31), and in university students ( g = 0.46). Risk of bias was considerable in most of the included studies. It was estimated that it will take another 326 years to have sufficient statistical power for showing an effect size of g = 0.50 of the 27 characteristics, and 1,372 years to show an effect size of 0.24. Although several dozens of studies have compared the effects of psychotherapies in specific target groups, we will need to develop more powerful alternatives to comparative outcome studies in order to identify personalized treatments for depression.
Lesbian, gay, bisexual and queer people (LGBQ; a sexual minority social group) access counseling and psychotherapy more frequently than heterosexual people, often working with heterosexual therapists ...(a sexual majority social group). Heterosexual therapists working with LGBQ clients is under-researched which means limited dialogue exists describing a significant yet sensitive area of sexuality difference where therapist and client hold diverging social experiences. To facilitate awareness development in person-centered therapy and beyond, the paper seeks to challenge such limited dialogue, stimulating discussion through considering how four heterosexual person-centered therapists experience working with LGBQ clients. This qualitative research project was designed using Interpretative Phenomenological Analysis as its methodology to explore the experiences of four heterosexual person-centered therapists who work with LGBQ clients. Findings centered upon four themes: shaping and forming, ways of seeing, witnessing clients and relationships with person-centered theory. The discussion considered the data in dialogue with person-centered theory, explored phenomenological therapy practice, intersectionality, power, and witnessing client experiences of social discrimination, and evaluated the non-pathologizing therapeutic potential that person-centered phenomenological practice holds for working with LGBQ clients. For theory development, the paper calls for further person-centered discourse exploring LGBQ experiencing.
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