Purpose: To reduce ceiling effects on domain scores (Task, Goal, and Bond) of the Working Alliance Inventory (WAI)-Rehabilitation Dutch Version by changing response scales and using Visual Analogue ...Scales (VASs).
Methods: Clients, who had at least three treatment sessions prior, randomly received one of the three versions of the WAI-Rehabilitation Dutch Version, using items with a balanced Likert scale, Positive-Packed Likert scale or VAS. Primary outcome was percentage of ceiling effects in total- and domain scores, secondary outcomes were construct validity and internal consistency of the three versions.
Results: One hundred and seventy-six clients randomly received a set of questionnaires (one of the three versions of the WAI-Rehabilitation Dutch Version, Session Rating Scale (SRS) and Helping Alliance Questionnaire (HAQ)-II); 152 participants (mean age 51.5 ± 16.3, 106 women) returned the questionnaires. No ceiling effects were present in the total scores of all versions. Significantly fewer ceiling effects were found in the VAS-Version (Goal: 8.0%, Bond: 7.7%) compared to the original (Goal: 18.0%, Bond: 29.8%) and Positive-Packed Version (Goal: 27.1%, Bond: 29.8%). Spearman's correlations between VAS-Version, SRS and HAQ-II ranged 0.747-0.845.
Conclusions: Visual Analogue Scales effectively reduced ceiling effects on domain scores of the WAI-Rehabilitation Dutch Version, while maintaining validity.
Implications for Rehabilitation
Visual Analogue Scales effectively reduced ceiling effects on domain scores of the Working Alliance Inventory-Rehabilitation Dutch Version, while maintaining construct validity.
The Working Alliance Inventory version with Visual Analogue Scales can be used in rehabilitation.
•Patient-centredness has developed since Mead and Bower’s review in 2000.•Four of Mead and Bower’s dimensions are still relevant.•Coordinated care is an increa used dimension of ...patient-centredness.•Basic elements: the patient, the doctor-patient relationship, coordination of care.
Patient-centredness is often linked to high-quality patient care, but the concept is not well-defined. This study aims to provide an overview of how patient-centredness has been defined in the literature since Mead and Bower’s review in 2000, and to provide an updated definition of the concept.
We performed a systematic literature search in PubMed to identify original articles with a sufficient definition of patient-centredness. We analysed extracted data defining patient-centredness.
Eighty articles were included. The dimensions “biopsychosocial”, “patient-as-person”, “sharing power and responsibility” and “therapeutic alliance” corresponded to four of five dimensions described by Mead and Bower. “Coordinated care” was a new dimension.
The identified dimensions are encompassed by three elements: the patient, the doctor-patient relationship and the framework of care i.e. the health care system. The additional focus on coordinated care could reflect increasing complexity of the health care system.
Narrowing down the understanding of patient-centredness to these three focus areas, viz. 1) understanding of the patients’ experience of the illness in their life situation, 2) the professional’s relationship with the patient, and 3) coordination of care in the system, could make the operationalisation and implementation of a patient-centred approach more manageable.
The therapeutic relationship between patient and physiotherapist is a central component of patient-centred care and has been positively associated with better physiotherapy clinical outcomes. Despite ...its influence, we do not know what conditions enable a physiotherapist and patient to establish and maintain a therapeutic relationship. This knowledge has implications for how clinicians approach their interactions with patients and for the development of an assessment tool that accurately reflects the nature of the therapeutic relationship. Therefore, this study's aim was to identify and provide in-depth descriptions of the necessary conditions of engagement of the therapeutic relationship between physiotherapists and patients.
Interpretive description was the qualitative methodological orientation used to identify and describe the conditions that reflect and are practically relevant to clinical practice. Eleven physiotherapists with a minimum 5 years of clinical experience and seven adult patients with musculoskeletal disorders were purposively sampled from private practice clinics in Edmonton, Canada. The in-person, semi-structured interviews were completed in a location of the participant's choice and were audio recorded and transcribed. Qualitative content analysis was used to analyze the textual data and constant comparison techniques were integrated to refine the categories and sub-categories. Rigour strategies used throughout the study were peer debrief, interview notes, reflexive journaling, memoing, member reflections, audit trail, and external audit.
Four conditions were identified as necessary for establishing a therapeutic relationship:
,
,
, and
. These conditions represent the intentions and attitudes of physiotherapists and patients engaging in the clinical interaction. Although distinct, the conditions appear related as being present and receptive create a foundation for being genuine and committed.
These conditions of engagement are needed for physiotherapist and patient to "be" in a therapeutic relationship. Although communication skills are important for advancing therapists' relational abilities, awareness and integration of intentions and attitudes are essential for shaping behaviors that develop the therapeutic relationship. These findings also suggest there are characteristics of the therapeutic relationship specific to physiotherapy. Therefore, theories from other contexts (e.g., psychotherapy) should be used judiciously to guide physiotherapy practice and research.
Objective: Our aim was to examine the reliability and validity of the Rupture Resolution Rating System (3RS), an observer-based measure of alliance ruptures and resolution processes. Method: We used ...the 3RS to rate early sessions from 42 cases of cognitive behavior therapy. We compared the 3RS to a simplified version of the Structural Analysis of Social Behavior (SASB), as well as patient and therapist self-reports of ruptures and the alliance. Results: Coders achieved high rates of interrater reliability on the frequency of confrontation and withdrawal ruptures and resolution strategies (ICCs = .85 to .98), as well as ratings of the therapist's contribution to ruptures and the extent to which ruptures were resolved (ICC = .92). Predictive validity analyses found that confrontation markers (d = .74), successful resolution (d = .67), and ratings of the therapist's contribution to ruptures (d = .61) predicted dropout from therapy. Analyses of convergent validity with the SASB failed to meet predictions; however, we observed theoretically coherent relations between 3RS and SASB variables. Confrontation rupture markers were significantly associated with patient self-report of rupture (d = 1.54) and therapist self-reported alliance (r = −.50, p = .002). Conclusions: This study provides evidence that the 3RS is a reliable and useful tool for examining psychotherapy process and predicting dropout.
Clinical or methodological significance of this article: This study provides evidence of the reliability and validity of the 3RS, an observer-based measure of alliance ruptures and resolution processes. The 3RS can be used to identify problems in the therapeutic relationship that are associated with premature dropout from therapy.
Speech-Language Therapists (SLT) may have negative approaches toward Adults Who Stutter (AWS). There is no consensus about the SLT perspectives on AWS. This study aimed to investigate the SLT ...approach to AWS and assessment-therapy components in their practices. SLT (N=209) were included in the study. The survey consisted of four sections: demographic information, assessment-therapy components, and attitudes. The results are reported through boxplot graphics. The majority of the SLT were female (86.6%) and aged in the young group (20-29 years) (81.2%). SLT noted that they frequently used non-standard tools in the assessments and traditional or contemporary methods are preferred in the therapy components. The participants mentioned that important to AWS's quality of life, resilience, and psychosocial characteristics. SLT are more likely to utilize non-standard approaches while evaluating AWS. Traditional methods, as well as current approaches, are preferred by the SLT. SLT cares about AWS's resilience and temperament differences.
Sexual minority clients report experiencing frequent microaggressions during therapy, however, therapists may not recognize those microaggressions or may be reluctant to self-report them. The main ...aim of the present study was thus to develop an observational measure of in-session therapist-committed microaggressions related to the sexual orientation of sexual minority individuals (e.g., those who identify as lesbian, gay, bisexual, or queer). The present study further examined the association between therapist-committed sexual orientation microaggressions and ruptures in the therapeutic alliance. We hypothesized that clinically significant microaggressions would be positively associated with withdrawal ruptures in the alliance. The sample consisted of 44 gay and bisexual men who participated in a cognitive behavioral treatment designed to reduce depression, anxiety, human immunodeficiency virus-transmission-risk behaviors, and substance use. An observer-based coding measure designed for this study, the Sexual Orientation Microaggression Rating Scale (SOMRS), was utilized to capture sexual minority microaggressions in the initial sessions of treatment. Good interrater reliability was achieved for the SOMRS. Microaggressions were coded in 34% of the sessions. Within the subset of sessions with coded microaggressions, a significant association was found between withdrawal ruptures and microaggression significance ratings. The SOMRS holds potential for supporting research on microaggression as well as future efforts to help clinicians recognize and repair in-session behaviors that negatively impact sexual minority clients.
Clinical Impact Statement
Question: Can therapist sexual orientation microaggressions and their resolutions be reliably measured by observers and are these events associated with alliance ruptures? Findings: Therapist sexual orientation microaggressions were reliably identified by observers, and in sessions that included sexual orientation microaggressions, a significant association between microaggressions and withdrawal alliance ruptures was found. Meaning: The Sexual Orientation Microaggression Rating Scale can be used to reliably code for sexual orientation microaggressions and their repair in therapy sessions. Sexual orientation microaggressions may contribute to client withdrawal. Next Steps: Future research can build on these findings by examining therapist sexual orientation microaggressions in larger and more diverse samples, by comparing self-report measures of microaggressions with this observer-based measure, and by assessing the association between sexual orientation microaggressions and outcome. The Sexual Orientation Microaggression Rating Scale can also inform efforts to train therapists to recognize subtle microaggressions.
The pattern of rupture and repair within therapeutic alliances has been associated with improved outcome. The present study adds to this body of research by examining rupture and repair from a dyadic ...perspective. First, we examined the relationship between mutual recognition of ruptures, rupture intensity, and client ratings of session helpfulness. We then examined client-therapist congruence regarding rupture and repair characteristics and their relation to client ratings of session helpfulness. Data were collected from 90 client-therapist dyads (providing two subsamples of 61 and 45 dyads) during 16 sessions of short-term psychodynamic therapy. Clients and therapists rated the occurrence of ruptures, rupture characteristics, and rupture repair following each session. Clients also rated session helpfulness following each session. We found a significant negative interaction effect, indicating that when clients rated ruptures as more intense, therapist rupture recognition was related to lower client ratings of session helpfulness. Client-therapist congruence in the perception of rupture intensity was positively related to client perceptions of the extent to which ruptures were discussed. Finally, we found a significant positive relationship between client-therapist congruence in their perception of rupture repair and client ratings of session helpfulness. This study demonstrates the significance of the dyadic view of the rupture/repair process. Therapist recognition of ruptures may not be enough to facilitate repair, specifically in ruptures with a high level of intensity. Nevertheless, congruence in intensity is valuable for addressing the rupture within the session, and congruence in repair is valuable for session helpfulness.
Clinical Impact Statement
Question: How are clients' and therapists' mutual recognition of rupture characteristics and their congruence in the perception of ruptures related to clients' ratings of increased session helpfulness and rupture resolution? Findings: When clients rated ruptures as more intense, therapist rupture recognition was related to lower client ratings of session helpfulness. Client-therapist congruence in rupture intensity was positively related to clients' perceptions of the level of rupture discussion. Client-therapist congruence in their perception of rupture repair was positively related to clients' ratings of session helpfulness. Meaning: Therapists' recognition of clients' ruptures is important since it predicts better process. However, it does not guarantee better session outcome. Next Steps: Examining those relationships with additional measures of ruptures and outcomes and looking at the nature of the dyadic process in psychotherapy.
Objective: Attrition is a common problem in youth trauma treatment, but there is currently little knowledge of why so many youths drop out. In this study, treatment variables (caregiver attendance in ...the first session and exposure vs. non-exposure-based treatment) and first-session process variables (the therapeutic alliance and youths' perceptions of parental treatment approval) were investigated as predictors of dropout. Method: Participants (N = 156, mean age = 15.1) were randomly assigned to trauma-focused cognitive behavioral therapy or therapy as usual in a community trial. Results: Dropout (n = 39, 25.0%) was predicted by a lack of caregiver attendance, lower rates of youth-perceived parental treatment approval, and weaker therapist-rated youth alliance. Neither type of treatment, youth-rated alliance or caregiver alliance, predicted dropout. Conclusions: The findings indicate that in addition to caregivers' actual participation in the first session, youths' perception of their parents' approval of treatment seems to influence treatment attendance. This finding implies that therapists should engage caregivers in therapy and address possible discordance in treatment goals and tasks. Furthermore, consistent with adult studies, exposure-based treatments do not appear to increase dropout rates.
Conversational artificial intelligence (CAI) presents many opportunities in the psychotherapeutic landscape-such as therapeutic support for people with mental health problems and without access to ...care. The adoption of CAI poses many risks that need in-depth ethical scrutiny. The objective of this paper is to complement current research on the ethics of AI for mental health by proposing a holistic, ethical, and epistemic analysis of CAI adoption. First, we focus on the question of whether CAI is rather a tool or an agent. This question serves as a framework for the subsequent ethical analysis of CAI focusing on topics of (self-) knowledge, (self-)understanding, and relationships. Second, we propose further conceptual and ethical analysis regarding human-AI interaction and argue that CAI cannot be considered as an equal partner in a conversation as is the case with a human therapist. Instead, CAI's role in a conversation should be restricted to specific functions.
Background The therapeutic alliance (TA) is a robust and pantheoretical predictor of treatment outcome in Face-to-Face- (F2F-) and Online-psychotherapy (Online-PT). Many authors have proposed several ...conceptualizations of TA, which are oftentimes operationalized. The resulting diversity of conceptualizations and measures is presented in this review. Methods We performed a three-parted literature search for self-report-instruments of TA in individual, voluntary F2F-PT with adults (1. utilization of past reviews, 2. systematic literature search yielding 5,205 articles, 3. reference lists). Analogously, we conducted a systematic literature search for instruments of TA in the Online-setting (yielding 200 articles). Additionally, we analyzed the content of the instruments qualitatively. Results A current overview of 48 instruments for measuring TA (46 for F2F-PT, 2 for Online-PT) including their conceptual backgrounds, characteristics and main content aspects is presented. Most instruments ( n = 24) operationalize one or more theoretical conceptualizations of TA. Other instruments are adaptation/syntheses of existing measures ( n = 14), based on literature searches ( n = 3) or on an empirical survey ( n = 3) and two instruments provide no conceptual background information. The content of the instruments mainly focused on the following aspects: 1. Self-disclosure and authenticity; 2. Agreement; 3. Active participation, motivation and compliance; 4. Trust and secure attachment; and 5. Considering needs/abilities/wishes of the patient. Additionally, a narrative review of various approaches to conceptualize TA is presented and linked to respective corresponding instruments. Discussion The broad variety of conceptualizations and measures of TA makes coherent research on TA difficult. There are conceptual challenges such as the role of attachment style in TA that remain to be clarified. The current conceptualizations and measures do not incorporate the practical experience and expertise of psychotherapists and patients sufficiently. A metatheoretical conceptualization and measure of TA based on an empirical survey of psychotherapists and patients could address these issues.
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