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Int J Environ Res Public Health ; 18(20)2021 10 12.
Article in English | MEDLINE | ID: covidwho-1480718


Few studies have examined the relationship between the therapeutic alliance in therapy and suicidal experiences. No studies have examined this relationship with people with non-affective psychosis. The present study sought to redress this gap in the literature. Sixty-four participants with non-affective psychosis and suicidal experiences who were receiving a suicide-focused cognitive therapy were recruited. Self-reported suicidal ideation, suicide plans, suicide attempts, depression, and hopelessness were collected from participants prior to starting therapy. Suicidal experience measures were collected again post-therapy at 6 months. Therapeutic alliance ratings were completed by clients and therapists at session 4 of therapy. Dose of therapy was documented in number of minutes of therapy. Data were analyzed using correlation coefficients, independent samples t-tests, a multiple hierarchical regression, and a moderated linear regression. There was no significant relationship found between suicidal ideation prior to therapy and the therapeutic alliance at session 4, rated by both client and therapist. However, there was a significant negative relationship between the client-rated therapeutic alliance at session 4 and suicidal ideation at 6 months, after controlling for pre-therapy suicidal ideation, depression, and hopelessness. Furthermore, the negative relationship between the client-rated alliance and suicidal ideation was the strongest when number of minutes of therapy was 15 h or below. A stronger therapeutic alliance developed in the first few sessions of therapy is important in ameliorating suicidal thoughts in people with psychosis. Nevertheless, it is not necessarily the case that more hours in therapy equates to a cumulative decrease in suicidal ideation of which therapists could be mindful. A limitation of the current study was that the alliance was analyzed only at session 4 of therapy, which future studies could seek to redress.

Psychotic Disorders , Therapeutic Alliance , Humans , Psychotherapy , Psychotic Disorders/therapy , Suicidal Ideation , Suicide, Attempted
J Anal Psychol ; 66(3): 484-505, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1299068


Given the contemporary situation of many analysts in the world now being forced to work online due to the effects of the COVID-19 pandemic, it is important to review the working online issue. Substantial debate over previous years has questioned whether a genuine analytic process can unfold through online work. This debate is reviewed with the conclusion that such a process is not necessarily precluded. Research outcomes are then reviewed to highlight those things that can facilitate positive outcomes when working online. These cover the 'online disinhibition effect', the therapeutic alliance, particular ways of using the screen, focussing on trauma, the importance of self-awareness, knowing the predictors of mental health, certain potential positives of isolation/quarantine and psychotherapy interventions that may be currently needed. Final recommendations and suggestions are then presented as in the diagnosis issue, professional development and guidelines to do with practical and ethical considerations.

Etant donnée la situation actuelle dans laquelle beaucoup d'analystes dans le monde sont maintenant obligés de travailler en ligne du fait des effets de la pandémie de COVID-19, il est important de revisiter le sujet du travail en ligne. Dans les dernières années, il y a eu un débat important sur la question de savoir si un authentique travail analytique pouvait se déployer dans le cadre d'un travail en ligne. Ce débat est revisité ici avec la conclusion qu'un tel processus n'est pas nécessairement rendu impossible. Les résultats de recherches sont alors étudiés afin de souligner les éléments qui peuvent faciliter des effets positifs quand on travaille en ligne. Cela recouvre 'l'effet de désinhibition du travail en ligne', l'alliance thérapeutique, les manières particulières d'utiliser l'écran, se concentrer sur le traumatisme, l'importance de la conscience de soi, la connaissance des indicateurs de santé mentale, certains aspects potentiellement positifs de l'isolation/la quarantaine et les interventions psychothérapeutiques qui peuvent alors être avisées. Des recommandations et des suggestions sont enfin présentées au sujet du diagnostic, de la formation continue et des consignes sur les considérations pratiques et éthiques.

Dada la situación contemporánea de muchos analistas en el mundo forzados en la actualidad a trabajar en línea debido a los efectos de la pandemia COVID-19, es importante revisar el tema del trabajo online. Durante los años previos, un debate sustancial ha cuestionado si un genuino proceso analítico puede llevarse a cabo a través del trabajo online. Este debate es revisado con la conclusión de que semejante proceso no está necesariamente impedido. Los resultados de la investigación son luego revisados para destacar aquellos elementos que pueden facilitar resultados positivos al trabajar online. Los mismos abarcan, 'el efecto online de desinhibición', la alianza terapéutica, los modos particulares de usar la pantalla, el focalizarse en el trauma, la importancia del autoconocimiento, el conocer los predictores en salud mental, ciertos potenciales positivos del aislamiento/cuarentena e intervenciones en psicoterapia que pueden ser necesarias en la actualidad. Se presentan recomendaciones finales y sugerencias, en el tema diagnóstico, desarrollo profesional y guías con consideraciones prácticas y éticas.

COVID-19 , Physical Distancing , Psychoanalytic Therapy , Telecommunications , Telemedicine , Therapeutic Alliance , Humans , Psychoanalytic Therapy/ethics , Psychoanalytic Therapy/standards , Telecommunications/ethics , Telecommunications/standards , Telemedicine/ethics , Telemedicine/standards
J Pers Assess ; 104(3): 417-427, 2022.
Article in English | MEDLINE | ID: covidwho-1268032


The Therapeutic Assessment (TA) model of psychological assessment has grown in use due to the demonstrated benefits to clients. However, to date, there have been no published articles on how conducting TA virtually may impact the process and experience. The COVID-19 global pandemic led to a rapid increase in virtual delivery of psychological services, including assessments. Assessors adapted procedures to ensure that clients were served ethically, the assessor-client relationship was considered, and the results were deemed valid. This empirical case study was conducted to evaluate test validity, therapeutic alliance, and the clinician's and client's experience of a TA conducted virtually. The validity of test administration was evaluated by experts, who reviewed video of the administration and test results; no concerns regarding integrity and interpretability of the results were identified. Therapeutic alliance, session process, and virtual presence were measured after each session. Both clinician and client reported positive experiences. The overall impact of the TA was evaluated through quantitative assessment of the client's experience and qualitative analysis of interviews. Collectively, this research demonstrates the feasibility of conducting a TA virtually, in an efficacious manner, that leads to positive client outcomes.

COVID-19 , Therapeutic Alliance , Empirical Research , Humans , Professional-Patient Relations
J Nerv Ment Dis ; 209(8): 543-546, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1234178


ABSTRACT: Social distancing due to COVID-19 may adversely impact treatment of adults with serious mental illness, especially those receiving intensive forms of community-based care, in part through weakening of the therapeutic alliance. Veterans and staff at a Veterans Affair (VA) medical center were surveyed 3 months after social distancing disrupted usual service delivery in intensive community-based treatment programs. Veterans (n = 105) and staff (n = 112) gave similar multi-item ratings of service delivery after social distancing, which involved far less face-to-face contact and more telephone contact than usual and rated their therapeutic alliances and clinical status similarly as "not as good" on average than before social distancing. Self-reported decline in therapeutic alliance was associated with parallel decline in clinical status indicators. Both veterans and staff indicated clear preference for return to face-to-face service delivery after the pandemic with some telehealth included.

Attitude of Health Personnel , COVID-19 , Case Management/standards , Community Mental Health Services/standards , Delivery of Health Care/standards , Patient Preference , Physical Distancing , Telemedicine/standards , Therapeutic Alliance , Adult , COVID-19/prevention & control , Female , Humans , Male , Middle Aged , United States , United States Department of Veterans Affairs , Veterans
Psychol Psychother ; 94(3): 854-883, 2021 09.
Article in English | MEDLINE | ID: covidwho-1096921


PURPOSE: The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. METHOD: Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. RESULTS: Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. CONCLUSIONS: Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. PRACTITIONER POINTS: Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.

Behavior Therapy/standards , Mental Disorders/therapy , Patient Satisfaction , Process Assessment, Health Care , Telemedicine/standards , Therapeutic Alliance , Videoconferencing/standards , COVID-19/prevention & control , Humans
Clin Psychol Psychother ; 28(2): 409-421, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-842000


The arrival of the coronavirus (COVID-19) pandemic has confronted us with a global and unprecedented challenge of community-wide psychological distress alongside reduced access to therapeutic services in the traditional face-to-face format, due to the need to self-isolate. This previously unimagineable set of circumstances provides a unique opportunity, and indeed an imperative, for videotherapy to fulfil its potential in addressing mental health and well-being needs from a distance. Historically, the uptake of videotherapy has been hindered by psychotherapist expectations of inferior therapeutic alliance and outcomes, in spite of considerable research evidence to the contrary. Research suggests that videotherapy provides a powerful pathway for clients to experience enhanced opportunities for self-expression, connection and intimacy. This more neutral therapeutic 'space' provides clients with multifarious opportunities for self-awareness, creative experience and collaboration, with potentially a greater sense of agency over their own experience. This paper explores ways in which videotherapy can lead to a revitalisation of the concept of the therapeutic relationship, in order to meet the challenges associated with COVID-19. A number of specific considerations for videotherapy adaptations and etiquette in the midst of COVID-19 are described.

COVID-19/prevention & control , Mental Disorders/therapy , Psychotherapy/methods , SARS-CoV-2 , Telemedicine/methods , Therapeutic Alliance , Humans