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Therapeutic alliance

Sigal Zilcha-Mano
Many therapists regard alliance ruptures as one of the greatest challenges therapists face in the therapy room. Alliance ruptures has been previously defined as breakdowns in the process of negotiation of treatment tasks and goals and a deterioration in the affective bond between patient and therapist. Alliance ruptures have been found to predict premature termination of treatment and poor treatment outcomes. But ruptures can also present important opportunities for gaining insight and awareness and for facilitating therapeutic change...
October 17, 2016: Clinical Child Psychology and Psychiatry
Thomas M Achenbach
As the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) acknowledges, DSM diagnostic categories do not fit the real-world heterogeneity, comorbidity, and complexity of most mental health problems. Many efforts to develop and test evidence-based treatments also fail to take account of the heterogeneity, comorbidity, and complexity of problems seen in the community settings where most mental health services are rendered. Most community services cannot attain the treatment specificity and fidelity characterizing randomized controlled trials, which often yield larger therapeutic effects than when the tested treatments are tried in community services...
October 13, 2016: Journal of Clinical Child and Adolescent Psychology
Uwe Altmann, Désirée Thielemann, Bernhard Strauß
There is a growing body of literature recognizing the importance of outpatient psychotherapy. Several studies investigated the efficacy of outpatient psychotherapy and aspects of the health care system under natural conditions. This paper gives an overview of studies from German speaking countries (TRANS-OP-, TK-, PAP-S- and QS-PSY-BAY-study).The results of the different studies indicate both, positive outcome of the therapies (e. g., reduction of symptoms with an average ES of 1,03; improvement of symptoms despite premature termination) as well as an economic benefit (end of treatment depending on treatment outcome and not limited by therapy sessions; extensions of psychotherapy only if patient is highly impaired and therapeutic alliance is positive; high reduction of supply costs and sick leave)...
October 2016: Psychiatrische Praxis
Jennifer W Mack, Maya Ilowite, Sarah Taddei
BACKGROUND: Previous work on difficult relationships between patients and physicians has largely focused on the adult primary care setting and has typically held patients responsible for challenges. Little is known about experiences in pediatrics and more serious illness; therefore, we examined difficult relationships between parents and physicians of children with cancer. METHODS: This was a cross-sectional, semistructured interview study of parents and physicians of children with cancer at the Dana-Farber Cancer Institute and Boston Children's Hospital (Boston, Mass) in longitudinal primary oncology relationships in which the parent, physician, or both considered the relationship difficult...
October 11, 2016: Cancer
Gianluca Villa, Mauro Neri, Rinaldo Bellomo, Jorge Cerda, A Raffaele De Gaudio, Silvia De Rosa, Francesco Garzotto, Patrick M Honore, John Kellum, Anna Lorenzin, Didier Payen, Zaccaria Ricci, Sara Samoni, Jean-Louis Vincent, Julia Wendon, Marta Zaccaria, Claudio Ronco
This article reports the conclusions of the second part of a consensus expert conference on the nomenclature of renal replacement therapy (RRT) techniques currently utilized to manage acute kidney injury and other organ dysfunction syndromes in critically ill patients. A multidisciplinary approach was taken to achieve harmonization of definitions, components, techniques, and operations of the extracorporeal therapies. The article describes the RRT techniques in detail with the relevant technology, procedures, and phases of treatment and key aspects of volume management/fluid balance in critically ill patients...
October 10, 2016: Critical Care: the Official Journal of the Critical Care Forum
M Morgiève, K N'Diaye, S Fernandez-Vidal, A-H Clair, L Mallet
INTRODUCTION: Obsessive compulsive disorder (OCD) is one of the most disabling mental health disorders due to its negative impact on the patient's quality of life as well on that of her living caregivers. This disorder generates an additional burden for relatives, which may in turn affect the family dynamics and impair the evolution of the disease. Along with medications, cognitive behavioral therapy (CBT) represents a well-validated first line of treatment for OCD. However, therapeutic responses across patients are uneven with often residual symptoms and limited quality of life improvements...
October 4, 2016: L'Encéphale
Danielle Magaldi, Leora Trub
OBJECTIVE: Spiritual/religious/non-religious (S/R/N) identity development is often neglected in psychotherapy training and represents an area where psychotherapists feel they lack competence. Such feelings can become even more pronounced when it comes to S/R/N self-disclosure. This study explores the decisions therapists make regarding self-disclosure, which impacts the psychotherapy process. METHOD: This grounded theory study explores psychotherapists' S/R/N self-disclosure based on qualitative interviews with 21 psychotherapists representing varied theoretical orientations and spiritual, religious, atheist, and agnostic backgrounds...
October 6, 2016: Psychotherapy Research: Journal of the Society for Psychotherapy Research
Ursula Running Bear, Janette Beals, Douglas K Novins, Spero M Manson
BACKGROUND: Little is known about factors associated with detoxification treatment completion and the transition to substance abuse treatment following detoxification among Alaska Native people. This study examined 3 critical points on the substance abuse continuum of care (alcohol detoxification completion, acceptance of referral to substance abuse treatment, entry into substance abuse treatment following detoxification). METHODS: The retrospective cohort included 383 adult Alaska Native patients admitted to a tribally owned and managed inpatient detoxification unit...
September 24, 2016: Addictive Behaviors
Carlos Roncero, Néstor Szerman, Antonio Terán, Carlos Pino, José María Vázquez, Elena Velasco, Marta García-Dorado, Miguel Casas
BACKGROUND: There is a need to evaluate the professionals' perception about the consequences of the lack of therapeutic adherence in the evolution of patients with co-occurring disorders. METHODS: An online survey, released on the Socidrogalcohol [Spanish Scientific Society for Research on Alcohol, Alcoholism and other Drug Addictions] and Sociedad Española de Patología Dual [the Spanish Society of Dual Pathology] web pages, was answered by 250 professionals who work in different types of Spanish health centers where dual diagnosis patients are assisted...
2016: Patient Preference and Adherence
Ann C Long, Erin K Kross, J Randall Curtis
PURPOSE OF REVIEW: Family-centered outcomes during and after critical illness assess issues that are most important to family members. An understanding of family-centered outcomes is necessary to support the provision of family-centered care and to foster development of interventions to improve care and communication in the ICU. RECENT FINDINGS: Current family-centered outcomes in critical care include satisfaction with care, including end-of-life care, symptoms of psychological distress, and health-related quality of life...
September 28, 2016: Current Opinion in Critical Care
Evan Senreich
BACKGROUND: There is a large body of literature regarding the need for culturally-informed practice with non-white populations in substance abuse treatment. Virtually nothing, however, has been written regarding the needs of white clients when they represent a small minority in treatment programs. OBJECTIVES: The primary purpose of this study is to compare perceptions of treatment and completion rates between white and nonwhite clients in a substance abuse treatment program where white clients represent a small minority...
September 28, 2016: Substance Use & Misuse
Tracy Higgins, Elaine Larson, Rebecca Schnall
OBJECTIVE: Patient engagement has been credited with contributing to improved outcomes and experiences of care. Patient engagement has become a widely used term, but remains a poorly understood concept in healthcare. Citations for the term have increased throughout the healthcare-related disciplines without a common definition. This study seeks to define the concept by identifying its attributes in the context of its use. METHODS: A concept analysis of the scientific literature in the health disciplines was performed using the Rogers method...
September 3, 2016: Patient Education and Counseling
A El Ammouri, H Kisra
BACKGROUND: Schizophrenia is a chronic, relapsing, mental disorder, and lack of adherence is a common and severe problem in such patients leadingto global and heavy consequences for patients (relapses, hospitalizations, impaired quality of life…), for the family and for society. Improved understanding of the underlying reasons will help to form intervention strategies relevant to the context. OBJECTIVES: We aimed to assess medication adherence among stable patients suffering from schizophrenia and to identify factors associated with non-adherence...
September 20, 2016: L'Encéphale
Nabil Berhili, Amine Bout, Hayat Hlal, Chadya Aarab, Rachid Aalouane, Ismail Rammouz
Ekbom syndrome or delusional parasitosis is a rare disease characterized by the unwavering conviction of having cutaneous infestation of insects or parasites. This is a monothematic delusion of hallucinatory origin that typically affects older women. We report the case of three patients with delusional parasitosis in different clinical settings. The first patient suffered from isolated delusional parasitosis corresponding to the condition described by Karl Ekbom. The second case suffered from secondary delusional parasitosis, occurring in the setting of leukoencephalopathy (CADASIL)...
2016: Pan African Medical Journal
Aoife Synnott, Mary O'Keeffe, Samantha Bunzli, Wim Dankaerts, Peter O'Sullivan, Katie Robinson, Kieran O'Sullivan
QUESTION: What are physiotherapists' perspectives on managing the cognitive, psychological and social dimensions of chronic low back pain after intensive biopsychosocial training? DESIGN: Qualitative study design using semi-structured interviews to explore physiotherapists' perceptions of their identification and treatment of the biopsychosocial dimensions of chronic low back pain after intensive Cognitive Functional Therapy (CFT) training. PARTICIPANTS: Thirteen qualified physiotherapists from four countries who had received specific CFT training...
October 2016: Journal of Physiotherapy
Elliot S Spengler, Deborah J Miller, Paul M Spengler
Sexual minority (SM) individuals live in a heterosexist society that denigrates their sexual orientation identity. The stigma and prejudice they regularly encounter is hypothesized to lead to their significantly increased risk for developing mental health disorders. Because of these factors, therapists should be diligent to create an affirming and supportive therapeutic environment but this is often not the case. SM clients frequently report experiencing sexual orientation microaggressions in therapy, such as heteronormative statements, a disregard for their sexual orientation identity, and an assumption that their presenting issues are rooted in their sexual orientation identity...
September 2016: Psychotherapy
D Leguay
This article attempts to identify and put into perspective the different approaches that could globally prevent the suffering induced by schizophrenia, from the detection of early psychosis to the impact on individual and family functioning and emotional health. Schizophrenia causes, at the community level, a number of difficult consequences and associated costs, which likely could be reduced if specific strategies, already known and documented internationally, were applied. Two areas not explored in this article: the role of medication and the issue of suicide prevention...
September 9, 2016: L'Encéphale
Susan W Krigel, James E Grobe, Kathy Goggin, Kari Jo Harris, Jose L Moreno, Delwyn Catley
INTRODUCTION: The decisional balance (DB) procedure examines the pros and cons of behavior change and was considered a component in early formulations of Motivational Interviewing (MI). However, there is controversy and conflicting findings regarding the use of a DB exercise within the treatment of addictions and a need to clarify the role of DB as a component of MI. METHODS: College tobacco smokers (N=82) with no intentions on quitting were randomly assigned to receive a single counseling session of either Motivational Interviewing using only the decisional balance component (MIDB), or health education around smoking cessation (HE)...
August 31, 2016: Addictive Behaviors
Melissa Thompson, Chris Henshall, Louis P Garrison, Adrian D Griffin, Doug Coyle, Stephen Long, Zayna A Khayat, Dana L Anger, Rebecca Yu
OBJECTIVES: To address the uncertainty associated with procuring pharmaceutical products, product listing agreements (PLAs) are increasingly being used to support responsible funding decisions in Canada and elsewhere. These agreements typically involve financial-based rebating initiatives or, less frequently, outcome-based contracts. A qualitative survey was conducted to improve the understanding of outcome-based and more innovative PLAs (IPLAs) based on input from Canadian and international key opinion leaders in the areas of drug manufacturing and reimbursement...
2016: ClinicoEconomics and Outcomes Research: CEOR
Nadine Satori
An innovative practice, therapeutic touch has been used for around ten years in the treatment of eating disorders. Delivered by nurse clinicians having received specific training, this approach is based on nursing diagnoses which identify the major symptoms of this pathology. The support is built around the body and its perceptions. Through the helping relationship, it mobilises the patient's resources to favour a relationship of trust, a letting-go, physical, psychological and emotional relaxation, and improves the therapeutic alliance...
September 2016: Soins. Psychiatrie
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