Search results

This study aims to explore the applicability of Bordin’s model of therapeutic alliance in talking therapies for people with intellectual disabilities.

People with intellectual disabilities and therapists in six therapy dyads were interviewed using a qualitative methodology. Data were analysed using thematic analysis to explore how people with learning disabilities constructed the dimensions of therapeutic alliance. Content analysis was then used to focus on therapy bond, therapy tasks and goals to explore the agreement on these dimensions between the therapist and client.

People with intellectual disabilities reported their experience of therapy in a way that initially validates the alliance dimensions of Bordin’s model. There was clear overlap within most dyads in the description of the characteristics of the bond, the tasks undertaken and the goals of therapy. Some therapists described additional goals based on their therapeutic model that were not clearly described by the client working with them.

This study is limited by only including six therapy dyads; however, the results suggest further research on the impact of therapy alliance and how goals and tasks are agreed would be valuable.

Very few studies have explicitly examined the client’s view of therapy alliance.

Offending behavior change programs play an important role in the prevention of criminal behavior, particularly when offered to violent offenders. There is, however, little consensus about how content should be delivered, despite agreement that the development of a strong therapeutic alliance (TA) is an important determinant of outcome. The purpose of this paper is to explore how the TA is formed within correctional programs.

In total, 27 therapists who delivered correctional group treatment explored issues relating to the role of the alliance in offending behavior programs. A grounded theory methodology was employed to develop a conceptual understanding of therapist perspectives and practises.

Three different modes of practice were identified: “educative” to enforce boundaries of group behavior; “engagement” to promote a collaborative approach; and “therapeutic” to enhance client insight.

Greater awareness of the skills and supports required to successfully develop strong TAs in correctional populations may assist better retention and treatment outcomes in offending behavior programs. The ability to work flexibly between different modes of practise may prove important to rehabilitation efforts.

A model of the TA based on therapists’ accounts of their practise in correctional programs is presented. It is anticipated that, particularly for novice correctional therapists, exploration of the ways in which the alliance can be established and ruptures responded to will enhance treatment efficacy, particularly in treating violent offenders who can be challenging to engage.

The results of empirical research on the patient–psychotherapist relationship have led to the fundamental conclusion that the therapeutic alliance is one of the key factors ensuring the positive outcomes of psychotherapy. The main aim of the present study is to determine what variables pertaining to the context of psychotherapy (type of treatment applied in accordance with the psychotherapist’s modality/orientation, type of disorder diagnosed in the patient) differentiated the alliance.

Participants for the main study were recruited from public and private psychotherapy offices across Poland. The working alliance was assessed based on 262 psychotherapist–patient dyads. The sample consisted of 428 participants. To assess the quality of therapeutic alliance, the author used the full version of the Working Alliance Inventory as adapted into Polish.

The results of analyses led to several basic conclusions. The study revealed a differentiating effect of type of psychotherapy on the quality of therapeutic alliance. Alliance quality was not differentiated by the type of disorder diagnosed in patients and treated in the psychotherapeutic process.

The results of analyses presented in this empirical study allowed for exploring the quality of the therapeutic alliance with contextual variables related to the psychotherapeutic process taken into account.

A better therapeutic alliance at the beginning of treatment for addictive behaviours has been found to prevent dropout. The purpose of this paper is to evaluate how the development of therapeutic alliance dimensions was associated with the dropout prevention.

A total of 23 participants presented a substance use disorder related to heroin or cocaine and were in three distinct treatment phases of a therapeutic community. Each participant filled in the therapeutic alliance measures once a week after mini-groups. A naturalistic prospective research design was used to collate 198 repeated alliance measures.

Participants who presented stable bond development at higher levels tended to stay in treatment, whereas those who developed stable bonds at lower levels tended to drop out. The goals and tasks dimension increased significantly across the phases and was not associated with dropout.

To prevent dropout, therapists should pay special attention to residents who manifest difficulties in establishing stable and secure bonds and not overestimate the impact of the goals and tasks alliance dimension, as it is not a failsafe indicator of treatment retention.

The alliance dimensions were differentiated (bond, goals and tasks) and studied throughout the treatment, pointing out the importance of therapeutic relationship dynamic variables to prevent dropout.

The purpose of this paper is to explore the relationship of two distinct variants of dispositional shame (internal and external shame) with collaborative, purpose-driven aspects of the patient–provider relationship (working alliance) and patient satisfaction. The aim of this research was to conduct a preliminary investigation into the relevance of dispositional shame in a general healthcare population.

In total, 127 community members (mean age 25.9 years) who reported that they had regularly seen a GP over the past year were recruited at an Australian university. Participants were asked to reflect on their relationship with their GP, and completed instruments assessing various domains of shame, as well as working alliance and patient satisfaction.

Non-parametric correlations were examined to determine the direction and strength of relationships, as well as conducting mediation analyses where applicable. Small, negative correlations were evident between external shame and working alliance. Both external and internal shame measures were also negatively correlated with patient satisfaction. Finally, the relationship of external shame to patient satisfaction was partially mediated by working alliance.

Both the reported quality of patient–provider working alliance, and level of patient satisfaction are related to levels of dispositional shame in patients, and working alliance may act as a mediator for this relationship.

The findings from this preliminary study suggest that internal and external shame are important factors to consider in the provision of medical care to maximise the quality of patient experience and working alliance.

This research aimed to explore individuals with intellectual disabilities (ID) experiences of the therapeutic relationship.

Six individuals with ID were recruited who were currently having 1:1 therapy. Semi-structured interviews focused on their experiences of the therapeutic relationship.

Using interpretative phenomenological analysis, six personal experiential themes were identified. These were labelled as a person-centred experience, the importance of adaptions, “I feel like I know you”, a secure base is offered, change does occur and an overlap of subjective experience. The results indicate that participants’ accounts of their experiences indicated that the relationship was important to them. This research also demonstrated that the benefits and value of involving individuals with ID in qualitative research.

To the best of the authors’ knowledge, exploring the therapeutic relationship from the perspective of individuals with ID has not been previously explored in the literature. This research highlights considerations for therapists working with this population to help them facilitate positive therapeutic outcomes.

A key aspect of psychologically informed planned environments (PIPEs), are the attachment theory-informed relationships between residents and staff (Bainbridge, 2017). The key-work provision of one-to-one support from officers to residents is one of the main ways through which relationships are formed. The purpose of this paper is to explore prison officers’ experiences of the key-work role within a PIPE in a women’s Prison in England.

Semi-structured interviews explored ten prison officers’ experiences. Interviews were analysed using thematic analysis.

Five main themes were identified; “Professional support”, “Negotiating Professional Boundaries”, “A Successful Relationship”, “Rupture and Repair” and “Growth for Everyone”. These themes reflected the framework around keywork; what support officers need to cope with the emotional demands of the role, and how to manage challenging situations and build meaningful key-work relationships.

Limitations include the lack of focus on diversity, the impact of the COVID-19 pandemic on officer experience and applicability to other PIPE services. Future research could address some of these limitations.

Practical implications highlight the need for consistent supervision, greater consideration of officers’ transition to the role and trauma-informed training.

The research provides an unprecedented account of prison officers’ experiences of the key-work role, adding to the limited literature within PIPEs in the women’s estate. The supportive nature of the key-work relationship was perceived by officers to contribute towards people’s sentence progression and officers’ personal and professional development.

Therapeutic relationships have been identified to be a key feature of staff working with patients within mental health settings and are widely referred to within research literature. The aim of this study is to explore the experiences of support staff within secure mental health services with regards to the formation and development of therapeutic relationships with patients.

Ten participants were interviewed, all of whom were unqualified support staff based within secure establishments and working directly with patients.

Interpretative phenomenological analysis of the data resulted in the identification of three themes: “Building bridges”: developing relationships with patients; “You do forget what they've done”: seeing the person and managing risk, and “Playing your cards close to our chest”: maintaining boundaries.

The themes are discussed and evaluated in terms of relationship formation and development, barriers that may prevent such relationships from being built and the implications for clinical practice.

The purpose of this paper is to investigate the phenomenon of the digital do-it-yourself (DiDIY) in the medical domain. In particular, the main contribution of the paper is the analysis and discussion of a questionnaire-based user study focused on 3D printing (3DP) technology, which was conducted among clinicians of one of the most important research hospital group in Lombardy, Italy.

A general reflection on the notion of knowledge artifacts (KAs) and on the use of 3DP in medicine is followed by the research questions and by a more detailed analysis of the specialist literature on the usage of 3DP technology for diagnostic, training and surgical planning activities for clinicians and patients. The questionnaire-based user study design is then emerging from the conceptual framework for DiDIY in healthcare. To help focus on the main actors and assets composing the 3DP innovation roles in healthcare, the authors model: the DiDIY-er as the main initiator of the practice innovation; the available technology allowing the envisioning of new practices; the specific activities gaining benefits from the innovative techniques introduced; and the knowledge community continuously supporting and evolving knowledge practices.

The authors discuss the results of the user study in the light of the four main components of our DiDIY framework and on the notion of KA. There are differences between high expertise, or senior, medical doctors (MDs) and relatively lower expertise MDs, or younger MDs, regarding the willing to acquire 3DP competences; those who have seen other colleagues using 3DP are significantly more in favor of 3DP adoption in medical practices, and those who wish to acquire 3DP competence and do-by-themselves are significantly more interested in the making of custom-made patient-specific tools, such as cutting guides and templates; there are many recurrent themes regarding how 3DP usage and application may improve medical practice. In each of the free-text questions, there were comments regarding the impact of 3DP on medical knowledge practices, such as surgical rehearsal, surgery, pathology comprehension, patient-physician communication and teaching.

The 3DP adoption in healthcare is seen favorably and advocated by most of the respondents. In this domain, 3DP objects can be considered KAs legitimately. They can support knowledgeable practices, promote knowledge sharing and circulation in the healthcare community, as well as contribute to their improvement by the introduction of a new DiDIY mindset in the everyday work of MDs.