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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.

Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders.

The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates.

Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant.

These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders.

The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders.

The aim of this research is to gain an insight into the attitudes that therapists, both qualified and trainee, have towards the use of artificial intelligence (AI)/machine therapy in therapeutic practice. The paper also aims to gain an insight into attitudes towards machine therapy and the potential of developing a therapeutic alliance with a machine therapist.

A short questionnaire was developed to gauge therapists and trainee therapists’ attitudes towards machine therapy. The questionnaire included a scenario for participants to read and then respond to questions on the therapeutic alliance using questions based upon those asked on the working alliance short inventory scale. At the end of the questionnaire, there was also the opportunity for participants to respond to an open-ended question.

It is evident from the responses that there is a clear reservation about the use of AI technology within the therapeutic setting. In spite of this reticence, many participants recognised the potential and are open to the possibilities this technology can bring. It was notable that the therapists largest concern was about the potential to create a strong bond with a machine therapist.

This paper presents findings on therapists’ attitudes towards AI use within therapeutic practice and machine therapy. Whilst limited in scope, it provides a yardstick for considering the way that attitudes towards these emerging technologies might change in the future.

The purpose of this paper, a qualitative study, is to explore service users’ experiences of attending clinical psychology within a public community adult mental health service.

Six individuals who had completed at least 16 sessions of psychotherapy participated in semi-structured interviews. Data were transcribed and analysed using interpretative phenomenological analysis.

The results showed the following overarching domains: the relationship and its impacts, structure and focus, and participant factors – timing/readiness. The importance of the use of language was also identified. Participants appeared to value a sense of humanity within the relationship. Interestingly, the personal impact of therapy as perceived by the participants was not focussed on symptom reduction, but on broader changes. The results are discussed in relation to the relevant literature.

Suggested principles for practice include maintaining attentiveness to relational factors, to client factors such as readiness for change and to the use of structure and flexibility. The use of recovery focussed and alliance measures are recommended.

For clinical psychologists providing psychotherapy within the public system, there are valuable lessons we can learn from asking the service users directly about their experiences, in terms of focussing on the human element of the relationship, and striking a balance between professionalism and humanity.

Several decades of mental health research in the UK repeatedly report that people of African-Caribbean origin are more likely than other ethnic minorities, including the White majority, to be diagnosed with schizophrenia and related psychoses. Race-based inequalities in mental healthcare persist despite numerous initiatives such as the UK’s ‘Delivering Race Equality’ policy, which sought to reduce the fear of mainstream services and promote more timely access to care. Community-level engagement with members of African-Caribbean communities highlighted the need to develop culturally relevant psychosocial treatments. Family Intervention (FI) is a ‘talking treatment’ with a strong evidence-base for clinical-effectiveness in the management of psychoses. Benefits of FI include improved self-care, problem-solving and coping for both service users and carers, reducing the risk of relapse and re-hospitalisation. Working collaboratively with African-Caribbeans as ‘experts-by-experience’ enabled co-production, implementation and evaluation of Culturally adapted Family Intervention (CaFI). Our findings suggests that a community frequently labelled ‘hard-to-reach’ can be highly motivated to engage in solutions-focussed research to improve engagement, experiences and outcomes in mental health. This underscores the UK’s Mental Health Task Force’s message that ‘new ways of working’ are required to reduce the inequalities faced by African-Caribbeans and other marginalised groups in accessing mental healthcare. Although conducted in the UK (a high-income multi-cultural country), co-production of more culturally appropriate psychosocial interventions may have wider implications in the global health context. Interventions like CaFI could, for example, contribute to reducing the 75% ‘mental health gap’ between High and Low-and-Middle-Income counties reported by the World Health Organization.

In the previous chapter, I introduced the reader to the ideas and research of the common factors. The common factors are varied and have demonstrated to have small to large effect sizes depending on what variable is being examined. In this chapter, I categorise four more evidence based relationship variables which tend to be more task orientated and aligned to the therapeutic alliance. Indeed, the therapeutic alliance, goals and collaboration, alliance rupture–repair, and feedback-informed care are four trans-theoretical factors that can contribute greatly to outcomes. At the same time, when poorly established they can and do impact negatively on client outcomes. This is not an exhaustive overview of the literature, rather each variable is briefly discussed, the evidence supporting the effectiveness is highlighted, and Top Tips are provided to assist the development of the practitioner.

The purpose of this study is to qualitatively explore the views and opinions of service users accessing remote therapy through a community forensic personality disorder service during the COVID-19 pandemic.

A qualitative exploratory approach was adopted. Nine community forensic service users accessing virtual/telephone therapy through a community forensic mental health service were interviewed using semi-structed interviews. Data was analysed using Braun and Clarke (2006) thematic analysis techniques.

Analysis resulted in three overall themes: experience of communication in the therapeutic relationship; impacts of the change to remote working and making the best of what we have. A further seven subthemes were developed. A range of advantages and disadvantages to remote therapy were highlighted.

This study was based on a small sample of service users accessing one community forensic service in England, and therefore caution should be taken when generalising the findings. All interviews were conducted remotely and thus may have only supported those who are able to engage in this way.

This paper has the potential to inform future remote therapy guidelines. Health services should consider keeping some elements of remote working and offering this as a choice to all service users.

This study is, to the best of the authors’ knowledge, the first study that attempts to explore the experiences of individuals accessing remote therapy within a forensic population who have personality disorders or traits.

Psychotherapy and clinical supervision outcomes are influenced by client and supervisee factors, one of which is cultural identity. Those with diverse racial and ethnic minoritised identities often experience disparities in therapy outcomes. Therapists and supervisors need to be responsive to the identity of those they support. The multicultural orientation (MCO) framework is an emerging concept in psychotherapy and clinical supervision that may offer these practitioners a framework to be responsive.

A preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews was conducted. Six databases, PubMed, Scopus, Embase, Academic Search Complete, Web of Science and PsychInfo, were searched for peer-reviewed literature published in English between the years 2000 and 2023.

A total of 1,553 sources were identified, of which (n = 42) are included in this review. Findings suggest that MCO is still in its infancy as applied to therapy and clinical supervision. Most of the research has been conducted in America, using quantitative methodologies with white western populations. Cultural humility is the most studied MCO pillar, and variables such as reductions in psychological stress, the working alliance and microaggressions are reported on as outcomes. MCO applied to the group therapy process is an emerging finding of interest. However, more research is needed, especially experiential designs across different and diverse populations and contexts.

MCO is an emerging therapy and clinical supervision process that has the potential to improve the outcomes for therapy clients and supervisees. Further research is needed to replicate current studies, and further research with diverse populations, countries and contexts should be undertaken as a priority.

In the previous chapters, we have explored some of the key debates around empirically supported treatments, and I have introduced the reader to the concept of evidence based practice as a tripartite model that speaks to a much wider understanding of therapy research and practice. In this chapter, I introduce the concept of the common factors and some of the research that supports the idea that in general all therapy approaches tend to be as effective as each other, indeed, a summary of this research going back as far as 1936 is highlighted. The common factor proposition rests on the premise that there are far more commonalities across diverse therapy methods, than differences, and that it is these trans-theoretical constructs that are responsible for the lion’s share of outcomes. After briefly reviewing some of the literature, several common factor models are presented for the reader to consider.

Despite its growing popularity in applied settings, executive coaching has to date received little attention in empirical research, especially in regard to the coaching process. This paper aims to investigate the effect of working alliance rating discrepancies on the development of coachees' self‐efficacy, a key outcome in leadership development.

The paper reports on a pre‐ post‐test study of a leadership development program taking place in a large North American manufacturing company. Data were collected from two samples: managers receiving coaching over an eight‐month period and internal certified coaches. In total, 30 coach‐coachee dyads were analyzed.

Results from an analysis of covariance did not support the authors' hypothesis, by indicating that coachees having worked with a coach who underestimated the working alliance, in relation to his or her coachee, experienced more growth in self‐efficacy than coachees who worked with a coach who either accurately estimated or overestimated the working alliance.

The results sugges that coaches should coach with an “ongoing and deliberately maintained doubt as their only certainty”. The importance for coaches to be sensitive to signs of what the coachee is experiencing, and to take the initiative to verify the coachee's comfort level with the way coaching is proceeding is addressed.

This study intended to delve deeper into the complexities of the coaching process by linking a key coaching process variable, the relationship, to coaching outcomes.