Therapeutic Relationship

The patient-physician therapeutic relationship begins before the two parties' verbal communication. For example, the patient may form an attitude from the non-verbal communication cues, such as the practice's physical environment, the processes and the administration staff. Colors, paintings and works of art, lighting, certificates, are features that may affect the patient during his waiting time and, probably, his relationship with the physician. This research wanted to examine patients' therapeutic experience, and, specifically, their perceptions on the ambient environment of physicians' waiting areas and practices and their relationship with trust and proximity to the physician. To this end, we conducted a quantitative research with 95 respondents of the psychiatric health sector. Data were analyzed through advanced statistics, using the SPSS 23 statistical package. Our findings imply that there is a relationship between the physician practice's interior decoration and the patients' trust and proximity. Specifically, cluster analysis grouped data in three clusters that we called as 'Leeries', 'Aloofs' and 'Intimates', showing variability on the variables patient's trust and proximity to physician as well as, on variables pertaining to practice' ambient environment. The paper discusses the findings and implications as well as the limitations and propositions for future research.

We investigated potential mechanisms of action for anger symptom reductions, specifically, the roles of anger regulation skills and therapeutic alliance on changes in anger symptoms, following group anger management treatment (AMT) among combat veterans with posttraumatic stress disorder (PTSD). Data were drawn from a published randomized controlled trial of AMT conducted with a racially diverse group of 109 veterans with PTSD and anger symptoms residing in Hawaii. Results of latent growth curve models indicated that gains in calming skills predicted significantly larger reductions in anger symptoms at post-treatment, while the development of cognitive coping and behavioral control skills did not predict greater symptom reductions. Therapeutic alliance had indirect effects on all outcomes mostly via arousal calming skills. Results suggest that generalized symptom reduction may be mediated by development of skills in calming physiological arousal. In addition, arousal reduction skills appeared to enhance one's ability to employ other anger regulation skills. Published by Elsevier Ltd.

Summary (article is in German):

The present article aims to present and explain the main features of the practice of Gestalt Theoretical Psychotherapy. Consequently, it begins with the question part of which superordinate whole this practice is, on which whole the meaning and effects of this practice ultimately depend and are determined. In the context of psychotherapy, the relationship between therapist and client is understood as this superordinate whole. Only in this context is it possible to make appropriate statements about the appropriate thematic focus. about the appropriate concrete forms of encounter and cooperation, about a meaningful choice of working methods and procedures, about interventions and techniques in Gestalt Theoretical Psychotherapy. Before these concrete topics of practice are dealt with in the further parts of this article, this first part shows what centring on relationships means in concrete terms for Gestalt Theoretical Psychotherapy and what results from it for the therapeutic practice.

Zusammenfassung:

Der vorliegende Beitrag stellt sich zur Aufgabe, die Praxis der Gestalttheoretischen Psychotherapie in ihren Grundzügen darzustellen und zu begründen. Folgerichtig beginnt er mit der Frage, Teil welches übergeordneten Ganzen diese Praxis ist, wovon also Bedeutung und Wirkung dieser Praxis letztlich abhängen und bestimmt werden. Als dieses übergeordnete Ganze wird im Kontext von Psychotherapien das Beziehungsgeschehen zwischen Therapeutin und Klientin verstanden. Erst in diesem Kontext lassen sich angemessene Aussagen über die jeweils passenden thematischen Fokussierungen, über die geeigneten konkreten Begegnungs- und Kooperationsformen, über eine sinnvolle Wahl der Arbeitsmethoden und Vorgangsweisen, über Interventionen und Techniken in der Gestalttheoretischen Psychotherapie treffen. Der Darstellung und Begründung dieser konkreten Teilbereiche der gestalttheoretisch-psychotherapeutischen Praxis ist daher im ersten Teil dieses Beitrags vorangestellt, worin die Beziehungszentrierung der Gestalttheoretischen Psychotherapie konkret besteht und was sich daraus für die therapeutische Praxis ergibt.

Recently, shocking facts show that 4,157 suicides happen per year in Canada (Chen, 2019). Per year, close to 800,000 people die in the world which is approximately 1 person in every 40 seconds. This a huge number which raises concerns in the medical fraternity about how to prevent it. More statistics show per day, 200 people attempt suicide but only 10 manage to succeed (Laverty, 2019). These statistics show that nurses all over the country are faced with patients with suicidal ideations in their daily work routine. It, therefore, becomes very necessary for them to understand proper and efficient therapeutic communication aimed at building therapeutic relationships between them and the patients.
To achieve the set learning goals, a thorough process of assessment, planning implementation and planning had to be carried out. Beginning with assessment, several literature sources touching on matters therapeutic communications were collected and evaluated. They were sorted depending on their relevance and the level of insight they offered on interpersonal relations in the medical field. After conducting the assessment, a planning process followed shortly after where the assessed resources were used in developing the orientation of therapeutic communication in developing therapeutic relations.

The focus of this research regards the use of artistic techniques within the field of Gestalt Therapy by questioning the confidence and resistance of a therapist on the occasion of using these said techniques. A phenomenological method of inquiry was used to collect data through a focus group, made up of three Gestalt therapists. The participants were gathered through the European Accredited Psychotherapy Training Institute – Gestalt Programme Training Institute Malta (EAPTI-GPTIM). Thematic Analysis was used to evaluate the individuals’ patterns of thought, attitudes, observational capacity, and emotional responses.

This study was aimed to investigate the effect of sweet violet (Viola odorata L.) blossoms powder (SVBP) on liver and injuries of rats injected with carbon tetrachloride (CCl 4). Thirty six mature albino rats, weighting 130-150 g per each, were used and divided into two main groups, the first group (Group 1, 6 rats) fed on basal diet and the other main group (30 rats) was injected by CCl 4 for two weeks to induce liver impaired rats then classified into sex sub groups as follow: group (2), fed on standard diet only as a positive control; groups 3, 4, 5 and 6 fed on standard diet containing 0.2, 0.4, 0.8 and 1.6 % of SVBP respectively. At the end of the experiment, 28 days, liver and kidney functions as well as serum lipid peroxidation were determined. The results indicated that treatment of animals with CCl 4 caused a significant increased (p≤0.05) in liver functions (AST, ALT and ALP activities), kidney functions (urea and creatinine levels) and serum lipid peroxidation (malondialdehyde level, MDA) compared to normal controls. Supplementation of the animal diets with SVBP (0.2 to 1.6 g/100g) prevented significantly (p≤0.05) the rise of mean serum AST, ALT and ALP activities; urea, creatinine and MDA levels. The rate of preventative was increased with the increasing of the SVBP supplementation level. It could be concluded that SVBP was effective in protecting against CCl 4-induced liver and kidney injuries. Therefore, we recommended like of that plant part, sweet violet blossoms, by a concentrations ranged 0.2-1.6 % amount to be included in our daily diets, drinks and food supplementation. [Yousif Elhassaneen, Sherif Sabry, Thoraya Musalum, Azza El-Eskafy and Abeer Abd El-Fatah. Effect of Sweet Violet (Viola odorata L.) Blossoms Powder on Liver and Kidney Functions as well as Serum Lipid Peroxidation of Rats Treated with Carbon Tetrachloride. J Am Sci 2013;9(5):88-95]. (ISSN: 1545-1003).

Background: Skills that enable the maintenance of productive relationships with clients are an essential aspect of therapeutic practice and include the use of therapeutic modes appropriate to clients' needs. The therapist requires a certain level of self-efficacy in order to use therapeutic modes in client–therapist interactions. Recently, a tool was developed to assess therapists' self-efficacy in the use of therapeutic modes. The structure of factors within and internal consistency of the self-efficacy for therapeutic mode use tool was examined.
Methods: Occupational therapists (n=51) from the UK and Iran completed the self-efficacy for therapeutic mode use assessment tool and provided sociodemographic information. The structure of factors was examined using principal component analysis and parallel analysis; internal consistency was assessed using Cronbach's α and inter-item correlation.
Results: Parallel analysis suggested that the preferred structure has only one factor, explaining 55.2% of data variance. The items' factor loadings ranged between 0.67 and 0.80, and the scale had a Chronbach α of 0.83.
Conclusions: The sum of the scale scores can be useful in occupational therapy research and audits focusing on self-efficacy in the use of therapeutic modes in practice.

Amaç: Kontrollü klinik araştırmalarca etkililiği ve etkinliği sıklıkla gösterilmiş olmasına karşın birçok klinisyenin Bilişsel ve Davranışçı Terapi (BDT)’nin belirli unsurlarına karşı olumsuz tutumlara sahip olduğu ve BDT’yi uygulamaktan kaçındıkları gözlemlenmiştir. Bu durumun ruh sağlığı hizmeti almak isteyen kişilere olumsuz yansıyabileceği düşünüldüğünden bu çalışmada Bilişsel Davranışçı Terapi’ye Yönelik Olumsuz Tutumlar Ölçeği’ni Türkçe’ye uyarlamak hedeflenmiştir. Yöntem: Bilişsel Davranışçı Terapi’ye Yönelik Olumsuz Tutumlar Ölçeği’nin Türkçe’ye çevirisi ve İngilizce’ye geri çevirisi klinik psikoloji alanında uzman kişiler tarafından yapılmış; çalışmanın yazarları tarafından ölçeğin son hali belirlenmiştir. Araştırmanın örneklemini kaygı bozuklukları ile çalışan ruh sağlığı alanında çalışan çeşitli meslek grubundan katılımcılar oluşturmaktadır. Katılımcılardan demografik bilgileri (cinsiyet, yaş, meslek, mesleki tecrübe süresi vb.) içeren bir formu ve Bilişsel Davranışçı Terapi’ye Yönelik Olumsuz Tutumlar Ölçeği’ni doldurmaları istenmektedir. Bulgular: Ölçeğin faktör yapısını ve uygunluğunu belirlemek amacıyla açımlayıcı faktör analizi ve doğrulayıcı faktör analizi yapılacaktır. Pearson korelasyon ve t-testleri analizleri ile katılımcıların demografik özelliklerinin ölçekten aldıkları puan ile ilişkili olup olmadığı belirlenecektir. Tartışma: Bilişsel Davranışçı Terapi’ye Yönelik Olumsuz Tutumlar Ölçeği’nin Türkçe’ye uyarlanmasının BDTye yönelik olumsuz tutumları tespit etmeye, bu tutumlardaki değişikliklerin kanıta dayalı BDT yöntemlerinin Türk toplumuda etkin bir şekilde kullanılmasına yol açıp açmadığının değerlendirilmesine katkı sağlayacağına inanılmaktadır.

Background: It is a well-established fact that the quality of the alliance and the results of the therapeutic processes go hand in hand, and it seems that it is the therapist's contribution which accounts mostly for that relationship. On the other hand, in recent years there has been an increasing focus on therapists training, and although studies consistently show the positive effects it has on therapists themselves, there is no conclusive evidence on the effect it has on the quality of the alliances that these build with their clients. Purpose: To systematically review the literature about the effect of alliance focused training on the quality of the alliance that therapists and their clients build. Method: A systematic search of the scientific literature published until 2018 identified 9 relevant studies, which were analyzed in terms of their methodologies and general results. Results: The publication rate of eligible papers for the analysis has remained close to 1 every 2 years since the publication of the first one of these in 2002. Most articles reported medium and significant effect sizes in favor of training, but there is not enough information to be able to draw conclusions regarding salient topics or methodologies for training. Discussion: The analysis shows promising results, but to be able to understand this phenomenon completely, the rate of publication of quality articles has to increase, and the results have to be analyzed with a more solid methodology.

From the eighteenth century patients might use ‘uneasiness’ / inquiétude to describe both a physical sensation and a personal anxiety. This double definition reflects the deep interrelation between emotion and sensation in the period. Inquiétude was embedded in a specific historical context, defined by humoral medical discourse, by the practice of self-writing, by the doctor-patient relationship, and by a semantic confusion in the use of certain words. Analysis of the different uses of inquiétude in nineteenth- and twentieth-century French novels shows that it increasingly described a mental state, such as an anxiety, but that the sensorial meaning persisted discreetly in different ways. Elements of neurophysiological theories and relevance theory offer some tools to bridge the gap between the two narrative genres and historical contexts.

La présente contribution cherche à comprendre, en se basant sur des faits de langues attestés sur corpus, comment et pourquoi des textes sont brefs au-delà de la contrainte scripturale. Le corpus qui sera soumis à l'analyse relève du thème de la souffrance, mis en place par une association de prévention contre le suicide, que nous appelons ici « Association Y ». Il est constitué de plusieurs centaines d'échanges chatés, allant de 2005 à 2015, et comprend exclusivement des textes intégraux et non des extraits, dont la réunion est justifiée par leur appartenance à la même praxis, le discours des souffrants, et au même genre, le chat. Pour traiter des liens entre temporalité, genre bref et interactions tchatées, nous procéderons en trois temps. Nous présenterons d'abord, dans ses grandes lignes, le corpus ainsi que le cadre théorique et les outils informatisés avant de décrire les caractéristiques propres au tchat, communes aux textes des souffrants, comme genre bref. Dans un second temps, nous mettrons l'accent sur les conditions éthiques, imposées en milieu associatif, pour que les souffrants puissent accéder au chat et mettre en discours leur récit à travers l'analyse de l'ethos des interactants en rapport avec la question de l'anonymat numérique pour montrer comment les conditions externes impactent la matérialité discursive du bref. Nous terminerons sur la façon dont les formes temporelles du « bref » règlent globalement, et de façon plus ou moins contraignante, les différents paliers du texte. Une attention particulière sera accordée, d'un point de vue discursif, à deux cas précis, celui de la ponctuation et celui des procédés de raccourcissement morpho-syntaxique propre à l'échange synchrone en tant que genre bref pour montrer comment la configuration de la temporalité des tchats détermine la textualité du bref comme genre. The present contribution aims to understand how and why texts are brief, beyond the necessity of being short. It is based on language facts, all attested in a corpus. The corpus we will subject to analysis, concerns the theme of suffering : it has been set up by a suicide

Ce premier dossier que la Revue Européenne des Migrations Internationales consacre à la santé mentale intervient à un moment où en France et en Europe les politiques migratoires en raison de leurs effets délétères portent atteinte aux droits, à l’accès aux soins et à la santé de nombreux migrants et exilés. Ce dossier sur la santé mentale en migrations internationales propose à travers des recherches d’horizons disciplinaires variés, des travaux empiriques décrivant les recours aux soins et les relations thérapeutiques en santé mentale des migrants à différents moments de leur expérience migratoire. Le prisme que constitue la santé mentale renouvelle la lecture des rapports sociaux dans lesquels le migrant est inséré, il permet également d’analyser les conditions sociales de production, d’expression et de gestion de leurs souffrances psychiques, aux échelles micro-, méso- et macro- sociales. Les modes de prise en charge — institutionnel, social, juridique, sanitaire — des migrants diagnostiqués « comme ayant des troubles mentaux, des difficultés psychologiques, ou simplement en état de souffrances » mettent en lien les effets des politiques migratoires, les dynamiques d’accueil et de prise en charge des migrants, l’organisation des systèmes de soins et la production des subjectivités et de mise en parole de soi.

Considérant que les personnes trans doivent avoir l'autorisation d'un·e psychologue pour avoir accès aux dispositifs médicaux de changements de sexe, le lien thérapeutique se construit à travers une dynamique relationnelle qui érige le clinicien en tant que gatekeeper et qui oblige le patient à développer des stratégies pour avoir accès aux services et aux soins qu'il nécessite. En effet, plusieurs personnes trans rapportent des interactions avec professionnels de la santé qui manquent de connaissances sur leurs besoins et expériences spécifiques en tant que population marginalisée et qui parfois les discriminent explicitement ou implicitement. En conséquence, un grand nombre de personnes trans évite le plus possible d'aller chercher des soins auprès du système de santé (MacKinnon, Tarasoff & Kia, 2016). Depuis les trois dernières décennies, des clinicien·ne·s et chercheur·e·s se sont penché·e·s sur la question de la transphobie clinique 1 en psychothérapie dans le but de développer une approche « transpositive » 2 (Coleman et al., 2011; Lev, 2009; Thornhill & Klein, 2010; Vanderleest & Galper, 2009). En m'appuyant sur cet héritage théorique, je vais travailler sur la thématique de l'alliance thérapeutique entre les patients trans et les psychologues dans le but de développer des outils qui permettraient d'améliorer et de renforcer cette alliance.

This article highlights organizational structure as a factor influencing conditions for helping relations. It is based on a survey study and an interview study, both directed at parents in families that have parallel contacts in different parts of Swedish personal social services (PSS). The aim is to describe and analyse conditions for helping relations when clients with complex needs encounter specialized PSS.
Low system trust, people processing dimensions of work, and an organizational and a professional emphasis on formal organizational structures and boundaries were found to constitute unfavourable conditions. Conversely, an occurrence of individual trust, people sustaining and people changing dimensions of work, as well as informal organization and individual social workers’ boundary spanning efforts, constituted favourable conditions. The article concludes that greater understanding of how clients are affected by contextual service conditions can give some pointers towards how to generally
improve services for vulnerable and disadvantaged populations.

Previous scholarly studies have discussed the use of Zen Buddhism
within the person-centred approach of Carl Rogers, demonstrating the feasible influence of Buddhism over Rogers’s theories. The present research delves into the convergence and divergence of person-centred therapy and the Mahāyāna (one of the current mainstreams of Buddhism) philosophy explicated within the Vimalakīrti Nirdeśa Sūtra (a significant Mahāyāna canon); in particular, the bodhisattva spirit and four immeasurables, including loving-kindness, compassion, empathetic joy, and equanimity. Findings indicate that Carl Rogers’s counselling principles and practices comply with the Buddhist teachings of phenomenal vision, actualising tendency, and innate eagerness to alleviate suffering. This discussion also analyses ideas that have
seldom been examined in person-centred principles, such as bodhisattva
altruism, mind purity in nature and impurity caused by bewilderment,
compassion fatigue, causes of suffering, and counselling techniques.
Mahāyāna wisdom potentially offers references to the Rogerian family of
theories, which also sheds light on the use of Buddhist-influenced non-medical interventions.