This thesis aims to increase the knowledge of courses and processes of change prior to and during psychodynamic child psychotherapy with parallel parent contact. The dissertation examines parents’ and psychotherapists’ stated goals and expectations prior to the child’s psychotherapy, processes of change focusing on the psychotherapeutic encounter between child and psychotherapist, and outcome gauged by standardized measures compared to experienced change regarding the child’s problems. This dissertation also wants to examine different instruments for describing the psychotherapeutic process. Data was collected from systematic case studies, at different times during the course of psychotherapy, with material from different sources, such as child psychiatric assessment before and after conducted psychotherapy, questionnaires, and video taping of therapy sessions. By examining the therapeutic encounter from the perspectives of child, parent and psychotherapist, an image of psychotherapy, which illustrates the complexity of the psychotherapeutic process, was created. The thesis is based on three articles: Study I examines parents’ and psychotherapists’ goals and expectations prior to psychotherapy. Study II is a close study of a video-taped individual therapy, in which the interaction between child and therapist is examined with the rating instrument Child Psychotherapy Q-set (CPQ), the psychotherapist’s description of the psychotherapy’s process, and the self-rating instrument Feeling Word Checklist (FWC-24). Study III examines change in global functioning ability after child psychotherapy. By examining several psychotherapies in order to construct qualitative understanding of low and high change, respectively, in rated global functioning, limitations in the rating instrument Children’s Global Assessment Scale (CGAS) are analyzed. The results point to: 1. The need for a culture of cooperation between family and the one conducting the treatment, where goals are formulated together and in accordance with the family’s frame of reference and life experiences, which can increase the possibility of creating positive expectations, and of adapting treatment to the family in question. 2. Different methods of examining psychotherapy reflect and complete the image of the psychotherapy process. 3. The psychotherapy process’s complexity and the difficulty in describing the effect of therapy with simple measurements or remaining psychiatric symptoms. Positive change in several areas, such as the child experiencing increased independence, gets access to more positive affections, has improved self-esteem and a more optimistic idea of the future, could be described as psychological phenomena and can be difficult to encompass with narrow psychiatric terminology. 4. The intersubjectivity between child and psychotherapist appears essential. The therapist’s attitude and interventions are characterized by creating a steady therapeutic framework for exploring the child’s problems. 5.  The importance of the therapist’s meta-competence, i.e., overarching competencies that psychotherapists need to use to guide any intervention, what interventions to use, and when they are suitable. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 2: Submitted.</p>

Background: Group CBT approaches have been shown to be equally as effective as individual CBT for reducing depressive symptoms and preventing relapse; however, the predictors of response are poorly understood. The primary objective of the studies presented in this thesis was to further examine the formal and process factors within group CBT for depression that contribute to various treatment outcomes. The first study investigated the relationship between group CBT for depression and changes in interpersonal distress, as well as the process mechanisms that might influence this relationship. The second study assessed whether formal feedback provided to therapists and clients derived from the Outcome Questionnaire (OQ-45), a robust measure of client functioning, would enhance group processes and treatment outcomes. Method: Study 1: Secondary data from clients having received individual CBT for depression at a community-based mental health training centre constituted one condition (18 clients). Data for the group condition (12 clients) were collected from clients attending group CBT for depression at a tertiary care facility. Relationship distress, as measured by the OQ-45 relationship distress subscale score, was assessed at intake and termination. Group participants also completed process measures at the start and end of treatment. In study 2, participants were recruited from a tertiary care facility to participate in a CBT group for depression. Participation involved completing brief questionnaires assessing psychological and process variables before and after treatment, as well as the OQ-45 at every session. Three groups (21 clients) received standard CBT and two groups (12 clients) received enhanced CBT, which included feedback about their progress from the OQ-45. Results: Results of study 1 suggest that clients who participated in group CBT experienced a significantly greater reduction in relationship distress across time than clients who participated in individual CBT. Results also indicate that therapeutic alliance, and not group cohesion, mediates the relationship between pretreatment relationship distress on posttreatment relationship distress in group CBT. Results of study 2 indicate that participants in the enhanced condition experienced greater improvements in quality of life, dysfunctional beliefs, and therapeutic bond at termination, relative to participants in the standard condition. Trends also suggest a greater reduction in depressive symptoms. Conclusions: Group CBT for depression may be more effective than the individual modality for reducing interpersonal distress. Furthermore, therapeutic alliance plays a significant role in improving interpersonal distress within a structured group CBT protocol. Feedback from the OQ-45 may help improve client outcomes and enhance therapeutic bonding with facilitators in group CBT for depression.

Inledning: Olika terapimetoder erbjuder olika sätt att hjälpa patienterna. ISTDP utmärker sig genom att vara offensiv och som i alla metoder tillskrivs alliansen en viktig roll. Det är terapeuter som ska jobba med alliansen men hur de upplever den, vilka likheter och olikheter de ser i de metoderna de jobbar med har knappast uppmärksammats. Studiens syfte är att belysa psykodynamiska psykoterapeuters syn på alliansen i både ISTDP och klassisk psykodynamisk psykoterapi. Frågeställningar: Hur ser kliniskt verksamma psykodynamiska psykoterapeuter på den terapeutiska alliansen i både klassisk psykodynamisk psykoterapi och ISTDP ser? Vilka är de skillnader och likheter i hur de skapar och upprätthåller den? Metod: Sex legitimerade psykodynamisk utbildade psykoterapeuter som är utbildade i ISTDP har intervjuats. Data samlades in genom semistrukturerade intervjuer. Grundad teori användes som metod för bearbetning och analys och materialet. Resultat: Skillnaderna finns i behovet av ram och kontrakt samt metodiken. En könsskillnad finns i synen på möjligheten att engagera sig, i tillskrivning av interventionernas betydelse för alliansskapandet och hur begrepp allians, anknytning och emotionell kontakt används. Likheter gäller betydelsen av terapeutens engagemang, kompetens och patientens problematik. Diskussion: Resultatet diskuterats utifrån terapeutens syn på alliansen. Terapeutens engagemang och patientens problematik samt hur metodiken påverkar alliansutvecklingen har diskuterats. Upplevelsen av att kunna skapa och upprätthålla alliansen har diskuterats utifrån tydlighet och ett könsperspektiv. / Introduction: Different therapy methods provide different help. ISTDP is distinguished by being more intensive and, as in all methods, also here alliance is important. Therapists are the one who are working with the alliance but how they experienced it, what similarities and differences there are in the different methods they work with, has rarely been investigated. The goal with the study is to illustrate psychodynamic psychotherapists view on alliance in both ISTDP and classic psychodynamic psychotherapy. Questions: How do clinically effective psychodynamic psychotherapists see the therapeutic alliance in both classic psychotherapy and ISTDP? What are the differences and similarities in how they create and maintain it? Method: Six licensed psychodynamic psychotherapists who also are educated in ISTDP have been interviewed. The research is based on grounded theory. Result: Differences that are found are the need for contract and frame and how the method is applied. A gender difference is in the therapist's view of the possibility of engagement, in ascribing signification to the interventions that bring about alliance and in the way alliance, attachment and emotional contact has been used. Similarities are regarding the importance of therapist's engagement, competence and patient's problems. Discussion: The result was discussed on base of the therapist's view upon alliance. Therapist's engagement and patient's problems as well as how the method has an impact on creating the alliance has been discussed. Therapist's experience of being able to create and maintain the alliance has been discussed from a gender perspective and legibility.

No description available.

Cette thèse interroge principalement le régime temporel et la dimension psycho-émotionnelle des patients atteints de maladies chroniques (diabète, insuffisances rénale et cardiaque) engagés dans des protocoles de télésurveillance et d’auto-gestion de soins à domicile en France : un ensemble de pratiques que l’on nomme le télésoin. L’analyse phénoménologique de « l’expérience patient » de la dialyse à domicile, du suivi cardiaque à distance et de l’insulinothérapie, remet au centre de la réflexion éthique les valeurs de temporalité et de sensibilité affective, constitutives de l’identité du « sujet de soin ». Mis à l’épreuve des objets informatisés du soin et autres objets connectés captifs de la temporalité de la maladie, que l’on appelle « chrono-technologies », l’individu n’est cependant pas l’objet neutre d’un symptôme à décrypter. Le patient est en effet une personne, c’est-à-dire à la fois un être personnel et un cosoignant dont le savoir sur la maladie peut et doit être pris en charge par des pratiques « chronosensibles», soucieuses du régime temporel et de la dimension psycho-affective de la personne.Ces pratiques relèvent d’une éthique axée sur la vulnérabilité, la santé émotionnelle et la dimension relationnelle du soin, reconnaissant sa dette envers l’éthique médicale et l’éthique Ducare, qui vise un triple objectif : encadrer les bonnes pratiques du télésoin, définir les conditions de possibilité d’une nouvelle alliance thérapeutique respectueuse des personnes dans leurs valeurs propres et leurs préférence et réconcilier la technicité et l’humanité du (télé)soin. / This thesis examines primarily the temporalities and the psycho-emotional dimensions of diabetes, chronic renal and heart failures in French patients engaged in home telemonitoring and self-care management practices, also known as telecare. Based on patients experience, the phenomenological approach to home dialysis, heart telemonitoring and insulintherapy proposed in this thesis, brings the values of temporality and affective sensibility, whichare constitutive of the “care subject’s” identity, back to the center of the current ethical debate.Technologically-challenged patients, using computerized devices and other connected objects to collect time-sensitive data about their health, also known as “chrono-technologies”, are not neutral carriers of diagnosable symptoms. Indeed, patients are persons, or personal beings aswell as co-carers, whose know-how must be acknowledged in “time-sensitive” care practices. Such practices, which address patients’ temporalities and psycho-emotional issues, require a relational ethics, inspired by medical ethics and an ethics of care, focusing on vulnerability andemotional health. The aim of this relational ethics is threefold: overseeing telecare good practices, defining the possible conditions for a new therapeutic alliance compliant with patients’own values and preferences and reconciling the technical and human sides of (tele)care.

When therapists engage with clients from a culture other than their own, narrative therapy can be applied to overcome the linguistic and cultural challenges that result. Accordingly, this type of therapy allows for collective interactional problem solving. Hence, a qualitative narrative approach to therapy is advocated as being more culturally sensitive in diverse settings, because it should enable therapists to determine their clients' worldviews. This is a critical aspect of cross-cultural assessment and intervention when establishing an effective therapeutic relationship. The purpose of this study was to explore and describe (Babbie&Mouton, 2001) the utility of narrative therapy in order to enable a therapeutic alliance in a cross-cultural psychological assessment and intervention in a remote school. For this purpose, a qualitative research approach was adopted together with a constructivist paradigm. In addition, a content analysis design was employed by analysing existing documents comprising field notes (those of the student therapist, the supervisor and two peer supervisors), a reflection journal and visual data generated during cross-cultural psychological assessment and intervention sessions at the school. After reviewing the relevant literature, a priori categories (deductive analysis) were identified and the data sources were searched for instances of therapeutic alliance. This study found that the therapist's counselling skills and, more specifically, displaying coordinated acts of concern to benefit the client, namely actions such as thorough planning with a rationale for change; clear, logical communication; giving opportunities for re-learning; giving time; cooperation; being involved (responsive and taking part); paying attention (awareness and insight); benevolence; giving advice; being respectful; and instilling/communicating a sense of hope, may prove to have potential value in establishing a therapeutic alliance with these clients. In addition, the study found that the use of a narrative therapy technique, the clients, positive affect and the interaction between the therapist and the clients (therapeutic relationship) contributed marginally to the established alliance. The findings of the study suggest, therefore, that cultural competence did not contribute meaningfully to the development of a therapeutic alliance in this specific case, as cultural competence skills were not observed in the actions of the therapist. The findings further suggest that common factors, such as those of the therapist, client, relationship, and technique, are interactive and dynamic, and are all necessary factors in establishing a therapeutic alliance in cross-cultural assessment and intervention at a remote school. Copyright / Dissertation (MEd)--University of Pretoria, 2011. / Educational Psychology / unrestricted

Syftet med studien var att beskriva psykoterapeuters upplevelser av att arbeta med klienter med perfektionism, då tidigare forskning har visat på att perfektionism har samband med psykisk ohälsa och sämre behandlingsutfall samt är en hindrande faktor i terapeutisk behandling. Kvalitativa, semistrukturerade intervjuer användes för att samla in data från sju erfarna legitimerade psykoterapeuter. Intervjumaterialet analyserades med hjälp av tematisk analys vilket mynnade ut i tre huvudteman: strävan efter perfektion, allianssvårigheter och terapeutiskt förhållningssätt. Slutsatser som dras i föreliggande i studie är att det terapeutiska arbetet kan påverkas av perfektionistiska klienters höga krav och förväntningar på sig själva och sin omgivning samt att deltagarna upplever att perfektionism skapar vissa svårigheter i den terapeutiska alliansen. Dessa utmaningar föranleder enligt deltagarna behov av ett terapeutiskt förhållningssätt som främjar trygghet och varsamt utmanande av perfektionistiska föreställningar. / The aim of the current study was to describe psychotherapists' experience of working with clients with perfectionism, as previous research shows that perfectionism is associated with mental illness, poorer treatment outcomes and is a disruptive factor in therapeutic treatment. Qualitative, semi-structured interviews were used to collect data from seven well experienced licensed psychotherapists. The interview material was analyzed using thematic analysis, which resulted in three main themes: the pursuit of perfection, alliance difficulties and therapeutic approach. Conclusions drawn in the present study are that the therapeutic work can be affected by perfectionist clients' high demands and expectations of themselves and people around and that the participants experience that perfectionism creates certain difficulties in the therapeutic alliance. According to the participants, these challenges give rise to a need for a therapeutic approach that promotes security and a careful questioning of perfectionist perceptions.

Background: Substitution treatment has become a stable part of the addiction services system for drug users. In the beginning, it primarily reacted to healthcare complications related to intravenous substance use and was an alternative for those not able to keep an abstinence. It is proved that only pharmacotherapy is not enough intervention and that it is key to add counseling or therapy as it becomes similarly effective as abstinence-oriented treatment where we work on lifestyle changes in clients. Objective: Identification of effective factors leading to an increase in quality of life from the perspective of clients in substitution treatment in CADAS SANANIM z.ú. Methods: A semi-structured interview and a standardized WHOQOL-BREF questionnaire of the World Health Organization were used to obtain the required data. The descriptive method of thematic (focal) analysis was used to process data from the interviews, and data from the questionnaire was evaluated according to the instructions of the User's Guide of the Czech version of the WHO quality of life. Sample: The research participants consisted of 11 clients of the substitution program in CADAS SANANIM z.ú., who have been in treatment for at least 5 years and are included in the stabilization phase category. I contacted 15 clients, which I...

Syftet med detta arbete har varit att skapa klarhet kring vad som definierar begreppet den terapeutiska relationen, samt att ge en beskrivning av vad man som professionell samtalsledare bör tänka på när det gäller att skapa en så god terapeutisk relation som möjligt.Detta har gjorts i utgångspunkt av kvalitativa djupintervjuer med sju professionella samtalsledare, vilka i sina respektive beskrivningar, tillsammans kommit att utgöra en bild av hur man kan se på dessa två olika aspekter av begreppet. Det insamlade materialet från dessa intervjuer har sedan kommit att tematiseras utifrån en hermeneutisk tolkningsmetod, varpå resultatet tolkats utifrån ett socialkonstruktivistiskt, samt ett inlärningsteoretiskt perspektiv.Av resultatet framkom, bland annat, att en definition av begreppet den terapeutiska relationen var svår att särskilja från konkreta beskrivningar av hur en samtalsledare bör arbeta för att skapa en god terapeutisk relation, samt vilka personliga egenskaper som utmärker en god terapeut.Nyckelord:, Common factors, Den terapeutiska alliansen Den terapeutiska relationen, Four stages of competence, Samtalsbehandling, Socialkonstruktivism / The main purpose of this report was to bring clarity to the definition about the concept of the therapeutic relationship, as well as providing a description of what the therapist needs to consider, when it comes to creating the “good therapeutic relationship”.This has been done on the basis of qualitative in-depth interviews with a total of seven therapists, who in their descriptions, together came to form an understanding of these two different aspects of the concept. The collected material from these interviews was then thematized, in the basis of a hermeneutic interpretation method, in after witch these results were interpreted from a social constructivist, and a learning-theory perspective.The main results show that a definition of the therapeutic relationship was difficult to distinguish from the descriptions of how therapists work to create a good therapeutic relationship, as well as the personal characteristics of “the good therapist”.Keywords: Common factors, Four stages of competence, Social constructivism, The therapeutic alliance, The therapeutic relation, Therapy

Research has consistently shown a positive association between the therapeutic alliance and family therapy outcome. Theory and preliminary research suggest that parent and adolescent agreement on the presenting problem would be a significant predictor of the therapeutic alliance in family therapy. This study used de-identified data from the Marriage and Family Therapy Practice Research Network. The presenting problem was assessed at the first session, and agreement in presenting problems was determined by matching the responses between the parents and adolescents. The within-system alliance item of the Intersession Alliance Measures-Family (IAM-F), assessed at the fourth session, was used to measure the therapeutic alliance. Adolescent sex and perception of who was responsible for the struggles that brought the family to therapy were included as control variables in the multivariate analysis. Results of the regression analysis indicated that agreement on the presenting problem was significantly predictive of the adolescents' report of the therapeutic alliance. Agreement on the presenting problem was not predictive of the parents' report of the therapeutic alliance. These findings reinforce the importance of addressing perceptions of the presenting problem and quickly establishing agreement between family members in order to enhance the development of the therapeutic alliance for adolescents. Limitations and directions for further research are discussed.