African American women, in particular those who are economically marginalized, are disproportionately subject to surveillance by social service and criminal justice agencies (James et al., 2003) and are vulnerable to race- and gender-biased policy implementation (Chibnall et al., 2003; Zerai, 2002). They also experience population-specific personal (Ehrmin, 2001, 2002), social (Riehman, Iguchi, Zeller, & Morral, 2003; MacMaster, 2005), and economic barriers (Tighe & Saxe, 2006) to accessing and entering substance abuse treatment services. These factors contribute to lower rates of treatment entry follow-through (Siqueland et al., 2002) and higher drop-out rates (Scott-Lennox, Rose, Bohlig, & Lennox, 2000) than women from other racial and ethnic groups. This qualitative study explored African American women’s perceptions of mandated referral to substance abuse treatment and the impact of those perceptions on their treatment entry. The sample included 17 women age 18 years and over who were currently enrolled at three gender-specific treatment programs (one intensive outpatient and two residential) in a major southeastern urban area. This naturalistic inquiry (Lincoln and Guba, 1987) was informed by Black feminist epistemology (Collins, 2000) in accordance with recommendations for culturally sensitive research with women of color (Landrine, Klonoff, & Brown-Collins, 1995). Participants completed one-time, in-depth (one to two hour) interviews in which they were invited to explore their experiences with mandated substance abuse treatment referrals from state agencies (child protective services and the criminal justice system). Results indicate that participants generally perceived the treatment mandate as helpful. However, they also indicated that their willingness and ability to follow-through with treatment entry were influenced by multidimensional (Marlowe, Merikle, Kirby, Festinger, & McLellan, 2001) and interacting factors. Participants identified influence factors that included intra- and interpersonal concerns, the quality of interactions with state agencies, and treatment-specific issues. Results are presented along with suggestions for counselors and future research.

Durant el segle XX s'ha anat configurant el concepte d'aliança terapèutica en psicoteràpia com una relació interpersonal existent i necessària entre el client i el terapeuta. Avui dia totes les orientacions teòriques atorguen a l'aliança terapèutica un paper central en la relació terapèutica. A més, des de l’àmbit de la recerca empírica, la relació entre l'aliança terapèutica i l’eficàcia del tractament en psicoteràpia ha estat constatada en nombrosos estudis. Tot i que l'origen d'aquest concepte es troba en la corrent psicoanalítica, la rellevància de l'aliança terapèutica és molt diferent segons l'opinió de diversos autors d'aquesta orientació. Per a alguns autors l'aliança terapèutica no és rellevant i pot arribar a ser interferidora del tractament, ja que la transferència és la peça clau. En canvi, per a altres autors psicoanalítics l'aliança terapèutica té un paper important en qualsevol tipus de teràpia. Dediquem un ampli apartat del treball a fer una revisió sobre la conceptualització de l'aliança dels autors psicoanalítics més destacats en l’àmbit. Nosaltres considerem que l'aliança terapèutica ha de ser presa en consideració en qualsevol tractament d'orientació psicoanalítica, ja que si no és degudament treballada pot dificultar el treball analític i, per tant, s'han de destinar a la seva formació i manteniment tant tècniques interpretatives com no interpretatives quan es requereixin. L'aliança terapèutica és, des del nostre punt de vista, un element de la relació terapèutica diferent a la transferència (i la seva respectiva contratransferència) i la relació real, que descrivim exhaustivament en el treball. En psicoteràpia psicoanalítica de parella, a causa de la gran diversitat de mecanismes que operen en aquest tipus de teràpia conjunta, la formació i el desenvolupament de l'aliança adquireixen major dificultat. Dediquem una part important del treball a enumerar i descriure aquests factors que influeixen en l'aliança a psicoteràpia de parella, així com les dimensions de l'aliança terapèutica en aquest tipus de tractament seguint el model del Sistema d'Observació de l’Aliança Terapèutica en Intervenció Familiar (SOATIF). Analitzem l'aliança terapèutica que estableix el psicoterapeuta de la sèrie nord-americana In treatment amb la parella que assisteix a la seva consulta durant nou sessions mitjançant la versió observacional del SOATIF (SOATIF-o), així com els altres elements de la relació terapèutica amb els que l'aliança interacciona. Considerem que el material és útil coma eina d'entrenament per fer ús de l'instrument i com a material docent, ja que apareixen reflectits els aspectes més importants de la relació terapèutica entre l'analista i la parella. / Durante el siglo XX se ha ido configurando el concepto de alianza terapéutica en psicoterapia como una relación interpersonal existente y necesaria entre el cliente y el terapeuta. Hoy en día todas las orientaciones teóricas otorgan a la alianza terapéutica un papel central en la relación terapéutica. Además, desde el ámbito de la investigación empírica, la relación entre la a lianza terapéutica y la eficacia del tratamiento en psicoterapia ha sido constatada en numerosos estudios. Pese a que el origen de este concepto se encuentra en la corriente psicoanalítica, la relevancia de la alianza terapéutica es muy diferente según la opinión de diversos autores de esta orientación. Para algunos autores la alianza terapéutica no es relevante y puede llegar a ser interferidora del tratamiento, ya que la transferencia es la pieza clave. En cambio, para otros autores psicoanalíticos la alianza terapéutica tiene un papel importante en cualquier tipo de terapia. Dedicamos un amplio apartado del trabajo a hacer una revisión obre la conceptualización de la a lianza de los autores psicoanalíticos más destacados en el ámbito. Nosotros consideramos que la alianza terapéutica debe ser tomada en consideración en cualquier trata miento de orientación psicoanalítica, ya que si no es debidamente trabajada puede dificultar el trabajo analítico y, por tanto, deben destinarse a su formación y mantenimiento tanto técnicas interpretativas como no interpretativas cuando se requieran. La alianza terapéutica es, desde nuestro punto de vista, un elemento de la relación terapéutica diferente a la transferencia (y su respectiva contratransferencia) y a la relación rea l, que describimos exhaustivamente en el trabajo. En psicoterapia psicoanalítica de pareja, a causa de la gran diversidad de mecanismos que operan en este tipo de terapia conjunta, la formación y el desarrollo de la alianza adquieren mayor dificultad. Dedicamos una parte importante del trabajo a enumerar y describir estos factores que influyen en la alianza en psicoterapia de pareja, así como las dimensiones de la alianza terapéutica en este tipo de tratamiento siguiendo el modelo del Sistema de Observación de la A lianza Terapéutica en Intervención Familiar (SOATIF). Analizamos mediante la versión observacional del SOATIF (SOATIF-o) la alianza terapéutica que establece el psicoterapeuta de la serie norteamericana In treatment con la pareja que acude a su consulta durante nueve sesiones, así como los otros elementos de la relación terapéutica con los que la a lianza interacciona. Consideramos que el material es útil como herramienta de entrenamiento para hacer uso del instrumento y como material docente, ya que a parecen reflejados los aspectos más importantes de la relación terapéutica entre el analista y la pareja. / During the twentieth century the concept of therapeutic alliance in psychotherapy has been shaped as an existing and necessary interpersonal relationship between the client and the therapist. Nowadays, all theoretical orientations have given to the therapeutic alliance a central role in the therapeutic relationship. Furthermore, empirical research has proved the relationship between the therapeutic alliance and the treatment efficacy in psychotherapy in numerous studies. Although the concept of the therapeutic alliance has its origin in the psychoanalytic theory, the relevance of the alliance is very different in the opinion of several authors of this orientation. For some authors, the therapeutic alliance is not relevant and can interfere in the psychoanalytic treatment, since the transference is the key element. On the other side, for other psychoanalytic authors the therapeutic alliance plays an important role in any kind of therapy. A large section of our work is devoted to do a review on the conceptualization of the alliance of the most prominent authors in the psychoanalytic field. We believe that the therapeutic alliance should be taken into consideration in any psychoanalytically oriented treatment, because if it is not properly treated, it can jeopardize the analytic work and, therefore, interpretive and non- interpretive interventions must be used when required. The therapeutic alliance is, from our point of view, an element of the therapeutic relationship different from the transference (and its respective counter-transference) and the real relationship, described both in detail in our work. In couple psychoanalytic psychotherapy, because of the great diversity of mechanism s that operate in this type of conjoint treatment, the formation and the development of the alliance become more difficult. A significant part of this work is devoted to list and describe the factors that influence the alliance as well as the dimensions of the therapeutic alliance in this type of treatment based on the System for Observing Family Therapy Alliances (SOFTA). The therapeutic alliance established by the psychotherapist and a couple who undergoes a treatment for nine sessions in the North American TV series In Treatment i s analyzed with the observational version of the SOFTA (SOFTA-o), as well as the other elements of the therapeutic relationship that interact with the alliance. We believe that the material is useful as a training tool for using the instrument and as teaching material, since the most important aspects of the therapeutic relationship between the analyst and the couple are represented.

Peer support groups (PSGs) for addiction recovery are the most common source for aftercare services once professional treatment has ended (Cloud, Rowan, Wulff, & Golder, 2007), and a significant number of individuals who seek help for a substance-related problem only seek that help from peer support organizations, such as Alcoholics Anonymous (White, 2010). In the last two decades, a different, more secular culture of “recovery” from self-defined problematic substance has led to the emergence of new PSGs (White, 2009). However, very few research studies to date have examined how more recent, typically secular, PSGs work, what aspects of them attract participants, and what participants find helpful about the group. Further, very little is known whether theories that have been applied to clinical treatment, such as the Stages of Change model, relate to the peer support environment. LifeRing is a secular PSG that views substance misuse as a learned habit that can be changed through taking responsibility for one’s actions and actively engaging with peers (Nicolaus, 2009). A particularly relevant model to LifeRing is Stages of Change, because LifeRing encourages personal responsibility and choice, does not prescribe any specific steps, and encourages individuals to build their own recovery plan that can help them stay motivated in recovery (Nicolaus, 2009). The current study examined data from 50 participants that attend LifeRing meetings on Vancouver Island. The results were not consistent with the Stages of Change framework. 4 Specifically, readiness to change and active group participation did not predict group engagement outcomes. Analysis of open-ended follow-up questions indicate that group cohesion and match in beliefs were significantly associated with greater active group participation and convenor alliance was significantly associated with group satisfaction, paralleling findings on the topic in the psychotherapy literature. Information from qualitative follow-up questions regarding helpful and unhelpful aspects of LifeRing are also discussed. / Graduate / avsotskova@gmail.com

Training in psychotherapy needs to involve more than merely skills and techniques. The field of psychotherapy needs to involve more than the application of formulas in a modernistic framework. This study proposes an approach to training in psychotherapy where the emphasis is on the client and the therapeutic relationship. Psychotherapy training should be an ongoing process and this study aims to facilitate and enhance that process for students. The study combines basic therapeutic skills and interpersonal psychotherapy to form a training programme referred to as the Basic Relational Skills Training (BRST) programme. The first part of the study provides a historical perspective of basic therapeutic skills, followed by a review of the relevant literature. The second part of the study constitutes a possible format for a training manual for the proposed BRST programme. The researcher hopes that the proposed BRST programme be utilised by trainers to assess the programme's efficacy. / Psychology / M.A. (Clinical Psychology)

This thesis investigates the construction of the therapist-client alliance in the therapeutic setting with perpetrators of intimate partner violence (IPV). Moreover, it explores the ways a Feminist Ethics of Care perspective could enhance the partnership between the actors. To fulfil such aims, the author conducted six in-depth semi-structured interviews with psychologists working at one of the most renowned institutions for perpetrators of IPV in Norway and Sweden. The analysis of the psychologists' discourses demonstrates that several factors are influential in the alliance construction. The most important aspects are: the clients' perspective towards the psychologists; the therapists' views towards the clients; the psychologists' engagement with moral sentiments; the power struggle between the actors; and the use of techniques for the professionals to enhance their connection with the clients. Besides that, the discourses also show that moral superiority seems to guide the psychologists when relating with the perpetrators. Their views are embedded in an individualistic ethics based on the principles of Kohlberg's Ethics of Justice. The thesis suggests that a collective ethics such as Gilligan's Feminist Ethics of Care would enhance the partnership between the actors. This theoretical framework allows the psychologists to change their superior moral views of the clients to a moral responsibility towards them. When such movement in perspective happens, the therapists begin to see the perpetrators as human beings with many different facets. Consequently, they truly deny a judgmental impression towards their identity.

No description available.

While cognitive-behavioral therapy (CBT) is the most well-established treatment for binge-eating disorder (BED), little is known about process factors influencing its outcome. The present study sought to explore the assessment of therapist adherence, its course over treatment, and its associations with patient and therapist characteristics, and the therapeutic alliance. In a prospective multicenter randomized-controlled trial comparing CBT to internet-based guided self-help (INTERBED-study), therapist adherence using the newly developed Adherence Control Form (ACF) was determined by trained raters in randomly selected 418 audio-taped CBT sessions of 89 patients (25% of all sessions). Observer-rated therapeutic alliance, interview-based and self-reported patient and therapist characteristics were assessed. Three-level multilevel modeling was applied. The ACF showed adequate psychometric properties. Therapist adherence was excellent. While significant between-therapist variability in therapist adherence was found, within-therapist variability was non-significant. Patient and therapist characteristics did not predict the therapist adherence. The therapist adherence positively predicted the therapeutic alliance. The ACF demonstrated its utility to assess therapist adherence in CBT for BED. The excellent levels of therapist adherence point to the internal validity of the CBT within the INTERBED-study serving as a prerequisite for empirical comparisons between treatments. Variability between therapists should be addressed in therapist trainings and dissemination trials.

Under pandemin COVID-19 har hälsovården tvingats till hastiga anpassningar i form av användning av vård via videolänk för kontinuitet, vilket berör även psykoterapi. Trots omfattande evidens för effektiviteten av terapi via videolänk finns fortfarande myter hos kliniker att den terapeutiska alliansen äventyras i det digitala forumet, vilket kan försvåra implementeringen. Studiens syfte var att utforska psykoterapeuters upplevelser av psykoterapi via videolänk, med särskilt fokus på den terapeutiska alliansen (TA). Genom semi-strukturerade intervjuer undersöktes psykoterapeuters föreställningar, anpassningar samt erfarenheter av denna omställning. Data analyserades utifrån kvalitativ innehållsanalys och resulterade i tre kategorier; Kommunikation, Den bärande relationen samt KBT-interventionerna. Huvudresultatet indikerar att klinikerna har behövt anpassa behandlingen kontextuellt, kommunikativt samt innehållsmässigt för att främja alliansen, och att TA går att utveckla över videolänk. Detta sammanfaller med tidigare internationella studiers resultat.  Utvecklingsområden som framkommit är aspekter självexponering som nytt fenomen och förändringar i maktstrukturen inom terapin. Omställningen har gått över förväntan positivt och delvis förändrat respondenternas inställning till videolänkterapi. Inom begränsningarna för denna studie beskrivs konsekvenserna och framtida forskningsriktningar. / During the pandemic COVID-19 the health care has suddenly been forced to adjust their work and start using video conference to keep the continuity, which also impacts psychotherapy. Despite extensive evidence of the efficiency of video conference psychotherapy there are still myths among clinicians that the therapeutic alliance can be endangered by the digital format, which can complicate the implementations. The aim of this study is to examine the psychotherapists' experiences of psychotherapy via video conference, with particular focus on the therapeutic alliance (TA). Through semi-structured interviews we examined the psychotherapists conceptions, adaptations and the experiences of this readjustment. Data were analyzed based on qualitative content analysis; Communication, The solid relation and the CBT-interventions. The main results indicated that the clinicians needed to adapt the treatment contextually, communicatively and in terms of content to frame TA, and that TA can be developed via video conference. This coincides with previous international research. Areas of development is the new phenomenon self-exposure and transformation/change of equalization of power.  The conversion has positively exceeded the expectations and has partly changed the respondents attitudes to therapy via video conference. Within the limitations of this study, implications and further directions for research are described.

Bakgrund: Fotboll är den sport där det uppskattas förekomma allra flest skador. Fysioterapeuter har en väldigt stor roll i rehabiliteringen av skadade fotbollsspelare på grund av den höga skadefrekvensen vilket innebär att de spenderar mycket tid med fotbollsspelarna. Hur situationerna med den skadade fotbollsspelaren ska hanteras under rehabiliteringsperioden blir därför väldigt viktig.   Syfte: Syftet med denna studie var därför att undersöka vilka utmaningar och möjligheter som fysioterapeuter ställs inför vid rehabiliteringen av skadade fotbollsspelare i svenska fotbollslag på elitnivå. Studien undersöker specifikt relationens betydelse och hur den bibehålls samt vad fysioterapeuten gör för att stödja spelarens motivation under rehabiliteringen.   Metod: En kvalitativ metod användes till studien och femfysioterapeuter som arbetade inom ett fotbollslag på elitnivå i Sverige intervjuades. Intervjuerna analyserades enligt kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre kategorier med tillhörande underkategorier: Relationens betydelse för en lyckad rehabilitering, Att stödja motivationen och vikten av att ha en gemensam plan samt Att våga bemöta och hantera känslor. Slutsats: I intervjuerna framkom att en bra relation uppbyggt av tillit, ärlighet och förtroende kan förenkla och leda till en bra rehabiliteringsprocess. Genom en vänskaplig relation, stöd av spelarens motivation och en psykisk delaktighet av fysioterapeuten genom hela rehabiliteringen kan rehabiliteringen bli enklare. Framtida forskning bör innehålla fler deltagande fysioterapeuter och möjligtvis inkludera intervjuer av skadade fotbollsspelare för att få fler perspektiv från de båda parterna i relationen.

This study examined scientific evidence of animal-supported work in connection with the therapeutic relationship. The study aimed to investigate whether animal-supported work has any impact on the therapeutic relationship. The study also aimed to examine in what way animal-supported work impacts the therapeutic relationship and whether the effects could be explained by relevant theories. Literature review was chosen as the method of study to fulfil the objectives of this study and data was analysed through thematic analysis. The data used in this study was found in articles through a structured search of the databases PubMed and Psycinfo. In summary, the study found that there is scientific evidence that animal-supported work does impact the therapeutic relationship. The study also found that evidence suggest that animal-supported work impacts the therapeutic relationship in many ways, most of which are positive. The study found that one viable way of explaining the effects of animal-supported work is through the neurobiological theory of oxytocin. The effects could also be explained by the developmental psychological attachment theory. The result of this study points to a need for further research of the effects of animal-supported work on the therapeutic relationship.