The aim of this study was to create an understanding through qualitative interviews with treatment providers, how their way of behaving towards young boys with gaming addiction affects the treatment. More specifically its aim was to find out how treatment providers help boys to break their ongoing gaming addiction and what kind of difficulties they have experiences from. The study's empirical material was obtained through semi-structured interviews with six treatment providers with experience of gaming addiction. Three themes were identified: difficulties, working methods and therapeutic alliance. The analysis was based on two different kinds of perspectives: symbolic interactionism and Erving Goffman’s dramaturgical perspective. The first theme has highlighted the subject's complexity, perceptions and self-insight. The clearest result that emerged under the second theme is the importance of different types of conversations. The study shows that motivational interviewing has helped young boys gain insight into their situation. Prohibition is not an appropriate measure, however, restrictions are necessary. The main result that emerged from the third and last theme is that therapeutic alliance is an important basis for change.

Made available in DSpace on 2016-03-22T17:27:22Z (GMT). No. of bitstreams: 1 Camila.pdf: 315174 bytes, checksum: 7f3cebe0af3e1a677f9c659d6402963b (MD5) Previous issue date: 2006-07-11 / Objective: to assess the impact of symptom severity on the development of the therapeutic alliance in women with postpartum depression undergoing brief cognitive psychotherapy. Method: this study is part of a randomised controlled trial that investigated the effectiveness of psychotherapy in the treatment of postpartum depression. Women were between 30 and 60 days postpartum and had a positive screen for mild to moderate depression. To assess depressive symptom severity, the Beck Depression Inventory was employed at the beginning and at the completion of treatment. The client and therapist forms of the Working Alliance Inventory (WAI) were used to evaluate the therapeutic alliance after the session 1, 4, 7. Data was analyzed with correlations and chi-square tests. Results: correlation analysis pointed to associations of the total WAI score (r = -0,35) and subscale task (r = -0,31) and bond (r = -0,57). Chi-squares tests were significant in the fourth session for the total WAI score (p ≤ 0,050) and the bond subscale (p. ≤ 0,037). Conclusion: the association of the investigated variables during the intermediary phase of the treatment was insufficient to indicate that depressive symptom severity had influence on the development of the therapeutic alliance. / Puerpério, Características do paciente, Relação terapêutica. 21 ABSTRACT Objective: to assess the impact of symptom severity on the development of the therapeutic alliance in women with postpartum depression undergoing brief cognitive psychotherapy. Method: this study is part of a randomised controlled trial that investigated the effectiveness of psychotherapy in the treatment of postpartum depression. Women were between 30 and 60 days postpartum and had a positive screen for mild to moderate depression. To assess depressive symptom severity, the Beck Depression Inventory was employed at the beginning and at the completion of treatment. The client and therapist forms of the Working Alliance Inventory (WAI) were used to evaluate the therapeutic alliance after the session 1, 4, 7. Data was analyzed with correlations and chi-square tests. Results: correlation analysis pointed to associations of the total WAI score (r = -0,35) and subscale task (r = -0,31) and bond (r = -0,57). Chi-squares tests were significant in the fourth session for the total WAI score (p ≤ 0,050) and the bond subscale (p. ≤ 0,037). Conclusion: the association of the investigated variables during the intermediary phase of the treatment was insufficient to indicate that depressive symptom severity had influence on the development of the therapeutic alliance.

Submitted by Maicon Juliano Schmidt (maicons) on 2015-04-01T13:33:36Z No. of bitstreams: 1 Natacha Hennemann de Oliveira.pdf: 602395 bytes, checksum: 69e665641c51e1a89cfa3f725c7a0ecc (MD5) / Made available in DSpace on 2015-04-01T13:33:36Z (GMT). No. of bitstreams: 1 Natacha Hennemann de Oliveira.pdf: 602395 bytes, checksum: 69e665641c51e1a89cfa3f725c7a0ecc (MD5) Previous issue date: 2013-01-31 / Nenhuma / Esta dissertação de mestrado volta-se para o conhecimento, aprimoramento e aplicação de questões relativas ao vínculo que se estabelece entre paciente e terapeuta durante a psicoterapia, a chamada aliança terapêutica (AT). O trabalho está organizado em dois artigos, um teórico e outro empírico. O artigo teórico trata de um levantamento assistemático, que dirige-se ao conhecimento da origem histórica do conceito da aliança terapêutica, desde sua origem na psicanálise até sua concepção atual de constructo ateórico. A partir dessa concepção, a aliança terapêutica (AT) é apresentada como um constructo imprescindível tanto para o andamento da psicoterapia como para a obtenção de resultados positivos. Além disso, são discutidos uma série de fatores que podem contribuir ou prejudicar o estabelecimento da aliança, tais como características do paciente e do terapeuta. Dessa forma, o artigo mostra que se esses fatores não forem observados, pode ocorrer o que chamamos de rupturas da AT. Essas rupturas podem se manifestar por distanciamento ou por confrontação do paciente, e cabe ao terapeuta identificá-las e trabalhá-las para evitar o abandono precoce do tratamento. O segundo artigo busca de uma forma empírica entender como se estabelece a AT em um contexto específico que é a psicoterapia obrigatória. Para isso, foram avaliados 51 pacientes, divididos em dois grupos: psicoterapia obrigatória (N=15) e psicoterapia buscada de forma voluntária (N=36). Os pacientes de ambos os grupos estavam em psicoterapia na mesma instituição e, antes de iniciarem a psicoterapia, foram avaliados em relação aos mecanismos defensivos (DSQ-40), às representações objetais (BORRTI - O) e ao nível de gravidade dos sintomas (SCL-90-R). Após a quinta sessão, os pacientes foram novamente avaliados em relação à AT (CALPAS-p) e à percepção de coerção (através de um questionário baseado no MacArthur Admission Scale- AES-15). Os resultados apontam que apesar do grupo obrigatório apresentar sintomas mais graves, e um maior número de sujeitos ter se sentido obrigado a ingressar na psicoterapia que o grupo obrigatório original, não houve diferenças significativas entre os grupos obrigatório e não obrigatório em relação à AT. Dessa forma, verificou-se que é possível o estabelecimento da AT, mesmo no contexto obrigatório de atendimento psicoterápico. / This dissertation addresses itself to the knowledge, improvement and implementation of issues related to the bond that is established between patient and therapist during psychotherapy, called the therapeutic alliance (TA). The work is organized in two papers, one theoretical and one empirical. The theoretical paper addresses the knowledge of the historical origin of the concept of the therapeutic alliance, from its origins in psychoanalysis until its current conception of atheoretical construct. Based on this concept, the therapeutic alliance (TA) is presented as an essential construct for both the progress of psychotherapy as to obtain positive results. In addition, a number of factors are discussed that can help or hinder the establishment of the alliance, such as characteristics of the patient and the therapist. Thus, the paper shows that if these factors are not observed, TA ruptures may occur. These ruptures may manifest by detachment or by patient confrontation, and it is responsibility of the therapist to identify the ruptures and work with them to prevent early abandonment. The second paper seeks an empirical manner of understanding how TA is established in a specific context that is the mandatory psychotherapy. To this end, 51 patients divided into two groups have been evaluated: mandatory psychotherapy (N = 15) and psychotherapy sought voluntarily (N = 36). Patients in both groups were in psychotherapy at the same institution, and before beginning psychotherapy, they were evaluated in relation to defensive mechanisms (DSQ-40), the object representations (BORRTI - O) and the level of severity of symptoms (SCL-90-R). After the fifth session, the patients were again assessed for TA (CALPAS-p) and coercion perception (through a questionnaire based on the MacArthur Admission Scale-AES-15). The results show that although the mandatory group presents more severe symptoms, and a greater number of individuals have felt compelled to join psychotherapy rather than the original mandatory group, there were no significant differences between mandatory and non-mandatory groups in relation to the TA. Thus, it has been found that it is possible to establish the TA, even in the context of mandatory psychotherapy.

Background: The use of telemedicine was gaining momentum. Although the strength of the therapeutic alliance (TA) correlated with treatment outcomes, there was no research exploring the skills, attitudes and behaviours that enhanced the TA during Skype consultations in palliative care. Aims: This study identified the skills, attitudes and behaviours that affected the TA between palliative care patients and health care professionals during Skype consultations and identified strategies that enhanced the TA. Study Design: Two cycles of action research engaged the participants in self-reflective inquiry and encouraged the identification of strategies that enhanced the TA and the Skype experience. Participants: Six health professionals and nine patients were recruited from a Hospice out patient service in one Health Authority in England. Data Collection: Data from the audio-recorded consultation were managed quantitatively and the TA was measured using the Working Alliance Inventory (S). Qualitative data were collected from participant interviews and focus groups attended by the professionals. Data Analysis: The analysis ran in parallel with the data collection, started after the first consultation and all sources of data were cross-referenced. Thematic analysis was used to sequentially code the qualitative data to help identify, examine and record patterns within the data set. Findings: The findings suggested that it was possible to establish and a positive therapeutic alliance between health professionals and palliative care patients when using Skype. There was a shift in perception for those health professionals who had reservations about their ability to establish a therapeutic alliance (TA) via a computer link. It was demonstrated that advanced communication skills were transferrable between face to face and video consultations. No additional communication skills training was needed to enable a strong TA when using Skype. Including some social talk, working with the patient’s as opposed to the professional’s agenda and actively offering solutions improved the Skype experience for the patients. The strategies that health professionals promoted to enhance the TA included using Skype with appropriately selected patients to complement the existing Service. Mandatory training in the effective use of Skype was recommended even for those health professionals who used Skype socially. Clarification to address the challenge of clinical governance was recommended. In keeping with an action research design the change impacted on both the health professionals own practice and the Organisation’s approach to telemedicine. The potential for using action research to engage nurses and doctors in critical self-reflective inquiry and to empower them to be change facilitators was demonstrated. Conclusion: Although a small sample size, this study identified strategies that enhanced the TA during Skype consultations. The findings were significant because they added to the current body of knowledge about using Skype to facilitate consultations within the palliative care population. Additionally, the findings may be transferable to different populations and healthcare contexts.

The transfer of cases is common in the practice of Marriage and Family Therapy (MFT). This is especially true in training clinics, where student interns regularly graduate and transfer their cases to students still in the program. Although some research has examined the effect of transferring cases of individual psychotherapy on the success of therapy outcome, little research has examined transfer cases in MFT settings. The transfer process can be conceptualized as a rupture in the therapeutic alliance. From this perspective, a strong therapeutic alliance may mitigate the negative impact of the rupture. Consequently, it was hypothesized that a strong therapeutic alliance with the initial therapist would predict a successful transfer process. Similarly, it was hypothesized that a strong therapeutic alliance with the new therapist would predict a successful transfer process. To test these hypotheses, data were examined from 49 individual, couple, and family therapy cases that experienced a transfer at an MFT training program at a university in the northeastern part of the United States. Results indicated that the therapeutic alliance with neither the initial or new therapist predicted successful therapy transfer. A possible explanation for the lack of significant results may be the small sample size, which limited the statistical power of the analyses. In addition, because of the small sample size, the individual, couple, and family cases were combined in the analyses. Because the therapeutic alliance in couple and family cases has different dimensions than it does in individual cases, it is possible that the true effect of the therapeutic alliance on transfer success was masked in the combined analysis.

The purpose of this study was to assess the impact of motivational interviewing (MI) counselor training in a public vocational rehabilitation (VR) setting. Data were collected from a total of 347 participants (67 counselors and 280 clients) in the experimental and comparison groups, during the pre-and-posttests. The counselors in the experimental group received a 4-hour standardized MI training and a 4-week follow up coaching sessions. Results of this study indicated that counselors in the experimental group demonstrated significant gains in their MI competence scores compared to the comparison group. The clients of the experimental group’s counselors significantly improved their engagement in VR services and working alliance with their counselors. Also, counselors’ education level and CRC status showed strong correlation with the posttest MI competence total scores. Finally, working alliance was found to be a significant predictor of client engagement. This study established the preparatory knowledge for the relationship between MI counselor training, client engagement, and counselor-client working alliance in a public rehabilitation setting. The results of this study contribute to the rehabilitation literature by providing evidence-based knowledge and tools designed to improve the quality of VR service outcomes, such as employment, for people with disabilities. With the findings of this research, there is evidence available to provide rehabilitation administrators to justify investing time and other resources into training rehabilitation counselors on the use of MI intervention. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

The commercial and sexual exploitation of children has become a global multi-billion dollar industry over the past several decades. Throughout history, therapists from various backgrounds have not only advocated against child trafficking but also provided therapeutic services to victims of such an inhuman crime—most of whom are female adolescents. Compared to their female counterparts, male therapists have been assigned CSEC cases involving female clients in excessively lower ratios. Researchers, however, have not fully captured what has prevented the female CSEC population from drawing interests from male counselors. This study explored potential reluctance in male therapists with regard to working with female CSEC clients. Under the qualitative research paradigm, semi-structured interviews were conducted with eight male therapists in Southern California. Results from the thematic analysis of the interview data demonstrated that male counselors are reluctant to work on a one-on-one basis with female CSEC clients due to (1) fear of sexual accusations and (2) lack of training. However, results also revealed that support from female colleagues can help dissipate the heavy clouds of fear associated with sexual allegations. Implications for social work and human service agencies were discussed. Keywords: male counselor, commercially and sexually exploited children, social work, colleague support.

African Americans do not seek mental health help at the same rate, as do European Americans; furthermore, African Americans who do seek help tend to leave therapy prematurely. A poor therapeutic alliance between African American clients and European American clinicians may be one reason that African Americans do not seek therapy or leave prematurely. The purpose of this phenomenological study was to understand the lived experience of African American clients in therapeutic relationship with European American clinicians. Rogers' theory of therapeutic alliance, which included empathy as a key concept, served as the conceptual framework of this study. Through purposeful sampling methodology, 10 participants were invited to participate, based on self-report of being African American and having had therapy with a European American clinician. Participants were interviewed regarding their lived experiences in therapy with a European American clinician. Interviews were recorded, transcribed, and analyzed using thematic analysis. There were 13 thematic findings. Findings revealed that more participants reported positive experiences in therapy than did participants who reported negative experiences. Empathy, therapeutic alliance, and trust were key factors to positive outcomes. Knowing and implementing what factors lead to positive alliance has valuable social change implications for European American clinicians and their African American patients. Clinicians should be trained in the importance of empathy, therapeutic alliance, and trust, especially when working in mixed racial therapeutic dyads.

Bakgrund: Anorexia nervosa klassificeras som en ätstörning som går ut på en avsiktlig viktnedgång som beror på förändrad kroppsuppfattning. I vårdandet av AN är det av stor vikt att sjuksköterskan fokuserar på individen bakom ätstörningen och är stöttande. Sjuksköterskan spelar en stor roll i vårdrelationen till patienten. Syfte: Syftet var att beskriva sjuksköterskan och patienten med anorexia nervosa perspektiv på den terapeutiska vårdrelationen. Metod: En allmän litteraturöversikt. Data analyserades kvalitativt och kvalitetsgranskades. Efter kvalitetsgranskning användes nio artiklar till resultatet. Resultat: Resultat som framkom i studien var att en positiv terapeutisk vårdrelationen mellan sjuksköterska och patient kan vara avgörande för tillfrisknandet. De kategorier som framkom i resultatet var: vårdrelation, stöd och motivation, Sjuksköterskans delaktighet och negativ vårdrelation. Konklusion: Den terapeutisk vårdrelation var essentiell för patientens välmående och upplevelse av trygghet under behandling. Arbetar sjuksköterskan utifrån en terapeutisk utgångspunkt och att ge patienten stöd under behandling kan patienten uppleva motivation till att genomgå behandling. / Background: Anorexia nervosa classifies as an eating disorder that involves a intentional weight loss that is caused by changed body image. In the caring of anorexia nervosa, it is essential that the nurse pay focus to the individual behind the eating disorder, as well as being supporting. The nurse plays a major role in the nursing care relationship with the patient. Purpose: The aim of this study was to describe the nurse and patient with anorexia nervosa perspective on a therapeutic alliance. Method: General literature review. Data were analysed on qualitative steps and quality-tested based on five analysis steps. After quality review, nine articles used for the result. Result: The results that emerged from the study were that a positive therapeutic alliance between the nurse and patient can be decisive for recovery. The categories that emerged in the result were: nursing care, support and motivation, the nurse’s participation and negative care relationship. Conclusion: The therapeutic alliance was essential for the patient’s wellbeing and feeling of safety during treatment. If the nurse work from a therapeutic alliance and support the patient during treatment, the patient gains motivation to undergo treatment.

<p>Allianser och interventioner</p><p>En studie av hur familjer upplevt en öppenvårdsinsats</p><p>och hur behandlingseffekt kvarstår</p><p>Sammanfattning</p><p>I Sverige utreds årligen uppskattningsvis 100 000 barn av socialtjänstens individ- och famil-jeomsorg och antalet strukturerade öppenvårdprogram har i det närmaste fördubblats sedan 1999. Många av dessa insatser har kommit att ersätta den traditionella institutionsvården. I och med ökningen av att antalet unga som numera hamnar i strukturerade öppenvårdsprogram behövs mer kunskap om såväl innehåll som resultat. Denna studies syfte är att undersöka och belysa en öppenvårdsverksamhets, i en mellansvensk kommun, innehåll d.v.s. vilka föränd-ringar som familjerna kan beskriva har skett samt om positiva förändringar kvarstår efter be-handling. Studien är av kvalitativ karaktär och resultaten bygger på intervjuer med familjer som deltagit i den aktuella behandlingen. Studiens tolkningsram belyser förutsättningar vilka ligger till grund för framgångsrik behandling. Viktiga inslag såsom terapeutisk allians och generella behandlingsprinciper vilka tar upp interventioner riktade mot avgörande risk- och skyddsfaktorer belyses. Resultatet visar att öppenvårdsverksamhetens behandlingsfaktorer intensitet och tillgänglighet har varit verksamma för att uppnå förändringar. Flertalet positiva förändringar har bestått efter behandlingens avslut. Resultatet antyder på att verksamheten skulle vinna på att bättre informera om behandlingens innehåll innan familjer tar ställning till att delta i behandling eller ej. Resultatet visar att arbetsplaner och målbeskrivningar skulle kunna göras tydligare för att bättre nå behandlingsresultat. Studiens resultat indikerar också betydelsen av att interventioner inom skolsituationen har betydelse för positiva förändringar. Ytterligare visar resultatet att flertalet familjer beskriver en mycket god terapeutisk allians och dess betydelse för uppnådd förändring.</p> / <p>Alliance and interventions</p><p>A study of how families have experienced open care treatment and the lasting effects of treatment.</p><p>Abstract</p><p>In Sweden approximately 100,000 cases involving children are investigated annually by the social services office for individual and family services. The number of registered cases in the open care service programs has almost doubled since 1999, replacing traditional institutional care. As a result of the increase in the number of children, more knowledge is needed con-cerning the underlying issues and results from the open care service program. The purpose of this study is to investigate and clarify the open care service program of a medium-sized Swe-dish county, to explain changes that have take place as described by the families themselves and which positive changes remain after treatment. The study’s analysis sheds light on which premises should exist for positive treatment. Important elements such as therapeutic care al-liance and general treatment programs and which interventions directed towards conclusive risk and protective factors are addressed. Results show that factors such as intensity and avail-ability of open care service programs treatment are instrumental in reaching changes and that the majority of changes have persisted after concluded treatment. Results suggest that open care service programs could benefit by better informing about treatment’s before families decide on participating in treatment or not. Also results indicate that action plans and descrip-tion of objectives could be made more explicit to better attain therapeutic results. Results also show that the majority of families describe a favorable therapeutic alliance and their signific-ance to viable change. Results also corroborate the importance of intervention in the school environment on attaining positive effects.</p>