While a significant amount of research illustrates the positive effects of therapists’ use of mindfulness, few studies have addressed whether therapists’ mindfulness actually improves psychotherapy outcomes. Additionally, no existing research has examined whether therapists’ use of a mindfulness exercise immediately before meeting with a client could also have a positive impact on the following session. The purpose of this study was to test whether engaging in a centering exercise 5-10 minutes before a session could have a positive impact on therapy, in particular on the therapists’ ability to remain present in session. Results indicated that the trainee therapists did not report changes in mindfulness after the brief mindfulness training program. Results also indicated that completing the centering exercise before a session did not appear to impact client ratings of therapeutic presence and session outcomes. The results suggest that more intensive training in mindfulness may be necessary to impact psychotherapy outcomes.

Extensive interdisciplinary common factor research has identified the therapeutic relationship as a consistent factor influencing therapeutic outcomes. We use Polyvagal and Interpersonal Neurobiology (IPNB) theories to guide an examination of the physiological mechanisms at work in the therapeutic relationship. Both Polyvagal and IPNB theories provide understandings about how humans are neurophysiologically wired for social connection. Each points to a sense of safety as being essential for meaningful connection to occur and clarifies that physiological attunement is an observable indicator of interpersonal connection. In this study, we use these theories to guide an examination of therapist physiological influence on clients in couple therapy, using continuous in-session data collection of respiratory sinus arrhythmia (RSA) for 22 heterosexual married couples and their therapist. Data were modeled in a multi-level path analytic framework to account for within-individual and within-couple effects. Results indicated that therapist RSA does not significantly predict lagged client RSA. A discussion of potential limitations, suggestions for therapists and recommendations for future study is included.

The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit by Paula A. Rodney MSN, California University of Pennsylvania, 2011 BSN, University of Virginia, 1979 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University April 2015   Patient satisfaction and clinical outcomes have become important issues in healthcare since the introduction of the Value Based Purchasing Program. Patient satisfaction, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, was declining and hospital-acquired pressure ulcers (HAPU), falls, and catheter-associated urinary tract infections (CAUTI) were rising on the pilot unit. The purpose of this non-experimental correlational design quality improvement project was to combine information from focus groups, a content analysis of the literature on Kristen Swanson's theory of caring, and relationship-based care, to develop and implement a relationship-based care delivery model. An additional aim was to determine its impact on patient satisfaction and the reduction of HAPU, falls, and CAUTI. The model was designed and implemented by a team consisting of bedside care providers, leaders, an educator, and a student facilitator. The components of the model included scheduling for continuity of care, whiteboards, seated bedside report, hourly rounding, a nurse advocate, and 5 focused minutes of attention per shift. Descriptive statistics were used to determine the mean change in HCAHPS scores before and after implementation of the model, and revealed improvements in dimensions of communication with nursing by 13.2%, responsiveness by 12.5%, overall rating of care by 14.5%, and willingness to recommend by 8.7%. The result of audits of the pilot unit's medical records indicated a reduction in falls by 3, HAPU by 2, and CAUTI by 2 from August, the baseline month. As a result of these findings the model will be implemented on all inpatient nursing units. The target audience for this project includes nursing leaders, educators, and bedside providers with interest in patient-centered care and staff empowerment.

While a significant amount of research illustrates the overall positive effects of therapists' general use of mindfulness, very few studies have addressed whether therapists' use of mindfulness translates to improved psychotherapy outcomes. The present study utilized a randomized-controlled design to test whether a brief mindfulness training program and pre-session mindfulness practice could have a positive impact on therapy; in particular, we hypothesized that mindfulness training and practice would improve ratings on therapeutic presence as rated by clients and therapists and session effectiveness as rated by clients. The present study also examined whether clients' subjective ratings of therapy outcome and therapists' theoretical orientation impacted outcome measures after therapists completed mindfulness training. The 20 participating therapists were randomly assigned to either the mindfulness training (MT) group or control group according to a computer generated randomization list. Results indicated that clients did not significantly improve on outcome measures after completing the mindfulness training. Clients' subjective ratings on a psychotherapy outcome measure did predict changes in their ratings of therapeutic presence. This finding may have important implications for future research examining client characteristics that may moderate the relationship between therapeutic presence and session outcomes. Limitations of the present study and future directions are discussed.

Mindfulness is a practice that has the potential to help counseling students build a variety of skills that are necessary for clinical efficacy, including therapeutic presence, attunement, empathy, cognitive flexibility, and non-reactivity. However, mindfulness is rarely taught to students in mental health training programs, which makes it an untapped possibility to improve counselor education. Additionally, rarely do researchers explore the role of counselor mindfulness and counselor trauma on clients' perceptions of therapeutic presence. Therefore, the purpose of this study is to explore the effects of a 15-week mindfulness training program for counseling students to understand its effect on client's perceptions of therapeutic presence, counselor state mindfulness development, and counselor trauma symptoms. Participants in this cluster-randomized controlled intervention were masters counseling students currently enrolled in clinical practicum accredited by the Counsel for the Accreditation of Counseling and Related Educational Programs (CACREP). Counselors provided data at three timepoints on their state mindfulness, trauma symptoms, and therapeutic presence. Clients provided data at three timepoints on their perceptions of their counselor's therapeutic presence. We analyzed data through repeated measures ANOVA and two-level longitudinal hierarchical linear models. Implications for counselor education, professional counselor development, and future research are offered and limitations are discussed.

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Inledning: Även om distansterapi visat sig vara effektivt och ger ökad tillgänglighet är många terapeuter ändå tveksamma till formatet. Syfte: Genom att undersöka hur övergången till distansformat enligt psykodynamiskt orienterade terapeuter påverkar den terapeutiska processen, dess ram och relationella kvalité ges ett bidrag till förståelse av denna tvekan. Metod: En kvalitativt inriktad fenomenologisk studie av semistrukturerade intervjuer med fem terapeuter. Resultat: Tematisk analys visar två teman: Närvaro och En ny situation med två respektive fyra underteman: möjliggörande och saknad respektive kropparnas kommunikation, saknad avgränsning, ramarbete och inre upptagenhet. Diskussion: En inre upptagenhet kan göra att närvaro som relationell kvalité i bemärkelsen emotionell, kognitiv och funktionell tillgänglighet försvåras i distansformatet. Inre upptagenhet kan bero på de ramfrågor som aktualiseras i övergången. Undersökningen resulterar i en modell som visar att i den mån en viss terapeutisk teknik, känsla i rummet eller terapeutroll föreligger som målsättning i den terapeutiska processen kommer den inre upptagenheten sannolikt kvarstå. Ökad förståelse för terapeuters målsättningar i och med den terapeutiska processen föreslås som en nyckel för vidare acceptans av distansformatet. / Introduction: Even though distance therapy has been shown to be effective across a range of measures and increases access many psychotherapists still remain sceptic to the format.   Aim: By examining how psychodynamic psychotherapists experience transitioning to distance therapy as regards the therapeutic process this study results in a contribution to the understanding of the continuing scepticism among therapists.  Method: A qualitative, phenomenological study of semi-structured interviews with five psychotherapists using thematic analysis.  Result: Two themes are identified: Presence and A new situation with two and four subthemes respectively: enabling and lamented; bodily communication, demarcation, therapeutic frame and preoccupation. Discussion: Due to preoccupation presence understood as a relational quality of emotional, cognitive and functional availability could be continually lamented in distance therapy. The discussion results in a model showing that if a certain therapeutic technique, feeling in the room or therapeutic role is an underlying intention in the therapeutic process preoccupation will continue to be a factor in distance therapy encounters. Increased knowledge as regards therapists´ intentions in the therapeutic process is forwarded as a key factor to further acceptance of the distance therapy format.

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